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PubMed2003

Criminality in the offspring of antenatally depressed mothers: a 33-year follow-up of the Northern Finland 1966 Birth Cohort.

BACKGROUND: No epidemiological studies have been reported on the association between mothers' antenatal depression and criminality in their offspring. METHODS: The material consists of a general population cohort of 12059 children born in 1966 in Northern Finland and followed to the end of 1998. Mothers were asked at midgestation by a nurse at the antenatal clinic if they felt themselves to be depressed. The Finnish Ministry of Justice provided information for all descendants on criminal offences. The associations between maternal depression and subgroups of violent and non-violent, violent recidive and non-recidive criminality in male and female offspring were analysed. RESULTS: Of the mothers 14% had depressed mood during pregnancy. A total of 607 (10.9%) male and 72 (1.3%) female criminal offenders were included in the cohort. When adjusted for mother's marital status, smoking, wantedness of the pregnancy, place of residence, socioeconomic status and perinatal complications, the odds ratio (OR) for males was 1.4 (95% CI 1.0-1.9) in the association between maternal depression and non-violent offenders, 1.6 (1.1-2.4) between maternal depression and violent offenders and 1.7 (1.0-3.0) between maternal depression and violent recidivists. The adjusted OR for females involved in non-violent crimes was 1.7 (0.9-3.3) and 0.6 (0.1-6.0) for violent crimes. LIMITATIONS: Maternal depression was not checked using a standardized assessment. CONCLUSIONS: For male offspring of antenatally depressed mothers there was a significant but slight increase in criminality. The emotional state of a pregnant mother may have some, but limited, influence on later criminality in the offspring.

Adolescent↗
PubMed1984

Memory, attention, and functional status in community-residing Alzheimer type dementia patients and optimally healthy aged individuals.

This paper reports the results of two studies. Investigation I examined patterns of cognitive performance in healthy controls and mildly-to-moderately impaired patients with senile dementia of the Alzheimer type (SDAT). Investigation II focused on the degree to which cognitive test scores could predict functional competence in SDAT patients. The samples included 23 controls, 18 mildly impaired SDAT, and 16 moderately impaired SDAT patients. Cognitive measures included tests of attention, calculation, recognition memory, recall, and orientation. The functional competence measures included maintenance, communication, and recreational abilities. Investigation I found that the patterns of attention and memory that distinguish control from mildly impaired SDAT patients differ from those that distinguish mildly from moderately impaired SDAT patients. Investigation II found that it is possible to predict behavioral competence in individuals with dementia from a knowledge of their attentional and memory deficits.

Activities of Daily Living↗
PubMed1981

Caries in primary dentition related to age, sex, social status, and county of residence in Finland.

The study material consisted of 1417 children 6-8 years old representing 86% of a stratified random sample from the Finnish population. Data on caries and social class were obtained by questionnaire from the municipal dental clinics in 1978. Clinical findings for primary teeth were recorded by local dentists. Incisors were excluded from the study. 80% of the children had caries lesions, and 63% were in need of restorative care. Mean dmft value was 4.4 mean dt, ft, and mt values were 2.3, 2.6 and 0.3, respectively. Occurrence of untreated caries lesions did not vary according to age. Compared to the girls, boys had lost twice as many teeth due to caries. No other differences were observed between sexes. Both past caries experience and need of restorative care increased continuously from the highest social class to the lowest. Observed regional differences were explained mainly by variation in social stratification, except in an area with abundant natural fluoride. More active dental care is needed for children with primary teeth, especially in lower social class.

Age Factors↗
PubMed2004

Another look at heavy episodic drinking and alcohol use disorders among college and noncollege youth.

OBJECTIVE: To estimate rates of heavy episodic drinking, alcohol abuse and alcohol dependence among U.S. adults 18-29 years of age and determine the relationship of these rates to student status and residence. METHOD: The analysis is based on data from a subsample of U.S. adults 18-29 years of age (N = 8666; 4849 female) who were interviewed as part of the 2001-02 National Epidemiologic Survey on Alcohol and Related Conditions (N = 43,093). Data were collected in personal interviews from a representative sample of adults 18 and older, living in households and selected group quarters in the United States, including Alaska, Hawaii and the District of Columbia. RESULTS: Of all adults 18-29 years of age, 73.1% reported any drinking in the past year, 39.6% reported any heavy episodic drinking, 21.1% reported heavy drinking more than once a month and 11.0% reported heavy drinking more than once a week. Among past-year drinkers, these correspond to rates of 54.3% for any heavy episodic drinking, 28.9% for heavy drinking more than once a month and 15.0% for heavy drinking more than once a week. Although rates of heavy episodic drinking were slightly higher for college students than for noncollege students (p < .01), differences according to place of residence were greater than differences according to student status. Overall, 7.0% of adults ages 18-29 met the DSM-IV criteria for alcohol abuse in the past year, and 9.2% met the criteria for alcohol dependence. The prevalence of abuse was highest among students living off campus (p < .01), and rates of dependence were highest among students living on campus (p < .01). CONCLUSIONS: Heavy episodic drinking and alcohol use disorders are youth as well as college phenomena. Prevention campaigns targeted at all youth are needed to supplement interventions conducted at the campus level.

