School-associated violent deaths in the United States, 1994-1999.

CONTEXT: Despite the public alarm following a series of high-profile school shootings that occurred in the United States during the late 1990s, little is known about the actual incidence and characteristics of school-associated violent deaths. OBJECTIVE: To describe recent trends and features of school-associated violent deaths in the United States. DESIGN, SETTING, AND SUBJECTS: Population-based surveillance study of data collected from media databases, state and local agencies, and police and school officials for July 1, 1994, through June 30, 1999. A case was defined as a homicide, suicide, legal intervention, or unintentional firearm-related death of a student or nonstudent in which the fatal injury occurred (1) on the campus of a public or private elementary or secondary school, (2) while the victim was on the way to or from such a school, or (3) while the victim was attending or traveling to or from an official school-sponsored event. MAIN OUTCOME MEASURES: National estimates of risk of school-associated violent death; national trends in school-associated violent deaths; common features of these events; and potential risk factors for perpetration and victimization. RESULTS: Between 1994 and 1999, 220 events resulting in 253 deaths were identified; 202 events involved 1 death and 18 involved multiple deaths (median, 2 deaths per multiple-victim event). Of the 220 events, 172 were homicides, 30 were suicides, 11 were homicide-suicides, 5 were legal intervention deaths, and 2 were unintentional firearm-related deaths. Students accounted for 172 (68.0%) of these deaths, resulting in an estimated average annual incidence of 0.068 per 100 000 students. Between 1992 and 1999, the rate of single-victim student homicides decreased significantly (P =.03); however, homicide rates for students killed in multiple-victim events increased (P =.047). Most events occurred around the start of the school day, the lunch period, or the end of the school day. For 120 (54.5%) of the incidents, respondents reported that a note, threat, or other action potentially indicating risk for violence occurred prior to the event. Homicide offenders were more likely than homicide victims to have expressed some form of suicidal behavior prior to the event (odds ratio [OR], 6.96; 95% confidence interval [CI], 1.96-24.65) and been bullied by their peers (OR, 2.57; 95% CI, 1.12-5.92). CONCLUSIONS: Although school-associated violent deaths remain rare events, they have occurred often enough to allow for the detection of patterns and the identification of potential risk factors. This information may help schools respond to this problem.     

Trends in pertussis among infants in the United States, 1980-1999

Context  Reported cases of pertussis among adolescents and adults have increased since the 1980s, despite increasingly high rates of vaccination among infants and children. However, severe pertussis morbidity and mortality occur primarily among infants. Objective  To describe the trends and characteristics of reported cases of pertussis among infants younger than 12 months in the United States from 1980 to 1999. Design, Setting, and Participants  Cases of pertussis in infants younger than 12 months in the United States reported to the National Notifiable Disease Surveillance System of the Centers for Disease Control and Prevention between 1980 and 1999, and detailed case data from the Supplementary Pertussis Surveillance System. Main Outcome Measures  Incidence and demographic and clinical characteristics of cases. Results  The incidence of reported cases of pertussis among infants increased 49% in the 1990s compared with the incidence in the 1980s (19 798 vs 12 550 cases reported; 51.1 cases vs 34.2 cases per 100 000 infant population, respectively). Increases in the incidence of cases and the number of deaths among infants during the 1990s primarily were among those aged 4 months or younger, contrasting with a stable incidence of cases among infants aged 5 months or older. The proportion of cases confirmed by bacterial culture was higher in the 1990s than in the 1980s (50% and 33%, respectively); the proportion of hospitalized cases was unchanged (67% vs 68%, respectively). Receipt of fewer doses of vaccine was associated with hospitalization, when cases were stratified by age in months. Conclusions  The incidence of reported cases of pertussis among infants increased in the 1990s compared with the 1980s. The limited age group affected, the increased rate of bacteriologic confirmation, and the unchanged severity of illness suggest that an increase in infant pertussis has occurred apart from any change in reporting. Strategies are needed to prevent the morbidity and mortality from pertussis among infants too young to be fully vaccinated, according to the current recommended schedules of vaccination in the United States.      

