Rubella screening and immunization of health care personnel: critical appraisal of a voluntary program.

At our health care center 1161 personnel and students were offered rubella antibody testing. Ninety-two percent were serologically screened or had been previously immunized or previously proven seropositive. Males were more likely to refuse serologic screening than females (p less than 0.01). Sixteen percent of the seroscreened individuals were found seronegative to rubella. Eighty-five percent of seronegative women less than or equal to 24 years old accepted immunization, as compared to 62% of older females and 55% of all males (p less than 0.01). The total cost of the program was over $11,000. Literature and data review failed to support an increased risk of rubella transmission and/or major consequences to pregnant patients in the health care setting as compared to the community. Voluntary rubella immunization is well received by seronegative young women. Programs for immunization of other health care personnel are unlikely to decrease the number of cases of congenital rubella, are costly, and are not well accepted. Education and immunization of all young susceptible women remain the best methods to substantially decrease the incidence of congenital rubella in a cost-effective manner in the near future.

Humanistic geriatric health care: an innovation in medical education.

A geriatric health maintenance program, started in 1976 as a community medicine elective, has developed into an innovative model in humanistic health care. Junior and senior medical students act as live-in facilitators of comprehensive health care for the elderly tenants in publicly subsidized housing units. Students rotate emergency night and weekend calls and hold weekly health clinics at the housing units. Weekly seminars are given by faculty members during which case presentations by students and topics related to the complex problems of the elderly are discussed. Important aspects of this elective are experiential learning in humanistic health care, exposure to ambulatory well or stable elderly people, development of communication/interpersonal skills, and acceptance of responsibility. The program has been received enthusiastically by tenants, community physicians, students, and an increasing number of faculty members at the University of Oregon Health Sciences Center School of Medicine.