Feasibility study of minimally trained medical students using the Rural Obstetrical Ultrasound Triage Exam (ROUTE) in rural Panama

BACKGROUND: Maternal and infant mortality rates reported in rural Panama are greater than those in urban regions. Bocas del Toro is a region of Panama inhabited by indigenous people at greater risk for pregnancy-related complications and deaths due to geographic isolation and limited access to health care. Portable ultrasound training programs have recently been implemented in low-resource settings to increase access to diagnostic imaging. The goal of this study is to determine the feasibility of teaching first-year medical students the Rural Obstetrical Ultrasound Triage Exam (ROUTE) to help identify pathology in pregnant women of the Bocas del Toro region of Panama.METHODS: Eight first-year medical students completed ROUTE training sessions. After training, the students were compared to professional sonographers to evaluate their accuracy in performing the ROUTE. Students then performed the ROUTE in mobile clinics within Bocas del Toro. They enrolled women pregnant in their 2nd or 3rd trimesters and measured biparietal diameter, head circumference, amniotic fluid index, fetal lie and placental position. Any abnormal measurement would be further analyzed by the lead physician for a potential hospital referral.RESULTS: A total of 60 women were enrolled in the study. Four women were detected as having a possible high-risk pregnancy and thus referred to a hospital for further evaluation.CONCLUSION: Based on our data, first-year medical students with additional training can use the ROUTE to identify complications in pregnancy using ultrasound in rural Panama. Additional studies are required to determine the optimal amount of training required for proficiency.     

Cognitive limitations associated with tamoxifen and aromatase inhibitors in employed breast cancer survivors

Objectives: Previous research has suggested that endocrine therapy is associated with cognitive limitations in breast cancer survivors (BCS); this study examined the relationship in employed BCS, an average of three years post‐primary treatment. Methods: 77 BCS with past or current exposure to tamoxifen or aromatase inhibitors and 56 BCS with no history of endocrine therapy completed self‐report measures of cognitive function, anxiety, depression, and fatigue as well as an online neurocognitive battery. Results: Exposure to endocrine therapy was not related to scores on the objective measures, but moderately related to perceived attentional problems at work (β = ?0.20; CI_0.95 = ?2.75, ?0.25) and perceived cognitive functioning in overall life (β = 0.17; CI_0.95 = 0.33, 11.47) in excess of what could be explained by symptom burden measures. No differences were reported between groups on symptom burden measures. Symptoms of physical fatigue, depression, and anxiety were positively associated with self‐report of general cognitive limitations (R² change range: 0.28–0.37), and symptoms of depression and anxiety were positively associated with perceived cognitive limitations at work (R² change range: 0.21–0.28). Discussion: Symptoms of depression, anxiety, and fatigue should be screened for and treated in BCS, as an approach to mitigating perceived cognitive limitations. However, healthcare providers should be aware that cognitive limitations exist in excess of what can be associated with symptom burden, and may be related to endocrine therapy and other cancer treatments. Copyright © 2010 John Wiley & Sons, Ltd.     

The influence of educational attainment on depression and risk of type 2 diabetes

Objectives. We investigated the association between major depressive disorder and type 2 diabetes, whether that association is explained by health behaviors, and whether it is influenced by educational attainment.Methods. We used discrete-time Cox proportional hazards models to determine the risk of type 2 diabetes associated with depression in a 23-year population-based cohort study.Results. Major depressive disorder was associated with higher risk of type 2 diabetes (hazard ratio [HR]=1.62) after we controlled for age, gender, race, education, smoking status, alcohol use, social network size, and antidepressant use. This association was more pronounced after we controlled for body mass index, family history, and health behaviors (HR=2.04; 95% confidence interval=1.09, 3.81). In stratified analyses, the risk associated with major depressive disorder was elevated among those with 12 or fewer years of education compared with those with at least some education beyond high school.Conclusions. The risk of type 2 diabetes associated with major depressive disorder persists over the life course and is independent of the effects of health behaviors, body mass index, and family history. Education is an important moderator of this association.Numerous retrospective observational studies have reported higher prevalence of depression among diabetic populations than among controls.1^,2 In the first prospective analysis, Eaton et al. found approximately 2 times higher risk of type 2 diabetes among those with major depressive disorder (MDD) 13 years previously than among those without depression,3 a finding that has been replicated with remarkable consistency.4 It is unclear whether the elevated risk of type 2 diabetes associated with depression is mediated by poor health behaviors (e.g., smoking, physical inactivity), physiological changes, or both. Depression is associated with lower socioeconomic status,5 but it is unknown whether indicators such as educational attainment moderate the associated risk of type 2 diabetes. One previous study suggested that the risk of type 2 diabetes among persons with depression was substantially greater among those with less than a high school education than among more-educated groups.6We prospectively examined the relationship between depression and type 2 diabetes, seeking to answer 2 questions: Do established risk factors for diabetes, such as family history, obesity, smoking, alcohol intake, dietary habits, and physical inactivity, explain the association between depression and risk of diabetes? Does educational attainment modify this relationship?     

