WorldWideScience

Sample records for california medical association

  1. Medical marijuana wins in California and Arizona.

    Science.gov (United States)

    James, J S

    1996-11-15

    Both California and Arizona have passed State legislation allowing medical use of marijuana, however, the law may now be unenforceable because of Federal laws against marijuana use for any reason. It is believed that some middle ground between allowing limited use of marijuana and outright banning is necessary considering today's medical needs. Among the demographic breakdowns on support of Proposition 215, allowing medicinal use of marijuana, was the observation that parents with children under 18 showed almost as much support for its passage as other adults, indicating no fear of it becoming abused by youth. Despite polls repeatedly showing support for the right to use marijuana for medical purposes, 44.3 percent still voted against it. The reasons are not known, but it is suggested that if the objections could be found and responded to, the initiative may work well enough to be an effective national model.

  2. 78 FR 77447 - California Wind Energy Association, First Solar, Inc. v. California Independent System Operator...

    Science.gov (United States)

    2013-12-23

    ... Energy Regulatory Commission California Wind Energy Association, First Solar, Inc. v. California Independent System Operator Corporation, Southern California Edison Company; Notice of Complaint Take notice... Practice and Procedure, 18 CFR 385.206 (2013), California Wind Energy Association and First Solar, Inc...

  3. Medical marijuana: Federal, State attacks against California cannabis clubs.

    Science.gov (United States)

    Gardner, F; James, J S

    1998-01-23

    The Clinton administration filed suit to close six marijuana buyers' clubs in California more than a year after Proposition 215, permitting medical use of the drug, was passed. This action was taken against six clubs: Cannabis Cultivators Club, Flower Therapy, Marin Alliance for Medical Marijuana, Oakland Cannabis Buyers' Cooperative, Santa Cruz Buyers' Club, and Ukiah Buyers' Club. Although Proposition 215 gives persons with a documented need for the drug a legal right to use it in California, the Federal prohibitions for its use still violates Federal law. In practice, social users can usually obtain marijuana while many patients who need it have no source from which to buy it. The history of the Federal attack on medical marijuana usage in California and the State's response are included.

  4. Self-medication practices in two California Mexican communities.

    Science.gov (United States)

    Pylypa, J

    2001-04-01

    Although social scientists have taken up the study of medication use in both developing and developed nations, the medication practices of immigrants remain largely unstudied. In this study, qualitative research was employed in order to describe and compare self-medication practices in two California Mexican immigrant groups: families living along the border near Tijuana, Mexico, and migrant farm worker families residing in illegal encampments and substandard housing in San Diego's North County. Medication and health seeking practices were found to vary according to the specific political-economic, sociocultural, and geographic contexts in which different subpopulations of California Mexicans live. The California-Mexico border area was examined as an important context for considering self-medication behaviors, since it permits border-crossing into Tijuana for the purpose of buying Mexican pharmaceuticals at low cost without a prescription. The popularity of injections among California Mexicans and the cross-border purchasing of injectable antibiotics and vitamins are discussed as issues of particular relevance for immigrants living along the border.

  5. American Medical Association

    Science.gov (United States)

    ... email newsletters for up-to-date medical news. Physician Data Privacy See how the AMA protects physicians’ privacy ... the new BP guideline Evidence-driven recommendations mean big changes for patients and physicians to understand. Here are 5 takeaways for your ...

  6. Medication-wide association studies

    NARCIS (Netherlands)

    P.B. Ryan (Patrick); D. Madigan (David); P.E. Stang (Paul); M.J. Schuemie (Martijn); G. Hripcsak (G.)

    2013-01-01

    textabstractUndiscovered side effects of drugs can have a profound effect on the health of the nation, and electronic health-care databases offer opportunities to speed up the discovery of these side effects. We applied a "medication-wide association study" approach that combined multivariate

  7. Science and Politics in "Friedrichs v. California Teachers Association"

    Science.gov (United States)

    Superfine, Benjamin Michael; Umpstead, Regina R.; Mayrowetz, David; Lenhoff, Sarah Winchell; Pogodzinski, Ben

    2018-01-01

    In March 2017, the Supreme Court decided "Friedrichs v. California Teachers Association" and upheld the constitutionality of agency fees for nonunion teachers. We examine how "Friedrichs" reflects a host of issues grouped around a patchwork of ideological commitments regarding teachers unions and public-sector unions more…

  8. Salary survey of the Medical Library Group of Southern California and Arizona.

    OpenAIRE

    Smith, J.L; Connolly, B.F.; Davis, M.; Graham, E; Wheeler, S

    1984-01-01

    The 1982 salary survey of the Medical Library Group of Southern California and Arizona (MLGSCA) indicates that 211 health sciences librarians in Southern California and Arizona earned a mean annual salary of $20,910 for 1982. Data analysis shows a positive correlation between salary and educational level. Other factors found to affect salary were job history, number of positions held, MLA certification, and professional responsibility. Age, gender, and MLA certification did not have a consist...

  9. Salary survey of the Medical Library Group of Southern California and Arizona.

    Science.gov (United States)

    Smith, J L; Connolly, B F; Davis, M; Graham, E; Wheeler, S

    1984-01-01

    The 1982 salary survey of the Medical Library Group of Southern California and Arizona (MLGSCA) indicates that 211 health sciences librarians in Southern California and Arizona earned a mean annual salary of $20,910 for 1982. Data analysis shows a positive correlation between salary and educational level. Other factors found to affect salary were job history, number of positions held, MLA certification, and professional responsibility. Age, gender, and MLA certification did not have a consistent positive correlation with salary. Results indicate that the salaries of hospital librarians are, on the average, roughly comparable to those of academic librarians in Southern California and Arizona. PMID:6743878

  10. Undocumented immigrants and their use of medical services in Orange County, California.

    Science.gov (United States)

    Chavez, Leo R

    2012-03-01

    Does an undocumented immigration status predict the use of medical services? To explore this question, this paper examines medical care utilization of undocumented Latino immigrants compared to Latino legal immigrants and citizens, and non-Latino whites in Orange County, California. Data were collected through a random sample telephone survey of 805 Latinos and 396 non-Hispanic whites between January 4 and January 30, 2006. Findings show that undocumented immigrants had relatively low incomes and were less likely to have medical insurance; experience a number of stresses in their lives; and underutilize medical services when compared to legal immigrants and citizens. Predictors of use of medical services are found to include undocumented immigration status, medical insurance, education, and gender. Undocumented Latinos were found to use medical services less than legal immigrants and citizens, and to rely more on clinic-based care when they do seek medical services. Copyright © 2011 Elsevier Ltd. All rights reserved.

  11. Saving tourists: the status of emergency medical services in California's National Parks.

    Science.gov (United States)

    Heggie, Travis W; Heggie, Tracey M

    2009-01-01

    Providing emergency medical services (EMS) in popular tourist destinations such as National Parks requires an understanding of the availability and demand for EMS. This study examines the EMS workload, EMS transportation methods, EMS funding, and EMS provider status in California's National Park Service units. A retrospective review of data from the 2005 Annual Emergency Medical Services Report for National Park Service (NPS) units in California. Sixteen NPS units in California reported EMS activity. EMS program funding and training costs totaled USD $1,071,022. During 2005 there were 84 reported fatalities, 910 trauma incidents, 663 non-cardiac medicals, 129 cardiac incidents, and 447 first aid incidents. Sequoia and Kings Canyon National Parks, Yosemite National Park, Golden Gate National Recreation Area, and Death Valley National Park accounted for 83% of the total EMS case workload. Ground transports accounted for 85% of all EMS transports and Emergency Medical Technicians with EMT-basic (EMT-B) training made up 76% of the total 373 EMS providers. Providing EMS for tourists can be a challenging task. As tourist endeavors increase globally and move into more remote environments, the level of EMS operations in California's NPS units can serve as a model for developing EMS operations serving tourist populations.

  12. Undocumented immigrants and their use of medical services in Orange County, California

    OpenAIRE

    Chavez, LR

    2012-01-01

    Does an undocumented immigration status predict the use of medical services? To explore this question, this paper examines medical care utilization of undocumented Latino immigrants compared to Latino legal immigrants and citizens, and non-Latino whites in Orange County, California. Data were collected through a random sample telephone survey of 805 Latinos and 396 non-Hispanic whites between January 4 and January 30, 2006. Findings show that undocumented immigrants had relatively low incomes...

  13. Medical complications associated with earthquakes.

    Science.gov (United States)

    Bartels, Susan A; VanRooyen, Michael J

    2012-02-25

    Major earthquakes are some of the most devastating natural disasters. The epidemiology of earthquake-related injuries and mortality is unique for these disasters. Because earthquakes frequently affect populous urban areas with poor structural standards, they often result in high death rates and mass casualties with many traumatic injuries. These injuries are highly mechanical and often multisystem, requiring intensive curative medical and surgical care at a time when the local and regional medical response capacities have been at least partly disrupted. Many patients surviving blunt and penetrating trauma and crush injuries have subsequent complications that lead to additional morbidity and mortality. Here, we review and summarise earthquake-induced injuries and medical complications affecting major organ systems. Copyright © 2012 Elsevier Ltd. All rights reserved.

  14. Examining the Association Between Temperature and Mental Health in California

    Science.gov (United States)

    Basu, R.; Gavin, L.; Pearson, D.; Malig, B. J.; Ebisu, K.

    2016-12-01

    Background: The association between temperature and morbidity from some specific causes has been well established. However, the association between temperature and mental health effects has not been examined closely, although those with mental illnesses may be susceptible to temperature. Methods: We obtained daily counts of emergency room visits and hospitalizations (ICD-9 codes) from the California Office of Statewide Health Planning and Development from 16 California climate zones from 2005 - 2013. Mean apparent temperature was determined by combining monitored temperature and humidity data from the US EPA, California Irrigation Management Information System, and the National Oceanic Atmospheric Administration and weighting monitor values by distance to zip code tabulation areas (ZCTA) and ZCTA populations in the same climate zone as each monitor. We used a two-stage hierarchical model to analyze this data, adjusted by the following independent variables: mean daily apparent temperature, holiday, day of the week, and a natural spline smoothing function of time. The regression was performed for both warm (5/1 - 10/31) and cold (11/1 - 4/30) seasons. Results were stratified by race/ethnicity and age group. Results: We observed an association between same-day mean apparent temperature and mental health outcomes during the warm and cold seasons. We also observed associations between temperature and suicide/self-injury and homicide/assault injury. A 10°F increase in mean apparent temperature was associated with a 4.98% [95% confidence interval, 3.73-6.23], 5.82% [4.34-7.30], and 7.43% [6.75-8.12], increase in mental health events, suicide, and homicide events during the warm season, respectively. Similar results were observed during the cold season. Effect modification by race/ethnic and age groups was observed for some outcomes for both seasons. Conclusions: Increase in mean apparent temperature was found to have same-day associations with several mental health

  15. Winter habitat associations of diurnal raptors in Californias Central Valley

    Science.gov (United States)

    Pandolrno, E.R.; Herzog, M.P.; Hooper, S.L.; Smith, Z.

    2011-01-01

    The wintering raptors of California's Central Valley are abundant and diverse. Despite this, little information exists on the habitats used by these birds in winter. We recorded diurnal raptors along 19 roadside survey routes throughout the Central Valley for three consecutive winters between 2007 and 2010. We obtained data sufficient to determine significant positive and negative habitat associations for the White-tailed Kite (Elanus leucurus), Bald Eagle {Haliaeetus leucocephalus), Northern Harrier (Circus cyaneus), Red-tailed Hawk (Buteo jamaicensis), Ferruginous Hawk (Buteo regalis), Rough-legged Hawk (Buteo lagopus), American Kestrel (Falco sparverius), and Prairie Falcon (Falco mexicanus). The Prairie Falcon and Ferruginous and Rough-legged hawks showed expected strong positive associations with grasslands. The Bald Eagle and Northern Harrier were positively associated not only with wetlands but also with rice. The strongest positive association for the White-tailed Kite was with wetlands. The Red-tailed Hawk was positively associated with a variety of habitat types but most strongly with wetlands and rice. The American Kestrel, Northern Harrier, and White-tailed Kite were positively associated with alfalfa. Nearly all species were negatively associated with urbanized landscapes, orchards, and other intensive forms of agriculture. The White-tailed Kite, Northern Harrier, Redtailed Hawk, Ferruginous Hawk, and American Kestrel showed significant negative associations with oak savanna. Given the rapid conversion of the Central Valley to urban and intensive agricultural uses over the past few decades, these results have important implications for conservation of these wintering raptors in this region.

  16. The medical complications associated with purging.

    Science.gov (United States)

    Forney, K Jean; Buchman-Schmitt, Jennifer M; Keel, Pamela K; Frank, Guido K W

    2016-03-01

    Purging behaviors, including self-induced vomiting, laxative abuse, and diuretic abuse, are present across many of the eating disorders. Here we review the major medical complications of these behaviors. Although we identified over 100 scholarly articles describing medical complications associated with purging, most papers involved case studies or small, uncontrolled samples. Given the limited evidence base, we conducted a qualitative (rather than systematic) review to identify medical complications that have been attributed to purging behaviors. Medical conditions affecting the teeth, esophagus, gastrointestinal system, kidneys, skin, cardiovascular system, and musculoskeletal system were identified, with self-induced vomiting causing the most medical complications. Purging behavior can be associated with severe medical complications across all body systems. Mental health professionals should refer patients with purging behaviors to medical providers for screening and treatment as needed. The medical work-up for individuals with eating disorders should include a comprehensive metabolic panel, complete blood count, and a full body exam including the teeth to prevent severe complications. Medical providers should screen patients for purging behaviors and associated medical complications, even in the absence of an eating disorder diagnosis, to increase the detection of eating disorders. Recognizing the link between purging and medical complications can aid in identifying potential eating disorders, particularly those that often elude detection such as purging disorder. © 2016 Wiley Periodicals, Inc.

  17. Early Medicaid Expansion Associated With Reduced Payday Borrowing In California.

    Science.gov (United States)

    Allen, Heidi; Swanson, Ashley; Wang, Jialan; Gross, Tal

    2017-10-01

    We examined the impact of California's early Medicaid expansion under the Affordable Care Act on the use of payday loans, a form of high-interest borrowing used by low- and middle-income Americans. Using a data set for the period 2009-13 (roughly twenty-four months before and twenty-four months after the 2011-12 Medicaid expansion) that covered the universe of payday loans from five large payday lenders with locations around the United States, we used a difference-in-differences research design to assess the effect of the expansion on payday borrowing, comparing trends in early-expansion counties in California to those in counties nationwide that did not expand early. The early Medicaid expansion was associated with an 11 percent reduction in the number of loans taken out each month. It also reduced the number of unique borrowers each month and the amount of payday loan debt. We were unable to determine precisely how and for whom the expansion reduced payday borrowing, since to our knowledge, no data exist that directly link payday lending to insurance status. Nonetheless, our results suggest that Medicaid reduced the demand for high-interest loans and improved the financial health of American families. Project HOPE—The People-to-People Health Foundation, Inc.

  18. Health Hazard Evaluation Report HETA 91-395-2244, Veterans Administration Medical Center, Los Angeles, California

    Energy Technology Data Exchange (ETDEWEB)

    Kelly, J.E.; Miller, A.

    1992-08-01

    In response to a request from an employee of the Veterans Administration Medical Center (SIC-8062), Los Angeles, California, an investigation was undertaken of exposures to chemicals in the laboratory department, excessive heat and humidity in the kitchen area of the dietetics department, and carbon-monoxide (630080) exposures inside the building. In three of five personal breathing zone samples taken in the histopathology laboratory, formaldehyde (50000) was detected at concentrations up to 0.17 part per million (ppm) and it was also present in all four of the area air samples at concentrations up to 1.1ppm. The predominant symptoms associated with work in the laboratory included occasional headaches and nose/throat irritation. Mild episodes of dermal irritation and rash were also reported. All carbon-monoxide levels were less than 5ppm. In the kitchens, relative humidity levels were below the recommended range. Temperatures were above the range of temperatures recommended for a medium level of work. The authors conclude that a potential carcinogenic risk existed for workers in laboratories which use formaldehyde. The authors recommend specific measures to lower the risk of formaldehyde exposures in the laboratory.

  19. The California 500: medical care at a NASCAR Winston Cup race.

    Science.gov (United States)

    Grange, Jeff T; Baumann, Gregory W

    2002-01-01

    Stock car racing is America's fastest-growing professional sport. With more than 5.5 million paid admittances and another 148 million watching the 34-race NASCAR Winston Cup series on television, emergency physicians are increasingly called upon to organize medical support for such events. Currently, little reliable information is available to assist in determining what specific personnel and equipment are necessary to optimally support a race event. To characterize the spectrum of presenting injuries and illnesses at a NASCAR Winston Cup event. This study was a retrospective review of all patients presenting to nine on-site first aid stations from June 19 to 22, 1997, for the inaugural California 500 race weekend at California Speedway in Fontana, California. Staffing of the nine first aid stations was provided by 20 paramedics, 25 emergency nurses, five emergency physicians, nine advanced life support (ALS) ambulances with two crew members each, and a medically configured helicopter with flight crew. Of the 923 patients seen, 38 were drivers/crew, 230 were track employees, and 644 were spectators. One hundred thirty-six of the patients were treated in the two infield facilities, while 787 were treated in the grandstand first aid stations. Patients seen per hour peaked just before the start of the race at 73 patients seen. Of the ten patients transported to the hospital, three required admission. No deaths occurred. These data may assist individuals planning medical support for large motorsports venues.

  20. 76 FR 46651 - Petition for Rulemaking Submitted by the California Association of Marriage and Family Therapists

    Science.gov (United States)

    2011-08-03

    ... COMMISSION 10 CFR Part 26 Petition for Rulemaking Submitted by the California Association of Marriage and... Riemersma, on behalf of the California Association of Marriage and Family Therapists (the petitioner... the Code of Federal Regulations (10 CFR) 26.187(b) to add marriage and family therapists as substance...

  1. California Diploma Project Technical Report II: Alignment Study--Alignment Study of the Health Sciences and Medical Technology Draft Standards and California's Exit Level Common Core State Standards

    Science.gov (United States)

    McGaughy, Charis; de Gonzalez, Alicia

    2012-01-01

    The California Department of Education is in the process of revising the Career and Technical Education (CTE) Model Curriculum Standards. The Educational Policy Improvement Center (EPIC) conducted an investigation of the draft version of the Health Sciences and Medical Technology Standards (Health Science). The purpose of the study is to…

  2. Association between licence status and medication errors.

    Science.gov (United States)

    Conroy, Sharon

    2011-03-01

    Unlicensed and off label drug use in children is common and leads to well-recognised problems. This study aimed to determine whether a relationship exists between medication errors and licence status. Reports of errors in a UK children's hospital from 2004 to 2006 were analysed in terms of licence status and degree of harm and compared to the incidence of unlicensed and off label drug use in the hospital. 20 of 158 (13%) errors were considered to have caused moderate harm and 12 of these involved unlicensed/off label drugs. 138 (87%) caused no or low harm. None caused severe harm. Unlicensed drug usage was significantly more likely to be associated with errors than licensed use in both children and neonates. Unlicensed drug use appears to be associated with medication errors in neonates and children. Medication errors causing moderate harm were significantly more likely to be associated with both unlicensed and off label than licensed drugs.

  3. Impact of emergency medical services stroke routing protocols on Primary Stroke Center certification in California.

    Science.gov (United States)

    Schuberg, Sam; Song, Sarah; Saver, Jeffrey L; Mack, William J; Cen, Steven Y; Sanossian, Nerses

    2013-12-01

    Organized stroke systems of care include Primary Stroke Center (PSC) certification and preferential emergency medical services (EMS) routing of suspected patients with stroke to designated PSCs. Stroke EMS routing is not nationally governed; in California, routing is determined by county. EMS routing policies might provide an incentive for PSC accreditation. We evaluated the relationship between independent adoption of EMS routing protocols and PSC designation acquisition in California. Dates of PSC certification were obtained through The Joint Commissions Website and confirmatory calls to stroke coordinators. Starting date of county EMS PSC routing policies was obtained from county EMS agencies. We provide descriptive analysis of number of hospitals achieving PSC designation relative to implementation of EMS routing policies for all counties with PSCs. By June 2012, there were 131 California PSCs in 27 counties, and 22 of 58 counties had implemented EMS routing policies. The greatest number of PSCs was in Los Angeles (30) followed by San Diego (11), Orange (9), and Santa Clara (9) counties. Achievement of PSC designation occurred more frequently immediately before and after EMS routing: 51 PSCs (39%) within 1 year; 85 PSCs (65%) within 2 years. The yearly rate of eligible hospital conversion to PSC designation accelerated concurrent with EMS diversion policy adoption from 3.8% before to 16.2% during and decelerated afterward to 7.6%. Implementation of EMS routing policies may be an important factor driving PSC certification. National adoption of stroke routing policies may lead to more PSCs, positively impacting patient care.

  4. Examining the relationship between the physical availability of medical marijuana and marijuana use across fifty California cities.

    Science.gov (United States)

    Freisthler, Bridget; Gruenewald, Paul J

    2014-10-01

    The purpose of the current study is to assess statistical associations between individual demographic and personality characteristics, the city-level physical availability of medical marijuana (as measured through densities per roadway mile of storefront dispensaries and delivery services), and the incidence and prevalence of marijuana use. Individual level data on marijuana use were collected during a telephone survey of 8853 respondents living in 50 mid-size cities in California. Data on medical marijuana dispensaries and delivery services were obtained via six different websites and official city lists. Three outcome variables pertaining to lifetime, past year use, and frequency of past year use were analyzed using random effects logistic models (for lifetime and past year use) and random effects tobit models (for frequency of past 365-day use). The current study finds that the total physical availability of medical marijuana through dispensaries and delivery services per roadway mile at the city-level is positively related to current marijuana use and greater frequency of use, controlling for a variety of demographic and personality characteristics. As expected, current physical availability of medical marijuana was unrelated to lifetime use. Regulations on the number and densities of marijuana outlets may be a sufficient means to restrain overall levels of marijuana use within cities. However, alternative use of delivery services may also provide easy access to marijuana and mitigate these effects. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  5. Asperger Syndrome: Associated Psychiatric and Medical Conditions.

