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PubMed1995

Emergency medicine resident moonlighting: a survey of program directors. CORD Task Force on Resident Moonlighting.

OBJECTIVES: 1) To systematically describe emergency medicine (EM) program directors' perceptions of the benefits and risks of resident moonlighting. 2) To assess moonlighting policies of EM residencies, the degree of compliance with these policies, and the methods of dealing with residents who are out of compliance. METHODS: A written survey was mailed or hand-delivered to all allopathic and osteopathic EM residency directors in the United States in 1992-93. Incomplete and ambiguous surveys were completed by phone. RESULTS: There was a 96% response rate (113/118). The average EM resident clinical workweek ranged from 38 to 50 hours while the resident was assigned to ED rotations. Most (90%) of the program directors believe moonlighting interferes with residency duties to some degree. Few (10%) programs prohibit moonlighting altogether, although 44% limit moonlighting to an average of 41.5 hours per month. Program directors believe residents moonlight primarily for financial reasons. Most (60%) of the program directors believe moonlighting offers experience not available in the residency, primarily related to autonomous practice. Fifteen programs reported residents who had been sued for malpractice while moonlighting, with one program director named along with the resident. One third of program directors have penalized residents for abuse of moonlighting privileges. CONCLUSIONS: EM residency directors are concerned about the effect of moonlighting on resident education. The directors' concerns regarding litigation, excessive work hours, and interference with residency duties are balanced by a general acceptance of the financial need to supplement residency income.

Adult↗
PubMed1999

Influence of the home environment on the development of obesity in children.

CONTEXT: Obesity is the most common health problem facing children. The most recent data from the National Health and Nutrition Examination Survey III suggest that 22% of children and adolescents are overweight and that 11% are obese. OBJECTIVE: To investigate prospectively the association between the home environment and socioeconomic factors and the development of obesity in children. DESIGN: Prospective cohort study. SETTING: The National Longitudinal Survey of Youth. Population. A total of 2913 normal weight children between the ages of 0 and 8 years were followed over a 6-year period. We examined the roles of race, marital status, maternal education, family income, and parental occupation, as well as standardized measures of the home environment (The Home Observation for Measurement of the Environment [HOME]-Short Form) on the development of childhood obesity. PRIMARY OUTCOME MEASURE: Incidence of obesity. Obesity was defined as a body mass index >95th percentile for age and gender at the 6-year follow-up. RESULTS: Maternal obesity was the most significant predictor of childhood obesity (OR: 3.62 [2. 65-4.96]). The HOME-Short Form cognitive scores and household income were also significant predictors of childhood obesity (OR, low HOME-cognitive: 2.64 [1.48-4.70], medium HOME-cognitive: 2.32 [1. 39-3.88]; low income: 2.91 [1.66-5.08], medium income: 2.04 [1.21-3. 44]). Children who lived with single mothers were also significantly more likely to become obese by the 6-year follow-up, as were black children, children with nonworking parents, children with nonprofessional parents, and children whose mothers did not complete high school. Neither the child's gender nor the HOME-emotional scores contributed to the development of obesity. After controlling for the child's initial weight-for-height z-score, maternal body mass index, race, marital status, occupation, education, and HOME emotional scores, only the HOME cognitive score and family income remained significant predictors of childhood obesity. CONCLUSION: Children with obese mothers, low family incomes, and lower cognitive stimulation have significantly elevated risks of developing obesity, independent of other demographic and socioeconomic factors. In contrast, increased rates of obesity in black children, children with lower family education, and nonprofessional parents may be mediated through the confounding effects of low income and lower levels of cognitive stimulation.

Chi-Square Distribution↗
PubMed2004

A study of ocular infections amongst primary school children in Delhi.

The present study of ocular infections was conducted amongst primary school children residing in an urban slum and rural area of Delhi. A total of four schools were selected, two from urban slum in Central Delhi Rouse Avenue and two from a peripheral village on the outskirts of Delhi. All the children studying in the above mentioned schools and residing in the same area were covered. All the study subjects were interviewed, clinically examined and given a proforma to be filled by their parents. Of the total 775 subjects only 91 (11.74%) had ocular infections. Conjunctivitis was the most prevalent infection followed by trachoma, stye, blepharitis and chalazion. The type and prevalence of infection was similar, in both sexes and both areas, rural and urban. There was a significant rising trend of ocular infection with increase in age. A significant association was found between ocular infections and religion but the association with per capita income was not significant.

Adolescent↗
PubMed1992

Helmets! All the pros wear them.

