Primary Care Access for All: A Roadmap for Addressing the Primary Care Crisis in Rhode Island.

Background: Primary care in Rhode Island is in crisis. The dearth of primary care providers is already affecting access to services and the situation is likely to worsen unless major steps are taken. There are inadequate numbers of trainees in primary care medical residencies, nurse practitioner (NP) and physician assistant (PA) training programs who plan to practice primary care in our state.

The Unique Value Proposition of Pediatric Health Care.

This document provides a framework for the value proposition of pediatric health care. It is intended to provide a succinct set of principles for establishing this proposition that demonstrates the short- and long-term value to the child and family, the health care system, and society as a whole.

True self-attributions shape judgments of blame in the context of addiction-relevant crime.

In three studies, we examined how attributing the criminal actions of a drug-addicted offender to their "true self" influences perceptions of their blameworthiness. Study 1 revealed that attributing a drug-addicted offender's crime (theft) to his true self positively predicted judgments of the offender's blameworthiness for the crime. Study 2 employed an experimental design and revealed that information connecting a crime (vs.

Birth Stories, Support, and Perinatal Emotional Health among Minority Adolescent Mothers: A Mixed Methods Study.

Study Objective: To explore minority, adolescent birth and perinatal experiences to inform and improve quality of care for this unique group.

Design: Mixed quantitative and qualitative study guided by Bourdieu's Social Fields framework.

Setting: Clinic dedicated to parenting adolescents, and a local charter school founded to serve pregnant and parenting young adults.

The Memory Quilt: Heart-and-Hands Learning for Palliative Care.

Nursing students' learning of adult and pediatric palliative care is a daunting experience. An effective initial teaching strategy using a Memory Quilt activity can improve nursing students' interpersonal and communication skills and help prepare them for end-of-life caring. These skills help students meet patient and family needs, as they transition to care settings.

Redesigning Health Care Practices to Address Childhood Poverty.

Child poverty in the United States is widespread and has serious negative effects on the health and well-being of children throughout their life course. Child health providers are considering ways to redesign their practices in order to mitigate the negative effects of poverty on children and support the efforts of families to lift themselves out of poverty. To do so, practices need to adopt effective methods to identify poverty-related social determinants of health and provide effective interventions to address them.

Partnering for health: collaborative leadership between a community health center and the YWCA central Massachusetts.

Background: A collaborative partnership among community-based organizations (CBOs)-a community-health center, a YWCA, and 2 academic health centers-developed and implemented open access to physical activity for health center patients.

Objective: To describe partnership approach taken by 2 CBOs; determine staffs' views of this unique partnership, highlight aspects of the partnership that contributed to its success, identify challenges and mechanisms for overcoming them, and note lessons learned. Assess health center patients' use of YWCA facility.

Low vitamin D status among obese adolescents: prevalence and response to treatment.

Purpose: To explore the prevalence of low vitamin D status among obese adolescents and to examine the effect of current management of low vitamin D status in these patients.

Methods: A retrospective chart review of obese adolescents who had been screened for vitamin D status by serum total 25-hydroxyvitamin D (25(OH)D) level. Vitamin D deficiency was defined as 25(OH)D level of <20 ng/mL, vitamin D insufficiency as 25(OH)D level of 20-30 ng/mL, and vitamin D sufficiency as 25(OH)D level of >30 ng/mL.

Bone accretion in adolescents using the combined estrogen and progestin transdermal contraceptive method Ortho Evra: a pilot study.

Objective: To date, there are no data regarding the effect of the transdermal combined estrogen and progestin contraceptive Ortho Evra on bone mineral content (BMC) and bone mineral density (BMD). We examined the effects of transdermally delivered ethinyl estradiol and norelgestromin on whole body (WB) BMC and BMD of the hip and lumbar spine (LS) of adolescent girls.

Methods: In a matched case-control study, girls (n = 5) who applied Ortho Evra for days 1-21 followed by days 22-28 free of medication for 13 cycles (about 12 months) were compared with 5 age- and ethnicity-matched control girls.

Isolated low HDL cholesterol emerges as the most common lipid abnormality among obese adolescents.

