Shortage of preventive medicine physicians.
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Career Choice↗
Biomedical subjects
M E Salive
Publications and source records attributed to M E Salive.
Characteristics of an endogenous glucocorticoid receptor stabilizing factor.
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Adrenalectomy↗
The epidemiology of fatalities reported to the vaccine adverse event reporting system 1990-1997.
PURPOSE: To examine the fatalities reported to the federally administered Vaccine Adverse Event Reporting System (VAERS), a passive surveillance system, in its first 7 years. METHODS: The working data set included variables such as demographic information, dates of vaccination, adverse event onset and death, vaccines administered, and vaccination facility data. Frequencies for these data and state reporting rates were calculated. RESULTS: A total of 1266 fatalities were reported to VAERS during July 1990 through June 1997. The number of death reports peaked in 1992-1993 and then declined. The overall median age of cases was 0.4 years, with a range of 1 day to 104 years. Nearly half of the deaths were attributed to sudden infant death syndrome (SIDS). CONCLUSIONS: The trend of decreasing numbers of deaths reported to VAERS since 1992-1993 follows that observed for SIDS overall for the US general population following implementation of the 'Back to Sleep' program. These data may support findings of past controlled studies showing that the association between infant vaccination and SIDS is coincidental and not causal. VAERS reports of death after vaccination may be stimulated by the temporal association, rather than by any causal relationship.
Adolescent↗
Preventive services for breast and cervical cancer in U.S. office-based practices.
BACKGROUND: This study was undertaken to examine patterns of delivery of preventive services for breast and cervical cancer and the bundling of several preventive services. METHODS: Data from the National Ambulatory Medical Care Survey on visits by women ages > or = 45 years to office-based physicians during 1989 and 1990 were analyzed for delivery of clinical breast examination, mammography, breast self-examination counseling, pelvic examination, and Pap smear. RESULTS: An estimated 38.7 million office visits included one or more preventive services for breast and cervical cancer (46.7 visits per 100 women per year). Visits that included clinical breast examination, Pap smear, and mammography together were largely provided by obstetricians and gynecologists, less by general/ family practice and general internal medicine physicians, and rarely by subspecialists. Twenty-two percent of these visits were periodic preventive visits, lowest for subspecialists and highest for general internists. Major sources of payment included insurance and personal resources at younger ages and Medicare at ages > or = 65. CONCLUSIONS: The periodic preventive visit has received only limited acceptance by physicians who provide preventive care for adult women. Payment for preventive visits changes with age and may affect the appropriate provision of services.
Aged↗
Gonorrhea prevalence in the Maryland state prisons.
During a 6-month period from July 1 through December 31, 1986, 2,598 consecutive men were screened for gonorrhea upon entry into the Maryland Division of Corrections. Twenty-eight men (1.1%) demonstrated positive cultures for gonorrhea with 27 of them (92%) asymptomatic. This prevalence is substantially lower than other rates reported from prisons and detention centers. Although the role of asymptomatic males as a reservoir for gonorrhea has been well delineated, standard recommendations for screening high-risk male populations such as prison inmates have not been established. These data suggest that screening in some correctional facilities may not be cost-effective given the low prevalence observed. In addition, contact tracing may be delayed by long holding periods in local detention facilities prior to transfer to the state prison system. These data underscore the need for additional analysis to determine the most effective program structure for screening in correctional facilities and detention centers.
Adult↗
The practice and earnings of preventive medicine physicians.
A shortage of preventive medicine (PM) physicians exists in the United States. Researchers know little about these physicians' earnings and practice characteristics. The American College of Preventive Medicine (ACPM) mailed a survey to all self-identified PM physicians on the American Medical Association (AMA) Physician Masterfile. A total of 3,771 (54%) responded; respondents' sex and region of residence were typical for PM physicians in general, with a slight excess of older physicians and those reporting board certification. A total of 2,664 (71%) were working full time, with median earnings of $85,000 (mean $90,000). Among full-time physicians, relatively higher earnings were associated with the following characteristics: male sex; age 45 to 64 years; major source of income from clinical, business, or industrial sources, rather than governmental or academic; and PM board certification. Full-time PM physicians earned much less than office-based private practitioners in several primary care specialties in 1989. The gap in earnings between PM specialists in government positions and those in the private sector is also substantial. Both disparities may require creative solutions.
Adult↗
Preventive medicine residency training: a resident's perspective.
