Why doctors choose small towns: A developmental model of rural physician recruitment and retention

Shortages of health care professionals have plagued rural areas of the USA for more than a century. Programs to alleviate them have met with limited success. These programs generally focus on factors that affect recruitment and retention, with the supposition that poor recruitment drives most shortages. The strongest known influence on rural physician recruitment is a “rural upbringing,” but little is known about how this childhood experience promotes a return to rural areas, or how non-rural physicians choose rural practice without such an upbringing. Less is known about how rural upbringing affects retention. Through twenty-two in-depth, semi-structured interviews with both rural- and urban-raised physicians in northeastern California and northwestern Nevada, this study investigates practice location choice over the life course, describing a progression of events and experiences important to rural practice choice and retention in both groups.     

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     

The onset of mammary adenocarcinoma in mice: A possible correlation with nutrition

The coexistence of child malnutrition and adult overweight/obesity typifies rapid nutrition transition and is likely widespread in poor urban populations. This cross-sectional study assessed households’ anthropometric profile and socio-economic characteristics in a shantytown in Haiti. Out of 203 sampled households, 14% had a malnourished child (<10 years) and an overweight mother. Overweight mother households (32%) had a better socio-economic status, irrespective of child nutritional status, than those with malnourished mothers and children (7%), or with malnourished children only (36%). In very poor urban settings, the coexistence of child malnutrition-maternal overweight/obesity may be primarily observed in relatively better-off households.     

Health actions and social class among older Australians

This paper aims to identify aspects of social class that are related to health actions important for older Australians. Data are from the 1994 Health Status of Older People Project baseline survey of 1,000 participants aged 65 and over in Melbourne. Analyses employed logistic regression controlling for age and gender. Physical activity was related to both former occupation and current income; social activity to former occupation; and not smoking to home ownership. Health promotion strategies require a better understanding of the ways in which aspects of social class affect the life course experiences of different birth cohorts. Promotion of physical and social activity in old age needs to take account of the continuing influence of advantages associated with social class.     

‘If I am not doing my own playing then I am not able to truly share the gift of play with children’: using poststructuralism and care ethics to examine future early childhood educators' relationships with play in adulthood

The current sociopolitical context of schooling is positioning play as incongruous with children's academic learning. As a result, teacher educators must increasingly guide future early childhood professionals to develop the skills and knowledge necessary to become effective play advocates. This includes articulating the value of play across the lifespan to a variety of stakeholders. Yet, ironically, many adult women entering the early childhood profession report that a wide range of barriers prevent them from including play in their adult lives. Two case studies highlight how early childhood graduate students use their experiences with play across the lifespan as a foundation for becoming play advocates. Nel Noddings's care ethics and feminist poststructural critiques of the construct of care inform the analysis and discussion of the findings. Implications suggest the importance of guiding early childhood professionals to acknowledge self-care as a component of care and play as an essential expression of self-care.     

Health status,work limitations,and return-to-work trajectories in injured workers with musculoskeletal disorders

BACKGROUND: The purpose of this study was to describe the health status and work limitations in injured workers with musculoskeletal disorders at 1 month post-injury, stratified by return-to-work status, and to document their return-to-work trajectories 6 months post-injury. METHODS: A sample of 632 workers with a back or upper extremity musculoskeletal disorder, who filed a Workplace Safety and Insurance Board lost-time claim injury, participated in this prospective study. Participants were assessed at baseline (1 month post-injury) and at 6 months follow-up. RESULTS: One month post-injury, poor physical health, high levels of depressive symptoms and high work limitations are prevalent in workers, including in those with a sustained first return to work. Workers with a sustained first return to work report a better health status and fewer work limitations than those who experienced a recurrence of work absence or who never returned to work. Six months post-injury, the rate of recurrence of work absence in the trajectories of injured workers who have made at least one return to work attempt is high (38%), including the rate for workers with an initial sustained first return to work (27%). CONCLUSIONS: There are return-to-work status specific health outcomes in injured workers. A sustained first return to work is not equivalent to a complete recovery from musculoskeletal disorders.     

