Medical Complications of Female Genital Mutilation

Abstract

More than 130 million women are subjected to genital mutilation. Despite increasing efforts to reduce the practice, there are many obstacles to eliminating this 2,000-year-old practice, which is based on strong cultural traditions. As college health clinicians provide care to more international students from countries where female genital mutilation is performed, increased awareness and knowledge of the procedure will enable clinicians to understand and manage its complications. We report a case of obstructive uropathy resulting in hydronephrosis secondary to female genital mutilation and review the medical literature regarding this and other complications of genital mutilation “surgery.”     

Educating Social Workers for Practice in Integrated Health Care: A Model Implemented in a Graduate Social Work Program

ABSTRACT

This article introduces a curricular innovation, the Integrated Health Scholars Program (IHSP), developed to prepare master's-level social work students for practice in integrated health care settings, and presents preliminary findings related to students’ self-reported program competencies and perceptions. IHSP, implemented in a research-intensive school of social work in a large midwestern public university, includes specialized course work, interprofessional education across health science disciplines, and field practicum in integrated health care settings. Curricular components support stepwise learning and follows the British Columbia model of interprofessional education learning tiers: exposure, immersion, and skill mastery. Despite IHSPs successful development in a well-resourced, supportive environment, challenges facing our profession's ability to develop and sustain training of MSW students in integrated health care are discussed.     

Health insurance literacy: A mixed methods study of college students

Objective: This study examines the health insurance literacy, or the ability to use health insurance effectively, of college students. Participants: A total of 455 students from a large, public university completed an online questionnaire in November 2016. Methods: A questionnaire examined students’ knowledge of commonly encountered health insurance terms and ability to apply that knowledge to determine cost-sharing in a clinical setting. Results: The majority of students were able to correctly identify the most commonly encountered terms, but could not identify terms related to plan types and options. Eighty-eight percent of students could not determine their cost-sharing for two presented scenarios. Approximately half of the students indicated they had been confused about their health insurance plan, with one-quarter of students stopping or delaying medical care due to confusion. Conclusions: Outreach and education for students should target specific deficits in knowledge such as those identified in this study.     

Medical decision-making: Whose values?

Abstract

Bioethical debates contribute to discussions about the direction of healthcare funding as we enter the twenty - first century. The funding of healthcare is debated by economists, bioethicists and clinicians. Because of their practice experience and knowledge base social workers are also well-placed to contribute to such issues. The debate has taken place at the ‘macro’ rather than the ‘micro’ level. Yet many ethical decisions about healthcare are made at the patient's bedside. Are they procedural or clinical decisions? Are decisions made for a group or class of patient or on an individual basis? Answers for these questions are sought in a study of medical decision-making for head-injured patients admitted to the Intensive Care Unit of a major teaching hospital.

This paper attempts to draw out ethical principles which are part of medical decision-making. The notion of contextual ethics is likened to the ecological approach of Carel Germain which provides a useful framework for ethnomethodological research.     

The Relationships of Information Efficacy and Media Literacy Skills to Knowledge and Self-efficacy for Health-Related Decision Making

Abstract

Objective: To compare the extent to which information efficacy (confidence for acquiring useful information) and media literacy skills predict knowledge and self-efficacy for preventing or treating the health threat of influenza. Participants: A random-sample survey of 1,379 residential students enrolled at a northwestern public university was conducted in fall 2009. Methods: Students accessed an Internet survey through a link provided in an e-mail. Results: Students who self-diagnosed correctly demonstrated higher levels of media literacy skills than those who self-diagnosed incorrectly. Among those who self-diagnosed incorrectly, the only predictor of knowledge was accessibility of information sources; low accessibility was associated with reduced knowledge. Information efficacy predicted self-efficacy for both groups. Conclusions: The results illustrate the limitations of information efficacy in the absence of media literacy skills. To decrease health risks, college health practitioners should promote media literacy while also ensuring easy access to high-quality information.     

