Physician attitudes regarding latent tuberculosis infection: international vs. U.S. medical graduates.

Tuberculosis in the U.S. is increasingly noted among the foreign-born, with many individuals at risk being managed by international medical graduates (IMGs). We utilized anonymous surveys using hypothetical scenarios to assess and compare the attitudes of IMGs and U.S. medical graduates regarding the treatment of latent tuberculosis infection (LTBI) to identify how attitudes and intentions may influence physician behavior. IMGs were less likely to treat LTBI in almost all scenarios. Educational efforts should focus on IMGs to encourage attitudes more consistent with U.S. guidelines.     

Revised U.S. adult and adolescent antiretroviral treatment guidelines; also revised pediatric guidelines

Both the U.S. adult and pediatric guidelines were revised in November 2003.     

Upper gastrointestinal symptoms in a U.S. national sample of adults with diabetes

BACKGROUND: Individuals with diabetes may be particularly susceptible to motility-related upper gastrointestinal (UGI) symptoms such as abdominal pain or discomfort, bloating, early satiety, nausea, and vomiting. We estimated the prevalence of UGI symptoms in a population-based sample of individuals with diabetes and determined whether cases and population controls differed in prevalence of UGI symptoms and in symptom features. METHODS: Individuals with diabetes (n = 483) and matched controls (n = 422) were recruited from a prior U.S. national health survey for a telephone interview on UGI symptoms. To confirm self-reported diabetes status, cases provided information on clinical management measures. Subjects were asked about UGI symptoms in the month before interview. Affirmative responses to initial questions triggered detailed questions about symptom frequency, timing, duration, and severity. Differences between cases and controls were evaluated. RESULTS: Cases not only had a significantly (P < 0.05) higher overall prevalence of one or more UGI symptoms in the past month (50%) than controls (38%), but they also reported a significantly greater number of UGI symptoms than controls. Almost 10% of cases reported three or more UGI symptoms in the past month compared with 2% of controls. Our study also identified UGI symptom features that were more relevant to cases and showed that one UGI symptom, heartburn, co-occurred significantly more often with UGI symptoms in cases than in controls. CONCLUSIONS: Upper GI symptoms are common in individuals with diabetes and more prevalent than in controls. The symptoms are non-specific and may reflect disruptions in motility or perception.     

The U.S. and Canadian health care systems: views of resident physicians.

OBJECTIVE: To evaluate U.S. and Canadian resident physicians' views about their health care systems. DESIGN: Self-administered questionnaire survey in 1989. PARTICIPANTS: Senior family medicine and internal medicine residents in Canada and in ten geographically representative American states. MAIN RESULTS: American and Canadian residents had similar levels of professional satisfaction and almost universally agreed on the ethical obligation to provide care to persons of all social circumstances, but U.S. residents were more likely to perceive a serious access problem in their country (75% compared with 18%) and to think that current controls on the medical profession interfere with patient care (81% compared with 58%; P less than 0.001). In addition, U.S. residents were more likely than Canadian residents to believe that primary care salaries were too low (78% compared with 38%) and that salaries of medical subspecialists (57% compared with 17%) and surgeons (85% compared with 28%) were too high. In general, residents preferred their own country's predominant health care system. Whereas 87% of U.S. physicians supported private fee-for-service health care, 85% of Canadian physicians supported government-funded national health insurance. Nonetheless, 42% of U.S. physicians supported and only 17% strongly opposed national health insurance as an alternative approach. About two thirds of respondents from both countries opposed a salaried national health service. CONCLUSIONS: American residents perceived greater problems with access, overall intrusions into medical practice, and fee disparities than did their Canadian counterparts. They preferred private fee-for-service health care, but few strongly opposed government-funded national health insurance as an alternative approach to the health care needs of the United States.     

Parental leave policies for faculty in U.S. medical schools

OBJECTIVE: To assess medical school policies for maternity and other parental leaves as well as related opportunities for part-time employment, flexibility in tenure systems, and the availability of child care centers. DESIGN: Cross-sectional survey of all 127 U.S. medical schools based on telephone interviews and review of faculty handbooks. MEASUREMENTS AND MAIN RESULTS: Ninety-three percent of medical schools responded. Twenty-two percent of medical schools have no written guidelines for maternity leave, 45% categorize maternity leave as a form of sick or disability leave, and only 34% have developed specific policies. Most schools (61%) require that maternity leave be taken from allotted sick days or from vacation days (or from both) for women to obtain salary support. The time available from sick and vacation leave averages 6.8 weeks. Although 72% of schools make allowances in the tenure probationary period for extended leaves of absence, few have developed specific provisions for childbearing or childrearing. Finally, 18% of medical schools have child care facilities. CONCLUSIONS: Considerable work is needed to develop adequate support for faculty members who are parents. Recommendations include developing specific parental leave policies and flexible tenure systems and providing adequate child care facilities.     

Global climate change and mammalian species diversity in U.S. national parks

National parks and bioreserves are key conservation tools used to protect species and their habitats within the confines of fixed political boundaries. This inflexibility may be their "Achilles' heel" as conservation tools in the face of emerging global-scale environmental problems such as climate change. Global climate change, brought about by rising levels of greenhouse gases, threatens to alter the geographic distribution of many habitats and their component species. With these changes comes great uncertainty about the future ability of parks and protected areas to meet their conservation mandates. We report here on an analysis aimed at assessing the extent of mammalian species turnover that may be experienced in eight selected U.S. national parks if climate change causes mammalian species within the continental U.S. to relocate to new geographic locations. Due to species losses of up to 20% and drastic influxes of new species, national parks are not likely to meet their mandate of protecting current biodiversity within park boundaries. This approach represents a conservative prognosis. As species assemblages change, new interactions between species may lead to less predictable indirect effects of climate change, increasing the toll beyond that found in this study.     

Geriatric medicine and geriatric psychiatry clinical services affiliated with U.S. academic medical centers

U.S. academic medical centers are providing many geriatric medicine (GM) and geriatric psychiatry (GP) clinical services at Veterans Health Administration (VHA) and non-VHA sites. This article describes the distribution and scope of GM and GP clinical services being provided. Academic GM leaders of the 146 U.S. allopathic and osteopathic medical schools were surveyed online in the spring of 2004. One hundred four program directors (71.2%) responded. These medical schools provided 1,325 GM and 376 GP clinical services, which included 654 VHA and 1,014 non-VHA GM and GP services, affiliation with 21 Programs of All-Inclusive Care for the Elderly, and 12 other specialized services. The mean number+/-standard deviation of distinct clinical services at each medical center was 16.4+/-8.2. More geriatrics faculty full-time equivalents, more time spent on training fellows, and designation as a GM Center of Excellence were associated with providing a wider range of geriatric clinical services. Using data from the survey, the first directory of GM and GP clinical services at academic medical centers was created (http://www.ADGAPSTUDY.uc.edu).