The Submissive Relationship of Public Health to Government, Politics, and Economics: How Global Health Diplomacy and Engaged Followership Compromise Humanitarian Relief.

This paper describes efforts by public health practitioners to address a health crisis caused by economic development policies that are unrestrained by either environmental, public health, or human rights mandates. Economic development projects funded by international funding institutions like the Inter-American Development Bank that reduce poverty when measured in terms of Gross Domestic Product (GDP) per capita in the transborder region between Suriname and French Guiana harm minority populations where commercial activities destroy, alter, and remove the resources upon which local communities depend. In this study, the structural causes of a community health crisis affecting Indigenous people in the transborder region between Suriname and French Guiana was addressed by seeking gatekeepers in government who have access to policy-making processes.

Neurological abnormalities in a mercury exposed population among indigenous Wayana in Southeast Suriname.

The indigenous Wayana community of Puleowime (Apetina) in Suriname is susceptible to the effects of mercury because they consume large amounts of fish compared to mainstream communities. Small-scale and artisanal gold mining activities occur at numerous sites in eastern and southeastern Suriname placing the Wayana at risk from exposure to mercury released into the environment. A previous community-led risk assessment study showed that the Wayana were at a high lifetime risk of adverse effects from exposure to mercury.

Implementation of quality improvement skills by primary care teams: case study of a large academic practice.

Background: Continuous quality improvement (QI) is important to primary care in general, and is emphasized as a key tenet of the primary care patient-centered medical home (PCMH) model. While team-based QI activities within the PCMH model are expected, concerns exist as to how successful efforts have been at implementing team-driven QI projects.

Objective: To (a) identify opportunities and challenges to QI efforts in a large primary care practice in order to (b) develop action plans to facilitate QI work into primary care teams.

Public health programs as surrogates for social action in Suriname, South America.

This paper addresses the merits of public health activism that advocates for social change in which health is the outcome of interest. We acknowledge that while efforts at the individual level are important, social network models consider the underlying mechanisms that lie outside the public health sector. This paper considers the inequitable health of Indigenous people who bear a disproportionate share of the negative health consequences due to economic development programs that follow an assimilation model.

Pilot study evaluating a practice-based learning and improvement curriculum focusing on the development of system-level quality improvement skills.

Background: We developed a practice-based learning and improvement (PBLI) curriculum to address important gaps in components of content and experiential learning activities through didactics and participation in systems-level quality improvement projects that focus on making changes in health care processes.

Methods: We evaluated the impact of our curriculum on resident PBLI knowledge, self-efficacy, and application skills. A quasi-experimental design assessed the impact of a curriculum (PBLI quality improvement systems compared with non-PBLI) on internal medicine residents' learning during a 4-week ambulatory block.

Community-led assessment of risk from exposure to mercury by native Amerindian Wayana in Southeast Suriname.

This study was a collaboration between Western public health researchers and Suriname indigenous communities. The question asked was "how can Western researchers effectively engage traditional indigenous communities in Suriname, South America, in public health research". The approach used a combination of Participatory Action Research methods in which "Western" researchers became participating observers in an indigenous-led research initiative.

Benefits and costs of pay for performance as perceived by residents: a qualitative study.

Purpose: To describe and interpret pay-for-performance (P4P) systems as perceived by internal medicine residents to develop curricula that relate P4P measures to quality improvement initiatives.

Method: In 2008-2009, the authors conducted a qualitative study in which 97 internal medicine residents completed a mandatory survey soliciting their views of the advantages and disadvantages of P4P. The authors analyzed responses to identify and categorize emergent themes.

Teaching quality improvement in the midst of performance measurement pressures: mixed messages?

Background: While the importance of teaching quality improvement (QI) is recognized, formal opportunities to teach it are limited and are not always successful at getting physician trainee buy-in. We summarize findings that emerged from a QI curriculum designed to promote physician trainee insights into the evaluation and improvement of quality of care.

Methods: Grounded-theory approaches to thematic coding of responses from 24 trainees to open-ended items about aspects of a QI curriculum.

Fatal hemolytic anemia associated with metformin: a case report.

Introduction: Metformin is a widely prescribed biguanide antidiabetic drug that has been implicated as a cause of hemolytic anemia in three previous case reports. We report a case of rapidly fatal hemolysis that was temporally associated with the initiation of metformin treatment for diabetes. Clinicians need to be aware of this rare but potentially serious side effect of metformin.

Pay for performance and medical education: strategies for preparing physicians of the future.

Performance-based reimbursement has become an increasingly important topic in the field of medicine and one that has met with significant legislative support. Small- and large-scale pilot programs in the United States and more comprehensive programs implemented abroad have yielded preliminary findings that raise several interesting questions regarding the form that pay-for-performance programs will take and concerns about the unintended and unforeseen consequences of this new reimbursement approach. One important area that has not been explored, however, is the potential implications of pay for performance to "clinician educators"-individuals from diverse health-related disciplines who both provide health care and are responsible for training the next generation of health care professionals.

Community-directed risk assessment of mercury exposure from gold mining in Suriname.

Objectives: The overarching objective of this project was to support the indigenous people in Kwakoegron, Suriname, in self-diagnosis of public and environmental health problems. The specific objectives, defined by the people of Kwakoegron were: (1) to determine for themselves if they are at risk of exposure to mercury (Hg) contamination, (2) to measure the extent of the Hg contamination problem, and (3) to initiate an intervention plan.

Methods: Field work was conducted from June 2005 to April 2006.

Reducing the rate of amputations in acute diabetic foot infections.

Many older diabetic patients present to the emergency room with limb-threatening foot complications, and may at the same time need attention to life-threatening endocrine, cardiac, or renal complications. To better serve the elderly veteran population at our institution, we designed a multidisciplinary, algorithmic approach that links the podiatry and medicine services to facilitate appropriate referral, admission, and management, with the ultimate goal of reducing the rate of amputations.

Fundamental predictability in multispecies competition: the influence of large disturbance.

Empirical evidence of chaos, or complex behavior, in ecosystems is scarce, presumably due to high system-level noise and/or the rarity of conditions necessary for complex behavior to arise. An alternative explanation might be that complex behavior is fragile and readily suppressed by disturbances that are common in many ecosystems. Here we investigated the role of disturbance frequency and magnitude on complex behavior and focused on population succession trajectories in a plankton system.