Library use and information-seeking behavior of veterinary medical students revisited in the electronic environment.

Veterinary medical students at Iowa State University were surveyed in January of 1997 to determine their general use of the Veterinary Medical Library and how they sought information in an electronic environment. Comparisons were made between this study and one conducted a decade ago to determine the effect of the growth in electronic resources on student library use and information-seeking behavior. The basic patterns of student activities in the library, resources used to find current information, and resources anticipated for future education needs remained unchanged. The 1997 students used the library most frequently for photocopying, office supplies, and studying coursework; they preferred textbooks and handouts as sources of current information. However, when these students went beyond textbooks and handouts to seek current information, a major shift was seen from the use of print indexes and abstracts in 1987 towards the use of computerized indexes and other electronic resources in 1997. Almost 60% of the students reported using the Internet for locating current information. Overall use of electronic materials was highest among a group of students receiving the problem-based learning method of instruction. Most of the students surveyed in 1997 indicated that electronic resources would have some degree of importance to them for future education needs. The electronic environment has provided new opportunities for information professionals to help prepare future veterinarians, some of whom will be practicing in remote geographical locations, to access the wealth of information and services available on the Internet and Web.

Health promotion mini-grants: grassroots implementation in New Mexico.

The populations of New Mexico are ethnically diverse, with large Hispanic and Native American components, and live in communities that are geographically dispersed and economically challenged. The University of New Mexico is located in Albuquerque, the state's only major urban area, and houses the state's only academic health sciences center. In 1986, the University received a grant from the W.K. Kellogg Foundation to establish health promotion/disease prevention curricula for health science students and create two Wellness Centers on campus. The Wellness Centers train students to be providers of health information and learn how to counsel and assist people with changing health-related behaviors. A campus-wide employee health promotion program was also implemented. Most of the instructional and service programs initiated by the grant have continued with stable institutional support. A later phase of the project was to encourage other agencies and organizations throughout New Mexico to adopt or expand their own health promotion initiatives. An operating premise of this phase was that local initiatives should respond to locally perceived priorities. To accomplish this, a program of mini-grants was designed to assist in creating health promotion programs within a variety of topic areas. Thirteen mini-grants were awarded to agencies representing diverse groups and cultures throughout New Mexico. Our experience with the mini-grants and the ability of organizations to sustain the activities past the period of grant support are described. The successful use of mini-grants has been reported elsewhere in the literature.

Impact of environmental patient education on preventive medicine practices.

BACKGROUND: Studies show that provider-oriented reminders alone are less effective at increasing physician compliance with prevention guidelines than are combinations of patient- and provider-oriented physician reminders. The effectiveness of environmental patient education (ie, office-based videos, pamphlets, and posters) without individual staff or educator involvement has not been well established. The objective of this study was to evaluate the effectiveness of environmental patient education in increasing the amount of preventive services patients receive. METHODS: A nonrandomized controlled trial using historical controls was conducted in a model family practice clinic at the University of New Mexico School of Medicine in Albuquerque. The study group (n = 389) included adult women who had been seen at the clinic at a time when educational materials were present in the waiting area. The control group (n = 381) were similarly selected patients seen during the same period of the previous year, when no such materials were available. During the intervention, patients in the waiting area were exposed to educational materials that encouraged them to ask their physicians about cholesterol testing, Papanicolaou (Pap) smears, tetanus boosters, and mammograms. For both the control and study groups, physician orders for preventive services were monitored over a 4-month follow-up period by reviewing medical records. RESULTS: There were no statistically significant changes in the number of cholesterol tests, Pap smears, tetanus boosters, or mammograms ordered after the environmental patient education intervention, despite adequate statistical power. CONCLUSIONS: Environmental patient education materials were not effective in increasing the amount of preventive services performed by physicians in this study. Although such interventions are inexpensive, easily comprehended, and well intended, they may be ineffective in increasing the performance of patient preventive services.

Navajo birth outcomes in the Shiprock uranium mining area.

The role of environmental radiation in the etiology of birth defects, stillbirths, and other adverse outcomes of pregnancy was evaluated for 13,329 Navajos born at the Public Health Service/Indian Health Service Hospital in the Shiprock, NM, uranium mining area (1964-1981). More than 320 kinds of defective congenital conditions were abstracted from hospital records. Using a nested case-control design, families of 266 pairs of index and control births were interviewed. The only statistically significant association between uranium operations and unfavorable birth outcome was identified with the mother living near tailings or mine dumps. Among the fathers who worked in the mines, those of the index cases had histories of more years of work exposure but not necessarily greater gonadal dosage of radiation. Also, birth defects increased significantly when either parent worked in the Shiprock electronics assembly plant. Overall, the associations between adverse pregnancy outcome and exposure to radiation were weak and must be interpreted with caution with respect to implying a biogenetic basis.

