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PubMed1996

The initial employment status of physicians completing training in 1994.

OBJECTIVE: To gain information about the career status of residents who completed graduate medical education training programs in selected specialties and subspecialties during the 1993-1994 academic year. DESIGN: A descriptive one-page survey of residency program directors, including two mailed follow-up surveys, was conducted from January 1, 1995 to June 1, 1995. SETTING: Directors of residency programs in 26 specialties and subspecialties accredited by the Accreditation Council for Graduate Medical Education, totaling 4369 programs. MAIN OUTCOME MEASURES: Program directors identified the number of resident physicians who completed the program, the known career status of those physicians, the number of physicians who had experienced difficulty finding a practice position, the characteristics of the full-time clinical practice positions, and the number of physicians who could not find full-time employment. The perceptions about likely trends in the availability of practice opportunities for graduates in the future and the likely change in the number of resident positions were also assessed. RESULTS: A total of 3090 program directors (70.7%) completed the survey. Respondents reported that 15999 resident physicians completed training in one of the 26 specialties and subspecialties, and 63.2% of these graduates were potentially seeking a professional position. Most of those not seeking a position were pursuing additional training (92.9%). Of those seeking employment, the percentage who did not find a full-time position in their specialty or subspecialty ranged between none in urology to 10.8% in pathology. Across all specialties, about 70% of graduates looking for full-time positions entered clinical practice in their specialty of training. Physicians pursuing generalist careers had fewer problems finding preferred positions than those pursuing nongeneralist specialties. Finally, program directors in most nongeneralist specialties believed that the degree of difficulty their graduates will experience in finding a full-time practice position will increase during the next year. CONCLUSIONS: Physicians attempting to enter practice in some specialties and in some regions of the country are experiencing difficulty. In some cases up to 10% of the resident physicians did not find full-time positions in their specialty or subspecialty. The differences noted between the generalist and nongeneralist specialties are consistent with widespread perceptions about the current market. These data establish the baseline for analyzing trends.

Data Collection↗
PubMed2004

The long arm of childhood: the influence of early-life social conditions on men's mortality.

Increasingly, social scientists are turning to childhood to gain a better understanding of the fundamental social causes of adult mortality. However, evidence of the link between childhood and the mortality of adults is fragmentary, and the intervening mechanisms remain unclear. Drawing on the National Longitudinal Survey of Older Men, our analysis shows that men's mortality is associated with an array of childhood conditions, including socioeconomic status, family living arrangements, mother's work status, rural residence, and parents' nativity. With the exception of parental nativity, socioeconomic-achievement processes in adulthood and lifestyle factors mediated these associations. Education, family income, household wealth, and occupation mediated the influence of socioeconomic status in childhood. Adult lifestyle factors, particularly body mass, mediated the effects of family living arrangements in childhood, mother's work status, and rural residence. Our findings bring into sharp focus the idea that economic and educational policies that are targeted at children's well-being are implicitly health policies with effects that reach far into the adult life course.

Aged↗
PubMed1995

Outcome of elderly patients requiring ventilatory support in intensive care.

The objectives of the study were: 1) to evaluate mortality in elderly patients requiring ventilatory support in Intensive Care Unit (ICU) and at 6, 12 and 18 months after discharge from ICU; 2) (main objective) to determine predictors of mortality in ICU and after discharge; and 3) to assess the life-style of survivors. One hundred and ten consecutive hospitalized patients > or = 70 years were included in this retrospective study. Follow-up evaluation was conducted by telephone interview. Mortality in ICU and after discharge was the outcome variable. Fifteen parameters were recorded at admission and during hospitalization. Residence, health status, and self-sufficiency were evaluated after discharge. 1) Mortality in ICU and at 6, 12 and 18 months after discharge was 38%, 60%, 63% and 67% respectively. 2) The predictors of mortality in ICU were admission in shock, and use of major therapeutic interventions. Predictors of mortality at 6 months were admission in shock, previous impaired health status and marital status. 3) Eighteen months after discharge 92% of the surviving patients (N = 33) had the same residence, 75% had the same health status, and 78% had the same autonomy compared with pre-admission status. We concluded that shock and previous health status but not age are predictors of short- and long-term prognoses in elderly patients hospitalized in ICU for mechanical ventilation.

