International and US medical graduates in US cities

Objectives This study examines the comparative distributions of postresident international medical graduates (IMGs) and US medical graduates (USMGs) in high and low poverty areas of US cities. Existing research has established that IMGs are more likely than USMGs to practice in urban areas, yet there is the question whether IMGs locate more frequently than USMGs in urban poverty areas. Methods Data from the 1997 AMA Physician Masterfile and 1990 US Census were merged to classify physicians' practices into low- and high-poverty areas in selected cities. Results In 14 cities with populations of 2.5 million or more, IMGs were located in a statistically significant disproportion in poverty areas of 7 cities. Of 36 cities with populations of 1,000,000 to 2,499,999, there were 5 cities that had significant IMG disproportions in poverty areas. Of a random sample of 27 cities with populations of 250,000 to 999,999, there were 2 cities that had significant IMG disproportions. Many cities in all three size categories had a large proportionate IMG complement of the total physician workforce located within high-poverty areas. Conclusions IMGs were found in disproportionate numbers in poverty areas in a number of US cities, especially the very largest ones. These findings are discussed in light of the current debate about a physician surplus and initiatives to reduce the number of IMGs in residency training.     

Epidemiological Transition and the Double Burden of Disease in Accra,Ghana

It has long been recognized that as societies modernize, they experience significant changes in their patterns of health and disease. Despite rapid modernization across the globe, there are relatively few detailed case studies of changes in health and disease within specific countries especially for sub-Saharan African countries. This paper presents evidence to illustrate the nature and speed of the epidemiological transition in Accra, Ghana’s capital city. As the most urbanized and modernized Ghanaian city, and as the national center of multidisciplinary research since becoming state capital in 1877, Accra constitutes an important case study for understanding the epidemiological transition in African cities. We review multidisciplinary research on culture, development, health, and disease in Accra since the late nineteenth century, as well as relevant work on Ghana’s socio-economic and demographic changes and burden of chronic disease. Our review indicates that the epidemiological transition in Accra reflects a protracted polarized model. A “protracted” double burden of infectious and chronic disease constitutes major causes of morbidity and mortality. This double burden is polarized across social class. While wealthy communities experience higher risk of chronic diseases, poor communities experience higher risk of infectious diseases and a double burden of infectious and chronic diseases. Urbanization, urban poverty and globalization are key factors in the transition. We explore the structures and processes of these factors and consider the implications for the epidemiological transition in other African cities.     

上海城市二级医院的生存发展之道

将现行的三级医疗服务体系转为两级新型城市卫生服务体系,这一新医改方案直接影响着上海城市公立二级医院的生存与发展。1.目前二级医院处于夹缝中求生存的尴尬现状：上有众多整体实力强劲的三级医院,下有政府加大投入的无数中小医疗机构。2.明确功能定位是二级医院谋求生存与发展的契机,其功能定位要与三级、一级医院有着鲜明差异。3.二级医院可通过科学布局、合理转型、发展专科、兼并托管、形成特色、提高质量、保证服务、财政投入、拉开收费等方法,获得生存与发展。     

Corporation-induced Diseases,Upstream Epidemiologic Surveillance,and Urban Health

Corporation-induced diseases are defined as diseases of consumers, workers, or community residents who have been exposed to disease agents contained in corporate products. To study the epidemiology and to guide expanded surveillance of these diseases, a new analytical framework is proposed. This framework is based on the agent-host-environment model and the upstream multilevel epidemiologic approach and posits an epidemiologic cascade starting with government-sanctioned corporate profit making and ending in a social cost, i.e., harm to population health. Each of the framework's levels addresses a specific level of analysis, including government, corporations, corporate conduits, the environment of the host, and the host. The explained variable at one level is also the explanatory variable at the next lower level. In this way, a causal chain can be followed along the epidemiologic cascade from the site of societal power down to the host. The framework thus describes the pathways by which corporate decisions filter down to disease production in the host and identifies opportunities for epidemiologic surveillance. Since the environment of city dwellers is strongly shaped by corporations that are far upstream and several levels away, the framework has relevance for the study of urban health. Corporations that influence the health of urban populations include developers and financial corporations that determine growth or decay of urban neighborhoods, as well as companies that use strategies based on neighborhood characteristics to sell products that harm consumer health. Epidemiological inquiry and surveillance are necessary at all levels to provide the knowledge needed for action to protect the health of the population. To achieve optimal inquiry and surveillance at the uppermost levels, epidemiologists will have to work with political scientists and other social scientists and to utilize novel sources of information.     

