Regional socioeconomic disparities in outcomes for workers with low back pain in the United States

Background

Although regional socioeconomic (SE) factors have been associated with worse health outcomes, prior studies have not addressed important confounders or work disability.

Methods

A national sample of 59 360 workers’ compensation (WC) cases to evaluate impact of regional SE factors on medical costs and length of disability (LOD) in occupational low back pain (LBP).

Results

Lower neighborhood median household incomes (MHI) and higher state unemployment rates were associated with longer LOD. Medical costs were lower in states with more workers receiving Social Security Disability, and in areas with lower MHI, but this varied in magnitude and direction among neighborhoods. Medical costs were higher in more urban, more racially diverse, and lower education neighborhoods.

Conclusions

Regional SE disparities in medical costs and LOD occur even when health insurance, health care availability, and indemnity benefits are similar. Results suggest opportunities to improve care and disability outcomes through targeted health care and disability interventions.     

Using financial incentives to attract medical residents to the periphery: The Israeli experience

Background

In 2011, Israel instituted financial incentives as part of a larger program to attract doctors to residency programs in peripheral hospitals.

Postgraduate medical training and migration in Europe: a survey of financial and labour conditions

Background and introduction  

Resident medical training following medical school is a period of great importance in the instruction and education of young physicians, but also the first step into the labour market for doctors. Unfortunately, the long educational curricula as well as the low economic remuneration render medical training attractive only in some European countries: often low salaries accompany endless weekly working hours with a wide range of differences among the European countries. The aim of this study was to analyse the different economic conditions for resident trainees by reporting the different salaries and the weekly burden of working hours, and also comparing the different costs of living in eight European countries and in Israel.     

The fate of medical students with different levels of knowledge: Are the basic medical sciences relevant to physician competence?

Purpose — This study was designed to test the hypothesis that an early gap in knowledge of sciences basic to medicine could have a sustained negative effect throughout medical school and beyond.Method — A longitudinal prospective study of 4,437 students who entered Jefferson Medical College between 1972 and 1991 was conducted in which the students were divided into three groups. Group I consisted of 392 who failed at least one of the basic sciences courses in the first year of medical school, Group II was comprised of 398 who did not fail but had low first-year grade-point averages; and 3,647 of the remaining sample were included in Group III. The groups were compared on retention and dismissal rates, medical school assessment measures, scores on medical licensing examinations, ratings of clinical competency in residency, board certification rates, and faculty appointments.Results — Significant differences were observed among the three groups confirming the hypothesis that students' level of knowledge in sciences basic to medicine early in medical school could predict later performance during medical school and beyond. Implications for early diagnosis of academic deficiencies, in better preparation of medical students, and in the assessment of clinical competency are discussed.     

Comparing United States versus international medical school graduate physicians who serve African- American and White elderly

OBJECTIVE: To examine the relationship that international medical school graduates (IMGs) in comparison with United States medical school graduates (USMGs) have on health care-seeking behavior and satisfaction with medical care among African-American and white elderly. DATA SOURCES: Secondary data analysis of the 1986-1998 Piedmont Health Survey of the Elderly, Established Populations for the Epidemiological Study of the Elderly, a racially oversampled urban and rural cohort of elders in five North Carolina counties. STUDY DESIGN: Primary focus of analyses examined the impact of the combination of elder race and physician graduate status across time using a linear model for repeated measures analyses and chi2 tests. Separate analyses using generalized estimating equations were conducted for each measure of elder characteristic and health behavior. The analytic cohort included 341 physicians and 3,250 elders (65 years old and older) in 1986; by 1998, 211 physicians and 1,222 elders. DATA COLLECTION/EXTRACTION METHODS: Trained personnel collected baseline measures on 4,162 elders (about 80 percent responses) through 90-minute in-home interviews. PRINCIPAL FINDINGS: Over time, IMGs treated more African-American elders, and those who had less education, lower incomes, less insurance, were in poorer health, and who lived in rural areas. White elders with IMGs delayed care more than those with USMGs. Both races indicated being unsure about where to go for medical care. White elders with IMGs were less satisfied than those with USMGs. Both races had perceptions of IMGs that relate to issues of communication, cultural competency, ageism, and unnecessary expenses. CONCLUSION: IMGs do provide necessary and needed access to medical care for underserved African Americans and rural populations. However, it is unclear whether concerns regarding cultural competency, communication and the quality of care undermine the contribution IMGs make to these populations.     