Aged↗
PubMed2003

The ecology of medical care for children in the United States.

BACKGROUND: Medical care ecology has previously been investigated for adults, but no similar exploration has been made specifically for children. OBJECTIVE: To describe proportions of children receiving care in 6 types of health care setting on a monthly basis and to identify characteristics associated with receipt of care in these settings. METHODS: Nationally representative data from the 1996 Medical Expenditure Panel Survey were used to estimate the number of children per 1000 per month who received care at least once in each type of setting. Multivariate analyses assessed associations between receiving care in various settings and children's sociodemographic factors (age, sex, ethnicity, poverty, parent's education, urban or rural residence, insurance status, and whether or not the child had a usual source of care). RESULTS: Of 1000 children aged 0 to 17 years, on average each month 167 visited a physician's office, 82 a dentist's office, 13 an emergency department, and 8 a hospital-based outpatient clinic. Three were hospitalized and 2 received professional health care in their home. Younger age was associated with increased proportions of children receiving care in all health care settings except dentists' clinics. Poverty, lack of health insurance, black race, and Hispanic ethnicity were associated with decreased receipt of care in physicians' and dentists' offices. Only age (<2 years and 13-17 years) and poverty status were associated with hospitalization (P <.05 for each). Rural residence was not associated with any significant variation in proportions of children receiving care in any setting. Having a usual source of care was associated with increased receipt of care in all settings except hospitals. CONCLUSIONS: The ecology of children's medical care is similar to that of adults in the United States in that a substantial proportion of children receive health care each month, mostly in community-based, outpatient settings. In all settings except emergency departments, receipt of care varies significantly by children's age, race, ethnicity, income, health insurance status, and whether they have a usual source of care.

Adolescent↗
PubMed2000

The relation between quality of co-ordination of nursing care and quality of life in Dutch nursing homes.

Quality of life of nursing home residents is a critical consideration in international health care policies and health care decisions. Yet, there is little relevant research to support decisions about client-tailored and effective nursing care for this population. Because of the permanency of their stay, the care received affects the quality of daily life. This study investigated the quality of co-ordination of care and the way it is related to gaps between needs and care supply, the quality of life and health status of residents living in Dutch nursing homes. To assess the perceived quality of life and experienced discrepancies between needs and care supply, 337 residents of 10 different nursing homes were interviewed. The quality of co-ordination of nursing care was assessed by judgements of the residents and nurses and by analysing the care documents. The results showed a relation between the co-ordination of care and care discrepancies; the higher the quality of co-ordination of care, the fewer the gaps between residents' needs and the care they received. The psycho-social aspects in particular showed a gap between the needs and care supply. As regards the relation between co-ordination of care and quality of life, the strongest positive relations were found between taking case histories, patient allocation and dimensions of quality of life. No direct relations were found between the co-ordination of care and care discrepancies on the one hand and the health status of the residents on the other. In conclusion, this study showed that the quality of co-ordination of care can affect the perceived quality of life of nursing home residents. To meet the residents' needs it is important to assess their physical and psycho-social needs accurately. More research focusing on this assessment is needed in order to improve the quality of life of nursing home residents.

Aged↗
PubMed1995

Admission health status differences of black and white indigent nursing home residents.

OBJECTIVE: To compare the health status of newly admitted lower socioeconomic status (SES) southern black (n = 81) and white (n = 53) nursing home residents. DESIGN: The study data were part of a larger prospective study on the health of newly admitted nursing home residents. SETTING: A 575-bed, government-funded nursing home providing care for indigent residents in a large southern city. PARTICIPANTS: Newly admitted black and white nursing home residents aged 60 and older. MEASUREMENTS: Mental status was measured using the Short Portable Mental Status Questionnaire, activities of daily living by Scaled Outcome Criteria, and medical status by medical diagnoses and medications. MAIN RESULTS: Blacks entering the nursing home were more cognitively and functionally impaired and had 3.7 years less education than white residents, but average age was not significantly different for black and white residents. CONCLUSIONS: Many common health status measures showed no significant black-white differences for institutionalized older adults when region and SES were constants. However, mental status, self-care activities, and marital status were significantly different. These findings indicate a possible impact of lifelong poverty or low educational attainment on the increased disability of indigent black older adults. Black residents in our study had less spousal support to remain in the community.

