Racial and Ethnic Disparities in Health: An Emergency Medicine Perspective

Significant disparities exist in health care based on race. Even when controlling for socioeconomic factors, minorities still have lower rates of utilization for certain procedures, higher mortality rates, and differences in usual source of care. There are a multitude of causes for these disparities, including differences based on access to care, the patient-doctor relationship, and insurance status. This article addresses possible factors that account for persistent disparities in health based on race and suggests approaches to remedying these disparities. Although many studies have been done on this topic, further research is needed to examine factors specifically in the emergency department setting.     

Are We Training Future Pain Specialists?

? Abstract: The purpose of this study was to determine whether pain practices in Tennessee are training future pain specialists. Following IRB approval, a questionnaire designed for the study was administered to members of the TN Pain Society. Results indicate that none of the subjects are training residents at their pain practice and the majority are not training pain fellows. Few attendings reported having trained in a pain fellowship themselves and the majority are reportedly not engaged in continuing pain management education through national or international organizations, such as the American Pain Society (APS) or the International Association for the Study of Pain (IASP). Of concern is whether or not this sample reflects the nature of pain practices throughout the country. If so, will there be a shortage of pain residents and fellows in the near future? Will pain practices be opened and operated by those who are not trained to treat chronic pain? ?     

Tibial Bone Geometry in Chronic Stroke Patients: Influence of Sex,Cardiovascular Health,and Muscle Mass

This study aimed to examine the geometry of the tibia in chronic stroke survivors. Fifty‐five ambulatory individuals with chronic stroke were included in the study. pQCT was used to obtain a cross‐sectional scan of the tibia at the 30% site on both the paretic and nonparetic sides. Leg lean mass was derived from a total body scan using DXA. Each subject was also evaluated for peak oxygen consumption rate, spasticity, and functional mobility. Paired t‐tests were used to compare the pQCT parameters between the two sides. Multiple linear regression analysis was used to identify the significant determinants of tibial bone strength index (BSI). In men, marrow cavity area on the paretic side was significantly greater than the nonparetic side (p = 0.011), whereas the total bone area showed no significant side‐to‐side difference (p = 0.252). In women, total bone area on the paretic side was significantly smaller than the nonparetic side (p = 0.003), whereas the marrow cavity area had no side‐to‐side difference (p = 0.367). Peak oxygen consumption (r² = 0.739, F_5,49 = 22.693, p < 0.001) and paretic leg lean mass (r² = 0.802, F_6,48 = 32.475, p < 0.001) remained independently associated with tibial BSI, after controlling for age, sex, body mass index, years since stroke onset, and physical activity level. The geometry of the tibia in stroke patients showed sex‐specific side‐to‐side differences. The results suggested that, whereas endosteal resorption was apparent in men, periosteal resorption was more predominant in women. The results also highlight the potential importance of promoting cardiovascular health and leg muscle mass in enhancing bone geometry in chronic stroke survivors.     

A novel quantitative method for measuring obstruction in the upper urinary tract: The 'obstruction coefficient'

Objectives:   To define an exact pressure-flow correlation in the upper urinary tract using an improved measurement method, to quantitatively characterize the degree of postrenal obstruction and to find a simple way of calculating it in everyday urological practice.
Methods:   The data of 112 cases were included in the analysis. The dynamic method of a multistep, constant pressure perfusion study was used to precisely measure a wide range of pressure-flow dependences. Values of established parameters measuring the degree of obstruction were compared: the intrapelvic pressure, the ureteral opening pressure and the newly introduced 'obstruction coefficient'.
Results:   Pressure-flow relations can be best presented by a parabolic curve described by the simple formula Y = AX² + B. Depending on the degree of obstruction, the shape of this curve can be characterized by a single number, that we defined as the 'obstruction coefficient'. Computer-based evaluation software for the easy calculation of this coefficient is presented here and freely available on demand. The Whitaker-test, the ureteral opening pressure, and the 'obstruction coefficient' showed significant correlation proving that the latter was clinically applicable in measuring the degree of obstruction.
Conclusion:   Calculation of the 'obstruction coefficient' enables us to exactly define the degree of upper urinary tract obstruction and to safely monitor for a long period conditions inhibiting ureteric passage.     

The effects of waiting time and waiting room environment on dental patients'' anxiety

A bstract — Estimates of anxiety, using the Spielberger Anxiety Inventory, were obtained from 96 dental patients awaiting treatment at the United Dental Hospital in Sydney and the Westmead Dental Clinical School. Of the 48 patients sampled at each hospital, 24 had been waiting 15 minutes or less, and 24 had been waiting for more than 15 minutes at the time of administering the Inventory. In both hospitals, measured anxiety levels were found to be significantly higher in those patients who had waited for the longer periods. In addition, in both hospitals, anxiety levels were found to be significantly higher in those patients who were attending for the first time than in those patients who were making subsequent visits. No significant differences between the two hospitals were found in the anxiety levels of patients awaiting treatment.     

Decreased motor activity of hyperactive children on dextroamphetamine during active gym program

The motor activity of 10 hyperactive boys was measured during eight 1-hour active gym classes. Children received either dextroamphetamine (0.5 mg/kg) or placebo elixir before each class, in a double-blind design. The program for each of the classes was participation in the active sports: hockey, basketball, and/or roller skating; the “task” throughout each hour was to play vigorously and continuously. The boys' mean hourly activity following amphetamine was slightly but significantly less than that following placebo. This findings is contradictory to the hypothesis that improved attention to an active task on stimulant would result in increased motor activity, and suggests the possibility of an independent direct effect of amphetamine on the motor system.