Sociodemographic,clinical and birth hospitalization characteristics and infant Hepatitis B vaccination in Washington State

ObjectiveHepatitis B (HepB) vaccine is recommended at birth; however, national coverage estimates fall far below target levels. Studies describing the factors associated with infant HepB vaccination are lacking. This study aimed to identify the sociodemographic, clinical and birth hospitalization factors associated with timely receipt of the first HepB vaccine dose.Study DesignThis retrospective cohort study included Washington State infants born weighing ≥2000 g who received birth hospitalization care at an urban academic medical center between January 2008–December 2013. Multivariable logistic regression was used to estimate adjusted odds ratios (AOR) and 95% confidence intervals (CI) for associations between maternal and infant characteristics and HepB vaccine receipt during the birth hospitalization.ResultsOf the 9080 study infants, 75.5% received HepB vaccine during the birth hospitalization. Infants had higher odds of being vaccinated during the birth hospitalization if they were Hispanic (AOR 2.08; CI: 1.63, 2.65), non-Hispanic black (AOR 2.34; CI: 1.93, 2.84) or Asian (AOR 2.70; CI: 2.22, 3.28) compared to non-Hispanic white. Infants with a Spanish- vs. English-speaking mother (AOR 1.97; CI: 1.46, 2.68), public vs. private insurance (AOR 2.01; CI: 1.78, 2.29), and those hospitalized ≥96 h vs. 24 to <48 h (AOR 1.67; CI: 1.34, 2.09) also had higher odds of vaccination.ConclusionsPopulations that are typically underserved (e.g., publicly insured, racial/ethnic minorities) had higher odds of receiving HepB vaccine during the birth hospitalization. These findings may aid in identifying high-risk infants who could benefit from targeted interventions to increase initial HepB vaccination.     

城乡老年人长期照护需求溢出:理论分析与实证检验

首先分析了老年人长期照护需求溢出的内在逻辑,构建了影响长期照护需求溢出内在逻辑的分析框架;然后依据中国综合社会调查(CGSS)2015年数据,运用多项有序Logit回归对老年人长期照护需求溢出的影响因素进行分析,得出以下结论:从全体居民来看,年龄、受教育程度、是否参加基本养老保险和政府在老年人生活帮助中的责任与长期照护外溢成正相关,身体健康状况、子女数、个人地位和家庭经济状况与长期照护需求外溢程度呈负相关。然而,城乡居民的照护需求外溢存在显著差异,城市居民长期照护需求外溢的程度要比农村居民高,影响农村居民照护需求外溢的主要是家庭经济状况,影响城市居民照护需求外溢的主要是养老保险和政府在老年人生活帮助中的责任。因此,要弘扬传统的孝文化,重视家庭的作用;理性定位政府责任边界,优先建立补缺型的照护津贴制度;统筹城乡照护服务发展,补齐农村照护短板。     

Determining the health benefits of green space: Does gentrification matter?

Urban green space is demonstrated to benefit human health. We evaluated whether neighborhood gentrification status matters when considering the health benefits of green space, and whether the benefits are received equitably across racial and socioeconomic groups. Greater exposure to active green space was significantly associated with lower odds of reporting fair or poor health, but only for those living in gentrifying neighborhoods. In gentrifying neighborhoods, only those with high education or high incomes benefited from neighborhood active green space. Structural interventions, such as new green space, should be planned and evaluated within the context of urban social inequity and change.     

Colonic function in rural and urban populations of Turkey

Two Turkish populations, one with an urban background and the other rural, were compared in regard to their colonic function. Rural subjects consume a diet with higher fiber than urban people in Turkey. The rural group had a greater daily fecal output, faster intestinal transit, and lower intraluminal pressure, with a greater output of calcium in the feces than those living in an urban area in Turkey. The effects are similar to those described when fiber is added to the diet. Urban dwellers in Turkey who lack these effects are said to have a rising incidence of fiber-related diseases of the colon, such as diverticular disease.     

Motivational interviewing integrated with social network counseling for female adolescents: a randomized pilot study in urban primary care

This study tested the efficacy of a brief preventive intervention for substance use and associated risk behaviors among female adolescent patients of an urban primary care health clinic. We integrated an evidenced-based motivational interviewing (MI) approach with a social network component to develop a 20-minute session, a social network intervention delivered in an MI-consistent style. Female adolescents (N = 28) 14 to 18 years old were recruited, provided consent/assent, were screened, and were randomly assigned to the treatment or control (no treatment) condition. The sample was 82% African American and 18% mixed race, with 32% living below the U.S. poverty line. At 1-month follow-up, teens in the treatment condition reported less trouble due to alcohol use, less substance use before sexual intercourse, less social stress, less offers for marijuana use, and increased readiness to start counseling compared with the teens in the control condition. Results provide support for socially based brief interventions with at-risk urban adolescents.     

城镇居民基本医疗保险与城镇贫困人群医疗救助制度衔接刍议

城镇居民基本医疗保险与城镇贫困人群医疗救助制度是社会保障体系的重要组成部分和社会保障领域改革的重要环节,两者衔接对缓解城镇贫困人员“看病难、看病贵”,提高卫生服务可及性、公平性有重要现实意义。结合两制度衔接现状,探讨两个制度衔接的必要性和可能性,以及当前两个制度衔接存在困难和问题,并提出相关的政策建议。