Adolescent↗
PubMed2003

A national survey on the current status of family practice residency education in geriatric medicine.

BACKGROUND AND OBJECTIVES: The dramatic increase in the elderly population expected over the next few decades will place a heavy strain on the current health care system. Family practice residents need to be prepared to take care of this geriatric population. In this study, we document the past, current, and future trends of geriatric education in family practice residency programs. METHODS: A survey was mailed to all family practice residency directors in the United States (n = 471). RESULTS: The response rate was 75%. Ninety-two percent of family practice residencies have a required geriatrics curriculum. Nursing homes, assisted living facilities, and home care are the predominant training sites for geriatrics. Training is most often offered in a longitudinal format. The mean number of physician faculty available to teach geriatrics is 2.6 per program (.83 full-time equivalent). Conflicting time demands with other curricula was ranked as the most significant barrier to geriatric education. Directors rated geriatrics as one of the three most important curriculum topics. CONCLUSIONS: Faculty development to enhance the number of faculty who can teach geriatrics and broadening the exposure of residents to the elderly in a variety of settings will be important to ensure that future generations of family physicians are adequately equipped to care for the geriatric population.

Aged↗
PubMedDate not supplied

Ethnicity, location, age, and fluoridation factors in baby bottle tooth decay and caries prevalence of Head Start children.

Baby bottle tooth decay (BBTD) is a term applied to a specific form of rampant decay associated with inappropriate bottle or breast feeding of infants and young children. Although the prevalence of BBTD has been studied in individual ethnic groups, comparison studies are rare. Head Start children have frequently served as study subjects for assessing the prevalence of BBTD. The purpose of this study was to compare BBTD and caries prevalence among Head Start children who are members of four ethnic groups in five southwestern States. Age, residence, and fluoridation status were also compared for the total sample and ethnic categories. The sampling process was a stratified random site selection; it was used to obtain data on 1,230 children. This number constituted 3 percent of the children enrolled in Head Start in Public Health Service Region VI (Arkansas, Louisiana, New Mexico, Oklahoma, and Texas) where the study was conducted. The criterion for determining the presence of BBTD was based on the number of carious deciduous maxillary incisors observed. The severity of the condition was reported as two of four and three of four of the target teeth affected. Thus, two levels of severity are reported. BBTD was prevalent in approximately 24 percent and 15 percent of the total sample, depending on the severity criterion used. Native American children had a significantly higher (P less than 0.05) prevalence than Hispanic, white, and black subjects. Rural children had significantly higher (P less than 0.05) prevalence of BBTD than nonrural children for all ethnic groups except whites. The prevalence of decayed and filled (df) surfaces of primary dentition was significantly greater for all rural than for non rural groups (P< 0.05).Children attending centers showed no significant differences based on fluoride status for the total sample or other variables. BBTD and caries prevalence increased with age. Studies are needed to identify predisposing factors among the ethnic groups and residence status in order for more effective preventive regimens to be developed, implemented,and evaluated.

Black People↗
PubMed2006

Survey of residency training in laparoscopic and robotic surgery.

PURPOSE: We determined the current status of residency training in laparoscopic and robotic surgery in the United States and Canada. MATERIALS AND METHODS: A total of 1,188 surveys were sent via the Internet to all 1,056 current urology residents and 132 program directors with an Internet address registered with the American Urological Association. RESULTS: Responses were received from 372 residents (35%) and 56 program directors (42%). Of respondents 47% reported greater than 100 laparoscopic procedures performed yearly by 1 (36%) or more (51%) faculty members. Robotic procedures were performed at 54% of the institutions, mainly consisting of prostatectomy and pyeloplasty. At all institutions laparoscopic radical nephrectomy was performed and those at 69% of the institutions believed that it is the gold standard for renal tumors today. Urologists were involved in 87% of adrenal surgeries and 54% of respondents believed that is the gold standard approach. However, only 35% of respondents had participated in laparoscopic adrenalectomy. Of respondents 36%, 42% and 17% reported that laparoscopic donor nephrectomy was performed by only urologists, only a nonurology transplant team and shared equally, respectively. Of respondents 41% planned on performing laparoscopic donor nephrectomy in the next year. Laparoscopic needle ablation renal surgery was done in 51% of the programs and percutaneous needle ablation was done in 63%. None of the respondents (0%) believed that it is the gold standard but 51% believed that ablative procedures look promising for renal tumors. Of respondents 39% had participated in robotic radical prostatectomy and 53% thought that it looked promising but was not the gold standard. Of respondents 31% believed that they will be performing robotic surgery after residency, 30% were unsure and 29% will not be using the robot. Overall 38% of residents thought that their laparoscopic experience was at least average or acceptable. CONCLUSIONS: A large number of laparoscopic urological procedures are being performed at training institutions with robotic procedures being performed at 54% of respondent facilities. Residents are participating in most cases but only 38% consider their laparoscopic experience to be satisfactory. A need still exists for increased laparoscopic training for residents, which can be accomplished by expanding training facilities and increasing the number of faculty members performing laparoscopic procedures.