    Science.gov (United States)

    Ghaziuddin, Mohammad

    2002-01-01

    This article explores the association of medical and psychiatric conditions with Asperger syndrome, based mainly on publications from the last two decades. It examines comorbidity of Asperger syndrome with mood disorders, schizophrenia, obsessive-compulsive disorder, attention deficit/hyperactivity disorder, tic disorders, violence and aggression,…

  6. Risk factors associated with leptospirosis in dogs from Northern California: 2001-2010.

    Science.gov (United States)

    Hennebelle, Janemarie H; Sykes, Jane E; Foley, Janet

    2014-10-01

    The present study was performed to identify risk factors for canine leptospirosis at a tertiary referral institution in northern California from 2001 through 2010 and to describe case characteristics. In this retrospective case-control study, 67 dogs with leptospirosis and 271 controls were evaluated at the William R. Pritchard Veterinary Medical Teaching Hospital (Davis, CA) from March, 2001 , through November, 2010. Medical records of cases and controls were analyzed to identify signalment, exposure history, and clinical signs that increased the risk for a diagnosis of leptospirosis. Among cases, most were vomiting and lethargic and had leukocytosis and azotemia. Total white cell count, neutrophil count, and monocyte count were higher in dogs with leptospirosis, whereas the platelet count was lower. Serum concentrations of urea nitrogen, creatinine, and bilirubin were elevated in dogs with leptospirosis as well. On average, case dogs were hospitalized for 11 days and had hospital bills exceeding $5000. Mortality was 13% of case dogs, with the predominant serovar being Pomona. Dogs with leptospirosis were more likely to reside in the central or south coast (odds ratio [OR]=7.33), Sierra Nevada foothills (OR=4.50), San Francisco Bay area (OR=4.2), and north coast (OR=2.85) of California when compared with controls. Dogs 5-10 years old (OR=3.22) or over 10 years old (OR=2.76) and herding (OR=3.1) or hound breed (OR=4.6) dogs were more likely to have leptospirosis than the control group. Leptospirosis was associated with acute renal failure in older, undervaccinated dogs. The regional distribution, large breed predisposition, and finding of predominantly Pomona serovar suggest wildlife or other contacts as an important route of exposure. Knowledge of risk factors, vaccination history, and clinical signs can increase an index of suspicion for leptospirosis and contribute to improved strategies for prevention of leptospirosis in dogs, understanding of the ecology of

  7. Teratogenic mechanisms associated with prenatal medication exposure.

    Science.gov (United States)

    van Gelder, Marleen M H J; van Rooij, Iris A L M; de Jong-van den Berg, Lolkje T W; Roeleveld, Nel

    2014-01-01

    Birth defects may originate through multiple mechanisms and may be caused by a variety of possible exposures, including medications in early pregnancy. In this review, we describe six principal teratogenic mechanisms suspected to be associated with medication use: folate antagonism, neural crest cell disruption, endocrine disruption, oxidative stress, vascular disruption, and specific receptor- or enzyme-mediated teratogenesis. Knowledge about these mechanisms, for some of which evidence is mainly derived from animal models, may not only be relevant for etiologic and post-marketing research, but may also have implications for prescribing behavior for women of reproductive age. Since combinations of seemingly unrelated medications may have effects through similar teratogenic mechanisms, the risk of birth defects may be strongly increased in multi-therapy. © 2014 Société Française de Pharmacologie et de Thérapeutique.

  8. Factors associated with stress among medical students.

    Science.gov (United States)

    Qamar, Khadija; Khan, Najamus Saqib; Bashir Kiani, Muhammad Rizwan

    2015-07-01

    To determine the probable factors responsible for stress among undergraduate medical students. The qualitative descriptive study was conducted at a public-sector medical college in Islamabad, Pakistan, from January to April 2014. Self-administered open-ended questionnaires were used to collect data from first year medical students in order to study the factors associated with the new environment. There were 115 students in the study with a mean age of 19±6.76 years. Overall, 35(30.4%) students had mild to moderate physical problems, 20(17.4%) had severe physical problems and 60(52.2%) did not have any physical problem. Average stress score was 19.6±6.76. Major elements responsible for stress identified were environmental factors, new college environment, student abuse, tough study routines and personal factors. Majority of undergraduate students experienced stress due to both academic and emotional factors.

  9. [Croatian Medical Association--Branch Zagreb].

    Science.gov (United States)

    Kaić, Zvonimir; Sain, Snjezana; Gulić, Mirjana; Mahovlić, Vjekoslav; Krznarić, Zeljko

    2014-01-01

    The available literature shows us that "Druztvo ljeciteljah u Zagrebus (the Society of Healers in Zagreb) was founded as far back as the year 1845 by a total of thirteen members. This data allows us to follow the role of doctors and health workers in Zagreb through their everyday profession, research, organizational and social work as well as management through a period of over one hundred to seventy years. The Branch Zagreb was active before the official establishment of subsidiaries of CMA which is evident from the minutes of the regular annual assembly of the Croatian Medical Association on 21 March 1948. Until the end of 1956, there was no clear division of labor, functions and competencies between the Branch and the Main Board. Their actions were instead consolidated and the Branch operated within and under the name of Croatian Medical Association. In that year the Branch became independent. The Branch Zagreb is the largest and one of the most active branches of the Croatian Medical Association. At the moment, the Branch brings together 3621 members, regular members--doctors of medicine (2497), doctors of dental medicine (384), retired physicians (710), and associate members (30 specialists with higher education who are not doctors). The Branch is especially accomplished in its activities in the area of professional development of its members and therefore organizes a series of scientific conferences in the framework of continuous education of physicians, allowing its members to acquire necessary points for the extension of their operating license. The choir "Zagrebacki lijecnici pjevaci" (Zagreb Physicians' Choir) of the Croatian Medical Music Society of the CMA and its activities are inseparable from the Branch Zagreb. The Branch is firmly linked to the parent body, the CMA, and thus has a visible impact on the strategy and the activities of the Association as a whole. Most professional societies of the CMA have their headquarters in Zagreb and this is

  10. Journal of the Eritrean Medical Association: Journal Sponsorship

    African Journals Online (AJOL)

    Journal of the Eritrean Medical Association: Journal Sponsorship. Journal Home > About the Journal > Journal of the Eritrean Medical Association: Journal Sponsorship. Log in or Register to get access to full text downloads.

  11. Journal of the Eritrean Medical Association: Site Map

    African Journals Online (AJOL)

    Journal of the Eritrean Medical Association: Site Map. Journal Home > About the Journal > Journal of the Eritrean Medical Association: Site Map. Log in or Register to get access to full text downloads.

  12. Association between workarounds and medication administration errors in bar-code-assisted medication administration in hospitals.

    Science.gov (United States)

    van der Veen, Willem; van den Bemt, Patricia M L A; Wouters, Hans; Bates, David W; Twisk, Jos W R; de Gier, Johan J; Taxis, Katja

    2017-08-22

    To study the association of workarounds with medication administration errors using barcode-assisted medication administration (BCMA), and to determine the frequency and types of workarounds and medication administration errors. A prospective observational study in Dutch hospitals using BCMA to administer medication. Direct observation was used to collect data. Primary outcome measure was the proportion of medication administrations with one or more medication administration errors. Secondary outcome was the frequency and types of workarounds and medication administration errors. Univariate and multivariate multilevel logistic regression analysis were used to assess the association between workarounds and medication administration errors. Descriptive statistics were used for the secondary outcomes. We included 5793 medication administrations for 1230 inpatients. Workarounds were associated with medication administration errors (adjusted odds ratio 3.06 [95% CI: 2.49-3.78]). Most commonly, procedural workarounds were observed, such as not scanning at all (36%), not scanning patients because they did not wear a wristband (28%), incorrect medication scanning, multiple medication scanning, and ignoring alert signals (11%). Common types of medication administration errors were omissions (78%), administration of non-ordered drugs (8.0%), and wrong doses given (6.0%). Workarounds are associated with medication administration errors in hospitals using BCMA. These data suggest that BCMA needs more post-implementation evaluation if it is to achieve the intended benefits for medication safety. In hospitals using barcode-assisted medication administration, workarounds occurred in 66% of medication administrations and were associated with large numbers of medication administration errors.

  13. Jewish holidays and their associated medical risks.

    Science.gov (United States)

    Urkin, Jacob; Naimer, Sody

    2015-02-01

    Religiosity is inherent in human cultures. Being different in many aspects, all have rules regarding appropriate behavior and rituals. Celebrations of social events and of holidays prevail in all major religions. These include code of dress, prayers, special food and activities which may have negative health implications. The Jewish religion is 'blessed' with an abundance of holidays each with its unique health implications. In this paper we provide an outline of the character of these festivals and possible medical repercussions on those celebrating them. Observant members of the Jewish religion and teams treating this population should be knowledgeable of potentially associated risks. Pre-holiday periods should be specifically targeted for educational and preventive activity in order diminish injury or morbidity.

  14. Medical history associated with adolescent powerlifting.

    Science.gov (United States)

    Brown, E W; Kimball, R G

    1983-11-01

    A questionnaire, designed to elicit information about the training, experience, and medical history of adolescent powerlifters, was administered to 71 contestants entered in the 1981 Michigan Teenage Powerlifting Championship. The average subject had participated in 4.1 workouts per week for 17.1 months. Each workout lasted an average of 99.2 minutes. The population sustained 98 powerlifting injuries which caused a discontinuance of training for a total of 1,126 days. The incidence and severity of pain in 13 regions of the body, as well as the site and type of powerlifting injury, were investigated. The low back region was shown to be the site with the greatest number of injuries (49). This region also had the highest percent of subjects recording an elevated occurrence and level of pain associated with powerlifting.

  15. A multi-institutional medical educational collaborative: advocacy training in California pediatric residency programs.

    Science.gov (United States)

    Chamberlain, Lisa J; Wu, Susan; Lewis, Gena; Graff, Nancy; Javier, Joyce R; Park, Joseph S R; Johnson, Christine L; Woods, Steven D; Patel, Mona; Wong, Daphne; Blaschke, Gregory S; Lerner, Marc; Kuo, Anda K

    2013-03-01

    Educational collaboratives offer a promising approach to disseminate educational resources and provide faculty development to advance residents' training, especially in areas of novel curricular content; however, their impact has not been clearly described. Advocacy training is a recently mandated requirement of the Accreditation Council for Graduate Medical Education that many programs struggle to meet.The authors describe the formation (in 2007) and impact (from 2008 to 2010) of 13 California pediatric residency programs working in an educational collaboration ("the Collaborative") to improve advocacy training. The Collaborative defined an overarching mission, assessed the needs of the programs, and mapped their strengths. The infrastructure required to build the collaboration among programs included a social networking site, frequent conference calls, and face-to-face semiannual meetings. An evaluation of the Collaborative's activities showed that programs demonstrated increased uptake of curricular components and an increase in advocacy activities. The themes extracted from semistructured interviews of lead faculty at each program revealed that the Collaborative (1) reduced faculty isolation, increased motivation, and strengthened faculty academic development, (2) enhanced identification of curricular areas of weakness and provided curricular development from new resources, (3) helped to address barriers of limited resident time and program resources, and (4) sustained the Collaborative's impact even after formal funding of the program had ceased through curricular enhancement, the need for further resources, and a shared desire to expand the collaborative network.

  16. Assessing social values for California's efforts to reduce the overuse of unnecessary medical care.

    Science.gov (United States)

    Perez, Susan L; Backman, Desiree; Ginsburg, Marge

    2017-11-16

    A partnership of large health-care purchasers created a workgroup to reduce the overuse of harmful and wasteful medical care in California. Employ a civic engagement process to identify the social values important to the public in considering different strategies to reduce overuse. Use of deliberation techniques for 3 case examples that explore possible strategies: physician oversight, physician compensation, increased patient cost-sharing or taking no definitive action. Five themes were identified, including strong support for physicians' leadership role to reduce overuse; nuanced enthusiasm for increasing patient cost-sharing to discourage excessive demand; and marked disapproval of physician compensation as a motivator. Most but not all of the perspectives voiced by participants are congruent with efforts to reduce overuse that is being initiated or discussed at the state, provider and health plan level. As health-care policymakers and leaders consider more targeted approaches to reducing overuse, these findings will inform decision-making. © 2017 The Authors Health Expectations Published by John Wiley & Sons Ltd.

  17. Supporting medical education research quality: the Association of American Medical Colleges' Medical Education Research Certificate program.

    Science.gov (United States)

    Gruppen, Larry D; Yoder, Ernie; Frye, Ann; Perkowski, Linda C; Mavis, Brian

    2011-01-01

    The quality of the medical education research (MER) reported in the literature has been frequently criticized. Numerous reasons have been provided for these shortcomings, including the level of research training and experience of many medical school faculty. The faculty development required to improve MER can take various forms. This article describes the Medical Education Research Certificate (MERC) program, a national faculty development program that focuses exclusively on MER. Sponsored by the Association of American Medical Colleges and led by a committee of established medical education researchers from across the United States, the MERC program is built on a set of 11 interactive workshops offered at various times and places across the United States. MERC participants can customize the program by selecting six workshops from this set to fulfill requirements for certification. This article describes the history, operations, current organization, and evaluation of the program. Key elements of the program's success include alignment of program content and focus with needs identified by prospective users, flexibility in program organization and logistics to fit participant schedules, an emphasis on practical application of MER principles in the context of the participants' activities and interests, consistency in program content and format to ensure standards of quality, and a sustainable financial model. The relationship between the national MERC program and local faculty development initiatives is also described. The success of the MERC program suggests that it may be a possible model for nationally disseminated faculty development programs in other domains.

  18. Effect of Brief Behavioral Intervention Program in Managing Stress in Medical Students from Two Southern California Universities

    OpenAIRE

    Bughi, Stephanie A.; Sumcad, Jennifer; Bughi, Stefan

    2009-01-01

    The study aims to assess 1) the prevalence of stress among a group of third and fourth year medical students (MS) from two Southern California universities and 2) the effect of a brief behavioral intervention program (BBIP) on stress management among the students instructed on stress intervention techniques. The stress level was determined by using the General Well Being Scale (GWBS), a self-report questionnaire designed by the National Center for Health Statistics.1 The stress testing was do...

  19. Insurance Coverage, Access to Care, and Medical Debt Since the ACA: a Look at California, Florida, New York, and Texas.

    Science.gov (United States)

    Gunja, Munira Z; Collins, Sara R; Doty, Michelle McEvoy; Beutel, Sophie

    2017-03-01

    ISSUE: The Affordable Care Act has significantly increased health insurance coverage and access to care among U.S. adults nationwide. However, the law gives states flexibility in implementing certain provisions, leading to wide variations between states in consumers’ experiences. GOAL: To examine the differences in insurance coverage, access to care, and medical bill problems in the four largest states—California, Florida, New York, and Texas—all of which have made different choices in implementing the law. METHODS: Analysis of the Commonwealth Fund Biennial Health Insurance Survey, 2016. FINDINGS AND CONCLUSIONS: In 2016, uninsured rates among adults ages 19 to 64 across the four states varied from 7 percent in New York and 10 percent in California to 16 percent in Florida and 25 percent in Texas. This variation was also apparent in the proportions of residents reporting problems getting needed care because of the cost—significantly lower in California and New York than in Florida and Texas. Lower percentages of Californians and New Yorkers reported having a medical bill problem in the past 12 months or having accrued medical debt compared to Floridians and Texans. These variations might be explained by several factors: whether the state expanded Medicaid eligibility; whether it ran its own health insurance marketplace; what the uninsured rate was prior to the Affordable Care Act; differences in the cost protections provided by private health plans; and demographic differences.

  20. Perceived stress and associated factors among medical students

    National Research Council Canada - National Science Library

    Abdalla A Saeed; Ahmed A Bahnassy; Nasser A Al-Hamdan; Faisal S Almudhaibery; Anisah Z Alyahya

    2016-01-01

    ...: To determine the prevalence and factors associated with perceived stress in medical students in the College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Fahad Medical...

  1. Third-World Hodgkin's disease at Los Angeles County-University of Southern California Medical Center.

    Science.gov (United States)

    Hu, E; Hufford, S; Lukes, R; Bernstein-Singer, M; Sobel, G; Gill, P; Pinter-Brown, L; Rarick, M; Rosen, P; Brynes, R

    1988-08-01

    The reported experience with Hodgkin's disease (HD) in the United States has come primarily from large referral centers that attract a predominantly white population of high socioeconomic status (SES). The majority of these patients had the nodular sclerosis (NS) histologic subtype and asymptomatic stage I/II disease. We have reviewed the records of 178 patients with HD seen within the past 17 years at Los Angeles County-University of Southern California Medical Center (LAC/USC), which is a nonreferral, government-operated facility. Our patient population was found to be heterogeneous, with 38% white, 22% black, and 36% Hispanic. Systemic "B" symptoms were noted in 62% of patients at diagnosis, and 63% had advanced disease (stage III or IV). NS pathologic subtype was present in only 52% of the group. Comparison between the races revealed: (1) Hispanics had a higher incidence of lymphocyte depleted subtype and less NS than whites (P less than .06); (2) whites had equal distribution between stages I/II and III/IV; (3) blacks and Hispanics presented more frequently with stage III/IV (P = .10); and (4) extranodal involvement occurred most often in bone in whites, and was equally distributed between liver, lung, and bone in blacks and Hispanics. We conclude that the lower SES, mixed racial population seen at our institution more closely resembles the reports of HD in Third-World countries and is characterized by advanced symptomatic disease. Further, the clinical pathologic characteristics of HD in the United States may vary significantly, depending upon the precise ethnic and socioeconomic status of the patients being served.

  2. Headache associated disability in medical students at the Kenyatta ...

    African Journals Online (AJOL)

    Objective: To study headache associated disability in a group of medical students at the Kenyatta National Hospital. Study design: Cross sectional survey. Results: Between October 1994 and January 1995 we conducted a survey on headache characteristics on medical students at both the Kenya Medical Training Centre ...

  3. Factors Associated with Undertreatment of Medical Student Depression.

    Science.gov (United States)

    Tjia, Jennifer; Givens, Jane L.; Shea, Judy A.

    2005-01-01

    The authors measured factors associated with undertreatment of medical students' depression. They administered a cross-sectional Beck Depression Inventory and sociodemographic questionnaire to students at 1 medical school, defining their outcome measure as the use of counseling services or antidepressant medication. Of an estimated 450 available…

  4. Triggered surface slips in southern California associated with the 2010 El Mayor-Cucapah, Baja California, Mexico, earthquake

    Science.gov (United States)

    Rymer, Michael J.; Treiman, Jerome A.; Kendrick, Katherine J.; Lienkaemper, James J.; Weldon, Ray J.; Bilham, Roger; Wei, Meng; Fielding, Eric J.; Hernandez, Janis L.; Olson, Brian P.E.; Irvine, Pamela J.; Knepprath, Nichole; Sickler, Robert R.; Tong, Xiaopeng; Siem, Martin E.

    2011-01-01

    The April 4, 2010 (Mw7.2), El Mayor-Cucapah, Baja California, Mexico, earthquake is the strongest earthquake to shake the Salton Trough area since the 1992 (Mw7.3) Landers earthquake. Similar to the Landers event, ground-surface fracturing occurred on multiple faults in the trough. However, the 2010 event triggered surface slip on more faults in the central Salton Trough than previous earthquakes, including multiple faults in the Yuha Desert area, the southwestern section of the Salton Trough. In the central Salton Trough, surface fracturing occurred along the southern San Andreas, Coyote Creek, Superstition Hills, Wienert, Kalin, and Imperial Faults and along the Brawley Fault Zone, all of which are known to have slipped in historical time, either in primary (tectonic) slip and/or in triggered slip. Surface slip in association with the El Mayor-Cucapah earthquake is at least the eighth time in the past 42 years that a local or regional earthquake has triggered slip along faults in the central Salton Trough. In the southwestern part of the Salton Trough, surface fractures (triggered slip) occurred in a broad area of the Yuha Desert. This is the first time that triggered slip has been observed in the southwestern Salton Trough.

  5. Inappropriate self-medication among adolescents and its association with lower medication literacy and substance use.

    Directory of Open Access Journals (Sweden)

    Chun-Hsien Lee

    Full Text Available While self-medication is common, inappropriate self-medication has potential risks. This study assesses inappropriate self-medication among adolescents and examines the relationships among medication literacy, substance use, and inappropriate self-medication.In 2016, a national representative sample of 6,226 students from 99 primary, middle, and high schools completed an online self-administered questionnaire. Multiple logistic regression analysis was used to examine factors related to inappropriate self-medication.The prevalence of self-medication in the past year among the adolescents surveyed was 45.8%, and the most frequently reported drugs for self-medication included nonsteroidal anti-inflammatory drugs or pain relievers (prevalence = 31.1%, cold or cough medicines (prevalence = 21.6%, analgesics (prevalence = 19.3%, and antacids (prevalence = 17.3%. Of the participants who practiced self-medication, the prevalence of inappropriate self-medication behaviors included not reading drug labels or instructions (10.1%, using excessive dosages (21.6%, and using prescription and nonprescription medicine simultaneously without advice from a health provider (polypharmacy (30.3%. The results of multiple logistic regression analysis showed that after controlling for school level, gender, and chronic diseases, the participants with lower medication knowledge, lower self-efficacy, lower medication literacy, and who consumed tobacco or alcohol were more likely to engage in inappropriate self-medication.Lower medication literacy and substance use were associated with inappropriate self-medication among adolescents.