Prevalence of overweight and obesity in the United States, 1999-2004

Context  The prevalence of overweight in children and adolescents and obesity in adults in the United States has increased over several decades. Objective  To provide current estimates of the prevalence and trends of overweight in children and adolescents and obesity in adults. Design, Setting, and Participants  Analysis of height and weight measurements from 3958 children and adolescents aged 2 to 19 years and 4431 adults aged 20 years or older obtained in 2003-2004 as part of the National Health and Nutrition Examination Survey (NHANES), a nationally representative sample of the US population. Data from the NHANES obtained in 1999-2000 and in 2001-2002 were compared with data from 2003-2004. Main Outcome Measures  Estimates of the prevalence of overweight in children and adolescents and obesity in adults. Overweight among children and adolescents was defined as at or above the 95th percentile of the sex-specific body mass index (BMI) for age growth charts. Obesity among adults was defined as a BMI of 30 or higher; extreme obesity was defined as a BMI of 40 or higher. Results  In 2003-2004, 17.1% of US children and adolescents were overweight and 32.2% of adults were obese. Tests for trend were significant for male and female children and adolescents, indicating an increase in the prevalence of overweight in female children and adolescents from 13.8% in 1999-2000 to 16.0% in 2003-2004 and an increase in the prevalence of overweight in male children and adolescents from 14.0% to 18.2%. Among men, the prevalence of obesity increased significantly between 1999-2000 (27.5%) and 2003-2004 (31.1%). Among women, no significant increase in obesity was observed between 1999-2000 (33.4%) and 2003-2004 (33.2%). The prevalence of extreme obesity (body mass index 40) in 2003-2004 was 2.8% in men and 6.9% in women. In 2003-2004, significant differences in obesity prevalence remained by race/ethnicity and by age. Approximately 30% of non-Hispanic white adults were obese as were 45.0% of non-Hispanic black adults and 36.8% of Mexican Americans. Among adults aged 20 to 39 years, 28.5% were obese while 36.8% of adults aged 40 to 59 years and 31.0% of those aged 60 years or older were obese in 2003-2004. Conclusions  The prevalence of overweight among children and adolescents and obesity among men increased significantly during the 6-year period from 1999 to 2004; among women, no overall increases in the prevalence of obesity were observed. These estimates were based on a 6-year period and suggest that the increases in body weight are continuing in men and in children and adolescents while they may be leveling off in women.      

Graduate medical education in the United States

The annual surveys of residency programs on which this report is based have had a higher than 90% response rate for the past 5 years. The count of available residency positions is a fluid entity and seems to be dependent on many factors, including funding and the number of qualified candidates seen by program directors. The number of GY-1 positions has not changed significantly during the past 3 years. The number of reported unfilled positions, including GY-1 unfilled positions, has increased each year since 1985. The total number of residents on duty decreased slightly in 1988. This decrease may be due to a lower response rate. The number of new entry residents (GY-1) has been decreasing since 1985. Thirty-nine percent of residents were training in family practice, internal medicine, or pediatrics. The number and percent of women in residency programs have remained steady. The percentage of FMG residents decreased slightly to 15.3% in 1988. The number of black non-Hispanic residents decreased in 1988, and the percentage of all residents who are black decreased slightly. The number of graduates of osteopathic medical schools in ACGME programs has increased 39% since 1986. The number of institutions involved in graduate medical education has not changed significantly during the past 3 years, although the number of institutions that are not hospitals has increased since 1983. Ninety-five percent of all types of institutions have some type of affiliation with a US medical school.     

Graduate medical education in the United States

The annual surveys of residency programs on which this report is based have had a higher than 90% response rate for the 5 years previous to 1989. Because of a change to the new electronic data collection system in 1989, the response rate decreased to 78.3%. To adjust for the lower response rate, a regression model computed from data from previous years was developed that permitted projected estimates for 1989 data. These numbers are included in several key tables. The number of GY-1 positions seems to have decreased for 1990, although this may be an artifact of the response rate. Reported unfilled positions, including GY-1 unfilled positions, have increased each year since 1985. The number of new-entry residents (GY-1) seems to be leveling out after decreasing since 1985. Because of the lower response rate, it is difficult to determine the trend in the total number of residents on duty. While the observed number of residents is lower than in 1988, statistical projections indicate an increase of 5% over the 1988 count. Thirty-nine percent of residents were training in family practice, internal medicine, or pediatrics. The number and percent of women in residency programs has remained relatively stable despite a steady increase in the number of women graduating from US medical schools. The percentage of FMG residents has continued to decrease. The percentage of black non-Hispanic residents remains steady. The number of graduates of osteopathic medical schools in ACGME programs has increased 17% since 1987. The number of institutions involved in graduate medical education has not changed significantly during the past 3 years.     

