Skip to main content

Currently Skimming:

11 Education and Outreach
Pages 274-308

The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.


From page 274...
... , which is administered by the Department of Justice (DOJ) and HRSA's responsibilities for the Radiation Exposure Screening and Education Program (RESEP)
From page 275...
... CHARACTERISTICS OF THE RADIATION EXPOSURE SCREENING AND EDUCATION PROGRAM Education is one of nine core activities expected of RESEP grantees. Grantees have told HRSA that they need guidance in public education and outreach mechanisms to those at risk or experiencing symptoms as a result of exposure to radiation (letter from HRSA to committee via Dr.
From page 276...
... The RESEP legislation does not specify populations for education and outreach, but HRSA implicitly adopted this framework, and we apply it here. Responsibilities With respect to its scope of services and diseases, RECA and especially the amendments in 2000 that mandated the RESEP program can be read narrowly as focusing on radiogenic diseases (and secondarily on some nonradiogenic pulmonary and renal conditions after occupational uranium exposures)
From page 277...
... Examples included concerns with attorney fees, lack of feedback to grantees from DOJ on outcomes of compensation claims, and resumption of nuclear weapons testing at the Nevada Test Site. Yet other matters, such as concerns with lack of public or private coverage or other means for paying medical costs of referrals and treatment, were ones that the committee discussed and used in arriving at policy and program recommendations found in other chapters of this report.
From page 278...
... or medical qualifications, but not all outside contracted specialty can prove eligibility because of Covers miners, millers, services difficulties documenting work and Nevada Test Site history downwinders in New Followup: RESEP clinic or Mexico, Arizona, Colorado, patient's IHS primary-care Have identified > 2000 and Utah physician individuals (Navajo and Hopi) (essentially Navajo Nation who may meet RECA populations)
From page 279...
... This change reduce number of RECA qualifying spirometry examinations · Necessity of "B" readings -- special radiologic interpretations evaluating for evidence of silicosis derived from black lung program -- which are increasingly hard to get · IHS is going digital and no NIOSH guidelines exist for readings of digital images · Use of unregulated, private consultants or lawyers who overcharge claimants · Consider amending RECA simply to require proof of exposure without proof of illness or illness severity, both for social justice reasons and given imperfection of current testing regimen, which requires that physicians and nurses compromise Hippocratic Oath to "do no harm" given that potential harm caused by medical testing rarely leads to therapeutic options (no treatment exists for pulmonary fibrosis) · Consider amending RECA to allow the use of affidavits for proof of presence or residence continued
From page 280...
... Mary's Remainder generally have thirdareas; Wyoming (uranium network; party insurance miners) Much RN educator instruction 90% are male and health information and recontact every 6 months ~69% are 65 years old ~90% are non-Hispanic white ~88% are former uranium industry workers (miners, mill workers, and ore transporters)
From page 281...
... · Expansion of eligibility for RESEP program to post-1971 miners or other groups not included in RECA legislation (but having same exposures) might provide some sense of "justice" to those not included in RECA without amending legislation · Consider expansion of downwinder category to other geographic regions with documented iodine-131 deposition (NCI study data)
From page 282...
... because of Outreach contacts OCN, CPON the proximity to geographic area -- Newspaper ads/articles -- radio Carolyn Rasmussen, RN, BS, related to Nevada Test Site spots/interviews: 276 OCN, CPON -- Television: 3 Dixie Regional Medical Provide much cancer screening -- Pamphlets distributed: 2,920 Center education, giving written -- Presentations: 20 544 SO 400 East material, to all patients, as well -- Fliers distributed: 3,360 St. George, Utah as general healthy life -- Interview for documentary on information to those with effects of nuclear testing: 1 Covers southwestern Utah identified diseases (hypertension, and the tristate area of diabetes, and so on)
From page 283...
... EDUCATION AND OUTREACH 283 Issues Identified Clinical: · Screening tests covered by grant monies because Medicare does not reimburse for "screening" examinations · Uranium miners, millers, ore transporters also get arterial blood gas tests, screening spirometry, two-view chest x ray, and CMP · Total medical referrals: 1,145 Referrals Made: -- Colonoscopy: 320 -- Mammography: 237 -- Prostate-specific antigen: 143 -- Pelvic exam: 62 -- Pap smear: 52 -- EGD: 15 -- Thyroid ultrasonography: 5 -- Testicular ultrasonography: 4 -- Breast ultrasonography: 3 -- Miscellaneous (for instance, to primary-care physician for non-RECA ailments) : 151 Abnormalities Found: -- Rectal mass or positive stool: 49 -- Suspicious skin lesion: 47 -- Breast Nodules: 24 -- Dysphagia: 2 -- Prostate nodules: 9 -- Thyroid nodule: 5 -- Testicular nodule: 5 -- Pulmonary nodule: 1 -- Prostate cancer: 1 Other: · Potential of reopening Nevada Test Site (underground "bunker bombs")
