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The longitudinal study of surgical residents, 1994 to 1996

JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS 1999年第6期188卷 575-585页

作者： Kwakwa, F Jonasson, O Amer Coll Surg Chicago IL 60611 USA

Background: The American College of Surgeons (ACS) has conducted a detailed annual survey of residents enrolled in surgical graduate medical education (GME) programs since 1982 and has regularly published the resulting data as the Longitudinal Study of Surgical Residents. This report documents surgical resident enrollment and graduation for the academic years 1994-95 and 1995-96. Study Design: The Medical Education Research and Information Database of the American Medical Association was supplemented by the existing ACS Resident Masterfile and by personal contact with program directors and their staffs to verify accuracy and completeness of reporting. Each resident was tracked individually through surgical GME. Results: The total number of surgical residents graduating from surgical GME in 1995 and 1996 has not changed since 1982. Most graduates of surgical residency programs are in obstetrics and gynecology, followed by general surgery;demographic analysis of the graduating cohort shows that most are Caucasian male graduates of US or Canadian medical schools, and that their age at graduation is 33 to 35 years. International medical graduates (IMG) make up 8.9% of entering surgical residents and 6% of graduates. Osteopathic medical school graduates account for 1.2% to 1.3% of entering and graduating surgical residents. Women represent 27% of entering and 23% to 24% of graduates of surgical GME. The largest number and proportion of women in surgical GME are enrolled in obstetrics and gynecology residency programs, where they make up the majority of entering and graduating classes. When all other surgical residency program enrollments are considered together, women make up 17% and 16% of entering residents in 1994 and 1995 respectively, and 13% and 14% of graduates in those years. Conclusions: Surgical GME enrollment and graduation is stable. Few women and ethnic minorities are enrolled in surgical residency programs. IMG enrollment and graduation in surgical GME is l

关键词：数据收集教育医学研究生/统计学和数值数据人种群/统计学和数值数据实习医师和住院医师职务/统计学和数值数据纵向研究性别因素专业外科/教育专业外科/统计学和数值数据美国成年人女(雌)性人类男(雄)性

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Respiratory distress syndrome and maternal birth weight effects

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OBSTETRICS AND GYNECOLOGY 2000年第2期95卷 174-179页

作者： Strandjord, TP Emanuel, I Williams, MA Leisenring, WM Kimpo, C Univ Washington Dept Pediat Sch Med Seattle WA 98195 USA Univ Washington Dept Epidemiol Sch Publ Hlth Seattle WA 98195 USA Univ Washington Ctr Human Dev & Disabil Seattle WA 98195 USA Univ Washington Maternal & Child Hlth Program Seattle WA 98195 USA Fred Hutchinson Canc Res Ctr Seattle WA 98104 USA

Objective: To study traditional risk factors and the intergenerational risk factor maternal low birth weight (LBW) for respiratory distress syndrome (RDS) in infants in multiple ethnic groups. Methods: The population-based database consists of hospital records linked to Washington state maternal and infant vital records. Four racial-ethnic groups were studied, whites, blacks, Native Americans, and Hispanics. Poisson regression models were used to estimate relative risks of various factors for RDS, Results: Rates for RDS were whites 1.2%, blacks 1.9%, Native Americans 1.3%, and Hispanics 1.0%. Maternal LBW was associated with increased relative risk (RR) for RDS in whites (2.6, 95% confidence intevral [CI] 1.6, 4.2) and blacks (3.3, 95% CI 1.9, 5.6) for infants born vaginally. Compared with mothers of normal infants, birth weights of mothers of infants with RDS and delivered vaginally were significantly lower in whites, blacks, and Native Americans. The association of maternal LBW with RDS persisted in blacks even when multiple risk factors were added to the model (RR 2.4;95% CI 1.1, 5.1). Conclusion: The association of maternal LBW with RDS is probably due in part to the association of maternal LBW with infant LBW and preterm birth. The strong persistent association of maternal LBW with RDS in blacks suggests that improvement of perinatal outcomes in that group will require improvement of long-term birth weight distribution. (C) 2000 by The American College of Obstetricians and Gynecologists.