Adult↗
PubMed1998

Employment-seeking experiences of resident physicians completing training during 1996.

CONTEXT: Studies analyzing the physician workforce have concluded that the United States is verging on a physician oversupply, yet we lack persuasive evidence that this is resulting in physician underemployment and/or unemployment. OBJECTIVE: To determine the degree to which graduating residents have difficulty finding or are unable to find employment in their primary career choices. DESIGN: Two 1-page surveys sent separately to residents and to program directors to collect information on the employment status of residents who were completing a graduate medical education program at the end of the 1995-1996 academic year. SETTING: A total of 25 067 resident physicians scheduled in the spring of 1996 to complete a residency program accredited by the Accreditation Council on Graduate Medical Education, and 4569 program directors in 31 specialties and subspecialties. MAIN OUTCOME MEASURE: Both the graduates' employment status and the degree of difficulty they experienced securing a practice position, as reported by resident physicians and program directors. RESULTS: After 6 months of data collection, 12135 (48.4%) of 25 067 resident physicians responded to the survey. Of the respondents, 11 200 had completed their training, and 7628 (68.1%) were attempting to enter the workforce, 28.4% were seeking additional training, and 3.5% were fulfilling their military obligations. Of the 7628 resident physicians who sought employment, 67.3% obtained clinical practice positions in their specialties, 15.5% took academic positions, 5.0% found clinical positions in other specialties, 5.1% had other plans, and 7.1% did not yet have positions but were actively looking. In addition, 22.4% of resident physicians who found clinical positions reported significant difficulty finding them. The subgroup reporting greater difficulty finding clinical positions included international medical graduates (more than 40%),those completing programs in the Pacific or East North Central region, and those in several specialties. The 1996 graduating residents reported significantly higher rates of difficulty finding suitable employment than program directors reported for their graduates (22.4% vs 6.0%); however, the percentage of graduates reported by both groups as entering the workforce was the same (68.1%). Program directors reported an unemployment rate of only 1.2%, for their 1996 graduates, which was less than the rate reported by the resident physicians (7.1%). CONCLUSIONS: Resident physicians' direct reports of their employment-seeking experiences differ from what program directors report. Program directors accurately determined the number of residents pursuing further training; however, they did not have complete information about the employment difficulties experienced by their graduates. Based on graduates' reports, we conclude that employment difficulties are greatest among international medical graduates and vary by specialty and geographic region.

Career Choice↗
PubMed2002

Increased medication use in a community environmentally exposed to chemicals.

An epidemiological health study compared the health status of residents of a town exposed to an accidental Catacarb chemical release from an adjacent oil refinery, with the health status of demographically similar residents of an unexposed town in the region. Few studies of Catacarb's effects on humans exist; however, animal studies have shown it to be a respiratory, gastro-intestinal, dermatological and visual irritant. As part of the study, health questionnaires assessing pre- and post exposure symptoms, illnesses and medication use were mailed to residents in both towns. Medication use is sometimes reported to be a more objective and reliable measure of health outcomes. The current paper compared medication use of exposed and unexposed residents. Significant increases after exposure were found in the use of the following medications: antacid, asthma medication, cough and cold medication, eye medication, headache medication and sleep medication. These increases were consistent with reported symptoms, albeit of greater magnitude; no increase in medication use for other illnesses was reported. Medication use in this sample was consistent with patients' report of symptoms and may be a better measure of outcome.

Accidents, Occupational↗
PubMed1998

1998 Joseph E. Whitley, MD, Award. Relationship between American College of Radiology in-training examination scores and American Board of Radiology written examination scores. Part 2. Multi-institutional study.

RATIONALE AND OBJECTIVES: The authors assessed the relationship between resident performance on the American College of Radiology in-training examination and subsequent American Board of Radiology written examination. MATERIALS AND METHODS: Percentile scores from the in-training examination (low score, < 20 percentile) and written board examination (low score, < 25 percentile) were collected for 513 residents from 11 university-based programs over a 7-year period. Mean in-training examination scores were compared for the high- and low-score written board examination groups. In-training examination scores were correlated with the written board examination scores. An odds ratio was calculated for the association between in-training examination and written board examination scores; this was adjusted for resident Alpha Omega Alpha (AOA) status, clinical training prior to radiology residency, the year the written board examination was taken, program size, and regional location of the program. RESULTS: The mean in-training examination scores were significantly higher in the high-score than the low-score written board examination group (P = .0001). There was a significant correlation between the in-training examination score and the written board examination score (P = .0001). The crude all-high in-training scores-written board scores odds ratio was 9.618, and the adjusted all-high odds ratio was 7.595. The final model included resident AOA status. CONCLUSION: Resident average in-training examination score was a strong predictor of the written board examination score, as noted in the earlier report. The resident with a low in-training examination score is at risk for poor performance on the written board examination.

Certification↗