Activities of Daily Living↗
PubMed2005

Barriers to health care and protocol-based treatment of ectopic pregnancy.

OBJECTIVE: To evaluate whether treatment provided for ectopic pregnancies was different for patients with identified barriers to health care, including ethnicity, lack of insurance, distance from the treating facility that provides services and undocumented residency, at an institution that utilizes a protocol-based algorithm for treatment of ectopic pregnancies. STUDY DESIGN: Charts of 401 patients who were diagnosed with ectopic pregnancy from January 1, 1993, through December 31, 1998, were reviewed to compare the use of medical treatment using methotrexate versus surgical treatment. Data were analyzed with respect to patient ethnicity, socioeconomic status (including insurance status and possession of a social security card [a proxy for legal residency status]), residence inside or outside the county of the treating facility, patient presentation and treatment outcomes. RESULTS: There was no difference in treatment modality or success of primary treatment for ectopic pregnancies between groups regardless of ethnicity, health care insurance, residence outside the county the treating facility was located in or possession of a social security number. CONCLUSION: The treatment of ectopic pregnancies at the University of New Mexico Health Sciences Center is consistent across ethnic and socioeconomic populations. A well-designed treatment protocol may help provide evidenced-based, consistent treatment for patients requiring care who also have identified barriers to medical and surgical treatment.

Abortifacient Agents, Nonsteroidal↗
PubMed2002

Ethnic-immigrant differentials in health behaviors, morbidity, and cause-specific mortality in the United States: an analysis of two national data bases.

This study examines the extent to which various ethnic-immigrant and US-born groups differ in their risks of all-cause and cause-specific mortality, morbidity, and health behaviors. Using data from the National Longitudinal Mortality Study, 1979-1989, we estimated, for major US racial and ethnic groups, mortality risks of immigrants relative to those of the US-born. The Cox regression model was used to adjust mortality differentials by age, sex, marital status, rural/urban residence, education, and family income. Logistic regression was fitted to the National Health Interview Survey data to determine whether health status and behaviors vary among ethnic-immigrant groups and by length of US residence. Compared with US-born whites of equivalent socioeconomic and demographic background, foreign-born blacks, Hispanics, and Asians/Pacific Islanders (APIs), US-born APIs, US-born Hispanics, and foreign-born whites had, respectively, 48%, 45%, 43%, 32%, 26%, and 16% lower mortality risks. While American Indians did not differ significantly from US-born whites, US-born blacks had an 8% higher mortality risk. Black and Hispanic immigrants experienced, respectively, 52% and 26% lower mortality risks than their US-born counterparts. Considerable differentials were also found in mortality for cancer, cardiovascular, respiratory, infectious disease, and injury, and in morbidity and health behaviors, with API and Hispanic immigrants generally experiencing the lowest risks. Consistent with the acculturation hypothesis, immigrants' risks of smoking, obesity, hypertension, and chronic condition, although substantially lower than those for the US-born, increased with increasing length of US residence. Given the substantial nativity differences in health status and mortality, future waves of immigrants of diverse ethnic and cultural backgrounds will likely have a sizeable impact on the overall health, disease, and mortality patterns in the United States.

Adult↗
PubMed2000

Social and personal resources and the prevalence of phobic disorder in a community population.

BACKGROUND: Phobic disorder is one of the most prevalent psychiatric disorders in community populations and much attention has focused on the association of sociodemographic factors and social resources with the disorder. There has been little investigation of the more personal resources such as self-confidence, religiosity, social support and self-perceived health that may increase vulnerability. METHODS: We used a sample of 2914 community residents aged 18 or older who participated in the Duke University Epidemiologic Catchment Area Study to explore the relationship between both social and personal resources and the prevalence of DIS/DSM-III phobic disorder. RESULTS: The 1-month prevalence of any phobic disorder was 7.6%. In bivariate analyses, we found both race/ethnicity and gender differences in prevalence, with a higher prevalence of phobic disorder in African-Americans and females. Lower socio-economic status, rural residence and unmarried status were also associated with current prevalence. No association was found for social network and social interaction. Impaired subjective social support, low self-confidence, perceived poorer physical health and co-morbid psychiatric disorder were significantly associated with current prevalence in uncontrolled analyses, while associations between lack of a confidant as well as religiosity and phobic disorder were not. Female gender (OR = 1.7), perceived low self-confidence (OR = 2.0), and two interaction terms, age x co-morbid psychiatric disorder and race/ethnicity x perceived physical health were associated with phobic disorder in controlled analyses using logistic regression. CONCLUSIONS: We conclude that both social and personal resources, particularly self-confidence, co-morbidity and perceived physical health are important correlates of phobic disorder.