  6. Social, cultural and economic factors associated with self-medication.

    Science.gov (United States)

    Machado-Alba, Jorge E; Echeverri-Cataño, Luis Felipe; Londoño-Builes, Manuel José; Moreno-Gutiérrez, Paula Andrea; Ochoa-Orozco, Sergio Andrés; Ruiz-Villa, Joaquín Octavio

    2014-01-01

    Self-medication is an increasingly frequent phenomenon worldwide; some studies suggest that there is a relationship with socio-economic and cultural factors. To determine the prevalence of self-medication and its related factors in a Colombian city. Cross-sectional descriptive study, in Pereira, Colombia. We selected 414 adults using simple randomization sampling with houses used as the observational unit. The IRIS-AM instrument was used to collect the information required. Four hundred and fourteen (414) people were interviewed, 62.6% were females, and mean age was 44 years; 77.5% of the sample had self-medicated at least once in their life and 31.9% during the last month. The most commonly used medications were: analgesics and antipyretics (44.3%), non-steroidal anti-inflammatory drugs and anti-rheumatic medication (36.4%), and anti-histamine medication (8.5%). The most commonly self-medicated symptoms were: headache (55.7%), cold (16.2%) and muscular pain (13.2%). Multivariate analysis revealed an association between self-medication throughout life and storing medications at home, and between a high level of education and having a favorable opinion of self-medication. Storing medications at home and recommending them to others were associated with self-medication during the previous 30 days. Self-medication rates were found to be similar to those reported globally, but there is not an established pattern for this practice. Associations were found between social and demographic variables and self-medication, which require further characterization. Intention to self-medicate has not been well-described in other studies, and may be an important indicator which will contribute to future understanding of this phenomenon.

  7. Update: mercury poisoning associated with beauty cream--Arizona, California, New Mexico, and Texas, 1996.

    Science.gov (United States)

    1996-07-26

    During September 1995-May 1996, the Texas Department of Health (TDH), the New Mexico Department of Health (NMDH), and the San Diego County (California) Health Department investigated three cases of mercury poisoning associated with the use of a mercury-containing beauty cream produced in Mexico. The ongoing investigation has found this product in shops and flea markets in the United States located near the U.S.-Mexico border, and a U.S. distributor has been identified in Los Angeles. The cream, marketed as "Crema de Belleza--Manning" for skin cleansing and prevention of acne, listed "calomel" (mercurous chloride [Hg2Cl2]) as an ingredient and contained 6% to 10% mercury by weight. This report presents findings of a continuing investigation by these health departments, the Arizona Dept of Health Services (ADHS), California State Department of Health Services (CSDHS), the Food and Drug Administration (FDA), and CDC.

  8. Association between the Medical College Admission Test scores and Alpha Omega Alpha Medical Honors Society membership.

    Science.gov (United States)

    Gauer, Jacqueline L; Jackson, J Brooks

    2017-01-01

    Medical schools worldwide are faced with the challenge of selecting from among many qualified applicants. One factor that might help admissions committees identify future exceptional medical students is scores on standardized entrance exams. The purpose of this study was to determine the association between scores on the most commonly used standardized medical school entrance exam in the USA, the Medical College Admission Test (MCAT), and election to the US medical honors society, Alpha Omega Alpha (AOA). MCAT scores and AOA membership data were analyzed for all the students pursuing Doctor of Medicine degrees at the University of Minnesota Medical School and who graduated between 2012-2016 (n=1,309). An independent-samples t-test found a significant difference (t=6.132, pmedical school was significantly associated with higher MCAT scores. Admissions committees should carefully consider the role of standardized entrance exam scores, in the context of a holistic review, when selecting for exceptional medical students.

  9. Chronic Obstructive Pulmonary Disease Illness and Medication Beliefs are Associated with Medication Adherence.

    Science.gov (United States)

    Krauskopf, Katherine; Federman, Alex D; Kale, Minal S; Sigel, Keith M; Martynenko, Melissa; O'Conor, Rachel; Wolf, Michael S; Leventhal, Howard; Wisnivesky, Juan P

    2015-04-01

    Almost half of patients with COPD do not adhere to their medications. Illness and medication beliefs are important determinants of adherence in other chronic diseases. Using the framework of the Common Sense Model of Self-Regulation (CSM), we determined associations between potentially modifiable beliefs and adherence to COPD medications in a cohort of English- and Spanish-speaking adults with COPD from New York and Chicago. Medication adherence was assessed using the Medication Adherence Report Scale. Illness and medication beliefs along CSM domains were evaluated using the Brief Illness Perception Questionnaire (B-IPQ) and the Beliefs about Medications Questionnaire (BMQ). Unadjusted analysis (with Cohen's d effect sizes) and multiple logistic regression were used to assess the relationship between illness and medication beliefs with adherence. The study included 188 participants (47% Black, 13% Hispanics); 109 (58%) were non-adherent. Non-adherent participants were younger (p adherent participants reported being more concerned about their COPD (p = 0.011; Cohen's d = 0.43), more emotionally affected by the disease (p = 0.001; Cohen's d = 0.54), and had greater concerns about COPD medications (p medications independently predicted non-adherence (odds ratio: 0.52, 95% confidence interval: 0.36-0.75). In this cohort of urban minority adults, concerns about medications were associated with non-adherence. Future work should explore interventions to influence patient adherence by addressing concerns about the safety profile and long-term effects of COPD medications.

  10. Walking the dog: is pet ownership associated with physical activity in California?

    Science.gov (United States)

    Yabroff, K Robin; Troiano, Richard P; Berrigan, David

    2008-03-01

    Several studies have reported positive associations between pet ownership and a variety of health outcomes. In this study, we explored associations between pet ownership and physical activity in a large, ethnically diverse population-based sample in California. Data from the California Health Interview Survey (CHIS) were used to assess the associations between pet ownership (ie, dog, dog and cat, cat, and non-pet owners) and transportation and leisure walking in a sample of 41,514 adults. Logistic regression was used to assess associations between pet ownership and type of walking, and linear regression was used to assess associations between pet ownership and total minutes walking per week. Dog owners were slightly less likely to walk for transportation than were non-pet owners (OR = 0.91; 95% CI: 0.85 to 0.99) but more likely to walk for leisure than non-pet owners (OR = 1.6; 95% CI: 1.5 to 1.8) in multivariate analyses. Overall, dog owners walked 18.9 (95% CI: 11.4 to 26.4) minutes more per week than non-pet owners. Walking behaviors of cat owners were similar to non-pet owners. Our findings support the moderate association between dog ownership and higher levels of physical activity.

  11. Association of urban runoff with coastal water quality in Orange County, California.

    Science.gov (United States)

    Dwight, Ryan H; Semenza, Jan C; Baker, Dean B; Olson, Betty H

    2002-01-01

    The associations between storm events, urban runoff, and coastal water quality have not been well investigated. A temporal and spatial analysis of 2 years of data was conducted to determine associations between urban river discharge and indicator bacteria levels for Southern California beaches and evaluate the contribution of anomalous precipitation to the association. Data show beaches next to rivers had the highest bacterial levels in both wet and dry seasons. Bacterial levels rose substantially across all sites during wet months, and river discharge and bacterial levels were all highest during the winter with the most rainfall. Precipitation was significantly associated (Spearman rank bivariate correlation, P swimming at beaches near rivers may pose a significant public health risk. The strong association found between precipitation and water pollution may be relevant to studies of potential health effects associated with climate change.

  12. Perceived stress and associated factors among medical students

    OpenAIRE

    Saeed, Abdalla A.; Bahnassy, Ahmed A.; Al-Hamdan, Nasser A.; Almudhaibery, Faisal S.; Anisah Z Alyahya

    2016-01-01

    Background: Stress and its psychological manifestations are currently a major source of concern. Medical education poses challenging and potentially threatening demands for students throughout the world. Objectives: To determine the prevalence and factors associated with perceived stress in medical students in the College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Fahad Medical City, Riyadh, Saudi Arabia. Materials and Methods: This was a cross-sectional study o...

  13. Driving and dementia California's approach to a medical and policy dilemma.

    OpenAIRE

    Reuben, D B; St George, P

    1996-01-01

    The cognitive impairment that defines dementia is thought to place affected persons at increased risk for unsafe driving. Nevertheless, many persons with dementia continue to drive after the onset of their illness. Since 1988 California physicians have been required to report older persons with Alzheimer's disease and related disorders to their local health departments, information that is then reported to the Department of Motor Vehicles (DMV). To reevaluate how it acts on this information, ...

  14. Factors associated with self medication practice among pregnant ...

    African Journals Online (AJOL)

    Introduction: studies in different parts of the world indicate that there is high level use of self medication among pregnant women. But there are no scientific evidences on it and factors associated with it in Bahir Dar city administration. The aim of this study was therefore to assess level of self medication and identify factors ...

  15. Medication Administration: Measuring Associate Degree Nursing Student Knowledge

    Science.gov (United States)

    Crowell, Debra L.

    2016-01-01

    The American Nurse Association's (ANA) provisions outline the commitment expected of nurses to protect the community from harm. Medication administration coincides with patient safety as a compelling obligation in nursing practice. The study's purpose was to examine retention of medication safety knowledge among first year nursing students, after…

  16. Three professors honored by Virginia Veterinary Medical Association

    OpenAIRE

    Douglas, Jeffrey S.

    2005-01-01

    The Virginia Veterinary Medical Association (VVMA) recently honored three professors from the Virginia-Maryland Regional College of Veterinary Medicine (VMRCVM) during its annual meeting at the Hotel Roanoke.

  17. Headache associated disability in medical students at the Kenyatta ...

    African Journals Online (AJOL)

    Eighty-six percent of the students with headache had their working ability disturbed to various degrees. ... No gender difference was found in the headache associated disability. ... (East African Medical Journal: 2002 79(10): 519-523) ...

  18. Concern between medication non-adherence and diabetes associated depression

    OpenAIRE

    Krishnan Vengadaragava Chary; Porchelvan Swaminathan

    2016-01-01

    Background: Diabetes mellitus is one of the health disorders that acquire mankind immensely. An ominous twin of diabetes mellitus is diabetes associated depression which is often unrecognised in routine diabetic care. The objective of this study was to find the prevalence and correlation between medication adherence and diabetes associated depression. Methods: It is a conducted as cross sectional study using Morisky medication adherence scale to evaluate treatment adherence of type II diab...

  19. Association Between Sleep Hygiene and Sleep Quality in Medical Students

    OpenAIRE

    Brick, Cameron A.; Seely, Darbi L.; Palermo, Tonya M.

    2010-01-01

    The aim of this study was to determine whether subjective sleep quality was reduced in medical students, and whether demographics and sleep hygiene behaviors were associated with sleep quality. A Web-based survey was completed by 314 medical students, containing questions about demographics, sleep habits, exercise habits, caffeine, tobacco and alcohol use, and subjective sleep quality (using the Pittsburgh Sleep Quality Index). Correlation and regression analyses tested for associations among...

  20. Factors Associated with Korean Immigrants' Medical Tourism to the Homeland.

    Science.gov (United States)

    Jang, Sou Hyun

    2017-07-01

    This study examined factors associated with first-generation Korean immigrants' medical tours to the homeland, which has emerged as a field of study in immigrant medical transnationalism and immigrant healthcare behaviors. This paper reports survey data from 507 Korean immigrants and indepth interviews with 120 Korean immigrants in the New York-New Jersey area. About one-fourth of survey respondents have visited their home country for medical care since their migration to the US. Of those with relatives in Korea, 29% have experienced at least one medical tour, compared to only 9.2% of those without relatives in Korea. Having frequent contacts with relatives in the home country was positively associated with the number of medical tour visits. Except for social transnational ties, other types of transnational ties with the home country were marginally related to Korean immigrants' medical tourism. Surprisingly, their health insurance status itself, which is assumed to be important, was not statistically associated with medical tourism. Although this study has the limitation of analyzing a convenience sample, it contributes to the literature on immigrant transnationalism and immigrant healthcare behaviors by using a mixed-methods approach to focus on one ethnic group's medical transnationalism.

  1. Analgesics Self-Medication and its Association with Sleep Quality among Medical Undergraduates.

    Science.gov (United States)

    Kumar, Amit; Vandana; Aslami, Ahmad Nadeem

    2016-12-01

    Self medication especially with analgesics is a common practice among undergraduate medical students. Variation in analgesic self medication prevalence and pattern is often seen due to geographical and target population differences. The mutual influence of pain and sleep quality might persuade students self medication behaviour. To assess analgesic self medication and its association with sleep quality among the medical undergraduates. A cross-sectional questionnaire based study was conducted from December 2015 to February 2016 among 320 medical undergraduates. The information about socio-demographic profile, symptoms, types of analgesics, source of information and reason for analgesic self medication was collected. The sleep quality of students was assessed by Pittsburgh Sleep Quality Index (PSQI). The qualitative variables were expressed as percentages. Odds Ratio (OR) with 95% Confidence Interval (CI) was also calculated. Chi-square test was used. Analgesic self medication prevalence was 49.7%, more prevalence seen among males, seniors, urban residents and students of working parents. Headache (48.4%) was the most common cause and paracetamol (79.7%) was most frequent drug used, based on knowledge obtained through textbook and internet (47.1%). Mildness of symptoms (49.1%) was the most important motivation behind self medication. Analgesic use was more (57.4%) among "poor sleepers" compared to "normal sleepers" (45.2%). Despite having easy accessibility to expert consultations, high prevalence of analgesic self medication among medical students and its association with poor sleep quality is a distressing issue. This indicates an urgent need of awareness programmes about harmful effects of self medication and healthy sleep practices.

  2. Personality traits associated with intrinsic academic motivation in medical students.

    Science.gov (United States)

    Tanaka, Masaaki; Mizuno, Kei; Fukuda, Sanae; Tajima, Seiki; Watanabe, Yasuyoshi

    2009-04-01

    Motivation is one of the most important psychological concepts in education and is related to academic outcomes in medical students. In this study, the relationships between personality traits and intrinsic academic motivation were examined in medical students. The study group consisted of 119 Year 2 medical students at Osaka City University Graduate School of Medicine. They completed questionnaires dealing with intrinsic academic motivation (the Intrinsic Motivation Scale toward Learning) and personality (the Temperament and Character Inventory [TCI]). On simple regression analyses, the TCI dimensions of persistence, self-directedness, co-operativeness and self-transcendence were positively associated with intrinsic academic motivation. On multiple regression analysis adjusted for age and gender, the TCI dimensions of persistence, self-directedness and self-transcendence were positively associated with intrinsic academic motivation. The temperament dimension of persistence and the character dimensions of self-directedness and self-transcendence are associated with intrinsic academic motivation in medical students.

  3. The sunshine act and medical publications: Guidance from professional medical associations.

    Science.gov (United States)

    Toroser, Dikran; DeTora, Lisa; Cairns, Angela; Juneja, Renu; Georgieva, Anna; Weigel, Al; Pepitone, Kim

    2015-01-01

    To review guidance from professional medical associations to physicians on the Sunshine Act, with a focus on industry support for medical publications. Using 'Sunshine Act' as a search term, we searched PubMed (dates February 2013 to November 2014) and the 'grey literature' using Google and Google Scholar. Online information was extracted from websites of pre-identified professional medical associations. Some professional medical associations have published peer-reviewed recommendations, position statements or general advice on their websites and in journals around the Sunshine Act. Associations also provided broad online educational resources for physicians. There was universal agreement between peer-reviewed publications, including guidelines, for the need for full transparency and disclosure of industry support. Surveys by some professional associations showed variance in opinion on the forecasted impact of the Sunshine Act on physician-industry relationships. There was scarce information specifically related to reporting requirements for industry-supported medical publications. There is a shortage of information for physicians from professional associations regarding the Sunshine Act and support for medical publications. Due to the lack of clear guidance regarding support for publications, there are presently varying interpretations of the Sunshine Act. The literature debates the potential impact of the Sunshine Act and expresses some concerns that physician-enabled innovation in drug development may be hindered.

  4. Analysis of Camp Pendleton California Medical Treatment Facility Budget and Execution Process

    Science.gov (United States)

    2008-12-01

    for the formal internship, residency, fellowship and graduate training in medicine and dentistry . Graduate Medical Education involves costs of in...Medical Information Management Center, and veterinary services. Excludes activities that provide support to the unique health care mission required by...care and services to authorized beneficiaries through the operation of hospital departments of dentistry and dental clinics and operation of

  5. Copper tolerance and distribution of epibiotic bacteria associated with giant kelp Macrocystis pyrifera in southern California.

    Science.gov (United States)

    Busch, Julia; Nascimento, Juliana Ribeiro; Magalhães, Ana Carolina Rubem; Dutilh, Bas E; Dinsdale, Elizabeth

    2015-07-01

    Kelp forests in southern California are important ecosystems that provide habitat and nutrition to a multitude of species. Macrocystis pyrifera and other brown algae that dominate kelp forests, produce negatively charged polysaccharides on the cell surface, which have the ability to accumulate transition metals such as copper. Kelp forests near areas with high levels of boating and other industrial activities are exposed to increased amounts of these metals, leading to increased concentrations on the algal surface. The increased concentration of transition metals creates a harsh environment for colonizing microbes altering community structure. The impact of altered bacterial populations in the kelp forest have unknown consequences that could be harmful to the health of the ecosystem. In this study we describe the community of microorganisms associated with M. pyrifera, using a culture based approach, and their increasing tolerance to the transition metal, copper, across a gradient of human activity in southern California. The results support the hypothesis that M. pyrifera forms a distinct marine microhabitat and selects for species of bacteria that are rarer in the water column, and that copper-resistant isolates are selected for in locations with elevated exposure to transition metals associated with human activity.

  6. The utility of the records medical: factors associated with the medication errors in chronic disease 1

    Science.gov (United States)

    da Cruz, Hellen Lilliane; Mota, Flávia Karla da Cruz; Araújo, Lorena Ulhôa; Bodevan, Emerson Cotta; Seixas, Sérgio Ricardo Stuckert; Santos, Delba Fonseca

    2017-01-01

    ABSTRACT Objective: This study describes the development of the medication history of the medical records to measure factors associated with medication errors among chronic diseases patients in Diamantina, Minas Gerais. Methods: retrospective, descriptive observational study of secondary data, through the review of medical records of hypertensive and diabetic patients, from March to October 2016. Results: The patients the mean age of patient was 62.1 ± 14.3 years. The number of basic nursing care (95.5%) prevailed and physician consultations were 82.6%. Polypharmacy was recorded in 54% of sample, and review of the medication lists by a pharmacist revealed that 67.0% drug included at least one risk. The most common risks were: drug-drug interaction (57.8%), renal risk (29.8%), risk of falling (12.9%) and duplicate therapies (11.9%). Factors associated with medications errors history were chronic diseases and polypharmacy, that persisted in multivariate analysis, with adjusted RP chronic diseases, diabetes RP 1.55 (95%IC 1.04-1.94), diabetes/hypertension RP 1.6 (95%CI 1.09-1.23) and polypharmacy RP 1.61 (95%IC 1.41-1.85), respectively. Conclusion: Medication errors are known to compromise patient safety. This has led to the suggestion that medication reconciliation an entry point into the systems health, ongoing care coordination and a person focused approach for people and their families. PMID:29236841

  7. Association between CFL1 gene polymorphisms and spina bifida risk in a California population

    Directory of Open Access Journals (Sweden)

    Lammer Edward J

    2007-03-01

    Full Text Available Abstract Background CFL1 encodes human non-muscle cofilin (n-cofilin, which is an actin-depolymerizing factor and is essential in cytokinesis, endocytosis, and in the development of all embryonic tissues. Cfl1 knockout mice exhibit failure of neural tube closure at E10.5 and die in utero. We hypothesized that genetic variation within the human CFL1 gene may alter the protein's function and result in defective actin depolymerizing and cellular activity during neural tube closure. Such alterations may be associated with an increased risk for neural tube defects (NTDs. Methods Having re-sequenced the human CFL1 gene and identified five common single nucleotide polymorphisms (SNPs in our target population, we investigated whether there existed a possible association between the genetic variations of the CFL1 gene and risk of spina bifida. Samples were obtained from a large population-based case-control study in California. Allele association, genotype association and haplotype association were evaluated in two different ethnicity groups, non-Hispanic white and Hispanic white. Results Homozygosity for the minor alleles of the SNPs studied (rs652021, rs665306, rs667555, rs4621 and rs11227332 appeared to produce an increased risk for spina bifida. Subjects with the haplotype composed of all minor alleles (CCGGT appeared to have increased spina bifida risk (OR = 1.6, 95% CI: 0.9~2.9, however, this finding is not statistically significant likely due to limited sample size. Conclusion The sequence variation of human CFL1 gene is a genetic modifier for spina bifida risk in this California population.