OBJECTIVE: To assess the outcome of a multidisciplinary community campaign to increase helmet use and determine the success of a school education and helmet distribution program. DESIGN: Survey research. SETTING: Large metropolitan area and two elementary schools. PARTICIPANTS: Five hundred representative families in a metropolitan area and students enrolled in two elementary schools. INTERVENTIONS: A 1-year-long regional media campaign and a helmet distribution program in one elementary school after 4 weeks of safety instruction. RESULTS: Evaluation of the community component 1 year after initiation of the campaign revealed a 23% awareness of the promotion. Factors associated with wearing a helmet in the community included higher income levels, higher level of education, and male sex. The school component survey revealed that 73% of the children in school A reported helmet use vs 23% in school B. This multifaceted approach to affect helmet use demonstrated variable success in our community. CONCLUSION: This campaign effort achieved its greatest success in promoting community awareness of the importance of helmet use. However, further studies need to be performed to determine the success of the school education and helmet distribution program.

Bicycling↗
PubMedDate not supplied

The epidemiology of Kawasaki disease in an urban hospital: does African American race protect against coronary artery aneurysms?

The etiology and pathogenesis of Kawasaki disease (KD) is largely unknown. Certain demographic factors and laboratory findings are predictive of the development of coronary artery (CA) aneurysms. The objectives of this study were to determine the epidemiology of KD patients in an urban hospital and determine risk factors associated with their development of CA abnormalities. A longitudinal case series of KD patients admitted to Children's National Medical Center from 1990 to 2002 was examined. Age, sex, ethnic background, duration of fever prior to diagnosis, address, month diagnosed, and CA abnormalities (ectasia or aneurysms) on echocardiography were recorded. Median household income was obtained from the U.S. Census Bureau Web site. The Student t-test, logistic regression analyses, and the Kruskal-Wallis test were used, with significance assumed at p < 0.05. A total of 302 patients were evaluated. CA abnormalties were found in 27 patients (9%), with aneurysms identified in 13 patients (4%). Age was 2.9 +/- 2.4 years (range, 2 months to 14 years). A total of 51 patients (16%) were < or =1 year and 35 patients (12%) were > or =5 years. Ethnic distribution was 54% (164) African American, 24% (72) Caucasian, 9% (29) Asian/Pacific Islander, 8% (23) Hispanic, and 5% (14) Middle Eastern. Only 2/164 (1.2%) African Americans developed CA aneurysms. Neighborhood median income of the cohort was $45,400 +/- $21,200 ($52,200 +/-$25,800 for patients with aneurysms). A total of 28% of cases clustered between December and January. Cases doubled annually in 1999-2001 compared to 1990-1998 (39 vs 19). Multivariate logistic regression found age between 1 and 5 years [p = 0.045; odds ratio, 0.31; 95% confidence interval (CI), 0.10-0.97] and African American race (p = 0.014; odds ratio, 0.15; 95% CI, 0.03-0.68) to be independently protective against CA aneurysms. Duration of fever prior to diagnosis, considered in 210 patients, was different between patients with and without aneurysms (11 +/- 5.3 vs 6.5 +/- 3.8 days, respectively, p = 0.0007). Multivariate logistic regression found fever longer than 5 days to be the only predictive factor associated with the development of aneurysms and any abnormality. African Americans had a shorter duration of fever than the rest of the cohort (6.03 vs 7.31 days), (p = 0.0087). The epidemiology of KD at our hospital is similar to that at other centers except for the predominance of African Americans with a shorter duration of fever prior to diagnosis and a decreased incidence of CA aneurysms compared to other ethnicities. The protective nature of African American ethnicity against the development of CA aneurysms raises speculation about the role of genetics and its interaction with immunity in the pathogenesis of KD.

Adolescent↗
PubMed2000

Public awareness, information sources and evaluation of oral implant treatment in Norway.

A nation-wide survey from a representative sample of the general Norwegian population was made in co-operation with Statistics of Norway, to assess public awareness, sources of information and evaluation of oral implants. A response rate of 70.8% was obtained. Of the general population 70.1% (95% confidence interval: 68.6-71.6%) had heard of oral implants. No specific demographic variables were associated with unawareness of oral implants. Of the general population 60.4% (95% confidence interval: 57.9-62.8%) evaluated oral implants positively and 56.7% (95% confidence interval: 54.7%-58.7%) would consider oral implants as treatment for themselves if needed, while 18.0% gave negative evaluation and 23.0% would not consider implant treatment. Logistic regression analyses indicated that young males in urban areas with high income and high educational level were most positive to oral implants. News media like newspapers and TV/radio were together with personal communications the most frequently indicated sources of information. News media were associated with negative evaluation of implants. The overall positive evaluation of oral implants suggests however that the Norwegian general public utilises several sources of information, and are able to evaluate them critically.