From page 284...
... Box 130 ~395 people screened, Montezuma Creek, UT 84534 of those screened: 15 positive results Covers the Utah Strip of the 15 people referred Navajo Nation through 3 community health centers and Regarding compensation: collaborates with St. Mary's 3 people received compensation Northern Navajo Medical ~16 applications submitted, but no Center, and Dixie Regional decision yet ~35 applications are in process
From page 285...
... EDUCATION AND OUTREACH 285 Issues Identified Clinical: · Other diseases not covered by RECA seen in miners -- cases of asbestosis found in miners with no other work history Other: · How to reach miners who might have moved away (involves contacting extended families, miner organizations, and use of "word of mouth") Clinical: · Little primary or preventive care available internally to these populations Other: · No feedback from Department of Justice, so they do not know where applications stand · Area is very rural and remote, and population does not have telephones or electricity, so followup must be by mail continued
From page 286...
... and Uranium Mining out in handbook. MPHC Industry Workers" contracts with three additional Medical screenings: main sites (Canyon lands 2002-2003: 86 Linda M
From page 287...
... EDUCATION AND OUTREACH 287 Issues Identified Arizona has high managed-care penetration, so we encounter problems with insurance plans in this state; most plans require that enrollee be associated with network of providers and have an established primary-care provider; if person with health insurance goes outside his or her network, the services rendered are not reimbursable, and patient is required to pay out of pocket for services Many Medicare beneficiaries elect to enroll in managed-care plan as secondary coverage for Medicare-covered services. Even though AZRESEP sites use sliding fee schedule for uninsured patients, patients who have health insurance usually do not qualify for it; because AZRESEP sites are required to bill for services, some people have been deterred from coming in for any medical screening that they may have to pay for even if they have health insurance Other identified issues have been that demand in Maricopa County for medical screening of RECAeligible people has been lower than expected, and cost of implementing full-fledged marketing campaign in area is beyond realm of funding resources; we initially thought that high number of eligible people would reside in Maricopa County (even though it is not classified as RECA downwinder county)
From page 288...
... If RECA moves to a national PC/AS mechanism for determining exposure and potential eligibility, even one involving the preassessment activities proposed earlier, RESEP audiences will expand geographically and change in demographics; similarly, HRSA's responsibilities for RESEP screening, education, and outreach will grow. In our judgment, therefore, HRSA may do well to revamp the RESEP program in several ways.
From page 289...
... . HRSA can work with research or technical assistance firms and with academic institutions and other organizations to develop and test educational messages, in various media, and to create and disseminate appropriate clinical practice guidelines and protocols.
From page 290...
... which population groups have incurred sufficient risk from fallout-related radiation exposure to warrant consideration for compensation. The committee expects this work to be made widely available to the US public.
From page 291...
... ) was often raised as an issue for the current RESEP program grantees and populations.
From page 292...
... Native Americans have a strong sense of being treated as "second-class citizens" at local treatment centers. The committee heard a good deal of testimony about apparent insensitivity to Native American traditions and medical practices.
From page 293...
... Many disorders, including many cancers, have no proven causal relationship with radiation exposure (as discussed in Chapters 4 and 7)
From page 294...
... 294 RADIATION EXPOSURE SCREENING AND EDUCATION PROGRAM Numeracy is a companion construct to literacy, although in the United States it is less well understood and measured. Sometimes deemed quantitative literacy, it comprises the knowledge and skills required to apply simple operations of arithmetic, either alone or sequentially, using numbers embedded in printed material.
From page 295...