关键词：年龄分布年龄因素出生体重接生产科人种群/统计学和数值数据孕龄发病率婴儿极低出生体重病案母亲/统计学和数值数据泊松分布呼吸窘迫综合征新生儿/流行病学呼吸窘迫综合征新生儿/人种学危险因素华盛顿/流行病学成年人女(雌)性人类婴儿新生妊娠

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Dental care utilization: How saturated is the patient market? (vol 130, pg 573, 1999)

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JOURNAL OF THE AMERICAN DENTAL ASSOCIATION 1999年第10期130卷 1430-1430页

作者： Brown, LJ Lazar, VL American Dental Association Health Policy Resources Center

Background. Dental care utilization is the percentage of the population who access dental services over a specified period. In this article, the authors report on the results of several dental care utilization studies. Methods. To date, dental utilization data have been gathered by large national studies via telephone interviews, face-to-face interviews or written surveys. In this article, the authors report on and compare dental care utilization rates provided by the Centers for Disease Control and Prevention, the National Center for Health Statistics, the Agency for Health Care Policy and Research and the American Dental Association. Results. As captured by the various studies, the percentage of people who indicated they visited a dentist within the past year increased gradually between 1983 and 1997. The authors found that dental care utilization rates are higher among women than they are among men, and they de- crease with age and increase with income and educational level. Conclusions. Although the available data vary, they suggest that more Americans are visiting a dentist. The demand for dental care is increasing overall, as well as across educational, racial and economic lines. Practice Implications. If, as re- cent studies suggest, approximately 75 percent of the population visits a dentist annually, there is only modest room for further expansion of dental care utilization. However, if dental care utilization rates are substantially lower, as reported in older studies, then there is a greater potential for in- creased dental care utilization.

关键词：年龄因素美国牙科协会美国疾病控治中心数据收集牙科医疗/统计学和数值数据牙科保健服务/统计学和数值数据教育程度人种群/统计学和数值数据收入/统计学和数值数据国家卫生统计中心(美国) 性别因素美国美国卫生保健研究和质量评估署成年人老年人女(雌)性人类男(雄)性中年人

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Ethnic differences in admissions to secure forensic psychiatry services

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BRITISH JOURNAL OF PSYCHIATRY 2000年第3期177卷 241-247页

作者： Coid, J Kahtan, N Gault, S Jarman, B St Bartholomews & Royal London Sch Med & Dent Sect Forens Psychiat London England Univ London Imperial Coll Sci Technol & Med Sch Med Dept Primary Hlth Care & Gen Practice London England

Background Persons of African-Caribbean origin are more frequently imprisoned, and increasing evidence suggests they are detained more frequently in psychiatric hospitals, following offending behaviour. Aims To estimate population-based prevalence rates of treated mental disorder in different ethnic groups compulsorily admitted to secure forensic psychiatry services. Method A survey was recorded of 3155 first admissions, from 1988 to 1994, from half of England and Wales, with 1991 census data as the denominator adjusted for under-enumeration. Results Compulsory admissions for Black males were 5.6 (Cl 5.1-6.3) times as high as, and for Asian males were half, those for White males;for Black females, 2.9 (Cl 2.4-4.6) times as high and for Asian females one-third of those for White females. Admissions of non-Whites rose over the study period. Patterns of offending and diagnoses differed between ethnic groups. Conclusions Variations in compulsory hospitalisation cannot be entirely attributed to racial bias. Community-based services may be less effective in preventing escalating criminal and dangerous behaviour associated with mental illness in African-Caribbeans. Declaration of interest None. Funding was provided by the Department of Health.

关键词：精神病人强制住院/统计学和数值数据英格兰/流行病学人种群/统计学和数值数据司法精神病学/组织和管理医院精神病/利用精神障碍/人种学精神障碍/预防和控制危险因素社会控制正式社会正义社会经济因素威尔士/流行病学西印度群岛/人种学青少年成年人女(雌)性人类男(雄)性

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Racial differences in the management of unstable angina: Results from the multicenter GUARANTEE registry

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AMERICAN HEART JOURNAL 1999年第6期138卷 1065-1072页

作者： Scirica, BM Moliterno, DJ Every, NR Anderson, HV Aguirre, FV Granger, CB Lambrew, CT Rabbani, LE Sapp, SK Booth, JE Ferguson, JJ Cannon, CP Brigham & Womens Hosp Div Cardiovasc Boston MA 02115 USA Harvard Univ Sch Med Boston MA USA Cleveland Clin Fdn Cleveland OH 44195 USA Univ Washington Seattle WA 98195 USA Univ Texas Hlth Sci Ctr Houston TX USA St Louis Univ Hlth Sci Ctr St Louis MO 63103 USA Duke Univ Med Ctr Durham NC USA Maine Med Ctr Portland ME 04102 USA Columbia Presbyterian Med Ctr New York NY 10032 USA Texas Heart Inst Houston TX 77025 USA