Adolescent↗
PubMed1995

Observations on nursing home residents with a history of hip fracture.

The authors evaluated nursing home residents with a prior history of hip fracture for osteopenia and its risk factors, and attempted to learn to what extent the residents' bone status had been considered by their primary care physicians. Thirty-one hip fracture residents in the Milwaukee VA nursing home were studied to determine their status with regard to bone mineral density of the proximal femur, and the following risk factors or predictors of osteopenia: history of smoking; history of fractures; calcium and vitamin D intake; underweight; immobility; hypogonadism; and administration of drugs that may accelerate bone demineralization. Data were also collected on the evaluation and management of the post hip fracture residents in three other nursing homes. In the Milwaukee nursing home, out of 31 hip fracture survivors, 74% had sustained a hip fracture before admission to the nursing home; 29% had a history of second fracture. In 84% of patients, there was no mention of osteopenia in the active medical problem list and, therefore, there was no intervention plan in place to improve or prevent further bone loss. Thirty-two percent were underweight, 36% were currently smoking, 55% were immobile, 64% were consuming at least one medication that might increase bone loss, calcium intake was less than 1,000 mg daily in 52%, and 66% were hypogonadal (serum testosterone level less than 300 ng/dL). Chart reviews of the hip fracture survivors at three other nursing homes revealed similar findings. Approximately 5-15% of nursing home residents are hip fracture survivors. They usually have severe osteopenia and multiple risk factors for further bone loss and future fractures.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed2004

Mental Status Expert: an expert system for scoring and reporting the mental status examination.

For neurology clerks and residents, the mental status examination is often the most difficult part of the neurological examination. We have developed the Mental Status Expert (MSE), a structured mental status examination designed for use by neurology student clerks and neurology residents. The MSE assesses seven areas of cognitive function: orientation and concentration, language, right parietal functions, left parietal functions, occipital lobe functions, frontal lobe functions, and memory. Norms for the test have been created based on administration to 281 subjects referred to the Neurology Clinic. The MSE uses production rules and other expert system features to assist in the scoring and reporting of test results.

Aged↗
PubMed1990

Pygmalion in the nursing home. The effects of caregiver expectations on patient outcomes.

Several characteristics of nursing home care can diminish rather than enhance the clinical status of older residents. In view of evidence from other settings that "interpersonal expectancy effects" can influence outcomes in a variety of relations, we conducted a randomized controlled trial to test the effects of caregiver expectations on the clinical status of nursing home residents. Within 2 weeks of admission, 63 older residents at six nursing homes were given a comprehensive assessment of cognitive, functional, and emotional status. Residents were then randomly assigned to a "high-expectancy" or "average-expectancy" condition. Nurses and aides were told that, in comparison with other residents having similar problems, residents in the high-expectancy group were predicted to perform above average in their rehabilitation. The assessment was repeated 3 months later; information on the health and psychosocial status of residents was drawn from their medical records covering the same period. Aides reported having higher expectations for treatment group residents. When assessed by a blinded research assistant, residents in the high-expectancy group experienced greater relief of depressive symptoms but showed greater decrements in functional independence in comparison with control residents. Treatment group residents were admitted significantly less frequently to hospitals despite a comparable number of emergency ward visits, suggesting a lower incidence of severe illness despite comparable medical surveillance. There was also a trend toward improved performance in mental status testing among the high-expectancy residents compared with controls (P = .08). Additional research is needed to define further the magnitude and mechanisms of expectancy effects in relations between nursing home caregivers and residents.

Activities of Daily Living↗
PubMed1996

The interactive effects of race and ethnicity and mother's residence on the adequacy of prenatal care.