  8. Changing patterns in water toxicity associated with current use pesticides in three California agriculture regions.

    Science.gov (United States)

    Anderson, Brian S; Phillips, Bryn M; Voorhees, Jennifer P; Deng, Xin; Geraci, Jeff; Worcester, Karen; Tjeerdema, Ron S

    2017-11-15

    Regulation of agriculture irrigation water discharges in California, USA, is assessed and controlled by its 9 Regional Water Quality Control Boards under the jurisdiction of the California State Water Resources Control Board. Each Regional Water Board has developed programs to control pesticides in runoff as part of the waste discharge requirements implemented through each region's Irrigated Lands Regulatory Program. The present study assessed how pesticide use patterns differ in the Imperial (Imperial County) and the Salinas and Santa Maria (Monterey County) valleys, which host 3 of California's prime agriculture areas. Surface-water toxicity associated with current use pesticides was monitored at several sites in these areas in 2014 and 2015, and results were linked to changes in pesticide use patterns in these areas. Pesticide use patterns appeared to coincide with differences in the way agriculture programs were implemented by the 2 respective Regional Water Quality Control Boards, and these programs differed in the 2 Water Board Regions. Different pesticide use patterns affected the occurrence of pesticides in agriculture runoff, and this influenced toxicity test results. Greater detection frequency and higher concentrations of the organophosphate pesticide chlorpyrifos were detected in agriculture runoff in Imperial County compared to Monterey County, likely due to more rigorous monitoring requirements for growers using this pesticide in Monterey County. Monterey County agriculture runoff contained toxic concentrations of pyrethroid and neonicotinoid pesticides, which impacted amphipods (Hyalella azteca) and midge larvae (Chironomus dilutus) in toxicity tests. Study results illustrate how monitoring strategies need to evolve as regulatory actions affect change in pesticide use and demonstrate the importance of using toxicity test indicator species appropriate for the suite of contaminants in runoff in order to accurately assess environmental risk. Integr

  9. Developing Information on Energy Savings and Associated Costs and Benefits of Energy Efficient Emerging Technologies Applicable in California

    Energy Technology Data Exchange (ETDEWEB)

    Xu, Tengfang; Slaa, Jan Willem; Sathaye, Jayant

    2010-12-15

    Implementation and adoption of efficient end-use technologies have proven to be one of the key measures for reducing greenhouse gas (GHG) emissions throughout the industries. In many cases, implementing energy efficiency measures is among one of the most cost effective investments that the industry could make in improving efficiency and productivity while reducing carbon dioxide (CO2) emissions. Over the years, there have been incentives to use resources and energy in a cleaner and more efficient way to create industries that are sustainable and more productive. With the working of energy programs and policies on GHG inventory and regulation, understanding and managing the costs associated with mitigation measures for GHG reductions is very important for the industry and policy makers around the world and in California. Successful implementation of applicable emerging technologies not only may help advance productivities, improve environmental impacts, or enhance industrial competitiveness, but also can play a significant role in climate-mitigation efforts by saving energy and reducing the associated GHG emissions. Developing new information on costs and savings benefits of energy efficient emerging technologies applicable in California market is important for policy makers as well as the industries. Therefore, provision of timely evaluation and estimation of the costs and energy savings potential of emerging technologies applicable to California is the focus of this report. The overall goal of the project is to identify and select a set of emerging and under-utilized energy-efficient technologies and practices as they are important to reduce energy consumption in industry while maintaining economic growth. Specifically, this report contains the results from performing Task 3 Technology Characterization for California Industries for the project titled Research Opportunities in Emerging and Under-Utilized Energy-Efficient Industrial Technologies, sponsored by

  10. Physicians' attitudes toward homosexuality and HIV: survey of a California Medical Society- revisited (PATHH-II).

    Science.gov (United States)

    Smith, Davey M; Mathews, Wm Christopher

    2007-01-01

    In 1982, Mathews et al. surveyed San Diego County Medical Society's (SDCMS) physicians about their attitudes toward homosexuality. They found significant differences in prevalence of homophobic attitudes by gender, year of medical school graduation, specialty, and practice setting. To assess current physicians' attitudes toward homosexuality and persons with HIV infection, an anonymous, self-administered, 17-item survey was mailed to all 4,385 members of the SDCMS and 1,271 UCSD physicians. The survey included items measuring attitudes toward homosexuality and toward entry to medical school and referral patterns, conditional on sexual orientation and HIV status of hypothetical referents. Only 3% of respondents would not admit a highly qualified homosexual applicant to medical school compared with 30% in 1982. Similarly, 9% would discontinue referrals to a gay pediatrician compared with 46% of respondents in 1982. Forty-two percent would not admit a "highly qualified but asymptomatic HIV-infected applicant with excellent response to antiretroviral therapy to medical school" and 66% would discontinue referral to a general surgeon known to be HIV infected. In multiple logistic regression analyses controlling for sex and medical school affiliation, significant (p attitudes toward homosexuals and year of graduation from medical school appear to be significant predictors of attitudes toward persons with HIV infection.

  11. Association of resident fatigue and distress with perceived medical errors.

    Science.gov (United States)

    West, Colin P; Tan, Angelina D; Habermann, Thomas M; Sloan, Jeff A; Shanafelt, Tait D

    2009-09-23

    Fatigue and distress have been separately shown to be associated with medical errors. The contribution of each factor when assessed simultaneously is unknown. To determine the association of fatigue and distress with self-perceived major medical errors among resident physicians using validated metrics. Prospective longitudinal cohort study of categorical and preliminary internal medicine residents at Mayo Clinic, Rochester, Minnesota. Data were provided by 380 of 430 eligible residents (88.3%). Participants began training from 2003 to 2008 and completed surveys quarterly through February 2009. Surveys included self-assessment of medical errors, linear analog self-assessment of overall quality of life (QOL) and fatigue, the Maslach Burnout Inventory, the PRIME-MD depression screening instrument, and the Epworth Sleepiness Scale. Frequency of self-perceived, self-defined major medical errors was recorded. Associations of fatigue, QOL, burnout, and symptoms of depression with a subsequently reported major medical error were determined using generalized estimating equations for repeated measures. The mean response rate to individual surveys was 67.5%. Of the 356 participants providing error data (93.7%), 139 (39%) reported making at least 1 major medical error during the study period. In univariate analyses, there was an association of subsequent self-reported error with the Epworth Sleepiness Scale score (odds ratio [OR], 1.10 per unit increase; 95% confidence interval [CI], 1.03-1.16; P = .002) and fatigue score (OR, 1.14 per unit increase; 95% CI, 1.08-1.21; P error was also associated with burnout (ORs per 1-unit change: depersonalization OR, 1.09; 95% CI, 1.05-1.12; P errors when adjusted for burnout or depression. Among internal medicine residents, higher levels of fatigue and distress are independently associated with self-perceived medical errors.

  12. Medication Discrepancies Associated With a Medication Reconciliation Program and Clinical Outcomes After Hospital Discharge.

    Science.gov (United States)

    Shiu, Jennifer R; Fradette, Miriam; Padwal, Raj S; Majumdar, Sumit R; Youngson, Erik; Bakal, Jeffrey A; McAlister, Finlay A

    2016-04-01

    To identify the frequency of unintended medication discrepancies 30 days postdischarge from medicine wards with interprofessional medication reconciliation processes and clinical import. Prospective cohort study of adults discharged between October 2013 and November 2014 from two teaching hospitals in Edmonton, Canada. The Best Possible Medication Discharge Plan (BPMDP) was prepared for all patients. Patients were called 30 days postdischarge to determine the medication discrepancy rate from the BPMDP and whether this was intentional or unintentional; three clinicians used standardized criteria to determine if the discrepancy was inconsequential. Electronic health records and patient contact were used to ascertain death, hospital readmissions, and emergency department (ED) visits at 90 days. Of 433 patients (mean age 64 yrs, 52% female, median discharge prescriptions 6 [interquartile range 4-9]), 168 (38.8%) had at least one unintentional medication discrepancy at 30 days (325 total discrepancies; median one [interquartile range 1-2 discrepancies per patient]). Patients with unintentional medication discrepancies were older (65.9 vs 61.9 yrs, p=0.03) with more discharge medications (7 vs 6, p=0.03). Most unintentional discrepancies (91.1%) were judged inconsequential. The presence of an unintentional medication discrepancy was not associated with 90-day readmission or death (42/167 [25.1%] vs 64/263 [24.3%], adjusted odds ratio 0.96 [95% confidence interval 0.60-1.54]) or ED visits (69 [41.3%] vs 101 [38.4%], adjusted odds ratio 1.11 [95% confidence interval 0.74-1.67]. Despite the presence of an interprofessional medication reconciliation process, over one-third of patients had a medication discrepancy within 30 days of discharge, although most were inconsequential and there was no association between unintended medication discrepancies and risk of readmission, ED visit, or death 3 months after discharge. © 2016 Pharmacotherapy Publications, Inc.

  13. Medical Care Provided Under California's Workers' Compensation Program: Effects of the Reforms and Additional Opportunities to Improve the Quality and Efficiency of Care.

    Science.gov (United States)

    Wynn, Barbara O; Timbie, Justin W; Sorbero, Melony E

    2011-01-01

    Since 2004, significant changes have been made to the California workers' compensation (WC) system. The Commission on Health and Safety and Workers' Compensation (CHSWC) asked the RAND Corporation to examine the impact that these changes have on the medical care provided to injured workers. This study synthesizes findings from interviews and available information regarding the implementation of the changes affecting WC medical care and identifies areas in which additional changes might increase the quality and efficiency of care delivered under the WC system. To improve incentives for efficiently providing medically appropriate care, California should revise its fee schedule allowances for services provided by hospitals to inpatients, freestanding ambulatory surgery centers, and physicians, create nonmonetary incentives for providing medically appropriate care in the medical provider network (MPN) context through more-selective contracting with providers and reducing medical review requirements for high-performing physicians; reduce incentives for inappropriate prescribing practices by curtailing in-office physician dispensing; and implement pharmacy benefit network regulations. To increase accountability for performance, California should revise the MPN certification process to place accountability for meeting MPN standards on the entity contracting with the physician network; strengthen Division of Workers' Compensation (DWC) authorities to provide intermediate sanctions for failure to comply with MPN requirements; and modify the Labor Code to remove payers and MPNs from the definition of individually identifiable data so that performance on key measures can be publicly available. To facilitate monitoring and oversight, California should provide DWC with more flexibility to add needed data elements to medical data reporting and provide penalties for a claim administrator failing to comply with the data-reporting requirements; require that medical cost

  14. Community composition, structure, and interrelationships in the marine intertidal Endocladia muricata – Balanus glandula association in Monterey Bay, California

    NARCIS (Netherlands)

    Glynn, Peter W.

    1965-01-01

    Studies of the community composition, structure and species interrelationships of the Endocladia-Balanus association were carried out on the rocky shores at the Hopkins Marine Station, Pacific Grove, California, over the period 1959—1961. The organisms making up this biotic association form a

  15. Strengthening the community college pathway to medical school: A study of latino students in California

    OpenAIRE

    Talamantes, E; Gonzalez, K; Mangione, CM; Ryan, G; Jimenez,A; Gonzalez, F; Greenwood, SS; Hayes-Bautista, DE; Moreno, G.

    2016-01-01

    © 2016 Society of Teachers of Family Medicine. All rights reserved. BACKGROUND AND OBJECTIVES: One third of Latino medical students begin their premedical undergraduate education at a community college (CC) or 2-year college, compared to a 4-year university. This study explored the academic and personal experiences Latino premedical students commonly encounter at the CC. METHODS: In 2013, five focus groups with Latino premedical and medical students (n=45) were conducted in Los Angeles and Sa...

  16. [Seroprevalence of risk factors associated with rickettsiosis (Rickettsia rickettsii) in humans in Baja California, Mexico].

    Science.gov (United States)

    Field-Cortazares, Jorge; Escárcega-Ávila, Angélica María; López-Valencia, Gilberto; Barreras-Serrano, Alberto; Tinoco-Gracia, Luis

    2015-01-01

    Rickettsiosis caused by Rickettsia rickettsii is capable of infecting vertebrates, including humans. The symptoms are high fever, headache, myalgia, nausea, vomiting, abdominal pain, and cough. Mortality can be up to 30% in untreated patients. To prove the existence of rickettsiosis in Ensenada, Baja California, Mexico, because no human cases have been reported. This observational, cross-sectional, descriptive study included 384 samples of humans in Ensenada, Baja California. Antibodies against R. rickettsii were measured with the kit R. rickettsii ELISA(®) Helica Biosystems, Inc., adapted for use in humans using human IgG conjugate antibodies. To determine the sensitivity and specificity, 32 human samples were submitted to IFA. Specific primers were used for the molecular diagnosis of R. rickettsii in dogs and ticks. The seroprevalence adjusted rickettsiosis in humans was 2.9% (95% CI: 0.8-5.3), seropositivity was not associated with sex, age, occupation, household, dogs, pet deworming program against ticks, the type of yard, and mobility of the dog between home and the street. With substantial agreement of k between ELISA and IFA, it follows that the results of seroprevalence of this work are reliable.

  17. Strengthening the Community College Pathway to Medical School: A Study of Latino Students in California.

    Science.gov (United States)

    Talamantes, Efrain; Gonzalez, Karla; Mangione, Carol M; Ryan, Gery; Jimenez, Alejandro; Gonzalez, Fabio; Greenwood, Seira Santizo; Hayes-Bautista, David E; Moreno, Gerardo

    2016-10-01

    One third of Latino medical students begin their premedical undergraduate education at a community college (CC) or 2-year college, compared to a 4-year university. This study explored the academic and personal experiences Latino premedical students commonly encounter at the CC. In 2013, five focus groups with Latino premedical and medical students (n=45) were conducted in Los Angeles and San Jose, CA. All students were enrolled or attended a CC. In addition, 20 CC key informants participated in semi-structured interviews to further describe the Latino CC premedical experience. The focus group and key informant transcripts were transcribed and analyzed for common themes using qualitative methods. Content analysis of 2,826 distinct comments identified major themes: (1) Personal health-related experiences in underserved communities, (2) CC relevant premedical guidance, (3) Limited preparation in navigating the pathways to medical school, and (4) Competing demands and college affordability. Early CC enrichment programs with direct ties to health professions advising programs, 4-year universities, medical schools, and physician mentors are needed to support Latino pre-medical students.

  18. Associations with E-cigarette use among Asian American and Pacific Islander young adults in California.

    Science.gov (United States)

    Maglalang, Dale Dagar; Brown-Johnson, Cati; Prochaska, Judith J

    2016-12-01

    With attention to the rapidly growing market of electronic nicotine delivery systems (ENDS/e-cigarettes) and the fastest growing US ethnic minority group, the current study explored associations between awareness, perceived risks, and use of ENDS among Asian American and Pacific Islander (AAPI) young adults. AAPI young adults (ages 18-25) in California were recruited via social media, college classes, listservs for AAPI-serving non-profits, and snowball sampling to complete an anonymous survey between 2014 and 2015. The sample (N = 501) was 57% women, 15% LGBTQIA; with a mean age of 21; 26% foreign-born; identifying as Filipino (29%), Chinese (24%), Vietnamese (14%), mixed-AAPI heritage (13%), or 21% other. Nearly half the sample (44%) reported ever ENDS use; 11% were current users. Current ENDS use was twofold greater for: Filipino and Vietnamese compared to Chinese respondents; men versus women; LGBTQIA-identified respondents; those vocationally trained; and employed. Awareness of ENDS from peers/friends was most common and was associated with ever though not current ENDS use. Most respondents perceived ENDS as harmful (62%); low compared to high risk perception was associated with a three-fold greater likelihood of ever use and six-fold greater likelihood of current use. Popular flavors were fruit (49%, e.g., lychee, taro) and candy/sweets (26%). Current users viewed ENDS as a healthier alternative or quit aid for conventional cigarettes (42%); recreation/social use (33%) also was common. Findings indicate ENDS visibility among AAPI young adults in California with affinity for flavors and many engaging in trial and current use for harm reduction and recreational/social aims.

  19. Association of nutritional risk and adverse medical outcomes across different medical inpatient populations.

    Science.gov (United States)

    Felder, Susan; Lechtenboehmer, Christian; Bally, Martina; Fehr, Rebecca; Deiss, Manuela; Faessler, Lukas; Kutz, Alexander; Steiner, Deborah; Rast, Anna C; Laukemann, Svenja; Kulkarni, Prasad; Stanga, Zeno; Haubitz, Sebastian; Huber, Andreas; Mueller, Beat; Schuetz, Philipp

    2015-01-01

    The aim of this study was to examine the prevalence of nutritional risk and its association with multiple adverse clinical outcomes in a large cohort of acutely ill medical inpatients from a Swiss tertiary care hospital. We prospectively followed consecutive adult medical inpatients for 30 d. Multivariate regression models were used to investigate the association of the initial Nutritional Risk Score (NRS 2002) with mortality, impairment in activities of daily living (Barthel Index nutritional risk and mortality (OR/HR, 7.82; 95% CI, 6.04-10.12), impaired Barthel Index (OR/HR, 2.56; 95% CI, 2.12-3.09), time to hospital discharge (OR/HR, 0.48; 95% CI, 0.43-0.52), hospital readmission (OR/HR, 1.46; 95% CI, 1.08-1.97), and all five dimensions of QoL measures. Associations remained significant after adjustment for sociodemographic characteristics, comorbidities, and medical diagnoses. Results were robust in subgroup analysis with evidence of effect modification (P for interaction Nutritional risk is significant in acutely ill medical inpatients and is associated with increased medical resource use, adverse clinical outcomes, and impairments in functional ability and QoL. Randomized trials are needed to evaluate evidence-based preventive and treatment strategies focusing on nutritional factors to improve outcomes in these high-risk patients. Copyright © 2015 Elsevier Inc. All rights reserved.

  20. Perceived stress and associated factors among medical students

    Directory of Open Access Journals (Sweden)

    Abdalla A Saeed

    2016-01-01

    Full Text Available Background: Stress and its psychological manifestations are currently a major source of concern. Medical education poses challenging and potentially threatening demands for students throughout the world. Objectives: To determine the prevalence and factors associated with perceived stress in medical students in the College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Fahad Medical City, Riyadh, Saudi Arabia. Materials and Methods: This was a cross-sectional study on all medical students of batches 9, 10, and 11, which constituted all the enrolled students. Data were collected using a questionnaire based on the Kessler10 psychological distress instrument with a total score ranging from 10 to 50 points in addition to some sociodemographic characteristics. Appropriate statistical test procedures were used to study the magnitude of stress and its risk factors. Results: Mean stress score of the eighty participants was 26.03 ± 9.7. Students with severe stress constituted 33.8%, and 30% were well. Severe stress was significantly associated with female gender and junior level. Nervousness, feeling hopeless, feeling restless, and depressed were the most important factors affecting students′ stress scores. Factor analysis revealed three hidden factors for stress in this group, namely, depression, nervousness, and age. Conclusion: Stress in medical students is prevalent and significantly associated with the female gender and the junior level. Implementation of coping programs is necessary.

  1. Perceived stress and associated factors among medical students.

    Science.gov (United States)

    Saeed, Abdalla A; Bahnassy, Ahmed A; Al-Hamdan, Nasser A; Almudhaibery, Faisal S; Alyahya, Anisah Z

    2016-01-01

    Stress and its psychological manifestations are currently a major source of concern. Medical education poses challenging and potentially threatening demands for students throughout the world. To determine the prevalence and factors associated with perceived stress in medical students in the College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Fahad Medical City, Riyadh, Saudi Arabia. This was a cross-sectional study on all medical students of batches 9, 10, and 11, which constituted all the enrolled students. Data were collected using a questionnaire based on the Kessler10 psychological distress instrument with a total score ranging from 10 to 50 points in addition to some sociodemographic characteristics. Appropriate statistical test procedures were used to study the magnitude of stress and its risk factors. Mean stress score of the eighty participants was 26.03 ± 9.7. Students with severe stress constituted 33.8%, and 30% were well. Severe stress was significantly associated with female gender and junior level. Nervousness, feeling hopeless, feeling restless, and depressed were the most important factors affecting students' stress scores. Factor analysis revealed three hidden factors for stress in this group, namely, depression, nervousness, and age. Stress in medical students is prevalent and significantly associated with the female gender and the junior level. Implementation of coping programs is necessary.

  2. Autism and associated medical disorders in a French epidemiological survey.

    Science.gov (United States)

    Fombonne, E; Du Mazaubrun, C; Cans, C; Grandjean, H

    1997-11-01

    To estimate the prevalence of autism, to assess the strength of its association with specific medical disorders, and to test for a secular increase in its incidence. An epidemiological survey was conducted among 325,347 French children born between 1976 and 1985 and living in three different French départements. Diagnosis, educational level, and associated medical conditions were abstracted from the records of children known to local educational authorities. Data were also pooled with those from another similar survey. One hundred seventy-four children (mean age: 11.6 years) with autism were identified. The prevalence rate was 5.35/10,000 (16.3/10,000 if other pervasive developmental disorders are included), with no difference according to geographical area or social class. Rates of medical conditions were as follows: 1.1% for tuberous sclerosis, 2.9% for chromosomal abnormalities including fragile X, 2.9% for cerebral palsy, 4.6% for sensory impairments, 0.6% for neurofibromatosis, 0.6% for congenital rubella, and 1.7% for Down syndrome. In the combined sample of 328 children with autism, the level and pattern of medical correlates were comparable, with tuberous sclerosis having a consistently strong association with autism. Prevalence rates were similar in successive birth cohorts. Medical disorders (excluding epilepsy and sensory impairments) accounted for fewer than 10% of the cases of autism. No secular increase in the prevalence of autism was found.

  3. ASSOCIATION BETWEEN POSITIVE CANINE HEARTWORM (DIROFILARIA IMMITIS) ANTIGEN RESULTS AND PRESENCE OF ACANTHOCHEILONEMA ODENDHALI MICROFILARIA IN CALIFORNIA SEA LIONS (ZALOPHUS CALIFORNIANUS).

    Science.gov (United States)

    Krucik, David D R; Van Bonn, William; Johnson, Shawn P

    2016-03-01

    This study establishes a relationship between positive canine heartworm (Dirofilaria immitis) test results frequently observed in California sea lions (Zalophus californianus) and infection with the filarid nematode Acanthocheilonema odendhali. Four commercially available canine heartworm antigen tests were evaluated for cross-reaction with A. odendhali in California sea lions. Sera were tested from fifteen California sea lions with A. odendhali-associated microfilaremia, confirmed by blood smear, and with no evidence of D. immitis infection at necropsy. Ninety-five percent of tests were falsely positive for D. immitis. This study also determined that the prevalence of A. odendhali infection in stranded California sea lions from central California is approximately 23% by comparing the number of findings of mircofilaremia to the total number of California sea lions sampled at The Marine Mammal Center between 2005 and 2011, inclusive. Acanthocheilonema odenhali microfilaremia in California sea lions is likely to cross-react with canine heartworm antigen tests, and clinicians should interpret results with caution.

  4. Conceptualisations of masculinity and self-reported medication adherence among HIV-positive Latino men in Los Angeles, California, USA.

    Science.gov (United States)

    Galvan, Frank H; Bogart, Laura M; Wagner, Glenn J; Klein, David J; Chen, Ying-Tung

    2014-06-01

    HIV-positive Latino men have been found to have poorer medication adherence compared to Whites. This study sought to identify how cultural conceptualisations of masculinity are associated with self-reported medication adherence among Latino men. A total of 208 HIV-positive men reported the number of doses of antiretroviral medication missed in the previous seven days (dichotomised at 100% adherence versus less). Conceptualisations of masculinity consisted of traditional machismo (e.g., power and aggressive attitudes, which are normally associated with negative stereotypes of machismo) and caballerismo (e.g., fairness, respect for elders and the importance of family). Multivariate logistic regression was used to identify factors associated with adherence. The mean adherence was 97% (SD = 6.5%; range = 57-100%). In all, 77% of the participants reported 100% adherence in the previous seven days. Caballerismo was associated with a greater likelihood (OR = 1.77; 95% CI: 1.08-2.92; p = 0.03) and machismo with a lower likelihood (OR = 0.60; 95% CI: 0.38-0.95; p = 0.03) of medication adherence. In addition, higher medication side-effects were found to be associated with a lower likelihood (OR = 0.59; 95% CI: 0.43-0.81; p = 0.001) of medication adherence. These findings reinforce the importance of identifying cultural factors that may affect medication adherence among HIV-positive Latino men resident in the USA.

