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J Health Care Poor Underserved ; 32(2): 598-606, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34120960


In response to the COVID-19 pandemic, the Herbert Wertheim College of Medicine's Neighborhood Health Education Learning Program (NeighborhoodHELP) initiated a longitudinal assessment and mitigation of social and health care challenges for a population of approximately 850 underserved households. Here, we describe the needs assessment, ensuing interventions, and lessons learned during this pandemic.

COVID-19/epidemiologia , Determinação de Necessidades de Cuidados de Saúde , Populações Vulneráveis , Adolescente , Adulto , Idoso , Criança , Serviços de Saúde Comunitária , Informação de Saúde ao Consumidor , Feminino , Florida/epidemiologia , Assistência Alimentar , Necessidades e Demandas de Serviços de Saúde , Humanos , Masculino , Área Carente de Assistência Médica , Pessoa de Meia-Idade , Pandemias , Determinantes Sociais da Saúde , Adulto Jovem
Perspect Biol Med ; 57(2): 208-23, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25544325


The early results of the Human Microbiome Project, released in June 2012, add to the overwhelming data that show that there are literally trillions of microbes that live in and on each human individual. This research raises profound questions about what it means to be an individual organism, human or otherwise. In this paper, we ask two broad questions: (1) how might we conceive of an individual organism, given these results? and (2) in light of this emerging conception of the individual organism, what are the implications for how humans conceive of their own self-sufficiency and interact with other members of the living world? We highlight the ontological and political presuppositions animating this research and return to Aristotle for insights into how to conceive of and how to behave towards and within a diverse community of interdependent living parts that function together as one.

Metagenoma , Microbiota , Ética em Pesquisa , Humanos , National Institutes of Health (U.S.) , Política , Estados Unidos
Med Inform Internet Med ; 32(2): 149-55, 2007 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-17541864


Computers, personal digital assistants (PDA), and the Internet are widely used as resources in medical education and clinical care. Educators who intend to incorporate these resources effectively into residency education programmes can benefit from understanding how residents currently use these tools, their skills, and their preferences. The researchers sent questionnaires to 306 US family medicine residency programmes for all of their residents to complete. Respondents were 1177 residents from 125 (41%) programmes. Access to a computer was reported by 95% of respondents. Of these, 97% of desktop and 89% of laptop computers could access the Internet. Residents accessed various educational and clinical resources. Half felt they had 'intermediate' skills at Web searches, 23% had 'some skills,' and 27% were 'quite skilled.' Those under 30 years of age reported higher skill levels. Those who experienced a Web-based curriculum in medical school reported higher search skills and greater success in finding clinical information. Respondents preferred to use technology to supplement the didactic sessions offered in resident teaching conferences. Favourable conditions exist in family medicine residency programmes to implement a blend of traditional and technology-based learning experiences. These conditions include residents' experience, skills, and preferences.

Computadores/estatística & dados numéricos , Medicina de Família e Comunidade , Internet/estatística & dados numéricos , Internato e Residência , Fatores Etários , Educação à Distância/métodos , Humanos , Armazenamento e Recuperação da Informação , Estados Unidos
Psychiatry Res ; 141(2): 193-200, 2006 Feb 28.
Artigo em Inglês | MEDLINE | ID: mdl-16457894


The Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial is a multi-site effectiveness study funded by the National Institute of Mental Health (NIMH) with the aim of identifying successful, acceptable and cost-effective treatment strategies for outpatients with unremitted depression. With enrollment of 4,041 adults with major depressive disorder (MDD), it is the largest controlled psychiatric treatment study ever undertaken. In the course of developing procedures to ensure that ambitious enrollment goals were met, a number of ethical and practical issues became apparent that underscore the conflicts between effectiveness research and human subject protections. These are delineated as they relate to study design; eligibility criteria; incentives to subjects; investigators and clinical sites; the complementary roles of clinical research coordinators (CRCs) and study clinicians; and recruitment and consent procedures. The STAR*D trial exemplifies the interplay and tension between those strategies that integrate research and clinical aims and roles in the service of enhancing external validity, site participation, and recruitment and retention versus those strategies that differentiate research and clinical treatment in the service of research integrity and human subject protections. We hope that a discussion of these key challenges and dilemmas and how they have been addressed will help inform future discussions concerning design and conduct of ethical effectiveness trials designed to optimize care in real world clinical settings.

Antidepressivos/uso terapêutico , Terapia Cognitivo-Comportamental/ética , Terapia Cognitivo-Comportamental/métodos , Transtorno Depressivo Maior/terapia , Ética Clínica , Adolescente , Adulto , Idoso , Terapia Combinada , Transtorno Depressivo Maior/tratamento farmacológico , Transtorno Depressivo Maior/economia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
Perspect Biol Med ; 46(3): 413-27, 2003.
Artigo em Inglês | MEDLINE | ID: mdl-12878811


Given the paradox of the success of modern medical technology and the growing patient dissatisfaction with present-day medicine, critics have called for a reevaluation of contemporary medical practice. This paper offers a phenomenological analysis of traditional Navajo healers and their ceremonies to highlight key aspects of healing. A phenomenological view of medical practice takes into account three key features: the lifeworld, the lived body, and understanding. Because of their closeness to a phenomenological view, traditional Navajo mythology and healing practices offer insight into the healing process. Contemporary physicians can appreciate the phenomenological elements of Navajo healing ceremonies, including the Mountain Chant. Navajo healers help patients make sense of their illnesses and direct their lives accordingly, an outcome available to contemporary practitioners, who are also gifted with the benefits of new technologies. By examining scientific medicine, Navajo healing practices, and phenomenology as complementary disciplines, the authors provide the groundwork for reestablishing a more therapeutic view of health.

Atitude Frente a Saúde/etnologia , Cura pela Fé/métodos , Índios Norte-Americanos , Xamanismo , Antropologia Cultural , Cura pela Fé/psicologia , Serviços de Saúde do Indígena , Saúde Holística , Humanos , Mitologia , Relações Médico-Paciente , Religião e Medicina
Am J Med Qual ; 18(2): 82-9, 2003.
Artigo em Inglês | MEDLINE | ID: mdl-12710557


This project explored the effect of a multifaceted quality improvement (QI) intervention at a university-based residency program clinic on the documented provision of preventive services. The intervention, based on the Put Prevention Into Practice program and standard QI techniques, consisted of patient self-administered Health Risk Profiles (HRPs) and a monthly educational curriculum for patients, staff, and providers. Documentation of preventive services in patient charts was measured using a repeated cross-sectional sampling design before and after the 1-year intervention period. Documentation of 8 of 19 preventive services under examination increased significantly (P < .05). Measurements of the intervention, including use of the HRPs and the educational curriculum, revealed little association with the observed improvements. Although the intervention was associated with improved documentation of clinical preventive services, specific elements of the intervention were underused. The authors postulate that the QI process fostered a culture change in the clinic that affected prevention activities. Whether the increased documentation of services reflected an increase in the actual provision of services and whether this increase is clinically significant require further study.

Medicina de Família e Comunidade/educação , Internato e Residência/normas , Cultura Organizacional , Serviços Preventivos de Saúde/estatística & dados numéricos , Gestão da Qualidade Total/organização & administração , Adulto , Idoso , Feminino , Pesquisa sobre Serviços de Saúde , Hospitais Universitários/normas , Humanos , Masculino , Pessoa de Meia-Idade , Estudos de Casos Organizacionais , Ambulatório Hospitalar/normas , Serviços Preventivos de Saúde/normas , Avaliação de Programas e Projetos de Saúde , Medição de Risco , Autoimagem