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PubMed2002

Residencies in addiction psychiatry: 1990 to 2000, a decade of progress.

This article reviews the history and status of addiction psychiatry residencies based on surveys conducted in 1990 and again in 1999. The 19 of 38 approved programs in operation since 1990 filled more positions than those that were more recently accredited, but they were not significantly different in time allocated to respective clinical assignments or in salary support. Altogether, the programs provide a broad array of training sites (inpatient and outpatient, alcohol and other-drug related) suitable for the diverse needs that graduates will encounter. There were, however, differences in the balance of time dedicated to research relative to patient care. Salaries were relatively modest and drawn from federal and local sources.

Education↗
PubMed1997

Effects of fluoride level in drinking water, nutritional status, and socio-economic status on the prevalence of developmental defects of dental enamel in permanent teeth in Saudi 14-year-old boys.

Fourteen-year-old boys from three regions of Saudi Arabia were surveyed in 1992/3. These regions were Jeddah (which receives desalinated water containing 0.22 mgF/l), Riyadh (receiving water containing 0.78 mgF/l) and Qassim (2.66 mgF/l). For each of these urban communities an adjacent rural community was selected; these received water with 0.25, 0.80, and 2.71 mg/l, respectively. Subjects from the urban communities were classified into high, medium and low socio-economic status based on area of residence, income and education level of parents. Nutritional status was calculated from height and age using WHO methods and expressed as height for age percentage of the median of the reference population (HAM); children with HAM scores of less than 95% were classed as malnourished. The developmental defects of enamel index was recorded on the buccal surface of all permanent teeth, by one examiner. Colour photographs of anterior teeth were read 'blind' to investigate examiner bias between regions-there was no bias. A total of 1,539 children were examined who had been continuously resident in that community. Overall, 83% of subjects had one or more enamel defects with a mean number of teeth affected per person of 9.6. Diffuse defects were the most common. Multivariate analyses revealed that all three variables-region, nutritional status, socio-economic status-were statistically significantly related to the prevalence of defects and the number of teeth affected: prevalence was highest in the region with the highest water fluoride concentration, in rural areas and in malnourished subjects. Maxillary incisor teeth were the most affected teeth in all regions. The findings have implications for those in public health who determine optimum fluoride levels in drinking water in Saudi Arabia and beyond.

Adolescent↗
PubMed1988

[Mexico: evaluation of medical training based on the results of a national test given to candidates for medical residencies].

This study assesses the current status of medical education in Mexico by evaluating the IX National Medical Residency Examination. The results indicate that the personal background of the candidates is related to the probability of their passing the examination: age; marital status; number of times they have presented the examination; length of time between graduation from medical school and the examination; place where social service was performed; and work experience. The authors observe a strong tendency toward specialization in the professional curricula of the medical schools in Mexico, with a consequent neglect of the national health system's present need for primary care. They therefore suggest that the educational institutions give thought to alternatives that would better equip the country's human resources to deal with current needs.

Aptitude Tests↗
PubMed2004

US graduate medical education, 2003-2004.

CONTEXT: Information about recent graduates of medical schools and the characteristics of physicians training in graduate medical education (GME) portends the size and composition of the US physician workforce of the near future. OBJECTIVES: To examine trends in training programs and career choices of graduating male and female residents and to monitor trends in the size of the entire residency population. DESIGN, SETTING, AND PARTICIPANTS: The American Medical Association and Association of American Medical Colleges jointly surveyed residency programs during the academic year 2003-2004 about active, transferred, and graduated residents, as well as about program characteristics. The 8192 programs confirmed the status of 94.6% of residents. Nearly 86% of program directors (n = 7040) completed the accompanying program survey. MAIN OUTCOME MEASURES: Overall trends during the last 6 years in the number and characteristics of residents and programs, as well as the specialty of male and female graduating residents. RESULTS: There were 99,964 active residents during the 2003-2004 academic year, the highest ever recorded by the National GME Census. The number of residents (n = 22,444) entering US graduate medical education programs for the first time is also the highest on record. In 1999, 28,773 physicians completed training, 10,546 (36.7%) of whom were women. In 2003, there were 29,745 graduates, 11,681 (39.3%) of whom were women, representing a 10.8% increase. The number of obstetrics/gynecology male graduates decreased 31.3%, while female graduates increased 18.2%. Other specialties that lost men and gained women were dermatology, family medicine, internal medicine, ophthalmology, pathology, psychiatry, and general surgery. The proportion of graduates who pursued additional training increased; percentages were 27.2% in 1999, 29.6% in 2001, and 32.1% in 2003. In 2000, 35.7% of programs provided opportunities to develop cultural competence; the percentage in 2003 was 50.7%. The percentage of programs with complementary/alternative medicine curriculum has held steady at 24%. CONCLUSIONS: The number of physicians in GME is at its highest, and nearly one third of physicians completing training in one program continue on in another. The choices of female residents parallel those of male residents in many respects, but there are important differences.