  5. [Sea star (Asteroidea) association structures on the rocky reef in the Gulf of California, Mexico].

    Science.gov (United States)

    Reyes Bonilla, Héctor; González Azcárraga, Adriana; Rojas Sierra, Aracely

    2005-12-01

    Sea stars are invertebrates that play relevant roles in rocky and coral reefs: they occupy different levels in food webs and may act as top predators. There are numerous studies on taxonomy and biogeography of the class in the eastern tropical Pacific, but information about the attributes and composition of its assemblages is scant. The objectives of this study were the examination and comparison of asteroid community structure from four regions of the Gulf of California, Mexico, characterized by the presence of rocky reefs, and the search for possible associations between pairs of species. In August 2004 we visited four locations in the western gulf: Bahia de Los Angeles (29 degrees N), Santa Rosalia (27 degrees N), Loreto (26 degrees N) and La Paz (24 degrees N), and censuses sea stars using 50 m2 belt transects (N=93). Abundance and species richness was estimated, as well as diversity (H'), evenness (J') and taxonomic distinctness (delta*); then, all variables were compared among regions with analysis of variance. In addition, an ordination analysis was run looking for groups of locations with similar faunistic composition. Our results showed that Loreto Bay had the highest richness and abundance of asteroids, probably because it presents a large number of habitats and multiple food sources; these conditions seem to favor the occurrence of rare species and of detritivores. However, there were no significant interregional differences among ecological indices, nor we detected groups of locations singled out because of its species composition. Thus, community structure of sea stars in rocky areas of the Gulf of California is quite homogeneous and do not change with latitude. This is a consequence of the fact that all regions under analysis had the species Phataria unifascialis and Pharia pyramidatus as dominant in number. There were significant positive associations between three pairs of species: apparently competition is not particularly relevant to control sea

  6. Management of Medical Wastes: Public Awareness and Associated ...

    African Journals Online (AJOL)

    A study was carried out in 49 institutions involved in the provision of health care services in Morogoro Municipality, Tanzania. The aim was to assess the common practices with respect to the management of medical waste. Awareness of workers in the institutions on the public and environmental health risks associated with ...

  7. Treatment of Diabetic Ketoacidosis Associated With Antipsychotic Medication: Literature Review.

    Science.gov (United States)

    Vuk, Antonia; Baretic, Maja; Osvatic, Martina Matovinovic; Filipcic, Igor; Jovanovic, Nikolina; Kuzman, Martina Rojnic

    2017-10-01

    The second-generation antipsychotics (SGAs) are associated with metabolic disturbances. Diabetic ketoacidosis (DKA) is a rare, but potentially fatal sign of acute glucose metabolism dysregulation, which may be associated with the use of SGAs. This study aims to review published reports of patients with schizophrenia and antipsychotic drug-associated DKA, focusing on the effective management of both conditions. Using a predefined search strategy, we searched PubMed and EMBASE from their inception to July 2016. The search terms were related to "diabetic ketoacidosis" and "antipsychotic medication." Case reports, case series, and reviews of case series written in English language were included in the review. Sixty-five reports were analyzed. In most patients who developed antipsychotic-associated DKA, 1 or more suspected antipsychotic medications were discontinued. In 5 cases, a rechallenge test was trialed, and in only 1 case, it resulted in the elevation of blood glucose. The majority was subsequently treated with a different SGA in combination with insulin/oral hypoglycemic agents; although approximately a third of patients had a complete resolution of symptoms or could control diabetes with diet only at the point of discharge. Patients taking antipsychotic medications should be regularly screened for insulin resistance and educated about potential complications of antipsychotic medications. This will allow clinicians to individualize treatment decisions and reduce iatrogenic contribution to morbidity and mortality. To achieve best treatment outcomes, antipsychotic-induced DKA should be treated jointly by psychiatry and endocrinology teams.

  8. Medical guidelines for space passengers. Aerospace Medical Association Task Force on Space Travel.

    Science.gov (United States)

    2001-10-01

    In the foreseeable future, private companies will manufacture space vehicles with a capacity of transporting tourists into low Earth orbit. Because of the stresses of spaceflight, the effects of microgravity, and limited medical care capability, a system of medical clearance is highly recommended for these space tourists. It is our purpose to establish guidelines for use by private businesses, medical providers, and those planning on being a space tourist. Consequently, a Task Force was organized by the Aerospace Medical Association (AsMA) for the purpose of facilitating safety of passengers, fellow passengers, crew, and flight operations. The guidelines are meant to serve only as a template with the full expectation that exceptions might be made with appropriate rationale.

  9. Correlations between root-associated microorganisms and peach replant disease symptoms in a California soil.

    Science.gov (United States)

    Yang, Jiue-in; Ruegger, Paul M; McKenry, Michael V; Becker, J Ole; Borneman, James

    2012-01-01

    Replant disease often occurs when certain crops are "replanted" in a soil that had previously supported the same or similar plant species. This disease typically leads to reductions in plant growth, crop yields, and production duration, and its etiology remains ill-defined. The objective of this study was to identify microorganisms associated with peach replant disease symptoms at a field location in California, USA. Soil samples were subjected to treatments to create various levels of replant disease symptoms. Clonal peach seedlings were grown in the treated soils in greenhouse trials. After 6 weeks, plant growth parameters were measured, and both culture and culture-independent analyses were performed to identify root-associated bacteria, fungi and stramenopiles. A total of 295,785 bacterial operational taxonomic units (OTU) were identified by an Illumina-based, high throughput sequence analysis of rRNA genes. Among the 60 most abundant OTUs, 27 showed significant (PChromatiales, Rhodocyclales, and Sphingomonadales. The most abundant fungi were Trichoderma asperellum, Trichoderma virens, Fusarium oxysporum, Ceratocystis fimbriata and Fusarium solani. The most abundant stramenopiles were Pythium vexans, Pythium violae and an unidentified Aplanochytrium species. Validation experiments using sequence-selective quantitative PCR analyses identified negative and positive associations between P. vexans and Trichoderma spp. and peach shoot weights, respectively. This study identified numerous microorganisms associated with peach replant symptoms, some of which have been previously identified while others represent new candidates. Subsequent Koch's postulates investigations will assess their possible roles in this replant disease.

  10. Depression, anxiety and their associated factors among medical students.

    Science.gov (United States)

    Alvi, Tabassum; Assad, Fatima; Ramzan, Mussarat; Khan, Faiza Aslam

    2010-02-01

    To determine the frequency of anxiety and depression among medical students of Wah Medical College and their associations with sociodemographic and educational characteristics if any. Cross-sectional survey. Wah Medical College, from September 2007 to March 2008. A sample of 279 students was included in the study after excluding first year medical students because they were admitted for less than 6 months. A self administered Encounter Form was administered. Sociodemographic and educational characteristics included age, gender, birth order, number of siblings, monthly income, monthly expenditure on education, academic performance in professional examination, past medical and past psychiatric history, substance abuse and family history of psychiatric illness. Beck depression inventory and beck anxiety inventory were used to assess the level of depression and anxiety. The chi-square test was applied at 5% level of significance to determine associated factors for anxiety and depression respectively. The mean age of students was 21.4+/-1.41 years with female preponderance i.e. 202 (72.4%). Anxiety was present in 133 (47.7%) students and depression in 98 (35.1%) students. Both were found concomitantly in 68 (24.37%) students. Age (p=0.013), gender (p=0.016), examination criteria dissatisfaction (p=0.002) and overburden with test schedule (p=0.002) were significantly associated with depression. Anxiety was significantly associated with gender (p=0.007), birth order (p=0.049), year of study (p=0.001), examination criteria dissatisfaction (p=0.010) and overburden with test schedule (p=0.006). One third of students were found to have anxiety and depression which was associated with the sociodemographic and educational factors as stated above.

  11. Gender-associated differences in matriculating and graduating medical students.

    Science.gov (United States)

    Bickel, J; Ruffin, A

    1995-06-01

    Data from the 1993 Matriculating Student Questionnaire (MSQ) and the 1994 Medical School Graduation Questionnaire (GQ) of the Association of American Medical Colleges were investigated for differences in responses between men and women. Notable differences were discovered, particularly with regard to career plans and experiences during medical school. Findings from the GQ include that a higher proportion of women rated curricular coverage of numerous subjects inadequate and that women students more frequently reported mistreatment during medical school. Women were also more likely than men to work in clinics serving the indigent and to complete a primary care clerkship. Over 30% of the 1994 women seniors, compared with 18% of the men, planned to pursue generalist careers. The authors discuss the gender-associated differences, with reference to previous studies, and conclude that medical educators should ensure that women have access to the same skill-development opportunities that men do and to a humane learning environment. Moreover, educators should examine what adaptations can encourage students of both genders to develop an ethic of "social responsibility."

  12. Regular and low-dose aspirin, other non-steroidal anti-inflammatory medications and prospective risk of HER2-defined breast cancer: the California Teachers Study.

    Science.gov (United States)

    Clarke, Christina A; Canchola, Alison J; Moy, Lisa M; Neuhausen, Susan L; Chung, Nadia T; Lacey, James V; Bernstein, Leslie

    2017-05-01

    Regular users of aspirin may have reduced risk of breast cancer. Few studies have addressed whether risk reduction pertains to specific breast cancer subtypes defined jointly by hormone receptor (estrogen and progesterone receptor) and human epidermal growth factor receptor 2 (HER2) expression. This study assessed the prospective risk of breast cancer (overall and by subtype) according to use of aspirin and other non-steroidal anti-inflammatory medications (NSAIDs) in a cohort of female public school professionals in California. In 1995 - 1996, participants in the California Teachers Study completed a baseline questionnaire on family history of cancer and other conditions, use of NSAIDs, menstrual and reproductive history, self-reported weight and height, living environment, diet, alcohol use, and physical activity. In 2005-2006, 57,164 participants provided some updated information, including use of NSAIDs and 1457 of these participants developed invasive breast cancer before January 2013. Multivariable Cox proportional hazards regression models provided hazard rate ratios (HRR) for the association between NSAID use and risk of invasive breast cancer as well as hormone receptor- and HER2-defined subtypes. Developing breast cancer was associated inversely with taking three or more tablets of low-dose aspirin per week (23% of participants). Among women reporting this exposure, the HRR was 0.84 (95% confidence interval (CI) 0.72-0.98) compared to those not taking NSAIDs and this was particularly evident in women with the hormone receptor-positive/HER2-negative subtype (HRR = 0.80, 95% CI 0.66-0.96). Use of three or more tablets of "other" NSAIDs was marginally associated with lower risk of breast cancer (HRR = 0.79, 95% CI 0.62-1.00). Other associations with NSAIDs were generally null. Our observation of reduced risk of breast cancer, among participants who took three or more tablets of low-dose aspirin weekly, is consistent with other reports looking at

  13. Physicians' and nurses' medical errors associated with communication failures.

    Science.gov (United States)

    Topcu, Ibrahim; Turkmen, Ayse Sonay; Sahiner, Nejla Canbulat; Savaser, Sevim; Sen, Hanife

    2017-04-01

    To determine medical errors associated with communication failures among physicians and nurses. This cross-sectional, descriptive study was conducted at 20 state hospitals and 14 training and research hospitals affiliated with the Istanbul City Health Directorate in Turkey, and comprised physicians and nurses. Data were collected between August 2012 and February 2013. A 16-item questionnaire was used that included questions regarding socio-demographic features such as age, gender, educational status, institution, occupation and working years. Questions also aimed at determining medical errors related to communication failures. The questionnaire was completed by the participants during face-to-face interviews. Of the 2,273 participants, 1,654(72.8%) were nurses and 619(27.2%) were physicians. Besides, 340(54.9%) physicians and 811(49.03%) nurses worked in state hospitals. The mean age of the physicians was 37.76±9.20 years (range: 22-62 years), and that of the nurses was 32.61±7.38 years (range: 17-62 years). Moreover, 137(22.1%) physicians and 258(15.3%) nurses had previously experienced medical errors. Also, 74(54%) physicians and 135(52.3%) nurses had experienced medical errors due to some communication error. The most common medical errors by physicians were incorrect drug administration 45(32.8%), and delivery of drugs to the wrong patient by nurses 103(40.7%). In addition, 58(42.3%) physicians made medical errors in adult surgical clinic services while 102(39.5%) nurses made medical errors in adult internal medicine clinics. The majority of medical errors originated from communication failures.

  14. Accreditation of Veterinary Medical Education: Part II--Influence of the American Veterinary Medical Association

    Science.gov (United States)

    Bauer, Elizabeth K.

    1975-01-01

    Traces the development, since its founding in 1863, of the American Veterinary Medical Association (AVMA) influence over the standards of training required in the veterinary profession. Attention is focused on the roles of the U.S. Department of Agriculture, the military, and the land-grant colleges in that development. (JT)

  15. Air emissions associated with decommissioning California's offshore oil and gas platforms.

    Science.gov (United States)

    Cantle, Peter; Bernstein, Brock

    2015-10-01

    The 27 oil and gas platforms offshore southern California are nearing the end of their productive lives and will be decommissioned in the near future. Many are in deep water and are correspondingly large, with the largest, Harmony, in 1200 feet of water and weighing approximately 43,000 tons. Nearly 30% of California's platforms are in water depths that exceed those of any previous decommissioning project anywhere in the world. Decommissioning will involve the operation of diesel-powered heavy equipment for long periods in virtually all phases of the operation (e.g, at the platform, in transit to and from the platform, in port, at offloading, salvage, and recycling facilities) in a region where air quality is a crucial concern for state, federal, and local regulatory agencies, as well as the public. To support future decision making about the choice between decommissioning options, we consider potential air emissions generated under complete and partial (removal to 85 feet below water line) removal options. We describe major emissions categories, and the environmental and human health issues associated with each, and examine how the regulatory system would operate in specific projects. We then describe methods to estimate emissions for a worst-case example involving the largest platform, Harmony. We estimate that complete versus partial removal of Harmony would result, respectively, in 600 or 89 tons of NOx, 50 or 7 tons of carbon monoxide, 29,400 or 4400 tons of CO2 , 21 or 3 tons of PM10, and 20 or 3 tons of PM2.5. Complete removal of Harmony's jacket and topsides creates approximately 6.75 times more air pollution than partial removal down to 85 feet below the sea surface. We discuss how the Harmony estimate can be used as a baseline to roughly estimate emissions from decommissioning other platforms, using expected time on station for the major categories of decommissioning equipment. © 2015 SETAC.

  16. Factors associated with disclosure of medical errors by housestaff.

    Science.gov (United States)

    Kronman, Andrea C; Paasche-Orlow, Michael; Orlander, Jay D

    2012-04-01

    Attributes of the organisational culture of residency training programmes may impact patient safety. Training environments are complex, composed of clinical teams, residency programmes, and clinical units. We examined the relationship between residents' perceptions of their training environment and disclosure of or apology for their worst error. Anonymous, self-administered surveys were distributed to Medicine and Surgery residents at Boston Medical Center in 2005. Surveys asked residents to describe their worst medical error, and to answer selected questions from validated surveys measuring elements of working environments that promote learning from error. Subscales measured the microenvironments of the clinical team, residency programme, and clinical unit. Univariate and bivariate statistical analyses examined relationships between trainee characteristics, their perceived learning environment(s), and their responses to the error. Out of 109 surveys distributed to residents, 99 surveys were returned (91% overall response rate), two incomplete surveys were excluded, leaving 97: 61% internal medicine, 39% surgery, 59% male residents. While 31% reported apologising for the situation associated with the error, only 17% reported disclosing the error to patients and/or family. More male residents disclosed the error than female residents (p=0.04). Surgery residents scored higher on the subscales of safety culture pertaining to the residency programme (p=0.02) and managerial commitment to safety (p=0.05). Our Medical Culture Summary score was positively associated with disclosure (p=0.04) and apology (p=0.05). Factors in the learning environments of residents are associated with responses to medical errors. Organisational safety culture can be measured, and used to evaluate environmental attributes of clinical training that are associated with disclosure of, and apology for, medical error.

  17. [Suicide Ideation Among Medical Students: Prevalence and Associated Factors].

    Science.gov (United States)

    Pinzón-Amado, Alexander; Guerrero, Sonia; Moreno, Katherine; Landínez, Carolina; Pinzón, Julie

    2013-01-01

    It is well documented that physicians have higher rates of suicide than the general population. This risk tends to increase even from the beginning of undergraduate training in medicine. There are few studies evaluating the frequency of suicidal behaviors in undergraduate medical students, particularly in Latin America. To determine the lifetime prevalence and the variables associated with suicidal ideation and suicide attempts in a sample of medical students from the city of Bucaramanga, Colombia. An analytical cross-sectional observational study was conducted to determine the lifetime prevalence of suicidal ideation and suicide attempts in a non-random sample of medical students enrolled in three medical schools in Bucaramanga. A self-administered questionnaire was voluntarily and anonymously answered by the participants. Validated versions of the CES-D and CAGE scales were used to assess the presence of depressive symptoms and problematic alcohol use, respectively. A multivariate logistic regression model was generated in order to adjust the estimates of variables associated with the outcome «suicidal ideation in life». The study sample consisted of 963 medical students, of which 57% (n=549) of the participants were women. The average age was 20.3 years (SD=2.3 years). Having had at least one episode of serious suicidal ideation in their lifetime was reported by 15.7% (n=149) of the students, with 5% (n=47) of the students reported having made at least one suicide attempt. Having taken antidepressants during their medical training was reported by 13.9% (n=131) of the students. The variables associated with the presence of suicidal ideation in the logistic regression model were: clinically significant depressive symptoms (OR: 6.9, 95% CI; 4.54-10.4), history of illicit psychoactive substance use (OR 2.8, 95% CI; 1.6-4.8), and perception of poor academic performance over the past year (OR: 2.2, 95% CI; 1.4-3.6). The logistic regression model correctly classified

  18. The "nuts and bolts" of implementing shared medical appointments: the Harvard Vanguard Medical Associates experience.

    Science.gov (United States)

    Berger-Fiffy, Jill

    2012-01-01

    Harvard Vanguard Medical Associates (Harvard Vanguard) decided to develop a Shared Medical Appointment (SMA) program in 2007 for a variety of reasons. The program has launched 86 SMAs in 17 specialties at 12 sites and has exceeded 13 000 patient visits. Currently, the practice offers 54 SMAs and is believed to be the largest program in the country. This article provides an overview regarding staffing, space and equipment, project planning, promotional materials, training programs, workflow development, and the use of quality improvement (ie, LEAN) tools used to monitor the work to be completed and the metrics to date.

  19. Wilderness restoration: Bureau of Land Management and the Student Conservation Association in the California Desert District

    Science.gov (United States)

    J. Dan Abbe

    2007-01-01

    The California Desert Protection Act of 1994 was the largest park and wilderness legislation passed in the Lower 48 States since the Wilderness Act of 1964. It designated three national parks and 69 Bureau of Land Management wilderness areas. The California Desert and Wilderness Restoration Project is working to restore and revitalize these lands through a public/...

  20. Systemic adenovirus infection associated with high mortality in mule deer (Odocoileus hemionus) in California

    NARCIS (Netherlands)

    Horzinek, M.C.; Woods, L.W.; Swift, P.K.; Barr, B.C.; Nordhausen, R.W.; Stillian, M.H.; Patton, J.F.; Oliver, M.N.; Jones, K.R.; Maclachlan, N.J.

    1996-01-01

    Seventeen counties in northern California experienced epizootics of high mortality in the mule deer (Odocoileus hemionus) population during the latter half of 1993. Thirteen deer submitted to the California Veterinary Diagnostic Laboratory System as part of this natural die-off had systemic

  1. Identification and frequency of Phytophthora species associated with foliar diseases in California ornamental nurseries

    Science.gov (United States)

    L. E. Yakabe; C. L. Blomquist; S. L. Thomas; J. D. MacDonald

    2009-01-01

    Numerous ornamental nurseries in 32 California counties were surveyed for leaf spots as part of the California Department of Food and Agriculture mandated surveys targeting Phytophthora ramorum. Tissue collected during the 2005 and 2006 surveys was initially screened by a Phytophthora-specific enzyme-linked immunosorbent assay...

  2. Reliability of Multiple Mini-Interviews and traditional interviews within and between institutions: a study of five California medical schools

    Directory of Open Access Journals (Sweden)

    Anthony Jerant

    2017-11-01

    Full Text Available Abstract Background Many medical schools use admissions Multiple Mini-Interviews (MMIs rather than traditional interviews (TIs, partly because MMIs are thought to be more reliable. Yet prior studies examined single-school samples of candidates completing either an MMI or TI (not both. Using data from five California public medical schools, the authors examined the within- and between-school reliabilities of TIs and MMIs. Methods The analyses included applicants interviewing at ≥1 of the five schools during 2011–2013. Three schools employed TIs (TI1, TI2, TI3 and two employed MMIs (MMI1, MMI2. Mixed linear models accounting for nesting of observations within applicants examined standardized TI and MMI scores (mean = 0, SD = 1, adjusting for applicant socio-demographics, academic metrics, year, number of interviews, and interview date. Results A total of 4993 individuals (completing 7516 interviews [TI = 4137, MMI = 3379] interviewed at ≥1 school; 428 (14.5% interviewed at both MMI schools and 687 (20.2% at more than one TI school. Within schools, inter-interviewer consistency was generally qualitatively lower for TI1, TI2, and TI3 (Pearson’s r 0.07, 0.13, and 0.29, and Cronbach’s α, 0.40, 0.44, and 0.61, respectively than for MMI1 and MMI 2 (Cronbach’s α 0.68 and 0.60, respectively. Between schools, the adjusted intraclass correlation coefficient was 0.27 (95% CI 0.20–0.35 for TIs and 0.47 (95% CI 0.41–0.54 for MMIs. Conclusions Within and between-school reliability was qualitatively higher for MMIs than for TIs. Nonetheless, TI reliabilities were higher than anticipated from prior literature, suggesting TIs may not need to be abandoned on reliability grounds if other factors favor their use.

