Objective Structured Clinical Examination From Virtually Anywhere!

The Objective Structured Clinical Examination (OSCE) is used in nurse practitioner (NP) education programs to evaluate students’ clinical competency. The OSCE was developed to be done with students on campus in a simulation laboratory, but for online NP programs, an on-campus environment is a barrier to the use of OSCEs. The virtual OSCE eliminates this barrier and provides an effective method of implementing OSCEs and evaluating student competencies in online NP education.     

Severe gastric dilatation due to superior mesenteric artery syndrome in anorexia nervosa

Forty‐seven year old female, with a history of anorexia nervosa, was admitted to a medical stabilization unit (ACUTE) complaining of abdominal pain exacerbated by oral intake, associated with nausea, and relieved by emesis. Admission body mass index was 10.6. Labs were notable for hepatitis and hypoglycemia. On her progressive oral refeeding plan, she suddenly developed severe abdominal pain. Computed tomography (CT) revealed gastric dilatation and superior mesenteric artery (SMA) syndrome. SMA syndrome is a rare complication of severe malnutrition resulting from compression of the duodenum between the aorta and the SMA. It is diagnosed by an upper gastrointestinal series or an abdominal CT. Gastric dilatation, in turn, is a rare complication of SMA syndrome to be included in the differential diagnoses of abdominal pain in severely malnourished patients as it is potentially life‐threatening. The patient was switched to an oral liquid diet, began weight restoring, and had resolution of symptoms. © 2015 Wiley Periodicals, Inc. (Int J Eat Disord 2015; 48:532–534)     

The Effect of Medicaid Primary Care Provider Reimbursement on Access to Early Childhood Caries Preventive Services

Objective

To examine receipt of early childhood caries preventive services (ECCPS) in two states'' Medicaid programs before and after the implementation of reimbursement to medical primary care providers (M-PCPs).

Data Sources

Enrollment and claims data from the Florida and Texas Medicaid programs for children ≤54 months of age during the period 2006–2010.

Study Design

We conducted time trend-adjusted, difference-in-differences analyses by using modified Poisson regressions combined with generalized estimating equations (GEEs) to analyze the effect of M-PCP reimbursement on the likelihood that an enrollee had an ECCPS visit after controlling for age, sex, health status, race/ethnicity, geographic location, and enrollment duration.

Data Extraction Methods

Enrollment data were linked to claims data to create a panel dataset with child-month observations.

Principal Findings

Reimbursement to M-PCPs was associated with an increased likelihood of ECCPS receipt in general and topical fluoride application specifically in both states.

Conclusions

Reimbursement to M-PCPs can increase access to ECCPS. However, ECCPS receipt continues to fall short of recommended care, presenting opportunities for performance improvement.     

National health accounts data from 1996 to 2010: a systematic review

Objective

To collect, compile and evaluate publicly available national health accounts (NHA) reports produced worldwide between 1996 and 2010.

Methods

We downloaded country-generated NHA reports from the World Health Organization global health expenditure database and the Organisation for Economic Co-operation and Development (OECD) StatExtract website. We also obtained reports from Abt Associates, through contacts in individual countries and through an online search. We compiled data in the four main types used in these reports: (i) financing source; (ii) financing agent; (iii) health function; and (iv) health provider. We combined and adjusted data to conform with OECD’s first edition of A system of health accounts manual, (2000).

Findings

We identified 872 NHA reports from 117 countries containing a total of 2936 matrices for the four data types. Most countries did not provide complete health expenditure data: only 252 of the 872 reports contained data in all four types. Thirty-eight countries reported an average not-specified-by-kind value greater than 20% for all data types and years. Some countries reported substantial year-on-year changes in both the level and composition of health expenditure that were probably produced by data-generation processes. All study data are publicly available at http://vizhub.healthdata.org/nha/.

Conclusion

Data from NHA reports on health expenditure are often incomplete and, in some cases, of questionable quality. Better data would help finance ministries allocate resources to health systems, assist health ministries in allocating capital within the health sector and enable researchers to make accurate comparisons between health systems.     

Household Debt and Relation to Intimate Partner Violence and Husbands' Attitudes Toward Gender Norms: A Study Among Young Married Couples in Rural Maharashtra,India

Objective

Evidence has linked economic hardship with increased intimate partner violence (IPV) perpetration among males. However, less is known about how economic debt or gender norms related to men''s roles in relationships or the household, which often underlie IPV perpetration, intersect in or may explain these associations. We assessed the intersection of economic debt, attitudes toward gender norms, and IPV perpetration among married men in India.

Methods

Data were from the evaluation of a family planning intervention among young married couples (n=1,081) in rural Maharashtra, India. Crude and adjusted logistic regression models for dichotomous outcome variables and linear regression models for continuous outcomes were used to examine debt in relation to husbands'' attitudes toward gender-based norms (i.e., beliefs supporting IPV and beliefs regarding male dominance in relationships and the household), as well as sexual and physical IPV perpetration.

Results

Twenty percent of husbands reported debt. In adjusted linear regression models, debt was associated with husbands'' attitudes supportive of IPV (b=0.015, p=0.004) and norms supporting male dominance in relationships and the household (b=0.006, p=0.003). In logistic regression models adjusted for relevant demographics, debt was associated with perpetration of physical IPV (adjusted odds ratio [AOR] = 1.4, 95% confidence interval [CI] 1.1, 1.9) and sexual IPV (AOR=1.6, 95% CI 1.1, 2.1) from husbands. These findings related to debt and relation to IPV were slightly attenuated when further adjusted for men''s attitudes toward gender norms.

