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At least 19 recordsLinked to original sources
PubMed2005

Primary care specialty, resident status, and male gender correlate with controlled drug contract use.

OBJECTIVE: With prescription drug abuse rising, physicians are often ambivalent about prescribing controlled drugs. To address their concerns, physicians widely use controlled drug contracts (CDC); however, CDC use is poorly studied. This preliminary study characterizes CDC users and identifies factors associated with CDC use. METHOD: Data were collected from a Web-based survey of University of Oklahoma College of Medicine medical trainee and faculty attitudes and prescribing practices regarding controlled drugs. Recruited via e-mail, participants submitted responses anonymously for a 6-week period from January through March 2004. Associations between demographic variables and participants' responses were analyzed using chi2 analysis to determine correlates of CDC use. Demographic variables included training status (medical student, resident, or faculty), age, gender, and faculty specialty. Variables of interest derived from the survey were CDC use, how respondents compared the risks and benefits of controlled drugs, and patient diagnosis. RESULTS: One hundred ninety-six surveys were submitted, with an estimated response rate of 20% to 30%. CDC use correlated with male gender (p = .0099), resident status (p = .0099), primary care specialty among faculty (p = .0001), and risk/benefit assessment (p = .04) but not patient diagnosis (p = .19) or participant age (p = .40). CONCLUSIONS: Despite limitations, the study findings suggest that a physician's gender, training status, medical specialty, and comparison of the risks and benefits of controlled drugs are factors that determine CDC use.

Journal Article↗
PubMed2002

Stress in medical residency: status quo after a decade of reform?

BACKGROUND: Although curricular reforms have attempted to address sources of stress in medical residency, no recent studies have examined the financial or emotional situations of current medicine residents. OBJECTIVE: To question medicine residents about financial status, educational debt, moonlighting, and psychological issues. DESIGN: Survey distributed in a nonrandomized fashion to medicine residents. SETTING: All 415 U.S. medicine residency programs. RESULTS: According to the questionnaire responses submitted by the 4128 (18%) participating residents, a substantial number of residents had financial and emotional distress that could have interfered with training. The reported educational debt was at least $50 000 for 1657 (42%) of the respondents and at least $100 000 for 737 (19%). The monthly disposable income was $100 or less for 1620 (43%) of the residents, and 637 residents (16%) could not afford safe housing. Among respondents in their 2nd through 5th year of postgraduate training, 2187 (52%) had insufficient funds to purchase books and equipment, and 678 (29%) could not afford the required fees for the American Board of Internal Medicine certifying examination; 2659 (33%) worked as moonlighters, and this percentage increased progressively with increasing educational debt. Four or five depressive symptoms during residency were reported by 1461 (35%) residents. Eight hundred ninety-nine residents (23%) thought they had become less humanistic over the course of their residency training; 2347 (61%) reported becoming more cynical. Female residents were more likely than male residents to report increased cynicism and multiple depressive symptoms. Increased cynicism and depressive symptoms were associated with increasing educational debt. CONCLUSIONS: Despite recent curricular reforms, an alarming number of current medicine residents report depressive symptoms, increasing cynicism, and decreasing humanism, which were associated with increasing educational debt and a need to moonlight for financial survival. Ongoing curricular reform, legislative relief from early loan repayment, and salary increases may be necessary to address these problems.

Employment↗
PubMed1989

Homosexuality and illegal residency status in relation to substance abuse and personality traits among Mexican nationals.

Maladaptive behavioral and personality reactions to severe stressors among Mexican homosexual men were assessed by comparing substance abuse and Rorschach data obtained from three samples: (a) homosexuals residing illegally in the United States (n = 40), (b) homosexuals living in Mexico (n = 21) and (c) heterosexuals living illegally in the United States (n = 25). The results of orthogonal contrasts showed very similar personality structure and substance abuse patterns among the participants in the two homosexual groups. As predicted, these men were found to be using alcohol or drugs to a greater extent than the heterosexual controls. Rorschach findings indicated that the homosexual subjects were experiencing dysphoric mood and distorted perceptions; they were also having significant difficulties coping with an environment that was discerned as increasingly dangerous. These results are relevant to the stress reduction hypothesis of addiction and provide quantitative information regarding the extent of psychopathology in this underserved Hispanic population.

Acculturation↗
PubMed1995

The relationship of farm residency status to demographic and service characteristics of agricultural injury victims in central Wisconsin.