  3. Reliability of Multiple Mini-Interviews and traditional interviews within and between institutions: a study of five California medical schools.

    Science.gov (United States)

    Jerant, Anthony; Henderson, Mark C; Griffin, Erin; Rainwater, Julie A; Hall, Theodore R; Kelly, Carolyn J; Peterson, Ellena M; Wofsy, David; Franks, Peter

    2017-11-06

    Many medical schools use admissions Multiple Mini-Interviews (MMIs) rather than traditional interviews (TIs), partly because MMIs are thought to be more reliable. Yet prior studies examined single-school samples of candidates completing either an MMI or TI (not both). Using data from five California public medical schools, the authors examined the within- and between-school reliabilities of TIs and MMIs. The analyses included applicants interviewing at ≥1 of the five schools during 2011-2013. Three schools employed TIs (TI1, TI2, TI3) and two employed MMIs (MMI1, MMI2). Mixed linear models accounting for nesting of observations within applicants examined standardized TI and MMI scores (mean = 0, SD = 1), adjusting for applicant socio-demographics, academic metrics, year, number of interviews, and interview date. A total of 4993 individuals (completing 7516 interviews [TI = 4137, MMI = 3379]) interviewed at ≥1 school; 428 (14.5%) interviewed at both MMI schools and 687 (20.2%) at more than one TI school. Within schools, inter-interviewer consistency was generally qualitatively lower for TI1, TI2, and TI3 (Pearson's r 0.07, 0.13, and 0.29, and Cronbach's α, 0.40, 0.44, and 0.61, respectively) than for MMI1 and MMI 2 (Cronbach's α 0.68 and 0.60, respectively). Between schools, the adjusted intraclass correlation coefficient was 0.27 (95% CI 0.20-0.35) for TIs and 0.47 (95% CI 0.41-0.54) for MMIs. Within and between-school reliability was qualitatively higher for MMIs than for TIs. Nonetheless, TI reliabilities were higher than anticipated from prior literature, suggesting TIs may not need to be abandoned on reliability grounds if other factors favor their use.

  4. Sentinel California sea lions provide insight into legacy organochlorine exposure trends and their association with cancer and infectious disease

    Directory of Open Access Journals (Sweden)

    Nistara Randhawa

    2015-12-01

    Conclusion: Organochlorine contamination has significant associations with health outcomes in California sea lions, raising concerns for humans and other animals eating tainted seafood. While environmental exposure to these organochlorines appears to be decreasing over time based on levels in sea lion tissues, their persistence in the environment and food web for all predators, including humans, and the associated serious health risks, warrant monitoring, possibly through sentinel species like marine mammals.

  5. Association of genetic and phenotypic variability with geography and climate in three southern California oaks.

    Science.gov (United States)

    Riordan, Erin C; Gugger, Paul F; Ortego, Joaquín; Smith, Carrie; Gaddis, Keith; Thompson, Pam; Sork, Victoria L

    2016-01-01

    Geography and climate shape the distribution of organisms, their genotypes, and their phenotypes. To understand historical and future evolutionary and ecological responses to climate, we compared the association of geography and climate of three oak species (Quercus engelmannii, Quercus berberidifolia, and Quercus cornelius-mulleri) in an environmentally heterogeneous region of southern California at three organizational levels: regional species distributions, genetic variation, and phenotypic variation. We identified climatic variables influencing regional distribution patterns using species distribution models (SDMs), and then tested whether those individual variables are important in shaping genetic (microsatellite) and phenotypic (leaf morphology) variation. We estimated the relative contributions of geography and climate using multivariate redundancy analyses (RDA) with variance partitioning. The modeled distribution of each species was influenced by climate differently. Our analysis of genetic variation using RDA identified small but significant associations between genetic variation with climate and geography in Q. engelmannii and Q. cornelius-mulleri, but not in Q. berberidifolia, and climate explained more of the variation. Our analysis of phenotypic variation in Q. engelmannii indicated that climate had more impact than geography, but not in Q. berberidifolia. Throughout our analyses, we did not find a consistent pattern in effects of individual climatic variables. Our comparative analysis illustrates that climate influences tree response at all organizational levels, but the important climate factors vary depending on the level and on the species. Because of these species-specific and level-specific responses, today's sympatric species are unlikely to have similar distributions in the future. © 2016 Botanical Society of America.

  6. Social Support and Lifestyle vs. Medical Diabetes Self-Management in the Diabetes Study of Northern California (DISTANCE)

    Science.gov (United States)

    Rosland, Ann-Marie; Piette, John D.; Lyles, Courtney R.; Parker, Melissa M.; Moffet, Howard H.; Adler, Nancy E.; Schillinger, Dean; Karter, Andrew J.

    2014-01-01

    Background In chronic illness self-care, social support may influence some health behaviors more than others. Purpose Examine the relationship between social support and seven individual chronic illness self-management behaviors including two healthy “lifestyle” behaviors (physical activity and diet) and five more highly-skilled and diabetes-specific (“medical”) behaviors (checking feet, oral medication adherence, insulin adherence, self-monitoring of blood glucose, and primary care appointment attendance). Methods Using cross-sectional administrative and survey data from 13,366 patients with type 2 diabetes, we specified Poisson regression models to estimate adjusted relative risks (ARR) of practicing each self-management behavior at higher vs lower levels of social support. Results Higher levels of emotional support and social network scores were significantly associated with lifestyle behaviors [healthful eating ARR (95%CI) 1.14 (1.08, 1.21) and 1.10 (1.05, 1.16), and physical activity 1.09 (1.01, 1.17) and 1.20 (1.12, 1.28)]. Both social support measures were also associated with checking feet [ARR 1.21 (1.12, 1.31) and 1.10 (1.02, 1.17)]. Neither measure was significantly associated with other medical behaviors. Conclusions Social support was associated with increased adherence to lifestyle self-management behaviors, but was not associated with increased medical self-management behaviors, other than foot self-examination. PMID:24794624

  7. Treatment of Diabetic Ketoacidosis Associated With Antipsychotic Medication

    Science.gov (United States)

    Vuk, Antonia; Baretic, Maja; Osvatic, Martina Matovinovic; Filipcic, Igor; Jovanovic, Nikolina; Kuzman, Martina Rojnic

    2017-01-01

    Abstract Background The second-generation antipsychotics (SGAs) are associated with metabolic disturbances. Diabetic ketoacidosis (DKA) is a rare, but potentially fatal sign of acute glucose metabolism dysregulation, which may be associated with the use of SGAs. This study aims to review published reports of patients with schizophrenia and antipsychotic drug–associated DKA, focusing on the effective management of both conditions. Methods Using a predefined search strategy, we searched PubMed and EMBASE from their inception to July 2016. The search terms were related to “diabetic ketoacidosis” and “antipsychotic medication.” Case reports, case series, and reviews of case series written in English language were included in the review. Results Sixty-five reports were analyzed. In most patients who developed antipsychotic-associated DKA, 1 or more suspected antipsychotic medications were discontinued. In 5 cases, a rechallenge test was trialed, and in only 1 case, it resulted in the elevation of blood glucose. The majority was subsequently treated with a different SGA in combination with insulin/oral hypoglycemic agents; although approximately a third of patients had a complete resolution of symptoms or could control diabetes with diet only at the point of discharge. Conclusions Patients taking antipsychotic medications should be regularly screened for insulin resistance and educated about potential complications of antipsychotic medications. This will allow clinicians to individualize treatment decisions and reduce iatrogenic contribution to morbidity and mortality. To achieve best treatment outcomes, antipsychotic-induced DKA should be treated jointly by psychiatry and endocrinology teams. PMID:28816925

  8. Association of medication attitudes with non-persistence and non-compliance with medication to prevent fractures.

    Science.gov (United States)

    Schousboe, J T; Dowd, B E; Davison, M L; Kane, R L

    2010-11-01

    Our objective was to assess the association of self-reported non-persistence (stopping fracture-prevention medication for more than 1 month) and self-reported non-compliance (missing doses of prescribed medication) with perceived need for fracture-prevention medication, concerns regarding long-term harm from and/or dependence upon medications, and medication-use self-efficacy (confidence in one's ability to successfully take medication in the context of their daily life). Non-persistence (stopping medication prematurely) and non-compliance (not taking medications at the prescribed times) with oral medications to prevent osteoporotic fractures is widespread and attenuates their fracture reduction benefit. Cross-sectional survey and medical record review of 729 patients at a large multispecialty clinic in the United States prescribed an oral bisphosphonate between January 1, 2006 and March 31, 2007. Low perceived necessity for fracture-prevention medication was strongly associated with non-persistence independent of other predictors, but not with non-compliance. Concerns about medications were associated with non-persistence, but not with non-compliance. Low medication-use self-efficacy was associated with non-persistence and non-compliance. Non-persistence and non-compliance with oral bisphosphonate medication have different, albeit overlapping, sets of predictors. Low perceived necessity of fracture-prevention medication, high concerns about long-term safety of and dependence upon medication , and low medication-use self-efficacy all predict non-persistence with oral bisphosphonates, whereas low medication-use self-efficacy strongly predicts non-compliance with oral bisphosphonate medication. Assessment of and influence of these medication attitudes among patients at high risk of fracture are likely necessary to achieve better persistence and compliance with fracture-prevention therapies.

  9. Correlations between root-associated microorganisms and peach replant disease symptoms in a California soil.

    Directory of Open Access Journals (Sweden)

    Jiue-in Yang

    Full Text Available BACKGROUND: Replant disease often occurs when certain crops are "replanted" in a soil that had previously supported the same or similar plant species. This disease typically leads to reductions in plant growth, crop yields, and production duration, and its etiology remains ill-defined. The objective of this study was to identify microorganisms associated with peach replant disease symptoms at a field location in California, USA. Soil samples were subjected to treatments to create various levels of replant disease symptoms. Clonal peach seedlings were grown in the treated soils in greenhouse trials. After 6 weeks, plant growth parameters were measured, and both culture and culture-independent analyses were performed to identify root-associated bacteria, fungi and stramenopiles. RESULTS: A total of 295,785 bacterial operational taxonomic units (OTU were identified by an Illumina-based, high throughput sequence analysis of rRNA genes. Among the 60 most abundant OTUs, 27 showed significant (P<0.05 negative correlation with peach shoot weights while 10 were positively correlated. Most of these OTUs belonged to the bacterial phylum Proteobacteria (96%, including the classes Gammaproteobacteria (44.4%, Betaproteobacteria (33.3% and Alphaproteobacteria (22.2%, and the orders Pseudomonadales, Burkholderiales, Chromatiales, Rhodocyclales, and Sphingomonadales. The most abundant fungi were Trichoderma asperellum, Trichoderma virens, Fusarium oxysporum, Ceratocystis fimbriata and Fusarium solani. The most abundant stramenopiles were Pythium vexans, Pythium violae and an unidentified Aplanochytrium species. Validation experiments using sequence-selective quantitative PCR analyses identified negative and positive associations between P. vexans and Trichoderma spp. and peach shoot weights, respectively. CONCLUSIONS: This study identified numerous microorganisms associated with peach replant symptoms, some of which have been previously identified while others

  10. Addressing the Learning Outcomes and Assessment Methods Associated with Participation in Student Government Associations: A Qualitative Study of California Community Colleges

    Science.gov (United States)

    Nevin, Miles J.

    2017-01-01

    This document analysis synthesized student learning outcomes (SLOs) and assessment methods from a sample of 36 student government associations in the California Community College system. Student learning outcomes were grouped according to "governance, ethical and civic behavior", and "experiential learning functions." Using…

  11. Fragile X syndrome: a review of associated medical problems.

    Science.gov (United States)

    Kidd, Sharon A; Lachiewicz, Ave; Barbouth, Deborah; Blitz, Robin K; Delahunty, Carol; McBrien, Dianne; Visootsak, Jeannie; Berry-Kravis, Elizabeth

    2014-11-01

    Fragile X syndrome (FXS) is the most common known genetic cause of inherited intellectual disability and the most common known single-gene cause of autism spectrum disorder. It has been reported that a spectrum of medical problems are commonly experienced by people with FXS, such as otitis media, seizures, and gastrointestinal problems. Previous studies examining the prevalence of medical problems related to FXS have been challenging to interpret because of their marked differences in population, setting, and sampling. Through this comprehensive review, we update the literature by reviewing studies that have reported on prominent medical problems associated with FXS. We then compare prevalence results from those studies with results from a large cross-sectional database consisting of data collected by fragile X clinics that specialize in the care of children with FXS and are part of the Fragile X Clinical and Research Consortium. It is vital for pediatricians and other clinicians to be familiar with the medical problems related to FXS so that affected patients may receive proper diagnosis and treatment; improved care may lead to better quality of life for these patients and their families. Copyright © 2014 by the American Academy of Pediatrics.

  12. Ethical issues associated with medical tourism in Africa

    Science.gov (United States)

    Mogaka, John J. O.; Mupara, Lucia; Tsoka-Gwegweni, Joyce M

    2017-01-01

    ABSTRACT Global disparities in medical technologies, laws, economic inequities, and social–cultural differences drive medical tourism (MT), the practice of travelling to consume healthcare that is either too delayed, unavailable, unaffordable or legally proscribed at home. Africa is simultaneously a source and destination for MT. MT however, presents a new and challenging health ethics frontier, being largely unregulated and characterized by policy contradictions, minority discrimination and conflict of interest among role-players. This article assesses the level of knowledge of MT and its associated ethical issues in Africa; it also identifies critical research gaps on the subject in the region. Exploratory design guided by Arksey and O’Malley’s (2005) framework was used. Key search terms and prior determined exclusion/inclusion criteria were used to identify relevant literature sources. Fifty-seven articles met the inclusion criteria. Distributive justice, healthcare resource allocation, experimental treatments and organ transplant were the most common ethical issues of medical tourism in Africa. The dearth of robust engagement of MT and healthcare ethics, as identified through this review, calls for more rigorous research on this subject. Although the bulk of the medical tourism industry is driven by global legal disparities based on ethical considerations, little attention has been given to this subject. PMID:28740618

  13. Ethical issues associated with medical tourism in Africa.

    Science.gov (United States)

    Mogaka, John J O; Mupara, Lucia; Tsoka-Gwegweni, Joyce M

    2017-01-01

    Global disparities in medical technologies, laws, economic inequities, and social-cultural differences drive medical tourism (MT), the practice of travelling to consume healthcare that is either too delayed, unavailable, unaffordable or legally proscribed at home. Africa is simultaneously a source and destination for MT. MT however, presents a new and challenging health ethics frontier, being largely unregulated and characterized by policy contradictions, minority discrimination and conflict of interest among role-players. This article assesses the level of knowledge of MT and its associated ethical issues in Africa; it also identifies critical research gaps on the subject in the region. Exploratory design guided by Arksey and O'Malley's (2005) framework was used. Key search terms and prior determined exclusion/inclusion criteria were used to identify relevant literature sources. Fifty-seven articles met the inclusion criteria. Distributive justice, healthcare resource allocation, experimental treatments and organ transplant were the most common ethical issues of medical tourism in Africa. The dearth of robust engagement of MT and healthcare ethics, as identified through this review, calls for more rigorous research on this subject. Although the bulk of the medical tourism industry is driven by global legal disparities based on ethical considerations, little attention has been given to this subject.

  14. Frequency and risk factors associated with emergency medical readmissions in Galway University Hospitals.

    LENUS (Irish Health Repository)

    Gorman, J

    2010-06-01

    Unplanned readmissions of medical hospital patients have been increasing in recent years. We examined the frequency and associates of emergency medical readmissions to Galway University Hospitals (GUH).

  15. Spatiotemporal spread of grapevine red blotch-associated virus in a California vineyard.

    Science.gov (United States)

    Cieniewicz, Elizabeth J; Pethybridge, Sarah J; Gorny, Adrienne; Madden, Laurence V; McLane, Heather; Perry, Keith L; Fuchs, Marc

    2017-09-15

    Grapevine red blotch-associated virus (GRBaV), the causative agent of red blotch disease, is a member of the genus Grablovirus, in the family Geminiviridae and the first known geminivirus of Vitis spp. Limited information is available on the epidemiology of red blotch disease. A 2-hectare Vitis vinifera cv. 'Cabernet franc' vineyard in Napa County, California, USA was selected for monitoring GRBaV spread over a three-year period (2014-2016) based on an initially low disease incidence and an aggregation of symptomatic vines at the edge of the vineyard proximal to a wooded riparian area. The incidence of diseased plants increased by 1-2% annually. Spatial analysis of diseased plants in each year using ordinary runs analysis within rows and Spatial Analysis by Distance IndicEs (SADIE) demonstrated aggregation. Spatiotemporal analysis between consecutive years within the association function of SADIE revealed a strong overall association among all three years (X=0.874-0.945). Analysis of epidemic spread fitting a stochastic spatiotemporal model using the Monte Carlo Markov Chain method identified strong evidence for localized (within vineyard) spread. A spatial pattern consisting of a combination of strongly aggregated and randomly isolated symptomatic vines within 8-years post-planting suggested unique epidemic attributes compared to those of other grapevine viruses vectored by mealybugs and soft scales or by dagger nematodes for which typical within-row spread and small-scale autocorrelation are well documented. These findings are consistent with the existence of a new type of vector for a grapevine virus. Copyright © 2017 Elsevier B.V. All rights reserved.

  16. Lead exposure in free-flying turkey vultures is associated with big game hunting in California.

    Directory of Open Access Journals (Sweden)

    Terra R Kelly

    Full Text Available Predatory and scavenging birds are at risk of lead exposure when they feed on animals injured or killed by lead ammunition. While lead ammunition has been banned from waterfowl hunting in North America for almost two decades, lead ammunition is still widely used for hunting big game and small game animals. In this study, we evaluated the association between big game hunting and blood lead concentration in an avian scavenger species that feeds regularly on large mammals in California. We compared blood lead concentration in turkey vultures within and outside of the deer hunting season, and in areas with varying wild pig hunting intensity. Lead exposure in turkey vultures was significantly higher during the deer hunting season compared to the off-season, and blood lead concentration was positively correlated with increasing wild pig hunting intensity. Our results link lead exposure in turkey vultures to deer and wild pig hunting activity at these study sites, and we provide evidence that spent lead ammunition in carrion poses a significant risk of lead exposure to scavengers.

  17. Lead Exposure in Free-Flying Turkey Vultures Is Associated with Big Game Hunting in California

    Science.gov (United States)

    Kelly, Terra R.; Johnson, Christine K.

    2011-01-01

    Predatory and scavenging birds are at risk of lead exposure when they feed on animals injured or killed by lead ammunition. While lead ammunition has been banned from waterfowl hunting in North America for almost two decades, lead ammunition is still widely used for hunting big game and small game animals. In this study, we evaluated the association between big game hunting and blood lead concentration in an avian scavenger species that feeds regularly on large mammals in California. We compared blood lead concentration in turkey vultures within and outside of the deer hunting season, and in areas with varying wild pig hunting intensity. Lead exposure in turkey vultures was significantly higher during the deer hunting season compared to the off-season, and blood lead concentration was positively correlated with increasing wild pig hunting intensity. Our results link lead exposure in turkey vultures to deer and wild pig hunting activity at these study sites, and we provide evidence that spent lead ammunition in carrion poses a significant risk of lead exposure to scavengers. PMID:21494326

  18. A Proteomic Characterization of Bordetella pertussis Clinical Isolates Associated with a California State Pertussis Outbreak

    Directory of Open Access Journals (Sweden)

    Yulanda M. Williamson

    2015-01-01

    Full Text Available Bordetella pertussis (Bp is the etiologic agent of pertussis (whooping cough, a highly communicable infection. Although pertussis is vaccine preventable, in recent years there has been increased incidence, despite high vaccine coverage. Possible reasons for the rise in cases include the following: Bp strain adaptation, waning vaccine immunity, increased surveillance, and improved clinical diagnostics. A pertussis outbreak impacted California (USA in 2010; children and preadolescents were the most affected but the burden of disease fell mainly on infants. To identify protein biomarkers associated with this pertussis outbreak, we report a whole cellular protein characterization of six Bp isolates plus the pertussis acellular vaccine strain Bp Tohama I (T, utilizing gel-free proteomics-based mass spectrometry (MS. MS/MS tryptic peptide detection and protein database searching combined with western blot analysis revealed three Bp isolates in this study had markedly reduced detection of pertactin (Prn, a subunit of pertussis acellular vaccines. Additionally, antibody affinity capture technologies were implemented using anti-Bp T rabbit polyclonal antisera and whole cellular proteins to identify putative immunogens. Proteome profiling could shed light on pathogenesis and potentially lay the foundation for reduced infection transmission strategies and improved clinical diagnostics.