GotFlu Channel: An Online Syndromic Surveillance Tool Supporting College Health Practice and Public Health Work

Abstract

Objective: Develop a tool to ease the burden of H1N1 influenza on a campus clinic by promoting self-care, generating medical notes, and identifying vulnerable students. Participants: Students at Brock University, a mid-sized urban campus; Brock's Student Health Services; and Niagara Public Health. Methods: Students accessed a controlled portal of Brock's Web site and self-identified onset/offset of influenza-like symptoms. Daily sign-in numbers were monitored and nonidentifiable aggregate data transferred to the local public health unit. Results: There was concordance among the number of college students signing in, local school absenteeism rates, and local rates of laboratory-confirmed influenza. Many visits to the campus health clinic were averted, 1,432 students used the tool. Conclusion: The online, real-time surveillance tool was effective in monitoring influenza activity on campus, providing timely health advice, decreasing unnecessary visits to the campus medical clinic, and assisting local public health in surveillance activities.     

Understanding vaccine knowledge,attitudes, and decision-making through college student interviews

Abstract

Objective: We aimed to explore knowledge, attitudes, and beliefs about vaccines required for college-entry and vaccine-related behaviors among college students. Participants: Thirty-three full-time undergraduate students, ≥ 18 years old, enrolled at public (2) and private (3) colleges and universities in metropolitan Philadelphia in fall 2016. Methods: We conducted semistructured interviews, which were double-coded with 5,015 comments overall and 99.3% intercoder reliability (κ?=?0.779) using NVivo 11 software. Results: Six key themes emerged: (1) low knowledge about vaccines and requirements; (2) mixed attitudes about required vs. recommended vaccines; (3) high trust in medical professionals; (4) low perceived risk for vaccine-preventable disease outbreaks; (5) substantial parental influence on students’ decision-making; and (6) low utilization of Student Health Services. Conclusions: This study revealed lack of knowledge about and low prioritization of vaccination despite overall positive attitudes towards vaccines. Prematriculation education of college students is critical to increasing vaccine knowledge and use.     

Behavioral Exploration of Career and Specialty Choice in Medical Students

Understanding the process by which students naturally construct and internalize their educational experiences relating to career development is important to career counseling. The author investigated how exploratory behaviors during a community‐based field experience course contributed to the vocational development of 1st‐year medical students. Behavioral exploration data regarding medical career development and specialty decision making were collected from 91 first‐year medical students before and after they engaged in an exploratory behavioral activity, the Ambulatory Care Experience course. Findings suggest that students had not progressed in their medical career development and that more uncertainty existed among students after completing the course.     

Classroom Goal Structures and HIV and Pregnancy Prevention Education in Rural High School Health Classrooms

Over 5,000 adolescents enrolled in required rural high school health courses reported their perceptions of mastery and extrinsic goal structures in their health classrooms. Data were collected from all students at three time points (prior to HIV and pregnancy instruction, 3 months after instruction, and 1 year after instruction). Results indicated that classroom goal structures were related to both proximal and distal knowledge, attitudes, intentions, and efficacy beliefs. Results in particular indicate that the perception of a mastery goal structure in health education classrooms fosters knowledge, improved attitudes, enhanced efficacy beliefs, and lower intentions to have sexual intercourse.     

Illness uncertainty and illness intrusiveness as predictors of depressive and anxious symptomology in college students with chronic illnesses

Objective: To examine predictors of psychological functioning in college students with chronic illnesses. Participants: Participants (N = 1413) included 364 students with self-reported diagnoses of asthma or allergies, 148 students with other chronic illnesses (eg, epilepsy, type 1 diabetes), and 901 healthy students. Data were collected between November 2013 and May 2015. Methods: Participants completed online measures of psychosocial functioning, including illness uncertainty, illness intrusiveness, depression, and anxiety. Results: Students with chronic illnesses other than asthma or allergies evidenced the greatest levels of anxious (p <. 05), but not depressive symptomology. Additionally, this group reported greater illness uncertainty and intrusiveness (p <. 05) compared to their peers. Uncertainty and intrusiveness independently predicted depressive and anxious symptoms for students in both illness groups. Conclusions: Compared to peers with asthma or allergies, college students with other chronic illnesses reported higher levels of anxious symptoms. Illness uncertainty and intrusiveness appear to be predictors of psychological distress, regardless of illness.     