This study performed a surveillance of a defined population in central Wisconsin during a two-year period that included six months of follow-up. The study included those who worked and lived on farms and those who only worked on farms. The injury rate for farm residents was 3.15 injuries per 100 persons per year. However, 195 of the 510 injuries (38.2%) involved persons who were not farm residents. For nonfarm residents, 88.7 percent of the victims were male, whereas for farm residents 79 percent of the victims were male. More than one half of the farm residents who were injured were the owners and an additional 21 percent were juvenile children. Of those aged 18 to 29 years, 51.3 percent were nonfarm resident victims and 15.2 percent were farm resident victims. Of nonfarm residents, 41.1 percent were married; of farm residents, 65.3 percent were married. More than one half of all injured nonfarm residents were seen within two hours of injury while one quarter of the injured farm residents were seen more than 24 hours after the injury. Only 4 percent of the injured farm residents were self-insured, but 15 percent of the nonfarm residents were self-insured. However, the time of injury, actual injuries, diagnoses rendered, and services received were similar for injured farm residents and injured nonfarm residents. Effective attempts to intervene on agricultural injuries will need to consider different risk factors for injuries for nonfarm residents as compared to farm residents.

Accidents, Occupational↗
PubMed2004

Population-based epidemiology of intensive care: critical importance of ascertainment of residency status.

INTRODUCTION: Few studies evaluating the epidemiology of critical illness have used strict population-based designs that exclude subjects external to the base population. The objective of this study was to evaluate the potential effects of inclusion of nonresidents in population-based studies in intensive care. METHODS: A population-based cohort study including all adults admitted to Calgary Health Region (CHR) multidisciplinary and cardiovascular surgical intensive care units (ICUs) between 1 May 1999 and 30 April 2003 was conducted. A comparison of patients resident and nonresident in the base population was then performed. RESULTS: A total of 12,193 adult patients had at least one admission to an ICU; 7767 (63.7%) were CHR residents, for an incidence of 263.7 per 100,000 per year. Male CHR residents were at significant increased risk for ICU admission as compared with females (330.5 per 100,000 versus 198.2 per 100,000; relative risk, 1.67; 95% confidence interval, 1.59-1.74; P < 0.0001), as were CHR residents aged 65 years and older as compared with younger patients (1719.9 per 100,000 versus 238.7 per 100,000; relative risk, 7.21; 95% confidence interval, 6.95-7.47; P < 0.0001). The mortality rate was significantly lower among non-CHR residents (12.7%) as compared with CHR residents (20.0%; P < 0.0001). Logistic regression modeling identified CHR residency as an independent risk factor for death (odds ratio, 1.4; 95% confidence interval, 1.2-1.5; P < 0.0001). CONCLUSION: This study provides information on the incidence of and demographic risk factors for admission to ICUs in a defined population. Inclusion of patients that are nonresident in base study populations may lead to gross errors in determination of the occurrence and outcomes of critical illness.

APACHE↗
PubMed1985

Malaria in non-endemic Kuwait: resident status of patients with imported infections and the need for prophylaxis.

Kuwait is non-endemic for malaria but, with a large expatriate population, the number of imported infections has escalated from 87 in 1980 to 534 in 1984, an increase of over 613%. During a period of 1 year at the Infectious Diseases Hospital, where most of the cases were diagnosed each year, 16.7% of blood samples sent for microscopy were positive for malaria; 95.47% of these patients were hospitalized for an average of 4 days. In a 2-year period, only three (0.52%) Kuwaiti nationals imported the infection out of a total of 577 patients with malaria. About equal numbers of expatriate 'residents' and 'new arrivals' were responsible for the remainder, but over 80% of patients with Plasmodium falciparum were 'residents'. The proportion of residents among the patients is increasing and will be more pronounced with the downturn in the economy. To curtail the tide of imported malaria, the current data suggests the viability of an active campaign to offer chemoprophylaxis to travellers at risk who are essentially 'semi-immune visitors of a non-malarious area visiting a malarious area'. The benefits of simple prophylactic measures need to be emphasized. The disinfection of aircraft arriving from endemic zones should be mandatory.

Antimalarials↗
PubMed2004

Attending to the lightness of numbers: toward the understanding of critical care epidemiology.