Reconsidering the role of social disadvantage in physical and mental health: stressful life events, health behaviors, race, and depression

Prevalence of depression is associated inversely with some indicators of socioeconomic position, and the stress of social disadvantage is hypothesized to mediate this relation. Relative to whites, blacks have a higher burden of most physical health conditions but, unexpectedly, a lower burden of depression. This study evaluated an etiologic model that integrates mental and physical health to account for this counterintuitive patterning. The Baltimore Epidemiologic Catchment Area Study (Maryland, 1993-2004) was used to evaluate the interaction between stress and poor health behaviors (smoking, alcohol use, poor diet, and obesity) and risk of depression 12 years later for 341 blacks and 601 whites. At baseline, blacks engaged in more poor health behaviors and had a lower prevalence of depression compared with whites (5.9% vs. 9.2%). The interaction between health behaviors and stress was nonsignificant for whites (odds ratio (OR = 1.04, 95% confidence interval: 0.98, 1.11); for blacks, the interaction term was significant and negative (β: -0.18, P < 0.014). For blacks, the association between median stress and depression was stronger for those who engaged in zero (OR = 1.34) relative to 1 (OR = 1.12) and ≥2 (OR = 0.94) poor health behaviors. Findings are consistent with the proposed model of mental and physical health disparities.     

The Relationship Between Substance Use and Sexual Health Among African-American Female Adolescents with a History of Seeking Mental Health Services

BackgroundThis study examined relationships between substance use patterns and problems and sexual health outcomes among low-income, urban, African-American female adolescents with a history of seeking mental health services.MethodsParticipants were recruited from outpatient mental health clinics serving urban, primarily low-income youth and families in Chicago, Illinois, as part of a 2-year, longitudinal investigation of HIV risk behavior during which they completed interviews every 6 months (five time points). Girls who completed at least one follow-up interview were invited to participate in a sixth wave of assessment to assess trauma exposure, substance use problems, and sexual risk. The current study (n = 177) examined the association between sexual risk behavior and substance use problems reported at the most recent interview (ages 14–22) and substance use patterns and sexually transmitted infections (STI) reported at all six times points. Multiple regression examined the combined and unique effects of different patterns of substance use and substance use problems as correlates of sexual risk behavior and STIs.FindingsSubstance use problems were associated with increased sexual risk behavior and increased likelihood of experiencing STIs. Substance use patterns were associated with sexual risk behavior.ConclusionsResults suggest that specific patterns of substance use and substance use problems are important to address in sexual health promotion among low-income, urban, African-American girls with a history of seeking mental health services. Understanding the nuances of these relationships is important in informing how to best serve this vulnerable group of adolescents who experience significant sexual risk and mental health care disparities.     

PERCEPTIONS OF PROCEDURAL JUSTICE MEDIATE THE RELATIONSHIP BETWEEN LOCAL VIOLENT CRIME DENSITY AND CRIME REPORTING INTENTIONS

Community attitudes toward the police are of increasing concern to scholars and practitioners. Although it is widely accepted that perceptions of procedural justice are influential in shaping citizens’ attitudes toward police, prior studies have not considered its relationship to crime density. To address this gap, we examined the relationship between crime density, perceptions of procedural justice, and intentions to report crimes to police using data from a demographically representative survey in an urban center widely known for exhibiting extremely high violent crime rates. We created a path model predicting perceptions of procedural justice, the likelihood of contacting police to report a crime, and the likelihood of socially interacting with police other than in relation to crime. The results indicate that independent of race and educational background, community members’ trust in police mediates the relationship between local crime density and their intentions report crimes to and otherwise interact with the police.