Lactose intolerance and health disparities among African Americans and Hispanic Americans: an updated consensus statement.

Dairy foods contribute nine essential nutrients to the diet including calcium, potassium and vitamin D; nutrients identified by the 2010 Dietary Guidelines for Americans as being "of public health concern" within the U.S. population. Milk and milk product intake is associated with better diet quality and has been associated with a reduced risk of chronic diseases or conditions including hypertension, cardiovascular disease, metabolic syndrome, Type 2 Diabetes and osteoporosis. Some research also indicates dairy food intake may be linked to reduced body fat, when accompanied by energy-restriction. On average, both African Americans and Hispanic Americans consume less than the recommended levels of dairy foods, and perceived or actual lactose intolerance can be a primary reason for limiting or avoiding dairy intake. True lactose intolerance prevalence is not known because healthcare providers do not routinely measure for it, and no standardized assessment method exists. Avoiding dairy may lead to shortfalls of essential nutrients and increased susceptibility to chronic disease. This updated Consensus Statement aims to provide the most current information about lactose intolerance and health, with specific relevance to the African American and Hispanic American communities. Topics covered include diagnostic considerations, actual and recommended dairy food intake and levels of consumption of key dairy nutrients among African Americans and Hispanic Americans; prevalence of self-reported lactose intolerance among various racial/ethnic groups; the association between dairy food intake, lactose intolerance and chronic disease; and research-based management recommendations for those with lactose intolerance.

EPSDT preventive services in a low-income pediatric population: impact of a nursing protocol.

Medicaid mandates coverage of clinical preventive services for children under the Early and Periodic Screening, Diagnosis, and Treatment program (EPSDT). This article assesses the usefulness of a nursing protocol for delivering comprehensive EPSDT services to pediatric patients during any primary care visit. Secondary data from a recent controlled trial were analyzed. An intervention group received the clinical protocol (n = 514 children in a low-income pediatric clinic), whereas data from a "usual care" comparison group were obtained from medical records (n = 115 children). The nursing protocol included 52 items corresponding to EPSDT services and was administered by a prevention nurse. In the intervention group, 11 605 out of 11 607 (approximately 100.0%) EPSDT service needs were initiated, as compared to 21.2% (572 out of 2695) in the comparison group (P < .001). The study demonstrates the feasibility of using a nursing protocol to integrate EPSDT clinical preventive services into pediatric visits.

HEDIS prevention performance indicators, prevention quality assessment and Healthy People 2010.

The purposes of the study were to contrast actual prevention services needs with quality assurance indicators from the Health Employer Data Information System (HEDIS-Medicaid 3.0) and the goals and objectives of Healthy People 2010, to calculate allowable Medicaid reimbursement for comprehensive prevention services, and to describe patient expectations for prevention counseling. We obtained a convenience sample of all ages (under 17 years = 514, 18 years or older = 473), both sexes (male = 393, female = 594), and three racial/ethnic groups: African American = 687, White =173, Hispanic = 88 in a clinic that predominantly served Medicaid-insured patients. Participants 18 years of age and older were interviewed about expectations for preventive counseling. According to procedures rated A or B by the second United States Preventive Services Task Force (USPSTF), these patients had 11,504 service needs. Performance indicators from HEDIS-Medicaid 3.0 would have covered 2,571 (22%) while the goals and objectives of Healthy People 2010 would have covered 11,437 (99%). Allowable Medicaid reimbursement estimates for 100% coverage averaged USD $206.13 per person. A majority of patients in all race-sex groups expected counseling at least once per year. The results show that a focus on HEDIS-Medicaid 3.0 quality indicators in these patients would have been inconsistent with the goals and objectives of Healthy People 2010, that it would have promoted patient mistrust by failing to meet patient expectations, and that payment for 100% coverage of A and B USPFTF recommended preventive services at Medicaid rates would have constituted a small fraction of per capita yearly U.S. health care expenditures.

The clinical skills laboratory: a cost-effective venue for teaching clinical skills to third-year medical students.

The authors taught clinical examination and procedural skills using manikins in a clinical skills laboratory as a part of an integrated curriculum in the third-year clerk-ship. This teaching modality was effective and well received by students and faculty.