Use of Standardized Patients to Evaluate the Physicians in Residence Program

Abstract

The purpose of this study was to evaluate the efficacy of the Physician in Residence (PIR) program at the Hazelden Residential Program of New York City as a substance abuse training approach using standardized patients (SP) and self-report ratings. Using an objective rating scale, two experienced drug counselors evaluated four videotaped interviews carried out by housestaff pre- and post-enrollment in the PIR program. In addition, housestaff completed self-report ratings regarding their knowledge, attitudes, and skills of substance abuse. Of the 23 housestaff who completed both pre- and post-PIR program videotape sessions, significant improvements were noted in both observer and self-reported ratings. Overall, self-report ratings showed a greater percent improvement than the counselor ratings. The PIR program may be an efficacious approach to teach substance abuse clinical skills to housestaff.     

International Abstracts

The goal of this study was to develop an understanding the developmental trajectory of smoking behaviors in adolescents who seek smoking cessation treatment to inform tailored prevention and treatment efforts; this includes identifying gender differences in smoking behaviors. Smoking trajectory was examined retrospectively in 639 treatment-seeking adolescents (59% female; 44% African American, 50% European American, mean ± SD daily cigarettes per day [CPD] 19.16 ± 7.2 for both girls and boys). Smoking trajectory variables examined included age at first cigarette, age at daily smoking (a proxy measure for onset of dependence), and age at treatment request. The time interval from first cigarette to daily smoking was shorter for girls than for boys (mean ± SD 0.9 ± 1.1 years for girls, 1.3 ± 1.5 years for boys, p < 0.01). From this clinical sample of adolescent smokers, findings suggest only a brief window of opportunity for secondary preventive interventions before the development of tobacco dependence. Additional research is needed to explore the specific factors that differentially affect smoking trajectory in girls compared to boys.     

Sexuality and gender: change through reflection and action

Gender and sexuality inequalities lie at the root of poor sexual and reproductive health (SRH). An India-based non-governmental organization (NGO) implemented a field-based methodology to integrate gender and sexuality into existing SRH projects in two states. Personal and organizational change occurred through critical analysis and experiential exercises which normalized topics on sexuality for program staff and communities. Staff learned how biases prevented them from engaging with communities. Community women came to understand sexual pleasure as an important aspect of strengthening the family and community. Mapping women's mobility revealed the link between sexuality, mobility and family honour. Gender myths, portraying men as oppressors, made explicit the narrow and biased picture of men that perpetuates through social norms maintained by staff and not only by communities in which they work. Methods improved social relations and prompted both behaviour and social changes at the community level.     

A new understanding in the epidemiology of melanoma

The incidence of melanoma is continuing to increase worldwide. UV exposure is a known risk factor for melanoma. Geographic location is known to influence UV exposure and the distribution of the incidence of melanoma. Furthermore, epidemiologic data suggest that gender and genetics may influence the distribution of melanoma on the body surface and histopathologic characteristics of the lesion. This article describes what is known about the impact of gender, ethnicity and geography on the progression of melanoma. Advanced-stage cutaneous melanoma has a median survival time of less than 1 year. Surgical removal, radiotherapy, chemotherapy, targeted therapies and a variety of immunotherapies have been utilized in the treatment of melanoma. Current treatment strategies and the results of recent clinical trials are also discussed in this article.     

A Typology of Work‐Family Arrangements Among Dual‐Earner Couples in Norway

A symmetrical family model of two workers or caregivers is a political goal in many western European countries. We explore how common this family type is in Norway, a country with high gender‐equality ambitions, by using a multinomial latent class model to develop a typology of dual‐earner couples with children based on the partners' allocations of paid and unpaid work. Using data on 2,617 respondents from the Norwegian Generations and Gender Survey, we estimate 4 classes, of which 2 are characterized by a fairly equal sharing between the partners and 2 have more traditional arrangements. Equal sharing is practiced by 4 out of 10 couples and is most likely when the partners are well educated and work regular hours and the father is in public‐sector employment. A traditional practice is likely when the partners have less education, the mother has health problems, the father has private‐sector employment, and the partners work irregular hours.     

Occupational Epidemiology in Agriculture: A Case Study in the Southern African Context

Abstract

Some challenges facing occupational epidemiology in developing countries are outlined in this case study of agriculture drawing on Southern African research. These include the characterization of exposures in resource- and data-poor environments typical of developing countries, the assessment of outcomes where cross-cultural and socio-environmental confounders may be substantial obstacles, and the impact of environmental exposures on workplace health. Traditional assignment of low priority to the chronic effects of low-dose exposures relative to acute morbidity in developing countries must be critically examined, as must the gender bias of much occupational epidemiology in agriculture. Advocacy issues involving child labor and the ethics of research among vulnerable groups deserve rigorous attention. It is argued that, if occupational epidemiology is to have meaningful impact on the health of the most marginalized groups of workers in developing countries, it must redefine itself in terms of a public health approach. The boundaries of epidemiologic inquiry need to be broad, and amenable to interfacing with policy research, using qualitative methods and participatory approaches. More so than in other industrial settings, epidemiologists must move from research to practice, seeking to take action where interventions are needed, and to evaluate such actions.