Adolescent↗
PubMed1997

The work incapacity and reintegration study: results of the initial survey conducted in the United States.

The United States and six other countries (Germany, Denmark, Norway, Sweden, Israel, and the Netherlands) are participating in a cross-national study of work incapacity and reintegration under the auspices of the International Social Security Association. The purpose of the study is to identify those medical and nonmedical interventions that are most successful in helping persons disabled due to a back condition return to work. The study involves a baseline survey and two follow-up surveys over approximately 2 years. This article reports on the findings from the baseline survey conducted in the United States. It compares the responses of persons from four study groups (the Social Security Administration's Disability Insurance (DI) beneficiaries and Supplemental Security Income (SSI) recipients, and temporary disability insurance (TDI) recipients from two States--California and New Jersey). The article discusses the potential influence of certain characteristics on the capacity for work reintegration. Study findings suggest that the characteristics of TDI recipients with back disorders may differ in some respects from those of recently entitled DI or SSI beneficiaries with similar impairments, and that there may be some correlation between work resumption and factors such as education occupation, work-related demands, and the presence of other chronic diseases.

Adult↗
PubMedDate not supplied

Retinotopic organization of the superior colliculus in relation to the retinal distribution of afferent ganglion cells.

Sensory representations in the brain exhibit topographic variations in magnification. These variations have been thought to reflect regional differences in the density of innervation at the sensory receptor surface. In the primate visual cortex, for example, local magnification factors have been reported to be proportional to the corresponding densities of retinal ganglion cells. We sought to learn whether this principle also operates in a second major retinofugal pathway--the projection to the superior colliculus. In cats, we first used retrograde transport to determine the retinal distributions of the ganglion cells that project to the colliculus. Then, we compared the numbers of colliculopetal ganglion cells in selected retinal sectors to the areas of the corresponding collicular representations. Collicular areal magnification was not simply proportional to the density of afferent ganglion cells, being instead at least 5-fold greater than expected in the representation of the central visual field. These data imply that incoming retinal afferents are more widely spaced in the central regions of the tectal map than in the map's periphery. Such variations in afferent density appear to play as large a role as the distribution of ganglion cells in determining the metric of the collicular map.

Afferent Pathways↗
PubMed1997

Nonprescription bronchodilator medication use in asthma.

STUDY OBJECTIVE: Many persons with asthma self-medicate with widely available and potentially hazardous nonprescription medicines. This study assessed the demographic and clinical covariates of self-treatment with over-the-counter asthma medications (OTCs). DESIGN AND SETTING: We conducted an analytical investigation using questionnaires and measures of lung function, comparing OTC and prescription medication users. We recruited adults with asthma by public advertisement. SUBJECTS: We studied 22 exclusive prescription asthma medication users, 15 exclusive OTC users, and 13 other subjects who combined prescription medication use with self-treatment with asthma OTCs. All but one OTC user self-medicated with a nonselective, sympathomimetic metered-dose inhaler. RESULTS: Taking income, access to care, and self-assessed disease severity into account, male gender was strongly associated with exclusive OTC use alone (odds ratio [OR]=8.9, 95% confidence interval [CI]= 1.3 to 61) and mixed OTC-prescription medication use (OR=9.7, 95% CI=1.1 to 83). The covariates of income, access to care, and self-assessed disease severity provided significant additional explanatory power to the model of exclusive OTC use (model chi2 difference 11.3, 5 df, p<0.05). Pulmonary function was similar among OTC and prescription medication users. However, prescription medication users' self-assessed asthma severity (mild compared to more severe) was associated with postbronchodilator reversibility of FEV1 obstruction (6% vs 18% reversibility, p<0.05) while exclusive OTC users' self-assessed severity showed the reverse pattern (19% vs 8%, p=0.2). CONCLUSION: Asthma education programs attempting to discourage unregulated bronchodilator use should give consideration to this profile of the "asthmatic-at-risk."

Adult↗
PubMed1982

Signal processing electronics for multiple electronic and optical measurements on cells.

Processing electronics for flow cytometry applications requiring simultaneous or sequential analysis of multiple electrical and optically sensed signals has been developed. A maximum of six analog signals are input to the processor. A measurement mode selector determines what signals are to be analyzed and the initial timing sequence of sense gates for acquiring signal crest values. Processor signal-triggering and sense gate time delays are selectable. Logic coincidence-anticoincidence circuits determine constraints on incoming signals. Gated peak-sense and hold signals are routed to computer interface electronics for digitizing and are then displayed as frequency distribution histograms using an LSI-11 computer. Signals also are processed as single parameters, ratios, and gated single parameters for output to a multichannel pulse-height analyzer and cell sorting electronics. The functional features of the processor are described along with examples illustrating simultaneous and sequential analysis of cultured cells stained with fluorescent dyes.

