Assessment and Prevention of Lead Poisoning in Refugee Populations.

Lead is a neurotoxin, and there are no safe blood lead levels identified for children. Even low levels of lead in blood have been shown to permanently harm the brain, affecting a child's development, intelligence, and academic achievement. In the U.S., refugee children are at an increased risk for lead poisoning. Preventing lead exposure can reduce damage to children's health. It is imperative that clinicians conduct an exposure assessment and offer anticipatory guidance to prevent exposure to lead, especially with sources such as cosmetics, ceramics, herbs, and toys.

Cultural sensitivity and health education: essential components to the success of the early detection cancer screening program for Latinas at MedStar Georgetown University Hospital.

Over 13 years, the Celebremos la Vida (CLV) program has offered free breast examinations, mammograms, and cervical cancer screenings to uninsured Latinas residing in the Northern Virginia suburbs of Washington, D.C. The CLV program aims to educate participants on the importance of breast self-examination and regular cancer screening for the early detection of breast and cervical cancer.

Breaking down barriers to breast and cervical cancer screening: a university-based prevention program for Latinas.

INTRODUCTION: The lower rate of utilization of mammography and cervical cancer screening observed for Latinas in the United States has been attributed to cultural, economic, and linguistic barriers they may encounter. METHODS: A screening program was implemented offering cancer prevention education plus breast and cervical cancer screening to Latinas, as well as all necessary follow-up care, at no cost to the participant. RESULTS: In the first 6 years of this project, a total of 928 screening visits occurred; 53% were participants who had returned at least once for additional annual screening. Ninety-one percent of participants preferred speaking in Spanish to their health care providers; however, only 2% identified a primary care provider and 5% stated they had health care insurance. The participant characteristics and results of initial evaluation, as well as necessary follow-up studies, are presented. CONCLUSIONS: By removing economic concerns and by providing care and education through bilingual staff in a culturally sensitive environment, some of the barriers to cancer screening for Latinas were overcome. The success of the program is reflected by a high rate of return for additional annual screening by our participants.

Pelvic examination training for interns: a randomized controlled trial.

PURPOSE: To evaluate the effectiveness of pelvic examination training for internal medicine interns conducted by instructors who also serve as models for the examination. METHOD: In 2001, 80 interns from three university internal medicine residencies completed questionnaires about their experiences with pelvic examinations. Interns who were available for training underwent baseline assessment of their pelvic examination skills and were randomized to training or to a control group that received only educational literature. Skills were assessed with a 29-item checklist at baseline and at follow-up by evaluators blinded to group assignment, and interrater agreement was estimated by review of audiotapes. RESULTS: Seventy-two interns were randomized and underwent baseline skills assessment. Seventy interns returned for follow-up assessment after approximately 14 weeks (range, 10-17 weeks). The 39 interns randomized to training and 33 randomized to the control group did not differ with respect to age, gender, or prior pelvic examination training. In both groups there was substantial variability in skills at baseline, with graduates of U.S. medical schools scoring significantly higher than did graduates of non-U.S. medical schools (0.66 versus 0.41, p < 10(-5)). Interns randomized to training had significantly higher scores at follow-up than did interns in the control group (0.79 versus 0.57, p < 10(-6)). For seven items verifiable by audiotape, interrater agreement was good (overall kappa, 0.54; range among items, 0.3-0.85). CONCLUSION: Specialized trainers can reliably evaluate and improve the pelvic examination skills of interns, and improvements are demonstrable three months after training. Further research is needed to ascertain whether training efficiency can be improved and to measure the impact of training on patient satisfaction and clinical outcomes.