Bioavailability and microbial adaptation to elevated levels of uranium in an acid, organic topsoil forming on an old mine spoil

An old mine spoil at a 19th-century mining site with considerable residues of uranium (400-800 mg U/kg) was investigated with respect to U concentrations in soil and plants and tolerance to U in the soil microbial community in order to describe the bioavailability of U. Measurements of soil fractions representing water-soluble U, easily exchangeable U, and U bound to humified organic matter showed that all fractions contained elevated concentrations of U. Plant U concentrations were only 10 times higher at the mine spoil site compared to the reference site (3 mg U/kg vs 0.3 mg U/kg), while the most easily available soil fractions contained 0.18 to 0.86 mg U/kg soil at the mine spoil. An ecotoxicity bioassay using incorporation of [3H]thymidine into the indigenous microbial communities of the two soils in the presence of increasing U concentrations showed that microorganisms at the mining site were sensitive to U but also that they had acquired a substantial tolerance toward U (EC50, the effective concentration reducing activity by 50% of UO2-citrate was approximately 120 microM as compared to 30 microM in the reference soil). In the assay, more than 40% of the microbial activity was maintained in the presence of 1 mM UO2-citrate versus 3% in the reference soil. We conclude that U-enriched mining waste can contain sufficiently elevated concentrations of bioavailable U to affect indigenous microorganisms and that bioavailable U imposes a selection pressure that favors the development of a highly uranium-tolerant microbial community, while plant uptake of U remains low.     

Actein and a fraction of black cohosh potentiate antiproliferative effects of chemotherapy agents on human breast cancer cells

The purpose of this study was to determine whether the triterpene glycosides present in black cohosh enhance the growth inhibitory effects of specific breast cancer chemotherapy agents. Black cohosh roots and rhizomes were extracted with methanol (MeOH)/water (H (2)O) and fractionated by solvent-solvent partitioning to yield three fractions: hexane, ethyl acetate (EtOAc) and water. The EtOAc fraction is enriched in triterpene glycosides, including the compound actein. Actein and the EtOAc fraction were then tested, alone and in combination with chemotherapy agents, for growth inhibition of the ER (-) Her2 overexpressing breast cancer cell line MDA-MB-453. We found that actein exerted a synergistic effect on growth inhibition when combined with doxorubicin or 5-flourouracil. Synergy was also obtained when the EtOAc fraction was combined with doxorubicin. Actein increased the percent of cells in the G1 phase of the cell cycle and had a similar effect when combined with 5-flourouracil or doxorubucin. Actein enhanced the induction of apoptosis by paclitaxel, 5-flourouracil or doxorubicin. Our results indicate that relatively low concentrations of actein or the EtOAc fraction of black cohosh can cause synergistic inhibition of human breast cancer cell proliferation when combined with different classes of chemotherapy agents.     

Liver transplant and hepatitis C in methadone maintenance therapy: a case report

Background

Drug-related death (DRD) figures, published by the national performance management framework, are used to monitor the performance of Drug (and Alcohol) Action Teams (D[A]ATs) in England and Wales with respect to reducing DRDs among drug abusers. To date, no investigation has been made into the types of death included in these figures, the demographic and drug profile of those who died, nor the likelihood of individuals included in DRD figures interacting with services designed to assist drug abusers. The aim of this work was to examine the characteristics of deaths classified as drug-related and to explore their applicability to performance-monitor drug-related services. Liverpool was chosen because it was reported by the national DRD monitoring system to have the highest number of DRDs in 2004.

Methods

Information was retrieved from the Liverpool coroner's records and established monitoring systems on individuals reported by the national performance monitoring system as a DRD between 1^st January 2004 and 30^th June 2005 (n = 70). Analyses assessed differences between those categorised by the national performance monitoring system as 'drug abusers/dependents' and 'non-drug abusers/dependents' using χ², Fisher's exact test and Mann-Whitney U.

Results

Non-drug abusers were significantly older (median age 53.59 vs. 38.23), had no recent contact with drug-related agencies (cv. 31.6% of abusers who had treatment contact) and had different post mortem drug profiles than drug abusers. A significantly greater proportion of non-drug abusers died from drug toxicity – predominantly through anti-depressants, anti-psychotics and analgesics.

Conclusion

Our findings suggest that the national DRD performance monitoring system includes deaths of people who are not drug abusers – individuals who are not the current focus of drug prevention, treatment or harm minimisation services. This raises concerns regarding the applicability of these figures to performance monitor D(A)ATs. Furthermore, using the more compact definitions used to monitor trends in DRDs across England, Wales and Europe fails to include a proportion of deaths attributable to drug misuse – such as those attributable blood-borne viruses. Current definitions used to monitor DRDs locally, nationally and across Europe fail to capture the true burden of drug-related mortality.