Adult↗
PubMed2005

Predisplacement and postdisplacement factors associated with mental health of refugees and internally displaced persons: a meta-analysis.

CONTEXT: The global refugee crisis requires that researchers, policymakers, and clinicians comprehend the magnitude of the psychological consequences of forced displacement and the factors that moderate them. To date, no empirical synthesis of research on these issues has been undertaken. OBJECTIVE: To meta-analytically establish the extent of compromised mental health among refugees (including internally displaced persons, asylum seekers, and stateless persons) using a worldwide study sample. Potential moderators of mental health outcomes were examined, including enduring contextual variables (eg, postdisplacement accommodation and economic opportunity) and refugee characteristics. DATA SOURCES: Published studies (1959-2002) were obtained using broad searches of computerized databases (PsycINFO and PILOTS), manual searches of reference lists, and interviews with prominent authors. STUDY SELECTION: Studies were selected if they investigated a refugee group and at least 1 nonrefugee comparison group and reported 1 or more quantitative group comparison on measures of psychopathology. Fifty-six reports met inclusion criteria (4.4% of identified reports), yielding 59 independent comparisons and including 67,294 participants (22,221 refugees and 45,073 nonrefugees). DATA EXTRACTION: Data on study and report characteristics, study participant characteristics, and statistical outcomes were extracted using a coding manual and subjected to blind recoding, which indicated high reliability. Methodological quality information was coded to assess potential sources of bias. DATA SYNTHESIS: Effect size estimates for the refugee-nonrefugee comparisons were averaged across psychopathology measures within studies and weighted by sample size. The weighted mean effect size was 0.41 (SD, 0.02; range, -1.36 to 2.91 [SE, 0.01]), indicating that refugees had moderately poorer outcomes. Postdisplacement conditions moderated mental health outcomes. Worse outcomes were observed for refugees living in institutional accommodation, experiencing restricted economic opportunity, displaced internally within their own country, repatriated to a country they had previously fled, or whose initiating conflict was unresolved. Refugees who were older, more educated, and female and who had higher predisplacement socioeconomic status and rural residence also had worse outcomes. Methodological differences between studies affected effect sizes. CONCLUSIONS: The sociopolitical context of the refugee experience is associated with refugee mental health. Humanitarian efforts that improve these conditions are likely to have positive impacts.

Emigration and Immigration↗
PubMed1999

Meat intake and risk of squamous cell esophageal cancer: a case-control study in Uruguay.

In order to examine the relationship between different types of meat and squamous cell cancer of the esophagus, a case-control study was carried out in Uruguay. Eighty-two cases and 248 hospitalized controls were frequency-matched on age, sex, residence and urban/rural status. All patients responded to a detailed questionnaire, which included a food-frequency form for 64 food items representative of the usual Uruguayan diet. Whereas increases in risk were observed for high intake of salted meat [odds ratio (OR) 2.5, 95% confidence interval (CI) 1.1-5.4] and lamb (OR 2.1, 95% CI 1.1-4.2), beef from cow was inversely associated with the risk of esophageal cancer (OR 0.4, 95% CI 0.2-0.9). Also, polyunsaturated fat from meat was associated with an increased risk (OR 3.2, 95% CI 1.0-9.8). Finally, total meat intake was not associated with squamous cell cancer of the esophagus.

Adult↗
PubMed1999

Occupational physical activity and renal cell cancer: a nationwide cohort study in Sweden.

The causes of renal cell cancer remain incompletely understood. In one previous retrospective case-control study, high occupational physical activity has been associated with a decreased risk among men, but not among women. Our aim was to investigate the association between occupational physical activity and renal cell cancer in a large cohort in Sweden. A cohort of Swedish men and women was identified in the nationwide censuses in 1960 and 1970, and the reported occupations were classified into 4 levels of physical demands. Follow-up from 1971 through 1989 was accomplished through record linkages to the Swedish Cancer Registry. Multivariate Poisson regression models were used to estimate relative risk (RR) and 95% confidence intervals (CI). We found a monotonic increase in risk of renal cell cancer with decreasing level of occupational physical activity among men (p for trend <0.001). After adjustment for socio-economic status, place of residence, and calendar year of follow-up, men with long-term sedentary jobs had a 25% (RR = 1.25, 95% CI 1.02-1.53) increased risk compared to men with physically demanding occupations. Among women there was no association, the dose-risk trend was not significant (p for trend >0.50). Occupational physical activity was inversely associated with renal cell cancer among men. The absence of association among women might be due to smaller range of exposure, confounding by household work or reproductive factors, or to a difference in biological response to physical activity in men and women.

