RESUMO
PURPOSE: To address minority health disparities in maternal and child health (MCH), increasing the diversity of the MCH workforce is an important strategy. DESCRIPTION: Guided by the MCH Leadership Competencies, we developed an undergraduate pipeline program for disadvantaged students. Our target population is minority undergraduates who are interested in entering health professions but have academic challenges. We identify these students early in their undergraduate careers and expose them to the field of MCH through a 4-unit course, summer field practicum at an MCH community-based organization or agency, and volunteer experience in a student-run organization focused on helping children and families. We also provide academic advising and personal counseling by a faculty mentor and leadership training opportunities. ASSESSMENT: Since 2006, 75 students have participated in our program, of which 36 are still enrolled and 39 have graduated. Among the graduates, three (8 %) have completed graduate school and are working in a health field; 11 (28 %) are enrolled in graduate school; and 13 (33 %) are currently applying to graduate school. Of the remaining graduates, seven (18 %) are employed in a health field, and five (13 %) are working in an unrelated field. CONCLUSION: Pipeline programs should attempt to reach students as early as possible in their undergraduate careers to more effectively influence their academic trajectories. Many minority students face academic and personal challenges; therefore, intensive academic advising and one-on-one faculty mentoring are important components of pipeline programs.
Assuntos
Ocupações em Saúde/educação , Saúde Materna , Grupos Minoritários/educação , Pediatria , Desenvolvimento de Programas/métodos , Estudantes , Escolha da Profissão , Necessidades e Demandas de Serviços de Saúde , HumanosRESUMO
At least half of women migraineurs experience menstrual migraine (MM), suggesting a hormonal explanation for the incidence of these headaches. Basic science efforts suggest a relationship between estrogen and the neurotransmitters and neuronal structures critical in the pathophysiology of migraine. The notion that MM is more severe, longer in duration, and more resistant to treatment than headaches occurring at other times during the menstrual cycle may apply more to women seeking treatment for their headaches than to migraineurs in the general population. Triptans have been shown to be effective as both an abortive and short-term preventive treatment, and estradiol has been shown to be an effective short-term preventive treatment. Ergotamines, combinations of drugs such as sumatriptan-naproxen sodium, and rizatriptan with dexamethasone show promise in the treatment of MM.
Assuntos
Cefaleia/diagnóstico , Cefaleia/etiologia , Síndrome Pré-Menstrual/complicações , Síndrome Pré-Menstrual/tratamento farmacológico , Quimioterapia Combinada , Feminino , Cefaleia/fisiopatologia , Humanos , Ciclo Menstrual/efeitos dos fármacos , Ciclo Menstrual/fisiologia , Síndrome Pré-Menstrual/fisiopatologiaRESUMO
BACKGROUND: Black and Hispanic stroke survivors experience higher rates of recurrent stroke than whites. This disparity is partly explained by disproportionately higher rates of uncontrolled hypertension in these populations. Home blood pressure telemonitoring (HBPTM) and nurse case management (NCM) have proven efficacy in addressing the multilevel barriers to blood pressure (BP) control and reducing BP. However, the effectiveness of these interventions has not been evaluated in stroke patients. This study is designed to evaluate the comparative effectiveness, cost-effectiveness and sustainability of these two telehealth interventions in reducing BP and recurrent stroke among high-risk Black and Hispanic stroke survivors with uncontrolled hypertension. METHODS/DESIGN: A total of 450 Black and Hispanic patients with recent nondisabling stroke and uncontrolled hypertension are randomly assigned to one of two 12-month interventions: 1) HBPTM with wireless feedback to primary care providers or 2) HBPTM plus individualized, culturally-tailored, telephone-based NCM. Patients are recruited from stroke centers and primary care practices within the Health and Hospital Corporations (HHC) Network in New York City. Study visits occur at baseline, 6, 12 and 24 months. The primary outcomes are within-patient change in systolic BP at 12 months, and the rate of stroke recurrence at 24 months. The secondary outcome is the comparative cost-effectiveness of the interventions at 12 and 24 months; and exploratory outcomes include changes in stroke risk factors, health behaviors and treatment intensification. Recruitment for the stroke telemonitoring hypertension trial is currently ongoing. DISCUSSION: The combination of two established and effective interventions along with the utilization of health information technology supports the sustainability of the HBPTM + NCM intervention and feasibility of its widespread implementation. Results of this trial will provide strong empirical evidence to inform clinical guidelines for management of stroke in minority stroke survivors with uncontrolled hypertension. If effective among Black and Hispanic stroke survivors, these interventions have the potential to substantially mitigate racial and ethnic disparities in stroke recurrence. TRIAL REGISTRATION: ClinicalTrials.gov NCT02011685 . Registered 10 December 2013.
Assuntos
Negro ou Afro-Americano , Monitorização Ambulatorial da Pressão Arterial/métodos , Administração de Caso , Hispânico ou Latino , Hipertensão/diagnóstico , Hipertensão/enfermagem , Acidente Vascular Cerebral/enfermagem , Telemedicina/métodos , Telemetria , Anti-Hipertensivos/uso terapêutico , Monitorização Ambulatorial da Pressão Arterial/economia , Monitorização Ambulatorial da Pressão Arterial/instrumentação , Administração de Caso/economia , Protocolos Clínicos , Análise Custo-Benefício , Desenho de Equipamento , Custos de Cuidados de Saúde , Conhecimentos, Atitudes e Prática em Saúde , Disparidades em Assistência à Saúde/etnologia , Humanos , Hipertensão/economia , Hipertensão/etnologia , Hipertensão/fisiopatologia , Cidade de Nova Iorque , Cooperação do Paciente , Educação de Pacientes como Assunto , Valor Preditivo dos Testes , Recidiva , Projetos de Pesquisa , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/economia , Acidente Vascular Cerebral/etnologia , Acidente Vascular Cerebral/fisiopatologia , Telemedicina/economia , Telemedicina/instrumentação , Telemetria/economia , Telemetria/instrumentação , Tecnologia sem FioRESUMO
OBJECTIVE: There are limited epidemiological data about headache in urban elderly persons in the United States, especially those from minority backgrounds. This article examines the prevalence of headache and associated psychosocial factors in a biracial sample of older adults in New York City. METHODS: Data from a population-based sample consisting of 214 Caucasians and 859 Blacks aged 55 and over (mean age: 68 years) were analyzed using an adaptation of George's Social Antecedent Model of Psychopathology. The model consisted of 15 independent variables, one interactive variable, and a dependent variable that dichotomized headaches that bothered respondents into "none or little of the time" versus "some, a good part, or most of the time" in the past few weeks. RESULTS: Controlling for design effects, 17.8% of the sample met headache criteria. For the entire sample, logistic regression analysis indicated that headache was significantly associated with anxiety symptoms, depressive symptoms, religiosity, and a smaller proportion of confidantes. When examined separately, headache among blacks was significantly associated with anxiety symptoms, larger social networks, and greater financial strain. Among Caucasians, headache was associated with anxiety symptoms, smaller social networks, religiosity, physical illness, and higher daily functioning. CONCLUSIONS: The study confirms earlier findings that anxiety and depressive symptoms are associated with headache in older adults. The results also identify other psychosocial factors that may differ by race. These findings have important implications with respect to the etiology and management of headache in older adults.