Most of the epidemiological studies in critical care do not express their results in terms of population burden of critical illness. This happens because the population at risk of critical illness is particularly difficult to estimate, once intensive care units (ICUs) receive patients from many sources. The study by Laupland in this issue of Critical Care provides a good estimate of the incidence of admission to ICUs in the Calgary Health Region. He considered the Calgary Health Region population as the denominator and explored the effects of a changing numerator according to the residency status (resident in Calgary or not) on the estimation of the burden of admission to the ICU. He demonstrated that if the residency status were not known, the incidence of admission to the ICU would have been overestimated by more than 50%. Furthermore, non-residents had a lower mortality despite higher Acute Physiology and Chronic Health Evaluation (APACHE) II and Therapeutic Intervention Scoring System (TISS) scores. There is tremendous variability in decisions to admit a patient to the ICU and the epidemiology of critical care is influenced by them in a subtle but inextricable way. An understanding of the population epidemiology of critical illness and the use of the ICU, the variations in these parameters, and factors that influence this variation is extremely important. The notable effect of a changing numerator on the estimation of the population burden of ICU admissions in the study by Laupland illustrates how fluid our estimates of disease incidence and mortality - the mainstays of epidemiology - can be.

APACHE↗
PubMedDate not supplied

Procedural training in family practice residencies: current status and impact on resident recruitment.

BACKGROUND: Although procedural training in family practice has recently received greater emphasis, the current status of this training in residency programs has not been reported. Considerable variation in procedural training among family practice residencies is allowed by the American Board of Family Practice and accreditation requirements. This study was performed to report the current status of procedural training in family practice residencies and to determine whether a correlation exists between the number of procedures taught in family practice residencies and successful resident recruitment. METHODS: A one-page questionnaire was developed to determine availability of teaching and type of instructor for 24 selected procedures. This questionnaire was mailed to all 398 family practice residency directors in the United States. Data from the survey were compared with the published residency match results in 1993 and 1994. RESULTS: Questionnaires were received from 363 programs, for a response rate of 91 percent. The current status of training in these procedures, presented by program type and geographic region, reflects considerable regional variation. Training in colposcopy and in cardiac stress testing was reported to be available in a greater percentage of programs than in previous studies. A significant positive correlation was found between the number of procedures taught by family physicians and residency match results. CONCLUSIONS: The 91 percent response rate lends credibility to this status report and indicates that family practice program directors recognize procedural training as an important issue. The trend toward greater availability of procedural training in family practice residencies is confirmed for selected procedures. Emphasis on procedural training by family physicians has a positive correlation with successful resident recruiting. The impact on medical student interest in family practice deserves further study.

Family Practice↗
PubMed2004

[A study on the health status of residents affected by flood disasters].

OBJECTIVE: To study the immediate and long-term effects of disasters caused by floods on residents health status. METHODS: Stratified sampling by ranks of flood disaster occurred in 1996 and 1998, flood disaster areas and control areas were carried out. A retrospective study was also carried out to study all diseases involved during 1996 - 1999. RESULTS: The incident rates of acute infectious disease in flooding areas in 1996 and 1998 were both higher than those of non-flooding areas (863.181/100 000 and 736.591/100 000, respectively). But there was no different between the incident rate of the first years in flooding areas and that of non-flooding areas. The prevalence rates of 8 kinds of chronic diseases related to circulatory system, nervous system, digestive system, injury and poisonous diseases in flooding areas were also higher than that in the non-flooding areas. The highest incidence rates of most diseases were in the mountainous flooding areas, followed by areas collapsed by flooding, and the lowest were seen in soakedareas by floods. The incidence rates of intestinal infectious diseases and respiratory infectious diseases were lower in areas where prevention and control measures were weak. CONCLUSION: Flood could lead to the increase of incidence rates both on acute infectious diseases and non-infectious diseases. Interventions on non-infectious diseases should also be enforced to stop the epidemics when preventing and controlling acute infectious disease.

Acute Disease↗
PubMed1995

Case-control study of squamous cell cancer of the oral cavity in Denmark.

A population-based case-control study was designed to examine if the risk of developing intra-oral squamous-cell carcinoma in Denmark was associated with occupation, marital status, residence, dental status, and exposure to coffee, tea, tobacco, and alcohol. Cases consisted of 161 consecutively-admitted incident patients with histologically verified, primary, intra-oral squamous-cell carcinoma treated at the Aarhus University Hospital from January 1986 to November 1990. For each case, three controls of the same gender and age were selected randomly from among nonhospitalized residents in the hospital's catchment area (some 1.4 m inhabitants). Four hundred of the selected 483 controls participated in the study. Risk was associated significantly with marital status, residence, dental status, alcohol consumption, and exposure to tobacco. When correcting for tobacco and alcohol consumption, only marital status and dental status remained significant. The association between risk and marital status was particularly prominent among divorced compared with married persons (odds ratio [OR] = 2.3, 95 percent confidence interval [CI] = 1.1-4.6). Persons with less than five teeth had an OR of 2.4 (CI 1.3-4.1) compared with persons with 15 or more teeth. Tobacco and alcohol exposure were the strongest individual risk-indicators in both lifetime and current consumption estimates, and their composite effect was particularly strong. Compared with nonusers, OR for tobacco (> 20 g/d) adjusted for alcohol = 5.8 (CI = 3.1-10.9); OR for alcohol (> 5 drinks/d) adjusted for tobacco = 8.4 (CI = 4.0-17.6). The OR for heavy users of tobacco and alcohol (> 20 g tobacco/d and > 5 drinks/d) was 80.7 (CI = 21.8-298.8). These results confirm that tobacco and alcohol contribute significantly to the risk of developing oral cancer. There were no significant differences between the risk estimates for the two genders or young and old persons. Two simulation studies indicate that the observed risk associated with tobacco and alcohol consumption cannot be explained reasonably by a high consumption among the 83 nonrespondents.