Preventive medicine as a discipline confronts considerable internal and external pressure today about society's needs for prevention specialists. Training in the field has remained static in the face of great changes. This article asserts the need to reassess the philosophy, content, and structure of graduate training in preventive medicine. The field of preventive medicine faces an identity crisis of its own making, trying to be everything to everybody. The need for funding to overcome the shortage of specialists remains a critical but difficult issue that demands innovative solutions.
Curriculum↗
Preventive medicine residents: a national survey.
Little is known about those physicians who pursue graduate medical education in preventive medicine, including aerospace medicine, general preventive medicine and public health, and occupational medicine. We surveyed resident physicians about their academic background, financial environment, clinical activities, and professional goals. A total of 147 residents (30%) responded from a population of 498 residents. The data suggest a lack of available information about preventive medicine training and careers among medical students who subsequently pursue such training. Their economic environment is extremely diverse, with a wide range of salary, "moonlighting" hours, educational loans, and service obligations. Although the median annual salary ($24,700) is similar to the national average resident salary, 32% of respondents earned less than $20,000, and 95% have educational debts averaging $30,900. Sixty-two percent of respondents perform clinical work in their residency, whereas 76% desire future clinical work as part of their practice. This gap is most pronounced in general preventive medicine and public health. The residents express a wide range of interests in future practice of preventive medicine; 54% are interested in government work, and 33% desire academic careers.
Adult↗
Coinfection with tuberculosis and HIV-1 in male prison inmates.
An association between past exposure to tuberculosis (TB) and infection with human immunodeficiency virus type 1 (HIV-1) was investigated using a case-control design among a 6-week sample of 698 male inmates consecutively admitted to the Maryland State prison system. Based on Mantoux testing and measurement of anti-HIV-1, we found a positive but not significant association between HIV-1 and TB infection (odds ratio 2.4, 95 percent confidence interval 0.9-6.3). The power of the study to detect an association of this magnitude was 0.57. Of the entire intake sample, 1.3 percent were found to be coinfected with TB and HIV-1. Some misclassification may have been present due to anergy or latent HIV-1 infection. The elevated risk of TB in coinfected inmates, coupled with the study results, suggest that the inmate screening process on entry to the prison should be modified to improve identification of coinfected people. Specifically, anergy testing should be added to the admission screening procedure, and appropriate voluntary anonymous HIV-1 antibody testing should be more widely available to inmates.
Acquired Immunodeficiency Syndrome↗
Board certification among preventive medicine residency graduates: characteristics, advantages, and barriers.
In 1991, a mail survey was conducted of graduates (1979-1989) of general preventive medicine/public health (GPM/PH) residency programs to obtain information about the graduates' demographic characteristics, training, and present professional work. Specifically, we evaluated the survey data for percentage of graduates with board certification, advantages of board certification, and barriers to board certification in preventive medicine (PM). The survey response rate was 74% (797 of 1,070 graduates). Only 45% of the respondents were board certified in PM as of 1991. The percentage of respondents board certified in PM was highest among military PM residency graduates and lowest among those from the Centers for Disease Control (CDC) PM residency. Reasons for not taking the board examination included the perception of limited benefit of board certification in current employment or professional endeavors, previous board certification in a clinical specialty, lack of a master of public health (MPH) degree, high cost and time commitment for the examination, and uncertainty about examination admission requirements. PM residency graduates with board certification in PM were more likely to be involved in public health and preventive medicine programs, devoted more time to administration and management, and earned more income than those PM residency graduates without PM board certification. Increasing the percentage of residency graduates who pursue PM board certification will require increasing the advantages of certification for practice, encouraging all residents to identify themselves as practicing the specialty of PM, and addressing the unique concerns of physicians who train both in PM and in a purely or primarily clinical specialty.
Attitude of Health Personnel↗
Physical activity and risk of severe gastrointestinal hemorrhage in older persons.