... Furthermore, reassurance may flow from educating both the public and health care providers that the relative risk of a radiogenic cancer (and therefore the likelihood that such a cancer will have been the consequence of an exposure to ionizing radiation) declines as time since exposure increases.
From page 296...
... The committee did not explore these options in detail but did agree that a specific recommendation that HRSA act was justified. The committee recommends that HRSA provide information to RECA populations about other radiation exposure compensation programs for which they might be eligible.
From page 297...
... They will differ by locality, but the overall conclusion is unassailable. Among the types of organizations mentioned were local health departments and socialservices departments, philanthropic entities (for example, local or regional foundations)
From page 298...
... If Congress acts on this recommendation, then HRSA almost certainly will need to develop some educational program for both patients and providers to explain how these provisions will work. Educational Needs Related to Clinicians Clinical Issues Facts now emerging about the long-term effects of radiation exposure on mental and emotional health must be emphasized in primary and specialty care fields.
From page 300...
... Although the exposures covered by RECA were not catastrophic accidents, it may now be the case, many decades later, that providing full and truthful information can help to diminish the psychologic burdens that RECA downwinder or other populations may exhibit. The committee recommends that HRSA undertake an enhanced program of education and communication about the risks posed by radiation exposure for people who may have been exposed to radiation from fallout from US nuclear-weapons testing.
From page 301...
... As already noted, the Native American groups in the current RECA areas of the southwest reported many instances in which they felt that the programs were not adequately responsive to their traditions and medical practices. HRSA needs to ensure that clinicians working in the RESEP programs are trained to understand cultural preferences and to develop ways to incorporate into their programs the nontraditional medical practices and life views of the Native Americans and of other groups and cultures (Blackhall et al., 1995; Carrese and Rhodes, 1995; Gostin, 1995)
From page 302...
... If this is a DOJ duty, such information must include explanation of the existence of the RESEP program. In addition, people must be told how they can find and access needed information, forms, and the like.
From page 303...
... Health education programs typically involve an intense evaluation of a well-defined target population; they examine knowledge, attitudes, goals, perceptions, social status, power
From page 304...
... . Health education principles have guided social movements and other broad health-related programs.
From page 305...
... Provider and patient personal Includes the provider's feelings, beliefs, values and barriers experiences. For example, a patient develops hepatitis while receiving isoniazid therapy, and this affects a physician's decisions regarding use of the therapy for future patients Provider and patient interpersonal Includes interpersonal interaction barriers, for and psychosocial barriers example "turf battles" and inability of providers to relate effectively with patients or with other providers Organizational barriers and lack Includes organizational, structural, and system of organizational support limitations, including those related to resources and administrative support, for example, lack of standing orders or incomplete standing orders for acute stroke in the emergency room; and process issues with imple menting physical-therapy or occupational-therapy orders Community barriers Includes existing community resources, public attitudes, and broader general support for a proposed new program Public policy barriers Includes existing local, state or federal policies (such as Medicare payment schedules)
From page 306...
... Personal Barriers Potential Effective Intervention Strategies Some Native Americans prefer Local Native Americans who have influence with nontraditional medical practice and these individuals should meet one-on-one to explore are fearful and suspicious of Western these fears, legitimize them, and try to develop a medicine. plan that would reduce the fears and allow these individuals to participate in the RECA programs.
From page 307...
... apparently required to determine eligibility for compensation. Community Barriers Potential Effective Intervention Strategies The targeted populations often live in Contractors cannot rely exclusively on media-based rural, geographically diverse, and health education.
From page 308...
... than expected when the RESEP program was created. The barriers (knowledge deficits, interpersonal, personal factors, organizational, community factors, and public policy)


This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More information on Chapter Skim is available.