Adult↗
PubMed1996

Cancer incidence among alachlor manufacturing workers.

A historical cohort study was conducted to evaluate cancer incidence among chemical workers with occupational and environmental exposure to alachlor, the active ingredient in a family of pre-emergent acetanilide herbicides. The study followed 943 workers with at least 1 year of cumulative employment at the Monsanto plant in Muscatine, Iowa, from startup of the alachlor manufacturing process in March 1968 through December 1990. Approximately 96% of all workers were successfully traced to determine their last known residence and cancer status. Eighteen workers were diagnosed with cancer during the follow-up period, based on pathology information from the statewide cancer registry maintained by the State Health Registry of Iowa. The standardized incidence ratio for all cancers was 1.5 (95% CI 0.9-2.4) for all workers exposed to alachlor, which was due primarily to elevated rates for colorectal cancer and chronic myeloid leukemia. Workers with 5 or more years in estimated high alachlor exposure jobs had elevated rates of colorectal cancer (3 cases, SIR = 5.2, 95% CI 1.1-15.1). Interpretation of the study results is limited by the small size of the study population, minimal length of follow-up, and current information concerning alachlor metabolism in primates and humans. Nonetheless, the findings suggest the need for continued evaluation of this and other alachlor-exposed cohorts.

Acetamides↗
PubMed2000

Plant foods and risk of laryngeal cancer: A case-control study in Uruguay.

In order to examine the relationships between plant foods, defined as the grouping of vegetables, fruits, tubers and legumes, with the risk of developing laryngeal cancer, a case-control study was conducted in Uruguay between 1998-1999. The study included 148 cases with histologically verified squamous cell carcinoma of the larynx, which were frequency matched on age, residence and urban/rural status with 444 hospitalized controls, afflicted by non-neoplastic conditions. Both series of patients were face-to-face interviewed in the hospitals shortly after admittance using a detailed questionnaire. This questionnaire included 62 queries on food items, representative of the usual diet of the Uruguayan population. Food items and food groups were adjusted for tobacco smoking, alcohol drinking and total energy intake. High consumption of plant foods was associated with an OR of 0.42 (95% CI 0.21-0.84). Among subgroups of plant foods, fruits and raw vegetables were associated with a strong reduction in risk (OR for the highest quartile of raw vegetables 0.29, 95% CI 0.15-0.56). Also, legumes were associated with a protective effect (OR 0.62, 95% CI 0.33-1.19). Among individual food items, tomatoes and oranges were associated with the stronger protective effects (OR for tomato intake 0.32, 95% CI 0. 17-0.58). The joint effect of heavy smoking and the low intake of vegetables and fruits displayed an increased risk of 19.2 (95% CI 5. 7-64.9).

Adult↗
PubMed2004

Hungarian cohort-controlled trial of periconceptional multivitamin supplementation shows a reduction in certain congenital abnormalities.

BACKGROUND: The 1984-1991 Hungarian randomized controlled trial (RCT) of periconceptional multivitamin supplementation containing folic acid (0.8 mg) showed a significant reduction in the first occurrence of neural tube defects (NTDs), and of urinary tract and cardiovascular abnormalities, but no reduction in orofacial clefts. A controlled cohort trial was designed to confirm or deny these results. METHODS: Supplemented women were recruited from the Hungarian Periconceptional Service using the same multivitamin as the Hungarian RCT. Unsupplemented pregnant women were recruited in the standard regional antenatal care clinics and were matched to each supplemented pregnant woman on the basis of age, socioeconomic status, place of residence, and year of pregnancy. RESULTS: A total of 3056 informative offspring were evaluated in each cohort. The occurrence of congenital cardiovascular malformations (31 vs. 50) was reduced (odds ratio [OR], 0.60; 95% confidence interval [CI], 0.38-0.96) in the supplemented cohort, accounted for mainly by ventricular septal defects (5 vs. 19; OR, 0.26; 95% CI, 0.09-0.72). There was no significant difference (14 vs. 19) in the occurrence of urinary tract defects between the two cohorts, but stenosis/atresia of pelvic-ureteric junction (2 vs. 13) showed a significant reduction (OR, 0.19; 95% CI, 0.04-0.86). The protective effect of the folic acid-containing multivitamin for NTDs (one offspring in the supplemented vs. nine in the unsupplemented cohort) was confirmed (OR, 0.11; 95% CI, 0.01-0.91). There was, however, no protective effect on orofacial clefts or on multiple congenital abnormalities. CONCLUSIONS: The results of this cohort-controlled trial support the findings of the previous Hungarian RCT. The primary prevention of some major structural birth defects by multivitamins containing folic acid or by folic acid has great public health importance.