Adequate prenatal care is known to reduce the risks of low birth weight and neonatal death, yet nearly one quarter of all women giving birth in the United States receive delayed, inadequate or no prenatal care. This suboptimal use of prenatal care has contributed to rates of low birth weight and neonatal mortality higher than those in most other industrialized nations. This paper examines the relationships among race/ethnicity, residence, maternal sociodemographic and medical risk characteristics, and use of prenatal care in the United States. Using data from the National Maternal and Infant Health Survey, this study found important differences in prenatal care use by race/ethnicity and residence, as well as interactive effects of these variables. Single marital status, nonmetropolitan residence, poverty, low level of education, and no insurance were more strongly associated with inadequate prenatal care for whites and Hispanics than for blacks. Nonmetropolitan residents were more likely to receive inadequate care, regardless of race/ethnicity or sociodemographic characteristics. Predicted probabilities of prenatal care use by race/ethnicity and residence showed that, regardless of risk, nonmetropolitan Hispanic women had the highest probability of obtaining inadequate prenatal care. Results highlight the continued importance of race/ethnicity and rural residence in determining prenatal care use and the need to design interventions targeted to these populations.

Black or African American↗
PubMedDate not supplied

The economic environment of resident physicians.

We examined the financial, working, and educational environment of resident physicians, using mail surveys of residents conducted in 1979 and 1983. Variables examined include annual residency salary, fringe benefits, educational debt, moonlighting income, hours and types of work, and perceived problems with the residency programs. Three conclusions are drawn from the surveys. First, the rapid increases in resident salaries prevalent in the late 1960s and early 1970s have been replaced by more modest advances. Second, resident physicians are not indicating great concern about their current financial status. Third, resident physicians work long hours, but teaching hospitals have not increased their use of residents. These findings illustrate the dual nature of residency training: residents are both students and employees.

Employment↗
PubMed2001

Epidemiology and factor analysis of obesity, type II diabetes, hypertension, and dyslipidemia (syndrome X) on the Island of Kosrae, Federated States of Micronesia.

OBJECTIVES: Obesity, type II diabetes, hypertension, and dyslipidemia are major causes of morbidity and mortality throughout the world. Though these disorders often cluster in individuals and families and are collectively known as syndrome X, the basis for this aggregation is not well understood. To further understand the pathogenesis of syndrome X, a comprehensive epidemiological study was undertaken on the Pacific Island of Kosrae, Federated States of Micronesia (FSM). METHODS: The entire adult (>20 years of age) population of Kosrae underwent a clinical evaluation that included a questionnaire that noted the participants' sex, family data including listing of biological parents, siblings, and children, smoking status, village of residence, age and health status. The medical evaluation included: anthropometric measures (weight, height, waist, hip), serum chemistries (leptin, fasting blood sugar (FBS), insulin, total cholesterol (TC), triglycerides (TG), and apolipoproteins B and A-I (apo B and apo A-I) and blood pressure (BP) measurements. RESULTS: Obesity (BMI >/=35) was found in 24%, diabetes (FBS >/=126 or 2-hour oral glucose tolerance test >/=200) in 12%, hypertension (SBP >/=140 or DBP >/=90) in 17%, and dyslipidemia (TC >/=240 or TG >/=200 or apo B >/=120 or apo A-I </=88) in 20% of the population. Significant covariate effects after multivariate analysis were as follows: sex affected the frequency of all four disorders, parity affected the frequency of dyslipidemia, smoking affected the frequency of obesity and diabetes, village of residence affected the frequency of obesity, hypertension, and dyslipidemia, and age affected the frequency of all four disorders. Factor analysis identified four independent factors that explained 73% of the total variance of the entire data set: factor 1 (weight, waist, leptin, insulin, and TG), factor 2 (TC, TG, apo B, apo A-I, and insulin), factor 3 (systolic and diastolic BP, FBS, waist and weight), and factor 4 (apo A-I, TG, leptin, and weight). CONCLUSIONS: This population-based study on the Island of Kosrae suggests that syndrome X is a composite of 4 independent factors: obesity with diabetes and hypertriglyceridemia, combined hyperlipidemia with diabetes, hypertension with obesity and diabetes, and increased HDL-low TG with thinness and high leptin. Further studies to identify the genetic components of these factors as well as the individual traits are under way.

Adult↗
PubMed2006

Predictive validity of five comorbidity indices in prostate carcinoma patients treated with curative intent.