Awareness and attitude of medical personnel in Kerala,India to transgender persons

IntroductionBeing one of the first Indian states to come out with a transgender bill in 2015, Kerala's Social Justice Department also implemented various health-based provisions for transgender individuals catering to their physical, mental, and gender-based health. Many of these are still in the process of being set up and transgender individuals will have to wait for smoother access to healthcare.AimThis study aims to assess the awareness regarding general transgender issues and health as well as the attitude towards transgender persons among the medical community- especially medical students and doctors who are a critical link for the integration of the transgender community into society.MethodResponses were collected from 452 medical doctors and students from Kerala through scales that measured awareness level and attitude, including transphobia. The relation of gender, age, years of experience, and specialty of medical personnel to the level of transphobia and awareness about transgender issues was also analyzed using statistical methods.Result and DiscussionTransphobia levels were moderate in the sample. Women and medical students had lower levels of transphobia than men and practicing doctors respectively. Awareness levels were average for general information about the transgender community, such as its core features and difference from other similar categories but were low on health-related aspects of transgender persons (such as their physical and mental health issues, healthcare provisions, and knowledge on gender affirmation surgery).ConclusionMore inclusive actions are needed in medical education, legislative actions, advocacy groups, and the formation of multidisciplinary surgical teams to further the cause of the transgender community.     

Assessment of an e-training tool for college students to improve accuracy and reduce effort associated with reading nutrition labels

Objective: Nutrition labels are often underutilized due to the time and effort required to read them. We investigated the impact of label-reading training on effort, as well as accuracy and motivation. Participants: Eighty college students (21 men and 59 women). Methods: The training consisted of a background tutorial on nutrition followed by three blocks of practice reading labels to decide which of two foods was the relatively better choice. Label-reading effort was assessed using an eye tracker and motivation was assessed using a 6-item scale of healthy food-choice empowerment. Results: Students showed increases in label-reading accuracy, decreases in label-reading effort, and increases in empowerment. Conclusions: The nutrition label e-training tool presented here, whether used alone or as part of other wellness and health programs, may be an effective way to boost students’ label-reading skills and healthy food choices, before they settle into grocery shopping habits.     

International female students’ experiences of navigating the Canadian health care system in a small town setting

Abstract

This pilot study explored the international female (IF) students’ (n = 17) lived experiences of health care accessibility while studying in a small town in Canada. Analysis guided by a phenomenological method resulted in three major themes – (1) after arriving to attend university, IF students experienced challenges in staying healthy, such as learning how Canadian medical insurance works and how to access medical help, (2) IF students developed a support system over time, consisting of their university’s student advisors, host families and friends and (3) as IF students became familiar with living in Canada, they developed self-directed care strategies such as taking care of each other if they became sick. They also became comfortable reaching out through social media to ask questions and connect with others who were also new to Canada. Recommendations included providing (1) alternative times for IF students to access medical care on campus, (2) a fund where IF students could borrow the upfront costs to see a doctor and (3) health care knowledge dissemination through various media throughout the school year. The outcomes of this study are generally encouraging and may assist IF students to make effective health care decisions while in Canada resulting in a less stressful academic experience.     

Teaching Successful Community Practice in Social Work

ABSTRACT

This article identifies and addresses a severe problem in the management of community practice projects of students in their second and third year in the Undergraduate Social Work program at the University of Haifa School of Social Work; namely, the current binary evaluation method based on total success or failure of the project.

Using a systems approach, this study creates a framework by which to ensure effective and positive outcomes for community practice projects carried out by undergraduate social work students (Freund, Arkin & Saltman, 1999). This framework is unique in that it draws on knowledge gained from organizational and community theories, as well as instructional theories for teaching social work practice.

The proposed framework includes three components that describe the factors necessary to help transform the student's learning experience: the organization's characteristics, the student's resources, and the evaluative measures.

This inter-conceptual approach enhances the ability of the instructor, the student, and the organization to build an appropriate organizational foundation for students operating communal programs. The underlying assumption is that an integrative approach promotes a better understanding of the components essential for building and evaluating social plans conducted by social work students.     