Adult↗
PubMed2001

The use of trial leave for restricted special hospital patients.

INTRODUCTION: For England and Wales, Section 17 of the Mental Health Act 1983 allows for compulsorily detained patients to have trial leave (TL) between hospitals or from hospital to community to allow a period of testing readiness for a change in residency and/or legal status. The aim of this study was to document the use of TL for the largest sub-group of such patients within two discharge cohorts from one high security hospital and to test for correlates. METHOD: Data were collected from the special hospitals' case register for two Broadmoor Hospital discharge cohorts, 1984 and 1990-94, of offender patients with hospital orders under Home Office restrictions on discharge (Section 37/41). RESULTS: In 1984, only two of the 29 people leaving special hospital did so under trial leave arrangements, but by 1990 to 1994, 71% of restricted hospital order departures were under trial leave (92/130), a significant change in practice. Focusing on only the later cohort, women were disproportionately more likely to leave in this way. Trial leave was used more for patients with an index offence of homicide, similarly for violent offences but less so for sex offences. Nature of disorder did not have any bearing on the use of trial leave. Use of trial leave did not significantly shorten length of stay within the special hospital. CONCLUSION: Trial leave has become the most usual route out of special hospital, and is the departure route used almost exclusively for women patients, yet there appears to be no obvious advantage for the patient in shortening length of stay in high security. However, there is no way of knowing how long patients would have stayed had the option of trial leave not been available to them. Furthermore, no advantage for the public was found in the preferential use of TL for discharges to the community.

Journal Article↗
PubMed1983

Hepatitis A and hepatitis B virus infection in children and adolescents in north-east Italy.

The sera of 722 children and adolescents without overt liver disease were tested for hepatitis B surface antigen (HBsAg), antiHBs and anti-hepatitis B core anti-HBc; 658 of the sera were also tested for anti-hepatitis A virus anti-HAV. Except for the "passive" antibody peak observed in babies, the anti-HAV age-specific prevalence was negligible until the age of 3; it then increased, reaching 35% by the age of 15. Serological evidence of HBV was present in 16% of the subjects: this prevalence was almost constant at all ages. The HBsAg carrier rate was highest in children under 5 years of age (7.6%) and decreased with age. However, only one HBsAg carrier was under 1 year of age. Anti-HBs age-specific prevalence increased progressively from 2.7% to 11.4%. Anti-HBc alone was present in 4.1% of the subjects. No significant sex differences were found in the prevalence of HBV serum markers or in the HBsAg carrier rate. Neither HAV nor HBV infection was significantly influenced by place of residence or socioeconomic status. It is concluded that in this area both HAV and HBV are endemic, but while HAV is mainly acquired at school, most of the HBV infections occur within the household. The results suggest that not only perinatal transmission, but also intrafamilial horizontal infection, plays a role in HBV spread among infants.

Adolescent↗
PubMed2002

Sociodemographic predictors of pap test receipt, currency and knowledge among Australian women.

BACKGROUND: Knowledge of sociodemographic variations in cervical cancer screening can help identify population groups at risk of underutilization of cervical cancer procedures and practices. The aim of this research was to examine sociodemographic predictors of receipt, currency (being up-to-date for), and knowledge of Pap test. METHODS: We used data from the 1995 National Health Survey. A subsample of women was given self-administered questionnaires that included questions about the Pap test. The sample size was 7,572. Using multiple logistic regression, we examined the association of age, marital status, region of residence, country of birth, Index of Relative Socioeconomic Disadvantage (IRSD), and education with Pap test receipt, currency, and knowledge. RESULTS: Women under 30 and over 49 years of age, those not presently married, those with lower levels of education, and those born in the Middle East or Asia (compared with the Australian/New Zealand-born women) were at a greater risk of not receiving and having no knowledge of Pap test. CONCLUSIONS: The results of this study suggest that, as part of a comprehensive cancer screening strategy, women who are unlikely to obtain a Pap smear might benefit from targeted interventions to improve adherence to cervical cancer screening programs.

Adolescent↗
PubMed1986

Southern Appalachia: analytical models, social services, and native support systems.