Background Prior studies, usually conducted with the use of insurance databases, have shown differences in the use of cardiac procedures between black patients and white patients hospitalized with various types of coronary artery disease. However, few data are available in prospectively collected cohorts of patients with unstable angina or on the use of appropriate medications OF interventions. Methods and Results We evaluated 2948 consecutive patients with unstable angina admitted to 35 hospitals across the United States in 1996, comparing nonwhite and white patients. Seventy-seven percent of patients were white, 14% were black, 4% were Hispanic, 1% were Asian, and 3% were other or unknown race. Differences were seen in coronary risk profile, with a higher incidence of hypertension and diabetes mellitus in nonwhites. Cardiac catheterization was performed less often in nonwhites compared with whites (36% vs 53%, P = .001). Even in patients meeting the criteria for appropriate catheterization in the Agency for Health Care Policy Research unstable angina guidelines, fewer nonwhites underwent catheterization (44% vs 61%, P = .001), but among these, fewer nonwhites had significant coronary stenosis (72% vs 90%, P = .001). However, among patients catheterized who had indications for revascularization, angioplasty and coronary artery bypass grafting were performed equally often in nonwhites and whites. Conclusions Current guidelines would recommend more aggressive use of cardiac catheterization for nonwhite patients. However, our findings suggest that racial differences may need to be included in the diagnostic and interventional algorithms.

关键词：心绞痛不稳定型/治疗人种群/统计学和数值数据心脏导管插入术住院前瞻性研究登记美国老年人女(雌)性人类男(雄)性中年人

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What determines geographical variation in rates of acceptance onto renal replacement therapy in England?

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Journal of Health Services Research and Policy 1999年第3期4卷 139-146页

作者： Roderick, P. Clements, S. Stone, N. Martin, D. Diamond, I. Health Care Research Unit Wessex Inst. Health Res. Development Southampton General Hospital Southampton SO9 4XY United Kingdom

Objective: To determine the independent effects of need and supply factors on the known geographical variation in acceptance rates onto renal replacement therapy (RRT) in England. Methods: Data were obtained from all renal units in England on the characteristics of all cases aged 16 years and over, resident in England, who were accepted onto RRT in 1991 and 1992. Of these, 5715 (94.5%) had a valid postcode that could be matched to a census ward. Multilevel modelling using Poisson regression was used. The number of acceptances in each census ward within age bands 16-34, 35-64 and 65+ was the dependent variable. Independent effects modelled were: (1) individual factors (age, sex);(2) census ward need factors - ethnicity (expressed as the percentage of the ward population that was Asian or African-Caribbean), socioeconomic deprivation - and supply factors - 'access' to the nearest renal unit using crowfly and road travel time and distance, and services available to each ward expressed as number of haemodialysis stations per 100,000 catchment population of the nearest renal unit;(3) district health authority level effects. Results: Age was a major determinant of acceptance, with a 7-fold higher rate in males aged over 64 years compared with younger men. Acceptance rates were lower in females, with a negative age-sex interaction in females aged over 64 years. The percentage of both Asian and African-Caribbean populations per ward was a highly significant positive determinant. Deprivation was also a significant determinant, best represented by a customised index. There was an inverse relation of acceptance with distance, especially road travel time. Other supply side variables had a significant effect though there was no independent district effect. There was some variation in the strength of these relationships by type of area (Greater London, urban and non-urban). Conclusions: Need and supply factors influence service use as expressed as acceptance onto RRT. Pressure to

关键词：卫生服务范围/统计学和数值数据英格兰人种群/统计学和数值数据地理学卫生服务易得程度/统计学和数值数据需求估价病人接受卫生保健的程度/统计学和数值数据病人遴选回归分析肾替代疗法/利用小地区分析旅行青少年成年人老年人女(雌)性人类男(雄)性中年人

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Breast cancer screening among ethnically diverse low-income women in a general hospital psychiatry clinic

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GENERAL HOSPITAL PSYCHIATRY 1999年第5期21卷 374-381页

作者： Friedman, LC Moore, A Webb, JA Puryear, LJ Baylor Coll Med Dept Psychiat & Behav Sci Houston TX 77030 USA Baylor Coll Med Dept Family & Community Med Houston TX 77030 USA