‘Understanding Disability’: Evaluating a contact-based approach to enhancing attitudes and disability literacy of medical students

Background

Health disparities and disparities in the provision of healthcare to people with disabilities remains a topic of concern. Research demonstrates that attitudes of healthcare providers contribute to this disparity. The approach to disability education and training in medical school warrants evaluation.

Perceptions of Greek medical students regarding medical profession and the specialty selection process during the economic crisis years

Purpose

To assess the beliefs and preferences of 6th year Greek medical students, regarding medical profession and the specialty selection process, in the years of financial crisis.

Setting

Democritus University of Thrace, Medical School, Alexandroupolis, Greece.

Material and methods

A custom questionnaire based on former similar studies was developed and administered to senior medical students. Further to demographics, the questionnaire gathered information on perceptions and trends regarding medical profession, the specialty and residency selection processes. Total question scores were summed for comparisons among questions. Mean scores and standard deviations were calculated for comparisons between student groups.

Results

111 students responded successfully to the instrument. “Helping patients” and the “scientific basis of medicine” were the fundamental reasons for choosing the medical profession. Compared to women, male students placed greater importance on the “financial allowances” (men: 3.73 ± 1.03, women: 3.05 ± 1.30, p = 0.01). Regarding the selection criteria for a certain specialty, “challenging specialty” and “bedside specialty”, were the main influence factors. Men more strongly preferred a specialty that could “financially support their desired lifestyle” (men: 3.93 ± 0.88, women: 3.41 ± 1.30, p = 0.02). Concerning selection criteria of a residency program, students chose a “well structured” program at a “recognized hospital/department”. Regarding the country of preference for their residency, 86% planned to continue abroad, primarily in Germany and the United Kingdom.

Conclusion

Greek medical students perceive the medical profession and the specialty process in a similar way like their colleagues form Western countries. However, the vast majority identify that migration to another country is the most promising alternative choice for their medical career.     

Stress,Anxiety, and Weight Gain among University and College Students: A Systematic Review

Background

Stress and anxiety levels are elevated among university and college students. Although high stress levels can lead to an increase in adiposity, it is not clear whether stress and anxiety experienced when in university or college have an influence on students’ weight.

Temporal and spatial variation of heat-related illness using 911 medical dispatch data

Background

The adverse effect of hot weather on health in urban communities is of increasing public health concern, particularly given trends in climate change.

Objectives

To demonstrate the potential public health applications of monitoring 911 medical dispatch data for heat-related illness (HRI), using historical data for the summer periods (June 1-August 31) during 2002-2005 in Toronto, Ontario, Canada.

Methods

The temporal distribution of the medical dispatch calls was described in relation to a current early warning system and emergency department data from the National Ambulatory Care Reporting System (NACRS). Geospatial methods were used to map the percentage of heat-related calls in each Toronto neighborhood over the study period.

Results

The temporal pattern of 911 calls for HRI was similar, and sometimes peaked earlier, than current heat health warning systems (HHWS). The pattern of calls was similar to NACRS HRI visits, with the exception of 2005 where 911 calls peaked earlier. Areas of the city with a relatively higher burden of HRI included low income inner-city neighborhoods, areas with high rates of street-involved individuals, and areas along the waterfront which include summer outdoor recreational activities.

Conclusions

Identifying the temporal trends and geospatial patterns of these important environmental health events has the potential to direct targeted public health interventions to mitigate associated morbidity and mortality.     

Early Elective Delivery Disparities between Non-Hispanic Black and White Women after Statewide Policy Implementation

Background

In 2011, Oregon implemented a policy that reduced the state's rate of early (before 39 weeks' gestation) elective (without medical need) births.