Adult↗
PubMed1998

The role of uninsurance and race in healthcare utilization by rural minorities.

OBJECTIVE: To examine the independent effects of minority status, residence, insurance status, and income on physician utilization, controlling for general health status and the presence of acute or chronic health problems. Of special interest was the question of utilization differences among rural minority populations, as compared with urban non-Latino whites. DATA SOURCE: Data from the 1992 National Health Interview Survey (NHIS). STUDY DESIGN: Multivariate analyses used multiple logistic regression methods to detect independent effects of residence and minority status on whether or not individuals used physician services. DATA COLLECTION/EXTRACTION METHODS: Data were obtained from the National Health Interview Survey, 1992. The survey included information about the race/ethnicity of the respondent, health status, utilization of services, insurance status, and socioeconomic status. PRINCIPAL FINDINGS: The most salient determinant of utilization of healthcare services is insurance status, regardless of race/ethnicity or (rural or urban) place of residence. Racial and ethnic minorities were less likely than whites to use physician services, and use was generally lower for rural residents. The most striking differences were for rural Latinos and rural Asians/other persons. CONCLUSIONS: Although the results demonstrate a need to adjust policies designed to improve utilization by accounting for particular problems faced by minority populations, they also demonstrate the primacy of addressing financial access.

Adolescent↗
PubMed2005

Survey of emergency medicine resident debt status and financial planning preparedness.

OBJECTIVES: Most resident physicians accrue significant financial debt throughout their medical and graduate medical education. The objective of this study was to analyze emergency medicine resident debt status, financial planning actions, and educational experiences for financial planning and debt management. METHODS: A 22-item questionnaire was sent to all 123 Accreditation Council on Graduate Medical Education-accredited emergency medicine residency programs in July 2001. Two follow-up mailings were made to increase the response rate. The survey addressed four areas of resident debt and financial planning: 1) accrued debt, 2) moonlighting activity, 3) financial planning/debt management education, and 4) financial planning actions. Descriptive statistics were used to analyze the data. RESULTS: Survey responses were obtained from 67.4% (1,707/2,532) of emergency medicine residents in 89 of 123 (72.4%) residency programs. Nearly one half (768/1,707) of respondents have accrued more than 100,000 dollars of debt. Fifty-eight percent (990/1,707) of all residents reported that moonlighting would be necessary to meet their financial needs, and more than 33% (640/1,707) presently moonlight to supplement their income. Nearly one half (832/1,707) of residents actively invested money, of which online trading was the most common method (23.3%). Most residents reported that they received no debt management education during residency (82.1%) or medical school (63.7%). Furthermore, 79.1% (1,351/1,707) of residents reported that they received no financial planning lectures during residency, although 84.2% (1,438/1,707) reported that debt management and financial planning education should be available during residency. CONCLUSIONS: Most emergency medicine residency programs do not provide their residents with financial planning education. Most residents have accrued significant debt and believe that more financial planning and debt management education is needed during residency.

Adult↗
PubMed2005

Female sooty mangabeys (Cercocebus torquatus atys) respond differently to males depending on the male's residence status-preliminary data.

I tested the hypothesis that free-ranging female mangabeys (Cercocebus torquatus atys) differentiate between males depending on their residence status. Adult males in this species employ two group-membership strategies: they are either full-time residents or part-time residents (i.e., present for several weeks at a time, then gone for several weeks, then present again, etc.). In a playback experiment I tested whether adult females with young infants responded differently to calls of adult males that were group members during the previous mating season as compared to males that belonged to neighboring groups during the mating season or were complete strangers. Males whose calls were played were present residents, part-time residents (absent for at least 3 months), neighbors, or complete strangers. Because infanticide is a potential risk in mangabeys, I predicted that females would respond differently to males that had resided in the group when their infant was conceived than they would to those that had not been present. The females showed a clear difference in their reaction to the playbacks of vocalizations from resident and part-time resident males as opposed to nonresidents.