BACKGROUND: Comorbidity is important to consider in clinical research on curative prostate carcinoma because of the role of competing risks. Five chart-based comorbidity indices were assessed for their ability to predict survival. METHODS: This was a case-cohort study of prostate carcinoma patient cohort treated with curative intent in Toronto and Southeast Cancer Care Ontario regions between 1990 and 1996; the subcohort was drawn from these men, whereas cases were cohort members who died from causes other than prostate carcinoma. Comorbidity data were obtained from medical charts (269 subjects). Vital status, age, area of residence, and socioeconomic status information were available. Predictive validity was quantified by the percent variance explained (PVE) over and above age using proportional hazards modeling. RESULTS: The Chronic Disease Score (CDS) (PVE = 11.3%; 95% confidence interval [95% CI], 3.5-22.8%), Index of Coexistent Disease (ICED) (PVE = 9.0%; 95% CI, 2.9-17.9%), Cumulative Illness Rating Scale (CIRS) (PVE = 7.2%; 95% CI, 1.4-17.1%), Kaplan-Feinstein Index (PVE = 4.9%; 95% CI, 0.6-12.8%), and Charlson Index (PVE = 3.8%; 95% CI, 0.3-10.9%) each explained some outcome variability beyond age. PVE differences among indices were not statistically significant. A comorbidity identified at the time of cancer diagnosis was the cause of death in 59.2% of cases (75% for cardiac or vascular causes). CONCLUSIONS: The better-performing, more comprehensive indices (CDS, ICED, and CIRS) would be useful in measuring and controlling for comorbidity in this setting. The CDS was easiest to apply and explained the most outcome variability.

Aged↗
PubMed2005

Gender differences in suicide risk by socio-demographic factors in Hong Kong.

Some peculiarly low male-to-female suicide ratios have been reported in the Far Eastern populations. This article attempts to investigate whether there are gender differences in suicide risk by socio-demographic factors in Hong Kong, and hereby to explain the low male-to-female suicide ratios. The effects of marital status, duration-of-residence, and occupational status on suicide are first studied by periodic suicide rates in 1990-1992, and 2000-2002, then by Poisson regression. Some interesting results are found: Unlike most findings elsewhere, migration in Hong Kong did not induce suicide; occupational status was negatively related to suicide only for men but not for women; the particularly low male-to-female suicide ratio was not due to a larger protection from marriage for men than for women as reported in the literature, but very probably to a very high suicide rate for the non-working population. The authors suggest some plausible explanations of the findings and hence further research to be conducted.

Adult↗
PubMed2006

Duration of unemployment and depression: a cross-sectional survey in Lithuania.

BACKGROUND: In spite of a growing economy, unemployment is still a severe socio-economic problem in Lithuania. Nonetheless, no studies have been performed about the associations between unemployment and mental health in Lithuania. The aim of this study was to evaluate the associations between unemployment duration and depression in Lithuania. METHODS: The data was collected in a cross-sectional study in 2005. There were 429 filled-in questionnaires received (53.6% response rate) from unemployed persons registered with the Kaunas Labour Market Office. The severity of depression symptoms was evaluated using the Beck Depression Inventory (BDI). Logistic regression was used to estimate the risk factors for occurrence of depression. Sex, age, place of residence, marital status, education, income and practiced religion were the independent variables. Long-term unemployment was defined as lasting a duration of 12 months or more. RESULTS: The findings showed that long-term unemployed persons had more episodes of a depressive mood in the past 12 months in comparison with the group of the short-term unemployed. In addition, the BDI score mean was higher among the long-term unemployed compared with the short-term unemployed (10.1 +/- 8.8 and 14.2 +/- 9.5 respectively, p < 0.001). It was estimated that the duration of unemployment and BDI score had a positive correlation (r = 0.1968, p < 0.001). Among the short-term unemployed, the risk of depression increased significantly when the person was female, had an older age and had experienced more episodes of unemployment. Among the long-term unemployed, an older age was the risk factor for development of depression. However, higher education and income were the factors that significantly decreased the risk of developing depression for-short term as well as for long-term unemployed. CONCLUSION: The results indicated that depression is a severe problem in the unemployed population. Depression is more elevated among the long-term unemployed. This leads to arguing for common efforts in providing needed social support and health care to reduce the effects of unemployment on mental health.

Adolescent↗