Seroprevalence of HIV-1 and hepatitis B and C in prostitutes in Albuquerque, New Mexico.

A survey of persons soliciting sex in an area known to be frequented by prostitutes in Albuquerque, NM, included 43 females and 66 males. Seroprevalence rates found in this population-based study were as follows: human immunodeficiency virus type 1 (HIV-1), 3%; hepatitis B, 39%; hepatitis C, 45%. Increased age, intravenous drug use, and condom use were independent risk factors for hepatitis B. Female gender and intravenous drug use were independent risk factors for hepatitis C. Neither sharing injection equipment nor engaging in receptive anal intercourse was independently associated with hepatitis B or C.

Implementing the Association of Teachers of Preventive Medicine's recommendations into the undergraduate medical school curriculum.

In 1989, an expert panel appointed by the Association of Teachers of Preventive Medicine proposed minimum curricular content requirements for health promotion-disease prevention, including recommendations for timing, duration, and course sequencing during medical school. Making clinical preventive medicine an integral part of a primary care rotation is a central feature of the proposal. The panel presents recommendations for using the Guide to Clinical Preventive Services, which assesses the effectiveness of 169 types of prevention interventions, in both undergraduate and postgraduate medical education. Recommendations for incorporating the guide into the undergraduate medical school curriculum are outlined. The recommendations include options for using the guide as part of a curriculum in quantitative skills, in clinical preventive medicine, in a primary care rotation, as a health services and community dimension curriculum, and as part of continuing self-education. Recognizing that teaching methods and curriculum structures are varied in preventive medicine, the panel designed the recommendations to be adaptable to all medical schools' programs. The recommendations are aimed at achieving the goal of making preventive medicine an integral part of the education, training, and practice of physicians.

Medications obtained in Mexico by patients in southern New Mexico.

Many health care providers practicing near the border between the United States and Mexico have serious concerns about their patients' using medications obtained in Mexico. Despite these concerns, the extent of this problem is not known. A survey administered in a publicly funded rural clinic and an urban private practice in southern New Mexico assessed this problem. The survey revealed that 87% of the rural clinic patients and 6% of the urban private practice patients had purchased medications in Mexico within the past two months. Further, 91% of the clinic patients and 56% of the private practice patients stated that they had, at some time, used medications from Mexico. Although many of these medications are fairly innocuous, their easy accessibility and lack of regulation can lead to serious health hazards.

Inventory of knowledge and skills relating to disease prevention and health promotion.

An inventory of the knowledge and skills appropriate for the instruction of medical students in the disciplines of disease prevention and health promotion was developed by a steering committee of medical practitioners and teachers, with the input of over 70 colleagues. The inventory, which is intended as a guide for curriculum planners, defines the fundamentals of subject areas appropriate for the general education of all physicians, including the skills and knowledge related to delivery of personal disease prevention/health promotion services, quantitative methods, health services organization and delivery, and community dimensions of medical practice, as well as attitudes and philosophy.

Scholarship support for Indian students in the health sciences: an alternative method to address shortages in the underserved area.

The University of New Mexico Area Health Education Center was established in conjunction with the Navajo Health Authority to begin health manpower development immediately in the Navajo Nation and surrounding areas (a territory approximately the size of West Virginia). To this end, a student support program was established at the Navajo Health Agency to recruit and support Indian students with scholarships, to provide them with culturally based counseling, and to reinforce the students' intentions of ultimately returning to serve Indian people. No payback penalties or other forms of coercion were used in this program to encourage students to return to the underserved Indian areas.From October 1973 through September 1977, 124 students graduated with 125 degrees or certificates in all aspects of health care. Of these 124 students, 76 were employed. The remaining were continuing their education, unemployed, untraceable, or deceased. Of the 76 employed, 61 were from tribes within the Navajo Nation; of these 61, 56 returned to their area to serve Indians. This return rate to an underserved area is substantially better than anticipated from a review of programs that employ a variety of coercive methods to encourage recipients of loans to settle in specific underserved areas after the necessary training.

Pulmonary embolism during mannitol therapy.