  19. Association of medical student burnout with residency specialty choice.

    Science.gov (United States)

    Enoch, Lindsey; Chibnall, John T; Schindler, Debra L; Slavin, Stuart J

    2013-02-01

    Given the trend among medical students away from primary care medicine and toward specialties that allow for more controllable lifestyles, the identification of factors associated with specialty choice is important. Burnout is one such factor. The purpose of this study was to examine the associations between burnout and residency specialty choice in terms of provision for a less versus more controllable lifestyle (e.g. internal medicine versus dermatology) and a lower versus higher income (e.g. paediatrics versus anaesthesiology). A survey was sent to 165 Year 4 medical students who had entered the residency matching system. Students answered questions about specialty choice, motivating factors (lifestyle, patient care and prestige) and perceptions of medicine as a profession. They completed the Maslach Burnout Inventory-Human Services (MBI), which defines burnout in relation to emotional exhaustion (EE), depersonalisation (DP) and personal accomplishment (PA). Burnout and other variables were tested for associations with specialty lifestyle controllability and income. A response rate of 88% (n = 145) was achieved. Experiences of MBI-EE, MBI-DP and MBI-PA burnout were reported by 42 (29%), 26 (18%) and 30 (21%) students, respectively. Specialties with less controllable lifestyles were chosen by 87 (60%) students and lower-income specialties by 81 (56%). Adjusted odds ratios (ORs) indicated that the choice of a specialty with a more controllable lifestyle was associated with higher MBI-EE burnout (OR = 1.77, 95% confidence interval [CI] 1.06-2.96), as well as stronger lifestyle- and prestige-related motivation, and weaker patient care-related motivation. The choice of a higher-income specialty was associated with lower MBI-PA burnout (OR = 0.56, 95% CI 0.32-0.98), weaker lifestyle- and patient care-related motivation, and stronger prestige-related motivation. Specialty choices regarding lifestyle controllability and income were associated with the amount and type of

  20. Long term marijuana users seeking medical cannabis in California (2001–2007: demographics, social characteristics, patterns of cannabis and other drug use of 4117 applicants

    Directory of Open Access Journals (Sweden)

    Bou-Matar Ché B

    2007-11-01

    Full Text Available Abstract Background Cannabis (marijuana had been used for medicinal purposes for millennia. Cannabinoid agonists are now attracting growing interest and there is also evidence that botanical cannabis is being used as self-medication for stress and anxiety as well as adjunctive therapy by the seriously ill and by patients with terminal illnesses. California became the first state to authorize medicinal use of cannabis in 1996, and it was recently estimated that between 250,000 and 350,000 Californians may now possess the physician's recommendation required to use it medically. More limited medical use has also been approved in 12 additional states and new initiatives are being considered in others. Despite that evidence of increasing public acceptance of "medical" use, a definitional problem remains and all use for any purpose is still prohibited by federal law. Results California's 1996 initiative allowed cannabis to be recommended, not only for serious illnesses, but also "for any other illness for which marijuana provides relief," thus maximally broadening the range of allowable indications. In effect, the range of conditions now being treated with federally illegal cannabis, the modes in which it is being used, and the demographics of the population using it became potentially discoverable through the required screening of applicants. This report examines the demographic profiles and other selected characteristics of 4117 California marijuana users (62% from the Greater Bay Area who applied for medical recommendations between late 2001 and mid 2007. Conclusion This study yielded a somewhat unexpected profile of a hitherto hidden population of users of America's most popular illegal drug. It also raises questions about some of the basic assumptions held by both proponents and opponents of current policy.

  1. MEDICAL ISSUES ASSOCIATED WITH ANABOLIC STEROID USE: ARE THEY EXAGGERATED?

    Directory of Open Access Journals (Sweden)

    Jay R. Hoffman

    2006-06-01

    Full Text Available For the past 50 years anabolic steroids have been at the forefront of the controversy surrounding performance enhancing drugs. For almost half of this time no attempt was made by sports governing bodies to control its use, and only recently have all of the major sports governing bodies in North America agreed to ban from competition and punish athletes who test positive for anabolic steroids. These punitive measures were developed with the primary concern for promotion of fair play and eliminating potential health risks associated with androgenic-anabolic steroids. Yet, controversy exists whether these testing programs deter anabolic steroid use. Although the scope of this paper does not focus on the effectiveness of testing, or the issue of fair play, it is of interest to understand why many athletes underestimate the health risks associated from these drugs. What creates further curiosity is the seemingly well-publicized health hazards that the medical community has depicted concerning anabolic steroidabuse. Is there something that the athletes know, or are they simply naïve regarding the dangers? The focus of this review is to provide a brief history of anabolic steroid use in North America, the prevalence of its use in both athletic and recreational populations and its efficacy. Primary discussion will focus on health issues associated with anabolic steroid use with an examination of the contrasting views held between the medical community and the athletes that are using these ergogenic drugs. Existing data suggest that in certain circumstances the medical risk associated with anabolic steroid use may have been somewhat exaggerated, possibly to dissuade use in athletes

  2. Factors associated with low adherence to medication in older adults

    Science.gov (United States)

    Tavares, Noemia Urruth Leão; Bertoldi, Andréa Dâmaso; Thumé, Elaine; Facchini, Luiz Augusto; de França, Giovanny Vinícius Araújo; Mengue, Sotero Serrate

    2013-01-01

    OBJECTIVE To assess factors associated with low adherence to pharmacotherapy in older adults. METHODS Cross-sectional population-based study, with a representative sample of 1,593 individuals aged 60 or older, living in the urban area of Bagé, RS, Southern Brazil, in 2008. A multiple stage sampling model was used. The data were collected through individual household interviews. The analyses of the association between low adherence regarding pharmacotherapy, measured using the Brief Medication Questionnaire (BMQ), and demographic, socioeconomic, behavioral, health, assistance and prescription factors were carried out applying Poisson regression model to assess crude and adjusted prevalence ratios, their respective 95% confidence intervals and p-value (Wald test). RESULTS Around 78.0% of individuals reported have taken at least one medication in the seven days prior to the interview. Of these, approximately one third (28.7%) were considered to have low adherence to the treatment. The factors significantly associated to low adherence to treatment were: age (65 to 74 years old), not having health insurance, having to purchase (totally or partially) their own medicines, having three or more morbidities, having functional disabilities and using three or more medicines. CONCLUSIONS The increased use of medicines by older adults, because of the high prevalence of non-communicable diseases in this group, and the access to the treatment need to be considered by health care professionals regarding fostering adherence to treatment, which increases therapeutic solutions and quality of life among older people. PMID:24626547

  3. [Factors associated with low adherence to medication in older adults].

    Science.gov (United States)

    Tavares, Noemia Urruth Leão; Bertoldi, Andréa Dâmaso; Thumé, Elaine; Facchini, Luiz Augusto; França, Giovanny Vinícius Araújo de; Mengue, Sotero Serrate

    2013-12-01

    To assess factors associated with low adherence to pharmacotherapy in older adults. Cross-sectional population-based study, with a representative sample of 1,593 individuals aged 60 or older, living in the urban area of Bagé, RS, Southern Brazil, in 2008. A multiple stage sampling model was used. The data were collected through individual household interviews. The analyses of the association between low adherence regarding pharmacotherapy, measured using the Brief Medication Questionnaire (BMQ), and demographic, socioeconomic, behavioral, health, assistance and prescription factors were carried out applying Poisson regression model to assess crude and adjusted prevalence ratios, their respective 95% confidence intervals and p-value (Wald test). Around 78.0% of individuals reported have taken at least one medication in the seven days prior to the interview. Of these, approximately one third (28.7%) were considered to have low adherence to the treatment. The factors significantly associated to low adherence to treatment were: age (65 to 74 years old), not having health insurance, having to purchase (totally or partially) their own medicines, having three or more morbidities, having functional disabilities and using three or more medicines. The increased use of medicines by older adults, because of the high prevalence of non-communicable diseases in this group, and the access to the treatment need to be considered by health care professionals regarding fostering adherence to treatment, which increases therapeutic solutions and quality of life among older people.

  4. Bartonella henselae prevalence in domestic cats in California: risk factors and association between bacteremia and antibody titers.

    OpenAIRE

    Chomel, B.B.; Abbott, R C; Kasten, R W; Floyd-Hawkins, K A; Kass, P.H.; Glaser, C A; Pedersen, N C; Koehler, J. E.

    1995-01-01

    The isolation of Bartonella henselae, the agent of cat scratch disease, from the blood of naturally infected domestic cats and the demonstration that cats remain bacteremic for several months suggest that cats play a major role as a reservoir for this bacterium. A convenience sample of 205 cats from northern California was selected between 1992 and 1994 to evaluate the B. henselae antibody and bacteremia prevalences and to determine the risk factors and associations between bacteremia and ant...

  5. Tobacco Use and Associated Factors in Medical Students

    Directory of Open Access Journals (Sweden)

    Hamideh Ebrahimi

    2017-02-01

    Full Text Available Background Many studies indicate that one of the leading preventable causes of premature death, disease and disability around the world is Tobacco use. Unfortunately, adolescents and young adults of colleges are often targeted of marketing by the tobacco industry. The aim of this study was to assess the relative frequency of tobacco use and associated factors in medical students. Methods This cross-sectional study has done among medical students in 2014 - 2015. Totally, 284 students from 4 levels (basic, extern, intern and residents were selected by random sampling from each category. We used a checklist for collecting demographic information that was distributed among participants by a trained interviewer. SPSS-11.5 software was used for data analysis andsignificance level was considered < 0.05. Results Among 284 medical students, 17 (6% smoked cigarette and 3 (1.05% used illicit substance. All of the users were male, 15 (88% of which were single. 1 (1.4 % of the basic level students, 6 (6.9 % of the externs, 9 (14.8 % of the Interns and 1(1.6 % of the residents used cigarette but the differences among these groups were not significant (P = 0.36. Generally, 13 (76.5% of the users resided in dormitory and the others lived in parental home, which shows a significant difference among these groups (P = 0.01.The logistic regression indicated stage level was positively associated with cigarette use (P < 0.007. Conclusions In this study, we evaluated how several environmental factors may influence illicit substance and tobacco use. We found an association between living in a dormitory and smoking cigarette, so it is an important factor to be considered in program planning for new students who entered into this environment.

  6. [Aesthetic plastic surgery from a medical association's point of view].

    Science.gov (United States)

    Schäfer, Robert D; David, Dagmar M

    2006-01-01

    Influenced by rapidly changing ideals of beauty, more and more people are turning to aesthetic surgery to meet current standards of beauty. In this situation physicians have to balance the patient's wishes by correctly interpreting his psychological condition and gaining his informed consent. In some situations, an operation can and must be denied. To improve transparency and quality the Medical Association North-Rhine (Arztekammer Nordrhein) established a public register of "aesthetic surgery" ("Plastisch-Operative Medizin"). Patients searching qualified aesthetic surgery can choose from a list of suitable specialists. Initial experience seems to confirm acceptance of this concept.

  7. Medical Issues Associated with Anabolic Steroid Use: Are They Exaggerated?

    Science.gov (United States)

    Hoffman, Jay R.; Ratamess, Nicholas A.

    2006-01-01

    For the past 50 years anabolic steroids have been at the forefront of the controversy surrounding performance enhancing drugs. For almost half of this time no attempt was made by sports governing bodies to control its use, and only recently have all of the major sports governing bodies in North America agreed to ban from competition and punish athletes who test positive for anabolic steroids. These punitive measures were developed with the primary concern for promotion of fair play and eliminating potential health risks associated with androgenic-anabolic steroids. Yet, controversy exists whether these testing programs deter anabolic steroid use. Although the scope of this paper does not focus on the effectiveness of testing, or the issue of fair play, it is of interest to understand why many athletes underestimate the health risks associated from these drugs. What creates further curiosity is the seemingly well-publicized health hazards that the medical community has depicted concerning anabolic steroidabuse. Is there something that the athletes know, or are they simply naïve regarding the dangers? The focus of this review is to provide a brief history of anabolic steroid use in North America, the prevalence of its use in both athletic and recreational populations and its efficacy. Primary discussion will focus on health issues associated with anabolic steroid use with an examination of the contrasting views held between the medical community and the athletes that are using these ergogenic drugs. Existing data suggest that in certain circumstances the medical risk associated with anabolic steroid use may have been somewhat exaggerated, possibly to dissuade use in athletes. Key Points For many years the scientific and medical communities depicted a lack of efficacy and serious adverse effects from anabolic steroid use. Clinical case studies continue to link anabolic steroid administration with myocardial infarct, suicide, and cancer, evidence to support a cause

  8. Statin and Its Association With Delirium in the Medical ICU.

    Science.gov (United States)

    Mather, Jeffrey F; Corradi, John P; Waszynski, Christine; Noyes, Adam; Duan, Yinghui; Grady, James; Dicks, Robert

    2017-09-01

    To examine the association between statin use and the risk of delirium in hospitalized patients with an admission to the medical ICU. Retrospective propensity-matched cohort analysis with accrual from September 1, 2012, to September 30, 2015. Hartford Hospital, Hartford, CT. An initial population of patients with an admission to a medical ICU totaling 10,216 visits were screened for delirium by means of the Confusion Assessment Method. After exclusions, a population of 6,664 was used to match statin users and nonstatin users. The propensity-matched cohort resulted in a sample of 1,475 patients receiving statin matched 1:1 with control patients not using statin. None. Delirium defined as a positive Confusion Assessment Method assessment was the primary end point. The prevalence of delirium was 22.3% in the unmatched cohort and 22.8% in the propensity-matched cohort. Statin use was associated with a significant decrease in the risk of delirium (odds ratio, 0.47; 95% CI, 0.38-0.56). Considering the type of statin used, atorvastatin (0.51; 0.41-0.64), pravastatin (0.40; 0.28-0.58), and simvastatin (0.33; 0.21-0.52) were all significantly associated with a reduced frequency of delirium. The use of statins was independently associated with a reduction in the risk of delirium in hospitalized patients. When considering types of statins used, this reduction was significant in patients using atorvastatin, pravastatin, and simvastatin. Randomized trials of various statin types in hospitalized patients prone to delirium should validate their use in protection from delirium.

  9. Polypharmacy patterns: unravelling systematic associations between prescribed medications.

    Directory of Open Access Journals (Sweden)

    Amaia Calderón-Larrañaga

    Full Text Available OBJECTIVES: The aim of this study was to demonstrate the existence of systematic associations in drug prescription that lead to the establishment of patterns of polypharmacy, and the clinical interpretation of the associations found in each pattern. METHODS: A cross-sectional study was conducted based on information obtained from electronic medical records and the primary care pharmacy database in 2008. An exploratory factor analysis of drug dispensing information regarding 79,089 adult patients was performed to identify the patterns of polypharmacy. The analysis was stratified by age and sex. RESULTS: Seven patterns of polypharmacy were identified, which may be classified depending on the type of disease they are intended to treat: cardiovascular, depression-anxiety, acute respiratory infection (ARI, chronic obstructive pulmonary disease (COPD, rhinitis-asthma, pain, and menopause. Some of these patterns revealed a clear clinical consistency and included drugs that are prescribed together for the same clinical indication (i.e., ARI and COPD patterns. Other patterns were more complex but also clinically consistent: in the cardiovascular pattern, drugs for the treatment of known risk factors-such as hypertension or dyslipidemia-were combined with other medications for the treatment of diabetes or established cardiovascular pathology (e.g., antiplatelet agents. Almost all of the patterns included drugs for preventing or treating potential side effects of other drugs in the same pattern. CONCLUSIONS: The present study demonstrated the existence of non-random associations in drug prescription, resulting in patterns of polypharmacy that are sound from the pharmacological and clinical viewpoints and that exist in a significant proportion of the population. This finding necessitates future longitudinal studies to confirm some of the proposed causal associations. The information discovered would further the development and/or adaptation of clinical

  10. Riverbed clogging associated with a California riverbank filtration system: An assessment of mechanisms and monitoring approaches

    Science.gov (United States)

    Ulrich, Craig; Hubbard, Susan S.; Florsheim, Joan; Rosenberry, Donald O.; Borglin, Sharon; Trotta, Marcus; Seymour, Donald

    2015-01-01

    An experimental field study was performed to investigate riverbed clogging processes and associated monitoring approaches near a dam-controlled riverbank filtration facility in Northern California. Motivated by previous studies at the site that indicated riverbed clogging plays an important role in the performance of the riverbank filtration system, we investigated the spatiotemporal variability and nature of the clogging. In particular, we investigated whether the clogging was due to abiotic or biotic mechanisms. A secondary aspect of the study was the testing of different methods to monitor riverbed clogging and related processes, such as seepage. Monitoring was conducted using both point-based approaches and spatially extensive geophysical approaches, including: grain-size analysis, temperature sensing, electrical resistivity tomography, seepage meters, microbial analysis, and cryocoring, along two transects. The point monitoring measurements suggested a substantial increase in riverbed biomass (2 orders of magnitude) after the dam was raised compared to the small increase (∼2%) in fine-grained sediment. These changes were concomitant with decreased seepage. The decreased seepage eventually led to the development of an unsaturated zone beneath the riverbed, which further decreased infiltration capacity. Comparison of our time-lapse grain-size and biomass datasets suggested that biotic processes played a greater role in clogging than did abiotic processes. Cryocoring and autonomous temperature loggers were most useful for locally monitoring clogging agents, while electrical resistivity data were useful for interpreting the spatial extent of a pumping-induced unsaturated zone that developed beneath the riverbed after riverbed clogging was initiated. The improved understanding of spatiotemporally variable riverbed clogging and monitoring approaches is expected to be useful for optimizing the riverbank filtration system operations.

  11. Active season microhabitat and vegetation selection by giant gartersnakes associated with a restored marsh in California

    Science.gov (United States)

    Halstead, Brian J.; Valcarcel, Patricia; Wylie, Glenn D.; Coates, Peter S.; Casazza, Michael L.; Rosenberg, Daniel K.

    2016-01-01

    Studies of habitat selection can reveal important patterns to guide habitat restoration and management for species of conservation concern. Giant gartersnakes Thamnophis gigas are endemic to the Central Valley of California, where >90% of their historical wetland habitat has been converted to agricultural and other uses. Information about the selection of habitats by individual giant gartersnakes would guide habitat restoration by indicating which habitat features and vegetation types are likely to be selected by these rare snakes. We examined activity patterns and selection of microhabitats and vegetation types by adult female giant gartersnakes with radiotelemetry at a site composed of rice agriculture and restored wetlands using a paired case-control study design. Adult female giant gartersnakes were 14.7 (95% credible interval [CRI] = 9.4–23.7) times more likely to be active (foraging, mating, or moving) when located in aquatic habitats than when located in terrestrial habitats. Microhabitats associated with cover—particularly emergent vegetation, terrestrial vegetation, and litter—were positively selected by giant gartersnakes. Individual giant gartersnakes varied greatly in their selection of rice and rock habitats, but varied little in their selection of open water. Tules Schoenoplectus acutus were the most strongly selected vegetation type, and duckweed Lemna spp., water-primrose Ludwigia spp., forbs, and grasses also were positively selected at the levels of availability observed at our study site. Management practices that promote the interface of water with emergent aquatic and herbaceous terrestrial vegetation will likely benefit giant gartersnakes. Given their strong selection of tules, restoration of native tule marshes will likely provide the greatest benefit to these threatened aquatic snakes.

  12. Recent physical-chemical anomalies and associated ecological responses in southern California kelp forests

    Science.gov (United States)

    Miller, R. J.; Reed, D.; Washburn, L.; Bell, T. W.; Blanchette, C. A.

    2016-02-01

    Time series data collected by the Santa Barbara Coastal Long-Term Ecological Research program on giant kelp forests and the environmental factors that influence them provide a unique opportunity to examine the extent and ecological consequences of recent anomalies in physical and chemical properties of a shallow water benthic marine ecosystem. Positive temperature anomalies have been recorded in all but two months since early 2013 with deviations ranging as high as 3.8 oC above the 14-year monthly mean, which is unprecedented in the time series. Positive anomalies in salinity (DS) were also observed every month since late 2012 and DS exceeded 0.3 for several months in 2013 and 2014. Positive DS values occurred in previous years, but were weaker and shorter in duration. Apart from 1-2 months, anomalies in nitrate, phosphate, and silicate turned consistently negative in late 2012. However, comparable anomalies in these nutrients occurred earlier in the record, especially before 2008 for nitrate and phosphate. Anomalies in key ecological characteristics of giant kelp forests associated with the large positive temperature anomalies have been much less striking. Water column chlorophyll a, the standing biomass of giant kelp and densities of many kelp forest consumers have been lower than normal in recent years, but not markedly so compared to other years in the time series. Shorter time series data on pigment concentrations in giant kelp revealed a declining trend in recent years, consistent with the below normal levels observed in kelp tissue nitrogen. The most dramatic change in kelp forests that coincided with the onset of the temperature anomalies was observed in sea stars, which first showed signs of a wasting disease in fall of 2013. The disease spread rapidly from north to south and by spring 2014 infections were prevalent throughout southern California. Large corresponding increases in the abundance of starfish prey have yet to be observed.

  13. Riverbed Clogging Associated with a California Riverbank Filtration System: An Assessment of Mechanisms and Monitoring Approaches

    Science.gov (United States)

    Ulrich, Craig; Hubbard, Susan S.; Florsheim, Joan; Rosenberry, Donald; Borglin, Sharon; Trotta, Marcus; Seymour, Donald

    2015-10-01

    An experimental field study was performed to investigate riverbed clogging processes and associated monitoring approaches near a dam-controlled riverbank filtration facility in Northern California. Motivated by previous studies at the site that indicated riverbed clogging plays an important role in the performance of the riverbank filtration system, we investigated the spatiotemporal variability and nature of the clogging. In particular, we investigated whether the clogging was due to abiotic or biotic mechanisms. A secondary aspect of the study was the testing of different methods to monitor riverbed clogging and related processes, such as seepage. Monitoring was conducted using both point-based approaches and spatially extensive geophysical approaches, including: grain-size analysis, temperature sensing, electrical resistivity tomography, seepage meters, microbial analysis, and cryocoring, along two transects. The point monitoring measurements suggested a substantial increase in riverbed biomass (2 orders of magnitude) after the dam was raised compared to the small increase (∼2%) in fine-grained sediment. These changes were concomitant with decreased seepage. The decreased seepage eventually led to the development of an unsaturated zone beneath the riverbed, which further decreased infiltration capacity. Comparison of our time-lapse grain-size and biomass datasets suggested that biotic processes played a greater role in clogging than did abiotic processes. Cryocoring and autonomous temperature loggers were most useful for locally monitoring clogging agents, while electrical resistivity data were useful for interpreting the spatial extent of a pumping-induced unsaturated zone that developed beneath the riverbed after riverbed clogging was initiated. The improved understanding of spatiotemporally variable riverbed clogging and monitoring approaches is expected to be useful for optimizing the riverbank filtration system operations.

  14. Concerns about medications mediate the association of posttraumatic stress disorder with adherence to medication in stroke survivors.