Graduate medical education in the United States

1. The annual surveys of residency programs on which this report is based have had a response rate higher than 90% for the past five years. 2. The count of available residency positions is a fluid entity and seems to be dependent on many factors, including funding and the number of qualified candidates seen by program directors. 3. The number of GY-1 positions has not changed significantly over the past three years. The number of reported unfilled positions, including GY-1 unfilled positions, has increased each year since 1985. The total number of residents on duty decreased in 1985 but increased in 1986 and in 1987. This increase is due mainly to the number of residents on duty in the new internal medicine and pediatric subspecialty programs. 4. The number of new-entry (GY-1) residents decreased in 1985, 1986, and 1987. 5. Thirty-nine percent of residents were training in family practice, internal medicine, or pediatrics. 6. The number and percentage of women in residency programs continue to increase, as they have for the past several years. 7. The percentage of foreign medical graduate residents decreased slightly to 15.6% in 1987. 8. The number of black non-Hispanic residents increased in 1987, although the percentage of black residents remained about the same. 9. The number of graduates of osteopathic medical schools in ACGME programs has increased 59% since 1985. 10. The number of institutions involved in graduate medical education has not changed significantly over the past three years, although the number of institutions that are not hospitals has increased since 1983. Ninety percent of all types of institutions have some type of affiliation with a US medical school.     

Graduate medical education in the United States

The annual surveys of residency programs on which this statistical report is based have had a 95% or higher rate of response for the past five years. The number of accredited programs increased in 1986, primarily as a result of the accreditation of subspecialty programs in internal medicine. The largest number of programs is found in general internal medicine, followed by family practice, general surgery, and obstetrics/gynecology. More than one fifth of the programs are located in the Middle Atlantic region of the United States, with the largest number in the state of New York. The number of positions offered by accredited programs has increased as a result of the increase in the number of specialties with accredited programs. The number of GY-1 positions projected in the fall to be offered the following July has not increased significantly over the past three years. The reader is cautioned that the "number of positions offered" is affected by many factors and is subject to frequent change throughout the year. The number of residents on duty in ACGME-accredited programs increased in 1986 as a result of the increase in number of programs. However, the number of GY-1 residents on duty has decreased by 7% since 1984. This decrease is largely accounted for by the number of FMGs in GY-1 positions, a 21% decrease since 1984. This is especially evident in number of US citizen FMGs in GY-1 positions, a 38% decrease in the same time period. The specific factors that have caused the decrease in number of GY-1 FMG residents are not known at this time. One explanation might be a hesitation on the part of program directors to appoint new FMGs. Another factor could be the lower pass rate of US citizen FMGs on the FMGEMS, one qualification for appointment to an ACGME-accredited program. The number and percentage of women in residency programs continues to increase as it has over the past several years. For example, in 1977 women accounted for only 15% of residents; in 1986 they were 27% of residents on duty. Although female residents are found in nearly all disciplines, two thirds of them are training in family practice, internal medicine, obstetrics/gynecology, pediatrics, or psychiatry.(ABSTRACT TRUNCATED AT 400 WORDS)     

Predicting commercial success for Australian medical inventions patented in the United States: a cross sectional survey of Australian inventors