Most low-income minority women do not obtain screening mammography on a regular basis. Compliance with recommended breast cancer screening guidelines may be even lower in women with psychiatric illnesses. We investigated compliance with breast cancer screening guidelines among 121 ethnically diverse low-income women recruited from a general hospital psychiatry clinic. Mammography and clinical breast examination (CBE) had been obtained in the previous year by 59% and 70% of the patients 40 years of age and older, respectively. Among patients 20 years of age and alder, 42% reported monthly breast self-examination (BSE). Physician recommendation of mammography was the strongest predictor of having obtained both a mammogram and a CBE within the previous year. There was an inverse relationship between breast cancer knowledge and screening mammography. Patients who were Hispanic, more educated, more confident in performing BSE, and whose physicians recommended monthly BSE were more likely to perform BSE monthly. These results highlight the importance of physician recommendation of compliance with screening guidelines for early detection of bl east cancer. Because psychiatric patients typically are treated by psychiatrists on a regular and frequent basis, psychiatrists are in a unique position not only to encourage cancer screening but also to monitor patient compliance with their recommendations. (C) 1999 Elsevier Science Inc.

关键词：年龄因素乳腺肿瘤/预防和控制乳腺肿瘤/心理学乳腺自我检查/利用人种群/心理学人种群/统计学和数值数据健康知识态度实践健康促进医院综合 Logistic模型乳房X线摄影术/利用普查/方法普查/心理学门诊部医院人群监测精神病学问卷调查抽样研究得克萨斯/流行病学妇女卫生成年人女(雌)性人类中年人

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Invited commentary: The challenge of multi-center cohort studies in the search for diet and cancer links

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AMERICAN JOURNAL OF EPIDEMIOLOGY 2000年第4期151卷 371-374页

作者： Riboli, E Kaaks, R Int Agcy Res Canc Unit Nutr & Canc F-69372 Lyon 08 France

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Hong kong and china in 1997: The implications for migration of elderly people- opportunities, constraints, or impetus

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Journal of Aging and Social Policy 1994年第4期5卷 119-136页

作者： Chow, Nelson Phillips, David R. Department of Social Work and Social Administration University of Hong Kong Hong Kong Institute of Population Studies University of Exeter United Kingdom

In 1997, Hong Kong changes from a British colony to a Special Administrative Region (SAR) of China. While officially it has been agreed that the status change should not alter the economic or social conditions in the territory substantially, many people believe that residents’ lives will be considerably affected. Hong Kong society has always been highly mobile and fluid in terms of migration, and it is only very recently that over half of the population have been bom in the territory. Many elderly people in Hong Kong were bom elsewhere and many Hong Kong families are fragmented, with members living in China, elsewhere in the Asia-Pacific region, North America, Australia, and Britain. The potential impact of 1997 on the lives and conditions of elderly residents is only now forming a focus of concern. This article considers what may happen in the closing years of this century and early next when the SAR emerges. There is already growing popular belief that, for financial and social reasons, some elderly people are going back to China for their retirement. However, evidence from a survey of 419 noninstitutionalized respondents found relatively few expressing a desire or willingness to retire to China. This article concludes with a discussion of why this may be so. A major reason may be that, with the increasing ease of visits between Hong Kong and China, Hong Kong elderly people might feel more comfortable with alternately living in China and Hong Kong instead of taking the bold decision of permanendy living in China. © 1993 by The Haworth Press, Inc. All rights reserved.

关键词：中国人种群/统计学和数值数据预测虚弱老人/统计学和数值数据香港政府政策居住流动性退休社会变迁老年人老年人 80以上女(雌)性人类男(雄)性

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Racial/ethnic disparities in admissions to public and private psychiatric inpatient settings: The effect of managed care

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ADMINISTRATION AND POLICY IN MENTAL HEALTH 1998年第2期26卷 101-109页

作者： Crawford, K Fisher, WH McDermeit, M Boston Univ Sch Med Div Psychiat Boston MA 02215 USA Univ Massachusetts Sch Med Dept Psychiat Amherst MA 01003 USA

This study investigates the effect of managed care on access patterns among people of color who are severely and persistently mentally ill. The distribution of admissions to public and private psychiatric hospitals was compared for African-American, Asian, Latino, and white case managed clients of the Massachusetts Department of Mental Health before and after implementation of Medicaid managed mental health care in October 1997. Managed care appears to have increased access to private services across all racial and ethnic groups, although admissions of non-white patients were still more likely to take place in publicly operated settings. These data suggest that equalizing access to putatively better inpatient treatment settings may be an externality of managed care.

关键词：大陆人口群人种群/统计学和数值数据卫生服务易得程度/标准卫生服务研究医院私立/利用医院精神病/利用医院公立/利用管理医疗规划/组织和管理马萨诸塞 Medicaid/组织和管理病人入院/统计学和数值数据美国成年人老年人老年人 80以上女(雌)性人类男(雄)性中年人

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