Animals↗
PubMed2001

"These young chaps think they are just men, too": redistributing masculinity in Kgatleng bars.

In the 19th century the BaKgatla polity was a chiefdom with a redistributional economy based on mixed agriculture. Sorghum beer was symbolic not only of the patrilineal core of their descent system and of the ideologies of reciprocity and redistribution, but also of masculinity and patriarchal control. With the establishment of a market economy, an industrial brewery and individual access to income, both beer and the act of drinking have been symbolically reconstructed. The ideology of redistribution was well suited to the support of the BaKgatla gerontocracy via alcohol production and consumption. The limits on production and consumption of beer inherent in the agricultural cycle and the control of young men's access by elders made alcohol an effective symbol of managerial competence from the limited context of household authority to that of the chiefdom as a whole. Today, young men's greater control of cash income has given them access to beer beyond the control of elders. As a result, the contrasting ideology of market exchange and competitive distribution of beer has contributed to the degradation of the power of seniors. After reviewing the historical background, this paper explores those changes. It argues that while the observed infrastructural changes have had a predictable impact on drinking behaviors and the symbolic structure of "seniority/masculinity", constructions of the "masculine community" in BaKgatla bars demonstrate continuity in key areas of mens' identities. If as anthropologists we see obvious discontinuities in behavior and ideology, the BaKgatla build selective bridges to "tradition" which seemingly ground the experience of change in relatively seamless continuity.

Adult↗
PubMed1999

Temporal dissociation of parallel processing in the human subcortical outputs.

Many tasks require rapid and fine-tuned adjustment of motor performance based on incoming sensory information. This process of sensorimotor adaptation engages two parallel subcorticocortical neural circuits, involving the cerebellum and basal ganglia, respectively. How these distributed circuits are functionally coordinated has not been shown in humans. The cerebellum and basal ganglia show very similar convergence of input-output organization, which presents an ideal neuroimaging model for the study of parallel processing at a systems level. Here we used functional magnetic resonance imaging to measure the temporal coherence of brain activity during a tactile discrimination task. We found that, whereas the prefrontal cortex maintained a high level of activation, output activities in the cerebellum and basal ganglia showed different phasic patterns. Moreover, cerebellar activity significantly correlated with the activity of the supplementary motor area but not with that of the primary motor cortex; in contrast, basal ganglia activity was more strongly associated with the activity of the primary motor cortex than with that of the supplementary motor area. These results demonstrate temporally partitioned activity in the cerebellum and basal ganglia, implicating functional independence in the parallel subcortical outputs. This further supports the idea of task-related dynamic reconfiguration of large-scale neural networks.

Basal Ganglia↗
PubMed1998

Assessment of dietary zinc in a population.

Assessment of dietary zinc status in a population requires several steps, consisting of the measurement of food intake distributions in the population; the analysis of local staple foods, from which zinc intake distributions can be determined, and the comparison of zinc intakes with requirement estimates to determine the risk of inadequate intakes. In low-income countries, these steps may be complicated by the lack of preexisting food-composition data, variations in food preparation methods, inhibition of absorption by other compounds in the diet, and variations in intake among seasons, individuals, and populations. Different techniques for determining the adequacy of zinc intake are compared. Whereas the techniques described in this paper allow for the determination of probability estimates for risk of zinc inadequacy, they do not allow for the identification of actual individuals in a population who are zinc deficient, or define the severity of zinc inadequacy. This information is vital, especially in areas where zinc deficiency is but one of many health problems, and can be obtained only from more detailed biochemical and physiologic studies of zinc status.

Biological Availability↗
PubMedDate not supplied

United States Spanish short-form-36 health survey: scaling assumptions and reliability in elderly community-dwelling Mexican Americans.