OBJECTIVES: To examine the commercial development of Australian medical patents and identify the determinants of their being used in innovations (new or improved products or production processes). DESIGN: Cross-sectional survey with a nested case-control study. PARTICIPANTS AND SETTING: 177 inventors listed as the first Australian on medical patents granted in the United States between 1 January 1984 and 30 December 1994, and surveyed in 1998-1999. MAIN OUTCOME MEASURE: A series of predictor variables (including characteristics of the patents; characteristics of the inventors; ideas, advice and funding during commercialisation; and the process of commercialisation) for whether or not a patent became an innovation. RESULTS: Half (89/177) of the medical patents became innovations, with 34% generating a total of A $287 million (13% over $1 million) in annual sales a median of 8 years after the patent had been granted. A patent was more likely to become an innovation if the inventor was employed by industry at the time of invention (odds ratio [OR], 3.2; 95% CI, 1.1-9.2), had invested their own finances (OR, 2.8; 95% CI, 1.0-7.4), and if the patent had been licensed (OR, 4.6; 95% CI 1.7-12.7), led to further patents (OR, 3.2; 95% CI, 1.0-10.4) and involved an industry partner in its commercial development (OR, 10.1; 95% CI, 3.6-27.7). It was less likely to become an innovation if finance came from a research funding agency (OR, 0.3; 95% CI, 0.1-0.8) and if interest from Australian industry was judged by inventors as "poor" (OR, 0.6; 95% CI, 0.4-0.9). CONCLUSIONS: Medical patents in the US listing Australian inventors are more likely to become innovations if they originate from industry rather than the public sector, and if inventors are willing to invest their own finances.     

Epidemiology of invasive group B streptococcal disease in the United States, 1999-2005

Christina R. Phares, PhD; Ruth Lynfield, MD; Monica M. Farley, MD; Janet Mohle-Boetani, MD; Lee H. Harrison, MD; Susan Petit, MPH; Allen S. Craig, MD; William Schaffner, MD; Shelley M. Zansky, PhD; Ken Gershman, MD; Karen R. Stefonek, MPH; Bernadette A. Albanese, MD; Elizabeth R. Zell, MStat; Anne Schuchat, MD; Stephanie J. Schrag, DPhil

JAMA. 2008;299(17):2056-2065.

Context  Group B streptococcus is a leading infectious cause of morbidity in newborns and causes substantial disease in elderly individuals. Guidelines for prevention of perinatal disease through intrapartum chemoprophylaxis were revised in 2002. Candidate vaccines are under development.

Objective  To describe disease trends among populations that might benefit from vaccination and among newborns during a period of evolving prevention strategies.

Design and Setting  Analysis of active, population-based surveillance in 10 states participating in the Active Bacterial Core surveillance/Emerging Infections Program Network.

Main Outcome Measures  Age- and race-specific incidence of invasive group B streptococcal disease.

Results  There were 14 573 cases of invasive group B streptococcal disease during 1999-2005, including 1348 deaths. The incidence of invasive group B streptococcal disease among infants from birth through 6 days decreased from 0.47 per 1000 live births in 1999-2001 to 0.34 per 1000 live births in 2003-2005 (P < .001), a relative reduction of 27% (95% confidence interval [CI], 16%-37%). Incidence remained stable among infants aged 7 through 89 days (mean, 0.34 per 1000 live births) and pregnant women (mean, 0.12 per 1000 live births). Among persons aged 15 through 64 years, disease incidence increased from 3.4 per 100 000 population in 1999 to 5.0 per 100 000 in 2005 (²₁ for trend, 57; P < .001), a relative increase of 48% (95% CI, 32%-65%). Among adults 65 years or older, incidence increased from 21.5 per 100 000 to 26.0 per 100 000 (²₁ for trend, 15; P < .001), a relative increase of 20% (95% CI, 8%-35%). All 4882 isolates tested were susceptible to penicillin, ampicillin, and vancomycin, but 32% and 15% were resistant to erythromycin and clindamycin, respectively. Serotypes Ia, Ib, II, III, and V accounted for 96% of neonatal cases and 88% of adult cases.

Conclusions  Among infants from birth through 6 days, the incidence of group B streptococcal disease was lower in 2003-2005 relative to 1999-2001. This reduction coincided with the release of revised disease prevention guidelines in 2002. However, the disease burden in adults is substantial and increased significantly during the study period.

     

美国毕业后医学教育的评鉴与认可

毕业后医学教育是医学教育连续统一体中的重要组成部分,是目前进一步完善我国医学教育体系的关键环节之一。本文介绍了美国毕业后医学教育评鉴与认可的组织实施情况,包括最新的发展趋势,并针对我国毕业后医学教育改革与发展的情况归纳了四点值得借鉴之处。     

美国医学信息学教育现状分析及启示

本文介绍了美国医学信息学教育的基本情况，并从教学层次、学位授予、课程设置、科研及师资等方面对美国近20所医学信息学教育机构进行分析和整理，以期从中得到某些启示，推动我国医学信息学教育的发展。