We explored Kentuckians' attitudes toward children with epilepsy. Questions compared respondents' attitudes about children with epilepsy, asthma, hyperactivity, and AIDS. Random digit dialing led to 617 completed interviews. The key questions asked concerned (a) how a pupil with each illness would alter the classroom environment, and (b) how the condition would affect the child's quality of life (QOL) at age 21 years. Respondents used a 0-10 rating scale (0 = worst, 5 = normal, 10 = best). A dichotomous variable divided respondents into those who rated below and those who rated at or above the norm: 24% predicted a deterioration of the classroom environment with the addition of a pupil with epilepsy (similar to AIDS at 26%); 41% predicted a lessened QOL at age 21 years (a worse rating than either asthma or hyperactivity). We created summary indexes, using difference scores between epilepsy ratings and ratings for the other conditions: Relative Educational Distance (RED) and Relative Quality of Life Distance (RQLD) measures. On the RED index, rural and Appalachian respondents showed the greatest prejudice toward pupils with epilepsy. Conversely, we noted the greatest prejudice in RQLD among urban residents (the best educated group). Our data do not support contentions that prejudices against persons with epilepsy are disappearing.

The purpose of this research was to develop further information relevant to the problem of utilization of dental services at neighborhood health centers. The research objectives were: (1) A descriptive assessment of the utilization trends of the population served by a neighborhood health center; (2) Some determination of any possible correlation between failed appointments and patients' satisfaction with dental care; and, (3) Some exploration of possible reasons for non-utilization of scheduled dental appointments by a sample of patients from the neighborhood health center who report a history of previous dental treatment. From dental clinic daily appointment sheets, an assessment of utilization trends of a neighborhood health center population for a seven-month period (jon trends of a neighborhood health center population for a seven-month period (June 1, 1973 to December 31,1973) was obtained. In addition, analyses of patient treatment records and information obtained from personal interviews with 40 individuals from the health center population facilitated the completion of the second and third research objectives. The results indicated: (1) Compared to the findings of earlier research,-3 the reported ratio of broken to total appointments scheduled for this study population was substantially lower; (2) There is a rather strong relation between satisfaction with care and the utilization of dental services at the neighborhood health center studied; (3) Satisfaction with care is dependent upon a number of factors; and (4) Reasons given for nonutilization of scheduled dental services are practical ones, of which some are also reflected in the reasons given ofr dissatisfaction with dental care.

No abstract

In the US, deaths from prescription opioids have quadrupled since 1999, prompting authorities to declare an "opioid abuse" crisis. Rising overdose deaths were attributed to trends in the overprescription of opioids, specifically the strength and duration of the initial prescription. We describe educational interventions designed to control healthcare professionals' (HCPs) opioid prescribing in the wake of this crisis. A review of relevant programs for practicing providers, medical residents, and medical students reveals a focus on educational interventions that we describe, borrowing from sociologist John McKinlay's metaphor for public health interventions, as "downstream." These downstream interventions concentrate on regulating and educating practicing HCPs rather than transforming the training environment for medical students and residents. We draw on theories of behavior change to call for the development of complementary "upstream" educational programs for future practitioners that focus on structural and psychosocial factors and may contribute to more sustainable behavior change outcomes.

Rural Haitian nutrition has long been a matter of concern to health workers. The diet is seriously restricted and there is widespread malnutrition. This is especially striking among lactating women. The Haitian government, under François Duvalier, began comprehensive programs designed to alleviate some of the economic and technologic factors which limit the diet. An equally serious restricting influence on the diet, however, and an influence which has gone largely unnoticed, is the hot/cold classification of life-states and foods stemming from an adherence to humoral medicine. Even though belief in humoral medicine is widely and consistently held in rural Haiti, there is no apparent recognition of its impact on nutrition by those working in this field. There is no mention of this belief system in the available literature on Haiti. This study examines and delineates the impact of humoral medicine upon the diet of the lactating Haitian woman. The data indicate that practices stemming from this belief system have an even more serious limiting impact upon rural dietary behavior than the economic, technologic and environmental factors, and must, therefore, be considered in any nutritional intervention program for Haitians either in Haiti or abroad.