Health Care Blog (Page 168)

The Legacy of Tuskegee and Trust in Medical Care: METHODS

Study Design and Population During July and August of 2003, participants were surveyed as part of a cross-sectional study designed to assess mistrust of the healthcare system. We conducted a telephone survey of a random samĀ­pie of residents of Baltimore City, MD. The data were collected as part of a larger study that focused on mistrust of the healthcare system among minorities at three sites: Washington, DC; New York City; and Baltimore. The Baltimore site focused on African Americans. This was in part due to the fact that the city has a long-standing, economically diverse, yet relatively segregated black population. This characteristic of Baltimore made sampling an economically diverse black population feasible without oversampling. In addition, each study location conducted a site-specific substudy. Baltimore was selected as the site for the Tuskegee substudy because of its large African-American population.

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The Legacy of Tuskegee and Trust in Medical Care

INTRODUCTION It is well documented that African Americans are more mistrustful of the medical care system than whites. Mistrust may be associated with underutilization of health services, a greater likelihood of refusal to participate in clinical research, reduced proclivity to donate organs or biological material, and more concern about unwitting enrollment in potentially harmful medical experiments. The mistrust expressed by African Americans has been attributed to a number of factors, including limited access to the medical care system, a consequence of historical segregation in hospitals, and discourteous treatment and maltreatment by hospital personnel and healthcare professionals. The Tuskegee Study of Untreated Syphilis in the Negro Male (Tuskegee study) is among the most often cited reasons for mistrust of medical care among African Americans.

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The Mobile Army Surgical Hospital: The Gulf War

Operation Desert Storm was the first major conflict involving U.S. forces since Vietnam. Over 500,000 U.S. troops were deployed, with thousands of additional coalition forces. It was clear from the onset that this war would be fought with a radically different strategy. The exceedingly rapid mobilization of troops and equipment ushered in a new era of military medical care. Medical units had to become smaller, more flexible and more mobile.

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The Mobile Army Surgical Hospital: Vietnam War – MUST vs. MASH

The Vietnam War was radically different from either the Korean War or World War II. Guerilla tactics employed by the Viet-cong required drastic changes in combat philosophy, with resulting changes in combat medical support. During this conflict, the “battlefront” was not readily evident. Therefore, some military planners did not regard mobile hospitals as essential. Thus, some U.S. military hospitals in Vietnam were established as semi-permanent, fully equipped facilities.

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The Mobile Army Surgical Hospital: The Korean War – The War that Defined the MASH

On Sunday, June 25, 1950 the North Korean People’s Army crossed the 38th parallel into South Korea. This led to the Korean War, which lasted nearly three years. One of the defining aspects of the Korean War was the use of the MASH. Ten MASH units supported four Army divisions (15,000 to 20,000 soldiers per division) at positions throughout North and South Korea. During the Korean War, the experiences of these MASH units translated to improvements in resuscitation and trauma care, patient transport, blood storage and distribution, patient triage, and evacuation.

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The Legacy of Tuskegee and Trust in Medical Care: Measures

Knowledge of the Tuskegee study was assessed by six items. The first five items were multiple-choice, with one correct response for each item. These survey items assessed factual information about the Tuskegee study. The final item asked if a similar study was possible today. Medical mistrust was assessed using the seven-item Medical Mistrust Index (MMI). The scale employs Likert-type response codes ranging from “strongly disagree” to “strongly agree.” Examples of items included in the mistrust scale are: “Patients have sometimes been deceived or misled by healthcare organizations” and “Healthcare organizations put the patient’s health first.” The MMI shows good reliability (Chronbach’s a = 0.76). Other measures used in the study were race, age, sex, education, income and insurance status. Age, education and income were analyzed as continuous variables. Race and sex were analyzed as binary variables. Insurance status categories were private, Medicaid, Medicare and uninsured. For analysis, three dummy variables…

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The Mobile Army Surgical Hospital

INTRODUCTION Mobile Army surgical hospitals (MASH) were designed to keep pace with combat units during time of war, providing immediate, lifesaving care to casualties. MASH units have been deployed in every major U.S. military conflict since World War II and are undoubtedly responsible for saving thousands of lives on the battlefield. Interwoven with this history of the MASH is the history of resuscitation and care of combat casualties. The authors of this article recently served with the 212th MASH during Operation Iraqi Freedom. The 212th entered Iraq on the first day of the war and cared for a large number of both military and civilian casualties during the initial weeks of this military campaign. In this article, we chronicle the history of the MASH and outline its many contributions to military and civilian trauma care.

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