It is argued that the analysis of social services in southern Appalachia benefits more from a model based on ethnicity than on more commonly used models based on lower socioeconomic status or rural residence. A theoretical model of ethnicity is generated which covers structural, cultural, and symbolic aspects. Results of an exploratory study of ethnic differences between Appalachians and non-Appalachians in a mountainous North Carolina county are presented which lend validity to the ethnicity model.

Appalachian Region↗
PubMed1989

Seasonality of birth in schizophrenia. An insufficient stratification of control population?

The seasonality of birth in 142 schizophrenics from Barcelona (Spain) has been studied, showing a pattern similar to that described by other authors, with a maximum in winter. If sample is compared with the local general population there are significant differences, but these disappear when the comparison is made with a control population properly stratified by age, sex, place of birth, place of residence and social status. The same results are obtained using statistical methods suggested by other authors. The seasonality pattern usually obtained in schizophrenia could be due to a selective stratification of the ill population based on variables that might or might not be related to illness.

Adolescent↗
PubMed1984

Large-bowel malignancy. Epidemiology and gut motility studies in South Asia.

Two hundred thirty-two cases of colorectal malignancy were studied between January 1975 and March 1981. The material was analyzed with respect to various epidemiologic features such as age, sex, residence, religion, socioeconomic status, diet, bowel habits, site of bowel involved, acute obstructive symptoms, and histopathology. The disease afflicted predominantly old people but at an age earlier than is reported in most western studies. Rectal cancer was more common in males, while colonic cancer involved the two sexes equally. Acute large-bowel obstruction was found in 19.4 per cent of patients. The rectum was the most common site (41.8 per cent). Of all the colonic malignancies, 63.4 per cent were in the right colon. Simultaneously, normal gut transit studies using radiopaque markers were conducted in 30 healthy volunteers. The colonic transit rate was 3.09 cm/hour. The markers had a faster gut transit but, interestingly, exhibited pronounced stasis in the right colon, which correlates well with the significantly higher incidence of right-sided malignancy.

Adolescent↗
PubMed2005

The effects of a National Breast and Cervical Cancer Early Detection Program on social disparities in breast cancer diagnosis and treatment in Massachusetts.

OBJECTIVE: To assess social disparities in breast cancer diagnosis and treatment by comparing the stage at diagnosis and treatment of women diagnosed with breast cancer through a National Breast and Cervical Cancer Early Detection Program (NBCCEDP) for low income and uninsured women in Massachusetts, the Women's Health Network (WHN), to other breast cancer patients in the state. METHODS: We linked data from the WHN and the Massachusetts Cancer Registry (MCR). We compared 331 WHN women and 13,372 other breast cancer patients in Massachusetts diagnosed from 1995 to 1999. We used logistic regression, controlling for age, race/ethnicity, marital status, region of residence, and stage, where appropriate. RESULTS: Compared to other breast cancer patients reported to the MCR, WHN women were just as likely to be diagnosed at an advanced stage (III or IV), treated with surgery, chemotherapy, and hormone therapy, and treated with complete mastectomy versus partial mastectomy. WHN women were less likely to receive radiation therapy (odds ratio = 0.7; 95% confidence interval = 0.6-0.9), particularly after partial mastectomy, and had a slightly longer time from diagnosis to treatment than other breast cancer patients (p < 0.01). CONCLUSIONS: Women diagnosed with breast cancer through a NBCCEDP in Massachusetts had similar stage and treatment patterns as other breast cancer patients in the state, except for the use of radiation therapy.

Adult↗
PubMed1990

Determinants of placement for sexually abused children.

While conducting a prospective study of 100 sexually abused children, we found a much higher rate of out-of-home placement than has been previously described for child maltreatment. This study was designed to determine which factors were most influential in predicting the placement experiences of this cohort. The children, ages 6-17 years, were recently substantiated victims of intrafamilial sexual abuse whose parents or guardians permitted study involvement. We examined child and family demographics, abuse characteristics, and family response as possible determinants of immediate and later placement. At the initial assessment, within a few weeks of the disclosure, 50% of the children had already been removed. A follow-up assessment of 83 children two years later revealed that 73% had been removed from the abusing home. In a multivariate regression model, only maternal support of the child emerged as a significant predictor of immediate placement and placement over time. The offender's status as a resident in the child's home was an important predictor of immediate placement but was not significant as a predictor of all placements at any time. As maternal support is an important predictor of the need for placement, workers are encouraged to seek ways of enhancing maternal support as a means of reducing placement.

Adolescent↗