Minnesota general surgeons. Where do they come from?

A downward trend in the number of graduates from U.S. allopathic medical schools applying for general surgery residency positions has raised questions about whether there will be sufficient numbers of general surgeons to meet future needs. Of particular concern are rural areas, which some studies have suggested will increasingly feel the effects of physician shortages because of the aging physician work force, increasing overall population, and aging patient population. Where physicians are educated and trained appears to have a significant effect on where they choose to practice. This article reports on a 2004 study of where practicing general surgeons in Minnesota went to medical school and did their residencies. According to the findings, the majority received their medical school and/or residency training in the Upper Midwest, and many have come from Minnesota's own medical schools and general surgery residency programs.     

Recommended dietary intakes for vitamin D: where do they come from,what do they achieve and how can we meet them?

There is substantial evidence that the prevalence of vitamin D deficiency is high across Europe, particularly, but not exclusively, among those resident at Northerly latitudes. This has significant implications for human health throughout the lifecycle and impacts upon healthy growth and development and successful ageing for current and possibly future generations. In recent years, there have been several important reports from North America and Europe in relation to dietary reference values (DRVs) for vitamin D. These may be of enormous value from a public health perspective in terms of preventing vitamin D deficiency and promoting adequate vitamin D status in the population. In this concise review, we provide a brief summary of current DRVs for vitamin D, their background and their application to vitamin D deficiency prevention. The review also provides some brief guidance with respect to applying the DRVs in a clinical nutrition setting. In addition, the review illustrates how current dietary intakes of most populations, young and adult, are well short of the newly established DRVs. Accordingly, the review highlights potential food‐based or dietary strategies for increasing the distribution of vitamin D intake in the population with the aim of preventing vitamin D deficiency. Finally, despite the explosion in scientific research in vitamin D and health, there are many fundamental gaps in the field of vitamin D from the public health perspective. The impact of these knowledge gaps on current DRVs for vitamin D is highlighted, as are some future developments that may help address these gaps.     

Medicare beneficiary counseling programs: what are they and do they work?

Medicare beneficiaries face myriad rules, conditions, and exceptions under the Medicare program. As a result, State Information, Counseling, and Assistance (ICA) programs were established or enhanced with Federal funding as part of the Omnibus Budget Reconciliation Act (OBRA) of 1990. ICA programs utilize a volunteer-based and locally-sponsored support system to deliver free and unbiased counseling on the Medicare program and related health insurance issues. This article discusses the effectiveness of the ICA model. Because the ICA programs serve as a vital link between HCFA and its beneficiaries, information about the programs' success may be useful to HCFA and other policymakers during this era of consumer information.     

Where do human organs come from? Trends of generalized and restricted altruism in organ donations

The supply of human organs for transplantation is undergoing a dramatic transformation. Using data from 30 countries for the years 1995-2007, this paper suggests that organ supply today is more dependent on direct donations than on the collective organ pool. This trend is analyzed by studying different modes of altruism: "generalized altruism" relates to the procurement of organs through a one-for-all collectivized system of donations whereas "restricted altruism" relates to one-to-one donations with organs considered personal gifts. The data suggest that transplants are becoming less and less social goods and more and more personal gifts. This trend is documented and discussed in light of the linkage that social scientists hypothesize between altruism and social solidarity. Whereas altruism is conceived as generating social solidarity, the rise in direct organ donations restricts the effect of altruism to one-to-one interactions rather than one-for-all giving.     

Where do we go from here?

In the past two and a half years since the Senate Committee began its study of the Canadian healthcare system, an abundance of reports on healthcare, at both the provincial and federal levels, have been issued that have provided the public and policy-makers with a comprehensive overview of the key issues and the main options for change. We have clearly reached a point where action of some sort can no longer be deferred on the grounds that further study is necessary. It is now a question of finding the political will to move forward with reform.     

Drug treatment courts are popular but do they work and are they ethical and appropriate for Canada?

Currently Canada is experimenting with the implementation of drug treatment courts. Pilot projects are underway in both Toronto and Vancouver. In the U.S., drug courts emerged as a response to the overcrowding of the prison system, the end product of the revolving door of substance dependent people moving through the court system. However, this expansion was not accompanied by any rigorous evaluation or critical reflection as to whether drug treatment courts can achieve their desired outcomes or if they are appropriate for dealing with substance dependent offenders. The purpose of this article is to take a critical look at this phenomenon and to discuss whether the drug court model is suitable for Canada.     

Household smoking bans: which households have them and do they work?

BACKGROUND: This study characterized Oregon households according to type and degree of restrictions on smoking and explored whether smoking restrictions are associated with decreased environmental tobacco smoke (ETS) exposure. METHODS: A population-based, random-digit-dialed cross-sectional telephone survey of 6,199 adult Oregonians was performed in 1997 to provide baseline data on tobacco use in Oregon. RESULTS: Seventy percent of Oregon households were composed of nonsmokers only, and 85% of those had a full ban on smoking inside the home. Of the households containing one or more smokers, 38% had a full household ban on smoking. Among respondents with a full ban in place, 99% of nonsmoker-only households reported that no one smoked in the home in the previous month, compared with 91% of households with at least one smoker. In both nonsmoker-only households and those with at least one smoker, full bans were strongly associated with awareness of the harm of ETS (OR = 12.8, 95% CI 7.3-22.3, and OR = 6.6, 95% CI 3.6-12.3, respectively). The presence of children in the household was also closely associated with full bans in the two types of households (OR = 4.6, 95% CI 2.8-7.6, and OR = 3.0, 95% CI 2.1-4.4, respectively). Nevertheless, 50% of households with children and a smoker present did not have a full ban in place. CONCLUSIONS: While the prevalence of household smoking restrictions is high in Oregon, there remains room for improvement, since 50% of households with a smoker and a child present do not have a full ban on indoor smoking. Public health messages that focus on household smoking restrictions may help protect nonsmokers from exposure to ETS.     

Where do they go, whom do they consult, and why? Health-seeking behaviors in the northern areas of Pakistan

This study presents an ethnographic account of health-seeking behaviors and determinants of health service utilization of people living in the rural Northern Areas of Pakistan. Data was gathered from 2004 to 2005 through 10 gender-specific focus group discussions. Sociodemographic characteristics, economic conditions, cultural forces, physical and environmental conditions, and health care service features form the behaviors. The complex composition of health care systems drives us to study the most intricate phenomenon of health care-seeking behaviors. Inappropriate or delayed health care-seeking could lead to undesirable health outcomes, high fertility, unwanted pregnancies, medical complications, and amplified susceptibility to future illnesses. At times it results in a significant economic burden when a simple illness becomes drawn out because of improper health-seeking behaviors. This study is an effort to present relevant information to the policy makers to reorient the health care services to make them more acceptable. It is recommended that this research be used for designing behavior change communication modules or social marketing campaigns in raising awareness about health in the community and sensitizing health care providers to the needs of their clients.