Conclusion

Findings suggest the need for combined gender equity and economic promotion interventions to address high levels of debt and related IPV reported among married couples in rural India.Intimate partner violence (IPV) perpetrated by male partners or husbands occurs in high proportions globally as well as in low- to middle-income countries such as India.^1,2 One recent multi-country household study found that 37% of men in India reported having ever perpetrated physical violence against a female intimate partner in their lifetime. The health burden of IPV has been well demonstrated, with significant effects on women''s sexual and reproductive health (e.g., increased sexually transmitted infections, unintended pregnancy, and poor pregnancy outcomes),^3–5 mental health (e.g., anxiety, depression, and substance use),^6,7 as well as a multitude of other poor health outcomes among women and their children (e.g., maternal and child malnutrition and infant death).^8,9Recent research among women has identified economic hardship (e.g., financial dependence on male partners and economic instability) as increasing women''s vulnerability to IPV.^10,11 Although studies have found an association between economic stressors and reports of male IPV perpetration,^12–16 no research has examined debt in relation to these outcomes.Debt and other economic decisions in the context of marriage, particularly in rural India, are largely under the control of husbands. Taking on debt may be associated with economic hardship, heightening stress levels among men, and, in turn, IPV. Also, previous work documenting the association between economic hardship and increased IPV perpetration by males^12–15 has largely been explained by perceptions related to men''s roles financially within the family (e.g., men who do not feel that they are providing financially for their families may perceive that they are not fulfilling their roles as husbands/males, and this perception related to lack of role fulfillment may escalate into violence). Given that a decision to take on debt appears to be largely controlled by men in this context and likely tied to their perceived role of providing financially for the family, a man''s decision to take out loans may be determined, in part, by their support of masculine gender norms (e.g., a man''s role in the family and male dominance and control in the household). In addition, given previous work highlighting the association between masculine gender norms and a number of risk behaviors among boys and men (e.g., substance and tobacco use and behaviors resulting in unintentional injury),^17–21 such gender norms may also be linked to taking on risks associated with debt, as well as debt-acquiring behaviors (e.g., spending money on nonessential goods such as alcohol).Gender norms pertaining to IPV, relationships, and the household are also important driving factors in terms of understanding men''s behaviors related to IPV. Cross-cultural research has shown that societies with greater gender inequities in social norms and policies have a higher prevalence of IPV.²¹ In the context of India and elsewhere, women''s low status in families and high levels of societal tolerance and acceptance of IPV promote IPV.²²More research is needed to understand economic hardship, and debt specifically, in relation to attitudes toward gender norms and IPV perpetration. Many studies have hypothesized that stress related to economic hardship and debts increases IPV perpetration;^12–15 however, less research has sought to understand the role of attitudes supportive of men''s more traditional gender norms in relationships or households in contributing to decisions to take on debt as well as in terms of explaining its association with increased IPV perpetration. Increased understanding of the mechanisms that explain associations between economic hardship/debt and IPV is needed to inform prevention approaches, particularly given the increasing number of economic promotion interventions being implemented globally and throughout India.Thus, the primary objective of the current study was to assess household debt in relation to husbands'' support of gender-inequitable norms and norms promoting IPV as well as husbands'' use of IPV against wives. The secondary objective of this study was to assess whether or not gender-based attitudes are important factors in debt and IPV, as well as in explaining an association between debt and increased risk for IPV perpetration among husbands.     

Association of Roadway Proximity with Fasting Plasma Glucose and Metabolic Risk Factors for Cardiovascular Disease in a Cross-Sectional Study of Cardiac Catheterization Patients

Background

The relationship between traffic-related air pollution (TRAP) and risk factors for cardiovascular disease needs to be better understood in order to address the adverse impact of air pollution on human health.

Objective

We examined associations between roadway proximity and traffic exposure zones, as markers of TRAP exposure, and metabolic biomarkers for cardiovascular disease risk in a cohort of patients undergoing cardiac catheterization.

Methods

We performed a cross-sectional study of 2,124 individuals residing in North Carolina (USA). Roadway proximity was assessed via distance to primary and secondary roadways, and we used residence in traffic exposure zones (TEZs) as a proxy for TRAP. Two categories of metabolic outcomes were studied: measures associated with glucose control, and measures associated with lipid metabolism. Statistical models were adjusted for race, sex, smoking, body mass index, and socioeconomic status (SES).

Results

An interquartile-range (990 m) decrease in distance to roadways was associated with higher fasting plasma glucose (β = 2.17 mg/dL; 95% CI: –0.24, 4.59), and the association appeared to be limited to women (β = 5.16 mg/dL; 95% CI: 1.48, 8.84 compared with β = 0.14 mg/dL; 95% CI: –3.04, 3.33 in men). Residence in TEZ 5 (high-speed traffic) and TEZ 6 (stop-and-go traffic), the two traffic zones assumed to have the highest levels of TRAP, was positively associated with high-density lipoprotein cholesterol (HDL-C; β = 8.36; 95% CI: –0.15, 16.9 and β = 5.98; 95% CI: –3.96, 15.9, for TEZ 5 and 6, respectively).

Conclusion

Proxy measures of TRAP exposure were associated with intermediate metabolic traits associated with cardiovascular disease, including fasting plasma glucose and possibly HDL-C.

Citation

Ward-Caviness CK, Kraus WE, Blach C, Haynes CS, Dowdy E, Miranda ML, Devlin RB, Diaz-Sanchez D, Cascio WE, Mukerjee S, Stallings C, Smith LA, Gregory SG, Shah SH, Hauser ER, Neas LM. 2015. Association of roadway proximity with fasting plasma glucose and metabolic risk factors for cardiovascular disease in a cross-sectional study of cardiac catheterization patients. Environ Health Perspect 123:1007–1014; http://dx.doi.org/10.1289/ehp.1306980