A 25-year-old paraplegic woman suffered cardiopulmonary arrest due to a major pulmonary embolism during intravenous mannitol therapy. Although it is possible that the mannitol caused an acute episode of hemagglutination, we postulate that rapid administration of mannitol caused dilation of her venous system, causing a preexisting clot to break loose.

Augmentation of clinical services in rural areas by health sciences students.

Over a five-year period 230 senior-level students in medicine, nursing, and pharmacy served in clinics located throughout five rural communities. Students participated in the development of the clinics and in the organization of services that otherwise would not have been delivered. Community-based preceptors helped integrate the students' learning about community processes. The project provided experiential learning and interdisciplinary interactions that were enthusiastically received by the students. Follow-up surveys suggested that the experience reinforced interest in eventual practice in rural areas and in interdisciplinary settings. The project demonstrated that students were able to provide clinical services which were useful and acceptable to the communities and which were supported by local practitioners.

Acceptance of the physician assistant by nonphysician health professionals in the Indian Health Service.

A survey of 55 licensed practical nurses, registered nurses and pharmacists in the Indian Health Service was conducted to determine attitudes about the use of physician assistants (PAs). The results tend to support findings of similar studies reported in the literature, but performed in other settings. Overall the PAs appear to have gained general acceptance among nonphysician health professionals. There are significant differences between the responses of LPNs and RNs, with the latter perceiving more conflict with PAs and being less supportive of the emergence of the role. Separation of the responses of LPNs and RNs, at least in this setting, appears to be an important distinction in the analysis and understanding of staff acceptance. Pharmacists were generally approving of the skill levels the PAs demonstrated in areas related to pharmacy, and tended to be intermediate in their response rates relative to LPNs and RNs in overall acceptance of the PA role.

Adenovirus type 2-simian virus 40 hybrid population: evidence for a hybrid deoxyribonucleic acid molecule and the absence of adenovirus-encapsidated circular simian virus 40 deoxyribonucleic acid.

The deoxyribonucleic acid (DNA) from the adenovirus-encapsidated particles of the adenovirus type 2 (Ad2)-simian virus 40 (SV40) hybrid population plaque variant (Ad2(++) HEY), known to yield SV40 virus with high efficiency, was studied by equilibrium density centrifugation followed by ribonucleic acid-DNA hybridization employing virus-specific complementary ribonucleic acids synthesized in vitro. These techniques establish linkage between the Ad2 and SV40 components in the adenovirus-encapsidated particles of this population. The linkage is alkali-resistant and presumably covalent; thus, the Ad2 DNA and SV40 DNA are present in a hybrid molecule. Velocity centrifugation studies in alkaline sucrose gradients eliminated the possibility that supercoiled circular SV40 DNA is present in the adenovirus capsids. The DNA obtained from the adenovirus-encapsidated particles of the Ad2(++) HEY population appears to consist of nonhybrid Ad2 DNA and Ad2-SV40 hybrid DNA molecules.

Equilibrium density gradient studies on simian virus 40-yielding variants of the adenovirus type 2-simian virus 40 hybrid population.

The simian virus 40 (SV40)-yielding variants of the adenovirus type 2 (Ad.2)-SV40 hybrid (Ad.2(++)) population were studied by means of fixed-angle equilibrium density gradient centrifugation in cesium chloride. The hybrid virions of the Ad.2(++) high-efficiency yielder population banded at densities of 0.004 g/cm(3) lighter than the nonhybrid Ad.2 virions. The degree of separation of the hybrid particles was sufficient to permit greater than 100-fold relative purification by two cycles of centrifugation. Hybrid particles that produce adenovirus plaques in African green monkey kidney cells by two-hit kinetics (one-hit kinetics when assayed on lawns of nonhybrid adenovirus) were not separable from the particles that yield SV40 virus. The hybrid particle in the Ad.2(++) low-efficiency yielder population was not separable from the nonhybrid Ad.2 virions.

Density differences between hybrid and nonhybrid particles in two adenovirus-simian virus 40 hybrid populations.

The adenovirus 7-simian virus 40 hybrid virus population E46(+) was subjected to fixed-angle equilibrium density gradient centrifugation in CsCl. A difference in buoyant density between the hybrid virion and its nonhybrid adenovirus 7 counterpart was noted, the hybrid virion possessing the lower buoyant density. This difference in buoyant density appeared to be accentuated in a population of adenovirus 2(+t7), a derivative of E46(+) in which the adenovirus 7-simian virus 40 genome had been transferred to an adenovirus 2 capsid.