HIV knowledge mediates the relationship between HIV testing history and stigma in college students

ABSTRACT

Objective: HIV-related stigma is one of the strongest barriers to prevention and treatment. HIV prevalence in U.S. college students is estimated around 0.02%, but is thought to be drastically underreported. We examined the influence of HIV knowledge on the relationship between HIV testing history and stigma in college students. Participants: A random sample of 2343 students, over the age of 18, attending a large university in the southeastern United States completed the survey in January 2016. Methods: A mediation model was constructed in regression framework to explore the relationship between HIV testing history, knowledge, and stigma. Results: HIV testing history was associated with higher knowledge scores (a path: B = 4.08, p < .001) and higher knowledge scores were associated with lower stigma (b path: B = .01, p < .001). These results suggest that HIV knowledge partially mediates the relation between HIV testing history and stigma in college students. Conclusions: HIV testing history may decrease stigma by increasing knowledge. Results can be used to inform college health promotion practice on developing programs and services.     

Changes in type 1 diabetes health indicators from high school to college

ABSTRACT

Objective: Evaluate trajectories of type 1 diabetes health indicators from high school through the first year of college. Participants: Seventy-four students with type 1 diabetes who maintained pediatric endocrinology care during the first year of college. Methods: Hemoglobin A_1c (HbA1c), blood glucose monitoring frequency, body mass index (BMI), and clinic attendance data were collected via retrospective medical chart review in spring 2012. Group-based trajectory models evaluated diabetes-related health indicators over time and identified distinct growth trajectory groups. Results: BMI increased and clinic attendance decreased in the first year of college. Trajectories for other health indicators were heterogeneous and stable over time; 69% of students were classified as having stable good glycemic control. Racial minority youth and youth on conventional insulin regimens were disproportionally represented in higher-risk groups. Conclusions: Diabetes health indicators are stable or decline upon college entrance. Results signal the need for targeted support for college students with type 1 diabetes.     

Assessing Social Work's Contribution to Controlled Studies of Adolescent Substance Abuse Treatment

ABSTRACT

Findings from a review of social work's contribution to the adolescent substance abuse treatment outcome literature between 1990 and 2001 are presented. Social work involvement in adolescent substance abuse treatment was evaluated through a computerized bibliographic search of medical and social science databases and by a manual search of 13 core social work journals. Results indicate that social work has contributed little to knowledge development in adolescent chemical dependency treatment. Investigators affiliated with a department or school of social work accounted for three of 15 controlled treatment outcome studies. Only one report was published in a core social work journal. Efforts to develop clinical guidelines in this important practice domain will founder until a sufficiently directive body of practice-relevant research accumulates to guide evidence-based substance abuse treatment for adolescents.     

The impact of a health education intervention on health behaviors and mental health among Chinese college students

Abstract

Objective: This study aimed to assess the impact of a health education intervention on health behaviors, self-efficacy, and well-being among college students. Participants: Between March and October 2016, a total of 532 undergraduates participated. Methods: A theory-based intervention was conducted at Wuhan University, China. Participants were assigned to a control or intervention group (IG). The IG attended a 7-week health education class on knowledge, attitude, and practice of health behaviors. Results: Participants in the IG, compared with those in the control group (CG), reported significantly increased prevalence of high physical activity and regular breakfast, as well as lower screen time, sugar beverage intake, and Internet addiction tendency. Furthermore, intervention students improved in health behavior scores (p?=?0.040), compared with the CG, while the changes in subjective well-being and self-efficacy remained similar between the two groups. Conclusions: Health education may promote health behaviors among Chinese college students.     

Roots of Futility,by Norman A. Polansky,Robert D. Borgman,and Christine De Saix. Jossey-Bass,San Francisco, 1972. $9.50 Hardbound. 288 Pages

Abstract

This paper describes a study of first year graduate social work students' work in practica and assesses their transfer of practice evaluation knowledge and skills from the classroom to the field. The data are drawn from case material recorded by the students using a structured recording format. The paper addresses three central questions. What were the salient features of the students' practices? Did students apply practice evaluation knowledge to their work with clients? And, what variables influenced the ways that the students practiced? Recommendations for enhancing class and field integration and for increasing knowledge and skill transfer given the significant influence of the practicum instructor's orientation are discussed.