Acoustic Stimulation↗
PubMed2005

Nutrition education for care staff and possible effects on nutritional status in residents of sheltered accommodation.

OBJECTIVE: We investigated the nutritional, cognitive and functional status in residents of two service-flat (SF) complexes and the effects of a nutrition education programme for care staff. DESIGN: Controlled nonrandomised study. SETTING: Two SF complexes, that is community-assisted accommodation. SUBJECTS: Of 115 eligible SF residents, 80 subjects participated (age 83+/-7 y, 70% women). INTERVENTION: The nutritional status was assessed using body mass index (BMI, kg/m(2)), subjective global assessment (SGA), serum concentrations of albumin, insulin-like growth factor-I (IGF-I) and vitamin B(12). Cognitive and functional status were evaluated using the Mini Mental State Examination (MMSE, 0-30 points, <24 points indicates impaired cognition) and the Katz activities of daily living (ADL) index, respectively. Two assessments were made with a 5-month interval. At the start, a 12-h education programme was given to the staff at one of the SF complexes. RESULTS: At baseline, the means of BMI and the biochemical nutritional indices were normal, whereas one-third had BMI <22 kg/m(2) and one-fourth had lost > or =10% of previous weight. According to SGA, 30% demonstrated possible or serious malnutrition. The median MMSE was 23 points (19.5-26.5, 25-75th percentile). Nearly 70% were ADL-independent. At the 5-month follow-up there were no differences in the nutritional and cognitive status of the residents. The nutritional knowledge of the staff improved slightly (P<0.05) at both SF complexes (NS between groups). CONCLUSIONS: Around one-third of SF residents appeared to be at nutritional risk. Five months after a 12-h staff nutrition education programme, no objective changes were seen in the nutritional status of the SF residents.

Activities of Daily Living↗
PubMed1999

Residential status and birth outcomes: is the rural/urban distinction adequate?

In studies comparing the birth outcomes of rural and urban women, residency status is frequently defined dichotomously as either rural or urban. Since residency status appears to be a continuum, however, the usefulness of other categorization systems needs to be explored. The purpose of this study was to compare birth outcomes using a three-level variable for residency status (rural, rural adjacent to urban, and urban). The study population was comprised of women who delivered by cesarean section over an 18-month period (N = 263) at a tertiary care hospital. Data were collected from patient charts, interviews, and the hospital information system. Residency status was determined by county of residence. Birth outcomes examined included gestational age, birthweight, Apgar scores, maternal complications, length of hospital stay, and costs of hospital care. Rural women had worse birth outcomes overall and traveled the greatest distance for delivery. Rural-adjacent women had the best birth outcomes of the three groups, yet were the youngest, least educated, least likely to be married, and the least likely to be privately insured. By using a nondichotomous three-level variable for residency status, two distinct groups of rural women were identified whose maternal health care needs may differ from each other.

Adult↗
PubMed2004

Correlates of resident psychosocial status in long-term care.

OBJECTIVES: This pilot study randomly selected five nursing homes, five assisted living facilities, and 16 family care homes from a South-Central state in the US to identify correlates of resident psychosocial status. METHODS: In-person and telephone interviews were conducted with administrators and resident-family-staff triads (n = 79) to gather information on setting, resident functional status, family involvement, sociodemographic context, and resident psychosocial status. RESULTS: Results indicated that type of facility, resident health conditions, resident race, and facility family orientation were significantly correlated with dimensions of resident psychosocial status. CONCLUSIONS: The findings suggest that multiple informants are necessary to determine the processes that lead to residents' quality of life, and the consideration of diverse settings offers greater insight into how positive resident adaptation is achieved in long-term care.

Aged↗
PubMed2002

Karnofsky Performance Status Assessment: resident versus attending.

BACKGROUND: Karnofsky Performance Status (KPS) is a commonly used scale to assess a patient's functional status. METHODS: Between September 1999 and March 2000, 117 patients were independently evaluated and assigned KPS scores by both an attending physician and a resident physician at the time of radiation therapy simulation. RESULTS: Both attending and resident median assigned KPS score was 80. Attending and resident KPS scores were identical for 50 patients (43%). When KPS scores differed, this difference was of the smallest incremental value (10 points) in 50 patients (75%). The Pearson correlation coefficient is 0.85, significant at the 0.01 level. CONCLUSION: KPS scoring by radiation oncology attending physicians is similar to that by resident physicians.

Adult↗