OBJECTIVE: To assess whether regular physical activity is associated with a decreased risk of severe gastrointestinal hemorrhage (GIH) in older persons. DESIGN: Cohort study with 3 years of follow-up. SETTING: Three communities of the Established Populations for Epidemiologic Studies of the Elderly. PARTICIPANTS: A total of 8205 persons aged 68 years or older, yielding 22,277 person-years of follow-up. MEASUREMENTS: The occurrence of severe GIH was defined as either a hospital discharge diagnosis of gastrointestinal bleeding associated with blood transfusion or death during the hospital stay or a nonhospital death with mention of GIH on the death certificate. Physical activity was measured by self-reported frequency of walking, gardening, or doing vigorous physical activity. Those participants doing the activity three times per week or more were compared with the remaining participants. Adjusted relative risks (RRs) of GIH were controlled for age, gender, body mass index, blood pressure, chronic conditions, number of hospital admissions in the past year, and number and types of drugs taken. RESULTS: Severe GIH occurred in 241 participants (rate, 10.8 per 1000 person-years). After adjusting for potential confounding variables, the RRs and 95% confidence intervals (CIs) for severe GIH associated with walking, gardening, and vigorous physical activity were 0.6 (0.4 to 0.8), 0.8 (0.5 to 1.1), and 0.7 (0.4 to 1.2), respectively. The RR associated with a summary variable for the three activities was 0.7 (95% CI, 0.5 to 0.9). These results were consistent after stratifying on health status and disability or by excluding those who were not mobile, ie, not able to walk half a mile or climb a flight of stairs. CONCLUSIONS: Regular physical activity is associated with a decreased risk for severe GIH in older persons.
Age Factors↗
Risk factors for septicemia-associated mortality in older adults.
Septicemia is the 10th leading cause of death among older adults in the United States; its mortality rate has steadily increased over the past decades. Little is known about factors which predispose to septicemia mortality in the elderly. The authors investigated risk factors for septicemia-associated mortality in 10,269 older adults as part of a longitudinal study of three communities (East Boston, MA; New Haven, CT; and Iowa and Washington Counties, IA). During 6 years of followup, 177 persons (3.2 per 1,000 person-years) had septicemia ICD9 038 (International Classification of Diseases, ninth revision) reported on their death certificate. In a multivariate proportional-hazards model, septicemia mortality was significantly (P < 0.05) and independently associated with age, male sex, history of diabetes, history of cancer requiring hospitalization, smoking one pack of cigarettes per day or more, not drinking alcohol in the year prior to baseline, disability in activities of daily living, cognitive impairment, and missing cognitive testing score. These factors might be useful in developing an at-risk population for testing septicemia treatment or prevention strategies in a community setting. Further investigation is needed to explain underlying mechanisms of increased risk of subsequent septicemia.
Age Factors↗
Disability and cognitive impairment are risk factors for pneumonia-related mortality in older adults.
The role of functional and cognitive limitations in the risk of pneumonia-related mortality in older adults was examined. As part of a cohort study in 3 communities (East Boston, MA; New Haven, CT; and Iowa and Washington Counties, IA), 6,234 women and 4,035 men ages 65 or older completed baseline interviews between 1981 and 1983 and were followed for up to 6 years. Sex-specific Cox proportional-hazards regression models were used to examine the association of baseline physical and cognitive functioning with report of pneumonia (ICD9 480-486) as an underlying, immediate, or contributing cause of death. During followup, a total of 243 men and 160 women died with pneumonia. Adjusting for age, race, education, evidence of five chronic diseases, and smoking status, a significantly increased risk of pneumonia mortality (P < 0.05) was found for limitations in activities of daily living and cognitive impairment among both men and women. Inability to walk a half mile, climb stairs, or perform heavy housework was significantly associated with increased risk of pneumonia mortality for women but not for men in the same multivariate models. Men and women whose body-mass index was above the median had significantly lower risk of pneumonia mortality compared with those in the lowest quartile. Further elucidation of the sequence between physical and cognitive impairment and risk of pneumonia will be important in reducing pneumonia-associated morbidity and mortality.
Aged↗
Preventive medicine physician satisfaction and its relation to practice characteristics.
BACKGROUND: Physicians specializing in general preventive medicine and public health manage programs, conduct research, and care for patients. This study examines their satisfaction overall and in five dimensions: contribution to people's lives, respect from physicians in clinical practice, research opportunities, income, and time to pursue outside interests. METHODS: A survey of 1979-1989 graduates of preventive medicine residencies rated satisfaction on a five-point scale. Linear models were used to regress physician satisfaction against employer, hours worked, practice content, and other covariates. RESULTS: Respondents' (n = 778) overall job satisfaction was high, with 44% very satisfied, 44% satisfied, 7% neutral, and 6% dissatisfied. Federal government physicians had the highest satisfaction overall and for research opportunities and time for outside interests. Independent, statistically significant (p < .001) associations were found between higher satisfaction with research opportunities among academic and federal government employers, among Caucasians, and those with substantial epidemiologic practice; and lower satisfaction with time to pursue outside interests, more hours worked, and among women. CONCLUSIONS: Physician satisfaction could be understood in relation to a number of practice characteristics including its content, hours worked, income, and employer. The results suggest ways to improve physician satisfaction, including balancing competing demands of practice and focusing the physicians' responsibilities.
Female↗