Physician Racial Bias and Word Use during Racially Discordant Medical Interactions

Physician racial bias can negatively affect Black patients’ reactions to racially discordant medical interactions, suggesting that racial bias is manifested in physicians’ communication with their Black patients. However, little is known about how physician racial bias actually influences their communication during these interactions. This study investigated how non-Black physicians’ racial bias is related to their word use during medical interactions with Black patients. One hundred and seventeen video-recorded racially discordant medical interactions from a larger study were transcribed and analyzed using Linguistic Inquiry and Word Count (LIWC) software. Physicians with higher levels of implicit racial bias used first-person plural pronouns and anxiety-related words more frequently than physicians with lower levels of implicit bias. There was also a trend for physicians with higher levels of explicit racial bias to use first-person singular pronouns more frequently than physicians with lower levels of explicit bias. These findings suggest that non-Black physicians with higher levels of implicit racial bias may tend to use more words that reflect social dominance (i.e., first-person plural pronouns) and anxiety when interacting with Black patients.     

The role of anxiety symptoms in school performance in a community sample of children and adolescents

Background  

Anxiety symptoms are relatively common among children and adolescents and can interfere with functioning. The prevalence of anxiety and the relationship between anxiety and school performance were examined among elementary, middle, and high school students.     

Exploring the Social-Ecological Determinants of Physical Fighting in U.S. Schools: What about Youth in Immigrant Families?

Background

Despite the growing presence of immigrant families in the US, little is known about physical fighting in school among youth from those families.

Objective

The present study examines the social-ecological determinants of school physical fighting among youth in immigrant families. Implications for practice are also discussed.

Method

Using the Children of Immigrants Longitudinal Study data set, the study sample consisted of 4288 immigrant students in 9th–12th grade. Models were estimated using multivariate logistic regression. Variables in the individual, family, friend/peer, and school contexts were included by fitting four hierarchical logistic models to the data.

Results

Results indicated that youth in immigrant families who are males, in lower grade level, racial/ethnic minorities, and of low family socio-economic status (individual) were likely to engage in physical fights. Youth in immigrant families who feel detached from their parents (family); speak another language with friends (friend/peer); and perceive school discipline to be unfair, feel discriminated against by teachers, and who perceive school crimes to be a problem (school) are also at an elevated risk of physical fights.

Conclusion

Findings from the study contribute to a growing body of research on youth in immigrant families.

     

Effects of an Afterschool Early Literacy Intervention on the Reading Skills of Children in Public Housing Communities

Background

Afterschool programs (ASPs) in the United States have been implemented in low income neighborhoods to enable at-risk youth to access educational support services to increase academic skills. However, mixed findings about the ASPs positively affecting academic performance suggests a need for additional evaluative studies.

Objective

The current study examines the effects of literacy training on the reading skills of kindergarten to third grade students who were enrolled in a community-based ASP in four public housing neighborhoods. Participants received structured literacy and reading training, individual tutoring, and a choice-based book distribution program.

Method

Assignment to treatment and comparison groups was based on residence in public housing neighborhoods. We implemented a quasi-experimental design to compare improvements in reading proficiency among ASP literacy program participants in four public housing neighborhoods and a comparable group of students residing in two other public housing neighborhoods without this ASP. Participants were enrolled in grades K to 3 (n = 543). The study lasted for 4 years, and an intent-to-treat approach was used to analyze outcomes.

Results

Mixed-effects models indicated that among a full sample and propensity-score matched sample, ASP participants demonstrated significantly better reading proficiency than comparison group participants over time.

Conclusions

Study findings provide preliminary evidence that it is possible to impact reading proficiency for very high-risk students in the early grades of elementary school. ASPs that target literacy among low-income students could play an important role in boosting student achievement, and therefore in narrowing the achievement gap as young people progress through school.

     

Mobile phone messages to provide support to women during the home phase of medical abortion in South Africa: a randomised controlled trial

Objectives

Home use of misoprostol for medical abortion is more convenient for many women than in-clinic use but requires management of abortion symptoms at home without provider backup. This study evaluated whether automated text messages to women undergoing medical abortion can reduce anxiety and emotional discomfort, and whether the messages can better prepare women for symptoms they experience.