BACKGROUND: Measuring health status is challenging in Mexican Americans and other diverse groups, because most health measurement instruments were developed and tested in English. Thus, it is difficult to determine whether measured health disparities are the result of actual differences or due to measurement error resulting from translation or conceptual differences. OBJECTIVES: The purpose of this study was to test the metric equivalence of the United States (US) Spanish Short-Form-36 Health Survey (SF-36) in a group of elderly Mexican Americans. In addition, the SF-36 scores of elderly Mexican American women in our sample were compared with normed scores for the SF-36 scales in the general population of elderly US women. METHOD: Health status was measured by the US Spanish SF-36 in telephone surveys conducted entirely in Spanish. The sample (N = 65) was elderly (mean age 75.3) and primarily female (78%). Most had less than 7 years of education and an annual income below $10,000. RESULTS: Missing data were negligible, and did not indicate difficulty with particular items. The item response values were well distributed and item response means were generally similar within a scale. Most item correlations were higher with the item's hypothesized scale than with other scales, though some items in the Mental Health, Vitality, and Social Functioning scales were highly correlated with other scales. Internal consistency reliability (Cronbach alpha) was.80 or above on all scales except Social Functioning (.69). SF-36 scale scores were lower in elderly Mexican American women than in elderly women in the general US population. DISCUSSION: The US Spanish SF-36 was a generally satisfactory measure of health status in a sample of elderly Mexican Americans with little formal education. The performance of some items in the Mental Health, Vitality, and Social Functioning scales warrants further research.

Acculturation↗
PubMedDate not supplied

The transtheoretical model: gender differences across 3 health behaviors.

OBJECTIVE: To investigate gender differences in stage-of-change distribution, self-efficacy, and decisional balance, for 3 health behaviors. METHODS: Five hundred fifty-four (males = 107; females = 447) low-income, predominantly African American, patients completed stage-of- change, self-efficacy, and decisional balance scales for smoking cessation, exercise adoption, and dietary fat reduction. RESULTS: Males and females differ in stage of change for smoking and exercise, but not dietary fat intake. CONCLUSIONS: Gender-specific interventions may be needed to promote certain health behaviors but not others, and self-efficacy and decisional balance may be related differently to stage of change in low-income populations.

Adult↗
PubMed2000

Organization of ambulatory care provision: a critical determinant of health system performance in developing countries.

Success in the provision of ambulatory personal health services, i.e. providing individuals with treatment for acute illness and preventive health care on an ambulatory basis, is the most significant contributor to the health care system's performance in most developing countries. Ambulatory personal health care has the potential to contribute the largest immediate gains in health status in populations, especially for the poor. At present, such health care accounts for the largest share of the total health expenditure in most lower income countries. It frequently comprises the largest share of the financial burden on households associated with health care consumption, which is typically regressively distributed. The "organization" of ambulatory personal health services is a critical determinant of the health system's performance which, at present, is poorly understood and insufficiently considered in policies and programmes for reforming health care systems. This article begins with a brief analysis of the importance of ambulatory care in the overall health system performance and this is followed by a summary of the inadequate global data on ambulatory care organization. It then defines the concept of "macro organization of health care" at a system level. Outlined also is a framework for analysing the organization of health care services and the major pathways through which the organization of ambulatory personal health care services can affect system performance. Examples of recent policy interventions to influence primary care organization--both government and nongovernmental providers and market structure--are reviewed. It is argued that the characteristics of health care markets in developing countries and of most primary care goods result in relatively diverse and competitive environments for ambulatory care services, compared with other types of health care. Therefore, governments will be required to use a variety of approaches beyond direct public provision of services to improve performance. To do this wisely, much better information on ambulatory care organization is needed, as well as more experience with diverse approaches to improve performance.

Adult↗
PubMed1998

Overweight children and adolescents: description, epidemiology, and demographics.

We describe prevalence and trends in overweight among children and adolescents (6 to 17 years old) in the US population and variation in the prevalence by sex, age, race-ethnicity, income, and educational level. Height and weight were measured in nationally representative surveys conducted between 1963 and 1994: cycles II (1963 to 1965) and III (1966 to 1970) of the National Health Examination Survey (NHES) and the National Health and Nutrition Examination Surveys (NHANES I, 1971 to 1974; NHANES II, 1976 to 1980; and NHANES III, 1988 to 1994). Overweight was defined by the age- and sex-specific 95th percentile of body mass index (BMI) from NHES II and III. BMI values between the 85th and 95th percentiles were considered an area of concern, because at this level there is increased risk for becoming overweight. Approximately 11% of children and adolescents were overweight in 1988 to 1994, and an additional 14% had a BMI between the 85th and 95th percentiles. The prevalence of overweight did not vary systematically with race-ethnicity, income, or education. Overweight prevalence increased over time, with the largest increase between NHANES II and NHANES III. Examination of the entire BMI distribution showed that the heaviest children were markedly heavier in NHANES III than in NHES, but the rest of the distribution of BMI showed little change. Data are limited for assessing the causes of the rapid change in the prevalence of overweight. The increased overweight prevalence in US children and adolescents may be one manifestation of a more general set of societal effects. Childhood overweight should be addressed from a public health perspective.

Adolescent↗