A 12-hour fasting lipid profile was obtained from 88 otherwise healthy obese (BMI > or = 95%) adolescents (age 16 +/- 1 years, BMI 36 +/- 1 kg/m(2), 55 males, 33 females, 57% Hispanic, 23% African American, 19% Caucasian, 1% Asian American). About 56% of the obese adolescents exhibited lipid abnormalities based on cutoff points established by American Heart Association (AHA) guidelines, and about 57% exhibited lipid abnormalities based on percentile values established by the Lipid Research Clinic Pediatric Prevalence Study. Isolated low high-density lipoprotein-cholesterol (HDL-C) was the most common abnormality (43% based on AHA, 36% based on the Lipid Research Clinic Pediatric Prevalence Study) among the obese adolescents with lipid disorders.

Survey of primary care pediatricians on the transition and transfer of adolescents to adult health care.

The transition and transfer from pediatrics to adult health care of youth with and without special health care needs has become a focus of professional organizations, health care insurers, national policy makers, and providers. To understand transition and transfer at a primary care practice level, all primary care pediatricians in Rhode Island were surveyed. Responses were received from 103 of 169 (60.

The medical genetics workforce: an analysis of clinical geneticist subgroups.

Purpose: Clinical geneticists with a Doctor of Medicine degree face challenges to meet the growing population demand for genetic services. This study was designed to assist the profession with workforce planning by identifying clinically relevant subgroups of geneticists and describing their professional characteristics and clinical practices. Geneticists' patient care productivity is compared across subgroups and other medical specialists.

U.S. genetics nurses in advanced practice.

Purpose: To describe characteristics and professional roles of genetics nurses in advanced practice.

Design: A cross-sectional descriptive survey administered in 2004 as one component of a comprehensive study of genetic services and the health workforce. The sample was 211 U.

Adolescents' experience with the combined estrogen and progestin transdermal contraceptive method Ortho Evra.

Background: The new combined estrogen & progestin contraceptive patch Ortho Evra was approved by the FDA in December 2001. To date, there is a paucity of data regarding its use in the adolescent age group. We examined adolescents' experience with this new contraceptive method.

A session of multiple choice questions in the orientation process to the adolescent medicine rotation.

Background: Although adolescent health care training curricula for resident physicians have been developed during the past 2 decades, little is known about the orientation process to the adolescent medicine rotation.

Description: Since 1996, we have incorporated a session consisting of 40 multiple-choice questions (MCQ) in the orientation process to our hospital-based adolescent medicine rotation. In this study, we evaluated residents' opinions about the MCQ format.

The use of the leukotriene receptor antagonist montelukast (Singulair) in the management of dysmenorrhea in adolescents.

Purpose: Previous studies have shown an increase in leukotrienes in the uterine tissue as well as in the menstrual flow of adult women with dysmenorrhea. An increase in leukotriene-E4, the major urinary leukotriene, was also reported in adolescent girls with dysmenorrhea, further suggesting a possible involvement of these potent vasoconstrictors and inflammatory mediators in generating dysmenorrhea symptoms. In the present study we examined whether blocking leukotrienes might alleviate symptoms of dysmenorrhea in adolescents.

Supplementation with vitamin C and/or vitamin B(6) in the prevention of Depo-Provera side effects in adolescents.

Background/objectives: Depo-Provera-induced menstrual irregularity is believed to be secondary to relative estrogen deficiency. Weight gain associated with this contraceptive method is believed to be due to Depo-Provera's steroid-like appetite stimulation effect and to an altered tryptophan metabolism. We examined whether vitamin C, an important factor in uterine estrogen binding, and vitamin B(6), a glucocorticoid antagonist and an important coenzyme in the tryptophan-serotonin pathway, might alleviate menstrual irregularities and weight gain associated with Depo-Provera.

Attachment classifications among 18-month-old children of adolescent mothers.

Objectives: To determine (1) patterns of secure vs insecure attachment relationships in infants of adolescent and nonadolescent mothers and (2) if these patterns are mediated by parenting characteristics, including depression, self-esteem, parenting stress, child abuse potential, psychological distress, rating of infant temperament, and the caregiving environment.

Participants: Fifty-one adolescent mothers and their 18-month-old infants were compared with 76 nonadolescent mothers and their 18-month-old infants.

Main Outcome Measures: Infant attachment classifications were assessed via the Ainsworth Strange Situation.