Study design

A multisite randomized controlled trial was conducted in which women undergoing early medical abortion were allocated to receive standard of care (SOC) only (n=235) or SOC+a messaging intervention (n=234). Consenting women were interviewed at the clinic after taking mifepristone and again at their follow-up clinic visit 2–3 weeks later; the intervention group received text messages over the duration of this period. Emotional outcomes were evaluated using the Hospital Anxiety and Depression Scale, Adler's 12-item emotional scale and the Impact of Event Scale-Revised. Preparedness for the abortion symptoms and overall satisfaction with the procedure were assessed using 4-point Likert-type scales.

Results

Between baseline and follow-up, anxiety decreased more (p=0.013), and less emotional stress was experienced (adjusted for baseline anxiety, p=0.015), in the intervention compared to the SOC group. Participants in the intervention group were also more likely to report that they felt very well prepared for the bleeding (p<0.001), pain (p=0.042) and side effects (p=0.027) they experienced. Acceptability and other negative emotions relating to the abortion did not differ between study groups. Ninety-nine percent of the intervention group stated that they would recommend the messages to a friend having the same procedure.

Conclusions

Text messages to women following mifepristone administration for early medical abortion may assist them in managing symptoms and appear highly acceptable to recipients.

Implication Statement

This randomized controlled trial provides evidence for the effectiveness of text messages following mifepristone administration in strengthening medical abortion care. The messages were associated with significant reductions in women's anxiety and stress during the abortion process; they improved preparedness for the abortion symptoms experienced and appeared highly acceptable.     

Reasons and outcomes of admissions to the medical wards of jimma university specialized hospital, southwest ethiopia

Background

Non-communicable diseases are the main reasons for admission to the medical wards in high-income countries. While in low and middle income countries communicable diseases are the main reasons for admission to the medical wards. However, in some low and middle income countries the reasons for admission are changing from communicable diseases to non-communicable diseases. But, data on reasons for admission to the medical wards of low income countries is scarce. Therefore, this study takes one year data from a low income country referral hospital aiming at describing the recent reasons and outcomes of medical admissions to see whether there is a change in reasons for admission and the outcome.

Methods

A retrospective study examined patient case notes and ward registration books of medical admissions at Jimma University Specialized Hospital from January 1, 2008 to December 31, 2008. Socio-demographic variables, reasons and outcomes of admission were some of the variables recorded during the data collection. The International Statistical Classification of Disease was used for sorting and categorizing the diagnosis. The data was then analyzed using SPSS windows version 13.0.

Result

A total of 610 patient case notes were reviewed. The mean age of the patients was 36 years (SD ± 15.75). The highest number of admissions 218 (35.7%) was among the age groups 21 to 30 years. Communicable diseases; namely severe community acquired pneumonia 139(22.8%), all infectious and parasitic diseases category 100 (16.4%), and pyogenic as well as chronic meningitis 80(13.1%) were the most common reasons for admission. The death rate among patients admitted to the medical wards was 12.6%.

Conclusions

Communicable diseases were still the common reasons for medical admissions at Jimma University Specialized Hospital. The outcome of medical admissions has not changed over sixteen years.     

Characteristics of graduating medical students who were matched and unmatched to hospital training posts

The purpose of this paper is to examine similarities and differences between graduating medical students who do and do not match through the National Internship and Resident Matching Programme (NIRMP). Data from graduates of 3- and 4-year undergraduate curricula were examined separately. A two way analysis of variance was used; the two independent variables were (1) whether the student was a 3- or 4-year medical graduate, and (2) the students' matched vs unmatched status. The dependent variables used in this study were in the following five categories: (1) demographic and academic performance upon entrance to medical school, (2) academic performance during medical school, (3) future practice preferences projected during medical school, (4) internship/residency choices, and (5) clinical performance during internship/residency. On the basis of the data presented, it is clear that there are few differences between matched and unmatched students that could be detected in over seventy-five measures examined. Within the unmatched group, however, the 3-year graduates differ in some respects from their 4-year colleagues. It is likely, therefore, that a different constellation of factors appears to be operating in these two unmatched groups but not within the matched groups.