    Science.gov (United States)

    Edmondson, Donald; Horowitz, Carol R; Goldfinger, Judith Z; Fei, Kezhen; Kronish, Ian M

    2013-11-01

    Post-traumatic stress disorder (PTSD) can be a consequence of acute medical events and has been associated with non-adherence to medications. We tested whether increased concerns about medications could explain the association between PTSD and non-adherence to medication in stroke survivors. We surveyed 535 participants aged 40 years or older who had at least one stroke or transient ischaemic attack in the previous 5 years. We assessed PTSD using the PTSD checklist-specific for stroke, medication adherence with the Morisky Medication Adherence Questionnaire, and beliefs about medications with the Beliefs about Medicines Questionnaire. We used logistic regression to test whether concerns about medications mediated the association between stroke-induced PTSD and non-adherence to medication. Covariates for adjusted analyses included age, sex, race, comorbid medical conditions, stroke-related disability, years since last stroke/TIA, and depression. Symptoms of PTSD were correlated with greater concerns about medications (r = 0.45; p medication non-adherence. Adjustment for concerns about medications attenuated the relationship between PTSD and non-adherence to medication, from an odds ratio [OR] of 1.04 (95% confidence interval [CI], 1.01-1.06; OR, 1.63 per 1 SD) to an OR of 1.02 (95% CI, 1.00-1.05; OR, 1.32 per 1 SD), and increased concerns about medications remained associated with increased odds of non-adherence to medication (OR, 1.17; 95% CI, 1.10-1.25; OR, 1.72 per 1 SD) in this fully adjusted model. A bootstrap mediation test suggested that the indirect effect was statistically significant and explained 38% of the association of PTSD to medication non-adherence, and the direct effect of PTSD symptoms on medication non-adherence was no longer significant. Increased concerns about medications explain a significant proportion of the association between PTSD symptoms and non-adherence to medication in stroke survivors. © 2013 The British Psychological Society.

  15. Mental Illness Is Not Associated with Adherence to Colorectal Cancer Screening: Results from the California Health Interview Survey.

    Science.gov (United States)

    Siantz, Elizabeth; Wu, Brian; Shiroishi, Mark; Vora, Hita; Idos, Gregory

    2017-01-01

    Colorectal cancer is the second leading cause of cancer-specific death in the USA. Evidence suggests people with mental illness are less likely to receive preventive health services, including cancer screening. We hypothesized that mental illness is a risk factor for non-adherence to colorectal cancer-screening guidelines. We analyzed results of the 2007 California Health Interview Survey to test whether mental illness is a risk factor for non-adherence to colorectal cancer-screening recommendations among individuals age 50 or older (N = 15,535). This cross-sectional dataset is representative of California. Screening was defined as either fecal occult blood testing during the preceding year, sigmoidoscopy, or colonoscopy during the preceding 5 years. Mental illness was identified using the Kessler K6 screening tool. Associations were evaluated using weighted multivariate logistic regressions. Mental illness was not associated with colorectal cancer-screening adherence (OR 0.89; 95% CI 0.63-1.25). Risk factors for non-adherence included being female (OR 1.25; 95% CI 1.09-1.44), delaying accessing health care during the previous year (OR 1.89; 95% CI 1.56-2.29). Unlike previous studies, this study did not find a relationship between mental illness and colorectal cancer-screening adherence. This could be due to differences in study populations. State-specific healthcare policies involving care coordination for individuals with mental illness could also influence colorectal cancer-screening adherence in California.

  16. Medical comorbidities associated with pediatric kidney stone disease.

    Science.gov (United States)

    Schaeffer, Anthony J; Feng, Zhaoyong; Trock, Bruce J; Mathews, Ranjiv I; Neu, Alicia M; Gearhart, John P; Matlaga, Brian R

    2011-01-01

    To characterize the relationship between pediatric kidney stone disease and the presence of hypertension (HTN), diabetes mellitus (DM), and obesity. In adults, kidney stone disease has been associated with medical comorbidities such as HTN, DM, and obesity. Similar analyses have never been performed for the pediatric population. The 2003 and 2006 Kids' Inpatient Databases were queried to identify subjects treated for kidney stone disease ("International Classification of Diseases" codes 9592.0 and 592.1). The comorbidities of HTN, DM, and obesity were identified using the provided comorbidity software. The risk of kidney stone disease associated with age, sex, and comorbidity status was evaluated using multivariate logistic regression. A total of 6,115,443 subjects were evaluated. Of these, 14,245 (0.2%) had a diagnosis of upper tract calculus (4092 boys and 10,045 girls, sex unavailable for 108). Age was the strongest independent predictor of stone risk (P children ≤10 years old and DM for children ≤5 years old. Stone risk was not affected by obesity in any age group. The results of our study have shown that kidney stone disease is significantly associated with age among all children and both HTN and DM for young children. Although exploratory, these findings are novel and suggest that kidney stone disease among young children might be associated with nonrenal, systemic disease states. Copyright © 2011 Elsevier Inc. All rights reserved.

  17. [A preparatory course for retirement by the Israeli Medical Association].

    Science.gov (United States)

    Mashiah, Tonni; Kushnir, Yacov

    2005-01-01

    Retirement can be traumatic, and physicians are not immune. The Israeli Medical Association (IMA) has been conducting a preparatory course for retirement for its members reaching retirement. The objective of the present study was to survey the characteristics of participating physicians, to map their activities following retirement, to gauge their appreciation of the course, and to assess their willingness to continue their association with the IMA. Questionnaires were mailed to 210 attendees of the IMA course in 2000-2002, and responses were tabulated and analyzed. The response rate was 33%--40 male and 30 female physicians, and 75% of them were still working at the time of response. They classified their quality-of-life as appropriate (70%), modest (2%), and unfitting (27%). Continued work was directly related to the preservation of fitting lifestyle (p music, going on trips and cultural events and engaged in sports; the minority spent time learning, busy with hobbies or volunteer work. Approximately half of the respondents attended continuing medical education classes. Much satisfaction was recorded for most activities, but television, friends, volunteer work or continuing education were only partly enjoyable. The IMA preparatory course was satisfactory according to 94% of the respondents, but many requested to broaden its scope. Over 92% wanted to maintain an "open-line" with the IMA, for obtaining information, counseling, and participation in social activities and continuing education. The majority was willing to volunteer in the IMA. No gender bias was found in most of the responses. This preliminary survey of physician retirement in Israel found that once physicians ceased working, many considered their life quality unfitting. The need to remain associated with the IMA is indicative of the large social and emotional importance of this membership.

  18. Can poetry make better doctors? Teaching the humanities and arts to medical students and residents at the University of California, Irvine, College of Medicine.

    Science.gov (United States)

    Shapiro, Johanna; Rucker, Lloyd

    2003-10-01

    The Program in Medical Humanities & Arts at the University of California, Irvine, College of Medicine has been in existence for five years. The program was implemented to enhance aspects of professionalism including empathy, altruism, compassion, and caring toward patients, as well as to hone clinical communication and observational skills. It contains elective or required curriculum across all four years of medical school and required curriculum in two residency programs, organized according to structural principles of horizontal coherence, vertical complexity, and patient care applications. The program emphasizes small-group, interdisciplinary teaching and faculty development, and is notable for learners' use of creative projects to reflect on patients and themselves. Evaluation of the program indicates a positive response among learners. More systematic studies point to increases in empathy and positive attitudes toward the humanities as tools for professional development as a result of exposure to the program curriculum. Future directions include closer collaboration with the University of California, Irvine, Schools of the Arts and Humanities, involvement of local artists and writers, and development of a graduation with distinction in humanities for medical students.

  19. Southern California Particle Center

    Data.gov (United States)

    Federal Laboratory Consortium — At the Southern California Particle Center, center researchers will investigate the underlying mechanisms that produce the health effects associated with exposure to...

  20. Prevalence of self-medication in Brazil and associated factors.

    Science.gov (United States)

    Arrais, Paulo Sérgio Dourado; Fernandes, Maria Eneida Porto; Pizzol, Tatiane da Silva Dal; Ramos, Luiz Roberto; Mengue, Sotero Serrate; Luiza, Vera Lucia; Tavares, Noemia Urruth Leão; Farias, Mareni Rocha; Oliveira, Maria Auxiliadora; Bertoldi, Andréa Dâmaso

    2016-12-01

    To analyze the prevalence and associated factors regarding the use of medicines by self-medication in Brazil. This cross-sectional population-based study was conducted using data from the PNAUM (National Survey on Access, Use and Promotion of Rational Use of Medicines), collected between September 2013 and February 2014 by interviews at the homes of the respondents. All people who reported using any medicines not prescribed by a doctor or dentist were classified as self-medication practitioners. Crude and adjusted prevalence ratios (Poisson regression) and their respective 95% confidence intervals were calculated in order to investigate the factors associated with the use of self-medication by medicines. The independent variables were: sociodemographic characteristics, health conditions and access to and use of health services. In addition, the most commonly consumed medicines by self-medication were individually identified. The self-medication prevalence in Brazil was 16.1% (95%CI 15.0-17.5), with it being highest in the Northeast region (23.8%; 95%CI 21.6-26.2). Following the adjusted analysis, self-medication was observed to be associated with females, inhabitants from the North, Northeast and Midwest regions and individuals that have had one, or two or more chronic diseases. Analgesics and muscle relaxants were the therapeutic groups most used for self-medication, with dipyrone being the most consumed medicines. In general, most of the medicines used for self-medication were classified as non-prescriptive (65.5%). Self-medication is common practice in Brazil and mainly involves the use of non-prescription medicines; therefore, the users of such should be made aware of the possible risks. Analisar a prevalência e os fatores associados à utilização de medicamentos por automedicação no Brasil. Este estudo transversal de base populacional foi realizado com dados da Pesquisa Nacional de Acesso, Utilização e Promoção do Uso Racional de medicamentos (PNAUM

  1. Phylogenetic, morphological and pathogenic characterization of Alternaria species associated with fruit rots of blueberry in California

    Science.gov (United States)

    Fruit rot caused by Alternaria spp. is one of the most important factors affecting the postharvest quality and shelf life of blueberry fruits. Alternaria spp. isolates were collected from decayed fruits of blueberry in the Central Valley of California during 2012 and 2013. The aims of this study wer...

  2. Estimating erosion risks associated with logging and forest roads in northwestern California

    Science.gov (United States)

    Raymond M. Rice; Jack Lewis

    1991-01-01

    Abstract - Erosion resulting from logging and road building has long been a concern to forest managers and the general public. An objective methodology was developed to estimate erosion risk on forest roads and in harvest areas on private land in northwestern California. It was based on 260 plots sampled from the area harvested under 415 Timber Harvest Plans...

  3. Herpetofauna associated with palm oases across the Californian-Sonoran transition in northern Baja California, Mexico

    Science.gov (United States)

    Hart Welsh; W. H. Clark; E. Franco-Vizcaíno; J. H. Valdéz-Villavicencio

    2010-01-01

    Ecological boundaries have been of interest to naturalists since the time of Darwin and Wallace because they are transitional zones on the landscape across which distinct changes occur in constitution of plant and animal communities. In the xeric landscapes of the central Baja California Peninsula, fan palm (Erythea armata and ...

  4. Forecast skill of synoptic conditions associated with Santa Ana winds in Southern California

    Science.gov (United States)

    Charles Jones; Francis Fujioka; Leila M.V. Carvalho

    2010-01-01

    Santa Ana winds (SAW) are synoptically driven mesoscale winds observed in Southern California usually during late fall and winter. Because of the complex topography of the region, SAW episodes can sometimes be extremely intense and pose significant environmental hazards, especially during wildfire incidents. A simple set of criteria was used to identify synoptic-scale...

  5. Copper tolerance and distribution of epibiotic bacteria associated with giant kelp Macrocystis pyrifera in southern California

    NARCIS (Netherlands)

    Busch, J.; Nascimento, J.R.; Magalhaes, A.C.; Dutilh, B.E.; Dinsdale, E.

    2015-01-01

    Kelp forests in southern California are important ecosystems that provide habitat and nutrition to a multitude of species. Macrocystis pyrifera and other brown algae that dominate kelp forests, produce negatively charged polysaccharides on the cell surface, which have the ability to accumulate

  6. Copper tolerance and distribution of epibiotic bacteria associated with giant kelp Macrocystis pyrifera in southern California

    NARCIS (Netherlands)

    Busch, Julia; Nascimento, Juliana Ribeiro; Magalhães, Ana Carolina Rubem; Dutilh, Bas E; Dinsdale, Elizabeth

    Kelp forests in southern California are important ecosystems that provide habitat and nutrition to a multitude of species. Macrocystis pyrifera and other brown algae that dominate kelp forests, produce negatively charged polysaccharides on the cell surface, which have the ability to accumulate

  7. Factors Associated with Delayed Childbearing: From the Voices of Expectant Latina Adults and Teens in California

    Science.gov (United States)

    Biggs, M. Antonia; Ralph, Lauren; Minnis, Alexandra M.; Arons, Abigail; Marchi, Kristen S.; Lehrer, Jocelyn A.; Braveman, Paula A.; Brindis, Claire D.

    2010-01-01

    There has been limited research on the protective factors that help Latinas delay childbearing until adulthood. In-depth interviews were conducted with 65 pregnant Latina teenage and adult women in California who were about to have their first child. Lack of or inconsistent birth control use as teens was attributed to wanting or ambivalence toward…

  8. Basic research on cancer related to radiation associated medical researches

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Jong In; Hwang, Dae Yong; Bang, Ho Yoon [and others

    2000-12-01

    Basic Research on Cancer related to Radiation Associated Medical Researches including 1. Establishment of animal model of colorectal cancer liver metastasis and measurement of angiogenesis, 2. Tissue expression of Tie-1 and Tie-2 in human colorectal cancer, 3. Enhancement of G2/Mphase Cell Fraction by Adenovirus-mediated p53 Gene Transfer in Ovarian Cancer Cell Lines, 4. Clinical Characteristics of the patients with Non-B Non-C Hepatocellular Carcinoma and Frequency of HBV, HCV and TTV Viremia in these Patients, 5. Significance of serum iron and ferritin in patients with stomach cancer, 6. Telomerase assay for early detection of lung cancer, 7. Study on the Usefulness of Aldehyde dehydrogenase-2 Genotyping for Risk Group of Alcohol-related Cancer Screening, 8. Gene therapy using hepatoma specific promoter, 9. Study on the Influence of DNA repair gene, XRCC1 Genotypes on the Risk of Head and Neck Cancer were performed.

  9. Estimating PM2.5-associated mortality increase in California due to the Volkswagen emission control defeat device

    Science.gov (United States)

    Wang, Tianyang; Jerrett, Michael; Sinsheimer, Peter; Zhu, Yifang

    2016-11-01

    The Volkswagen Group of America (VW) was found by the US Environmental Protection Agency (EPA) and the California Air Resources Board (CARB) to have installed "defeat devices" and emit more oxides of nitrogen (NOx) than permitted under current EPA standards. In this paper, we quantify the hidden NOx emissions from this so-called VW scandal and the resulting public health impacts in California. The NOx emissions are calculated based on VW road test data and the CARB Emission Factors (EMFAC) model. Cumulative hidden NOx emissions from 2009 to 2015 were estimated to be over 3500 tons. Adult mortality changes were estimated based on ambient fine particulate matter (PM2.5) change due to secondary nitrate formation and the related concentration-response functions. We estimated that hidden NOx emissions from 2009 to 2015 have resulted in a total of 12 PM2.5-associated adult mortality increases in California. Most of the mortality increase happened in metropolitan areas, due to their high population and vehicle density.

  10. Factors associated with dropout in medical education: a literature review

    DEFF Research Database (Denmark)

    O'Neill, Lotte Dyhrberg; Wallstedt, Birgitta; Eika, Berit

    2011-01-01

    Medical school dropout may have negative consequences for society, patients, the profession, schools and dropouts. To our knowledge, the literature dealing with dropout from medical school has never been systematically and critically appraised....

  11. Report of Medical Women's Association of Nigeria, Rivers State Branch MWAN Week 2016.

    OpenAIRE

    Ogu Rosemary N; Agala Vetty R

    2016-01-01

    Medical Women’s Association of Nigeria (MWAN), an affiliate of the Medical Women’s International Association (MWIA) is a nonprofit professional organization of female medical doctors and dentists dedicated to promoting the health of the populace with a focus on women and children. The Association dedicates a week annually to carry out activities that raise awareness on prevailing preventable health issues, continuing medical education for doctors/healthcare providers, organize symposia/semina...

  12. Preclinical medical student observations associated with later professionalism concerns.

    Science.gov (United States)

    Burns, Cynthia A; Lambros, M Ann; Atkinson, Hal H; Russell, Greg; Fitch, Michael T

    2017-01-01

    Professionalism is a core physician competency and identifying students at risk for poor professional development early in their careers may allow for mentoring. This study identified indicators in the preclinical years associated with later professionalism concerns. A retrospective analysis of observable indicators in the preclinical and clinical years was conducted using two classes of students (n = 226). Relationships between five potential indicators of poor professionalism in the preclinical years and observations related to professional concerns in the clinical years were analyzed. Fifty-three medical students were identified with at least one preclinical indicator and one professionalism concern during the clinical years. Two observable preclinical indicators were significantly correlated with unprofessional conduct during the clinical years: Three or more absences from attendance-required sessions (odds ratio 4.47; p=.006) and negative peer assessment (odds ratio 3.35; p=.049). We identified two significant observable preclinical indicators associated with later professionalism concerns: excessive absences and negative peer assessments. Early recognition of students at risk for future professionalism struggles would provide an opportunity for proactive professional development prior to the clinical years, when students' permanent records may be affected. Peer assessment, coupled with attention to frequent absences, may be a method to provide early recognition.

  13. Access to medical care among persons with musculoskeletal conditions. A study using a random sample of households in San Mateo County, California.

    Science.gov (United States)

    Yelin, E; Bernhard, G; Pflugrad, D

    1995-08-01

    To study access to medical care services, including subspecialty care, among persons with musculoskeletal conditions. In early 1993, a random sample of households in San Mateo County, California, was screened for the presence of household members with musculoskeletal conditions, and a member of each household so identified was administered a structured survey about access to medical care and other related subjects. Eighty-six percent of all persons with a musculoskeletal condition had ever seen at least one physician for the condition, but only 6.5% had ever seen a rheumatologist. Those without health insurance were only 82% as likely as those with health insurance to have ever seen a physician. Most persons with a musculoskeletal condition have seen a physician for the condition, but lack of health insurance significantly reduces the proportion who have done so.

  14. Store and prescription characteristics associated with primary medication nonadherence.

    Science.gov (United States)

    Jackson, Tristen H; Bentley, John P; McCaffrey, David J; Pace, Pat; Holmes, Erin; West-Strum, Donna

    2014-08-01

    Primary medication nonadherence (PMN) is any instance whereby patients fail to initiate a pharmacotherapy regimen after receiving a prescription for new therapy. The Pharmacy Quality Alliance (PQA) has proposed a standardized definition for PMN and a quality measure to assess the rates of PMN in community pharmacies. To (a) measure PMN using the proposed PQA measure with data available from a pharmacy dispensing system and (b) identify the prescription-level (patient, prescriber, and medication) and store-level (store and neighborhood) characteristics associated with PMN. This study was approved by a southern university institutional review board, and a data use agreement was in place. A large national pharmacy grocery chain provided de-identified, transactional data for 2010 through January 2012, for 100 pharmacies (de-identified unique patient and store codes were available). The proposed PQA-PMN measure was used, and PMN rates were calculated. Investigators examined adult individuals with a new electronic prescription for any of the included medications during the measurement period and determined whether the medication or an appropriate alternative was claimed within 30 days. Multilevel logistic regression with a random intercept was used to evaluate prescription-level and store-level predictors of PMN. Prescription-level variables included prescriber type, PQA-defined drug class, patient gender and age, whether the prescription was accompanied by another prescription on the same day, payment source, and out-of-pocket costs. A daily average prescription volume variable was calculated for each pharmacy as a store-level variable. Additional store-level variables were derived from the 2007-2011 American Community Survey, available from the U.S. Census Bureau (median household income, educational level, percentage of minorities, and percentage aged 65 years and over in the census tracts where the pharmacies are located).  Of the e-prescriptions during the 1-year

  15. Medical insurance claims associated with international business travel.

    Science.gov (United States)

    Liese, B; Mundt, K A; Dell, L D; Nagy, L; Demure, B

    1997-07-01

    Preliminary investigations of whether 10,884 staff and consultants of the World Bank experience disease due to work related travel. Medical insurance claims filed by 4738 travellers during 1993 were compared with claims of non-travellers. Specific diagnoses obtained from claims were analysed overall (one or more v no missions) and by frequency of international mission (1, 2-3, or > or = 4). Standardised rate of claims ratios (SSRs) for each diagnostic category were obtained by dividing the age adjusted rate of claims for travellers by the age adjusted rate of claims for non-travellers, and were calculated for men and women travellers separately. Overall, rates of insurance claims were 80% higher for men and 18% higher for women travellers than their non-travelling counterparts. Several associations with frequency of travel were found. SRRs for infectious disease were 1.28, 1.54, and 1.97 among men who had completed one, two or three, and four or more missions, and 1.16, 1.28, and 1.61, respectively, among women. The greatest excess related to travel was found for psychological disorders. For men SRRs were 2.11, 3.13, and 3.06 and for women, SRRs were 1.47, 1.96, and 2.59. International business travel may pose health risks beyond exposure to infectious diseases. Because travellers file medical claims at a greater rate than non-travellers, and for many categories of disease, the rate of claims increases with frequency of travel. The reasons for higher rates of claims among travellers are not well understood. Additional research on psychosocial factors, health practices, time zones crossed, and temporal relation between travel and onset of disease is planned.

  16. Emergency medical dispatch codes association with emergency department outcomes.

    Science.gov (United States)

    Hettinger, A Zachary; Cushman, Jeremy T; Shah, Manish N; Noyes, Katia

    2013-01-01

    Emergency medical dispatch systems are used to help categorize and prioritize emergency medical services (EMS) resources for requests for assistance. We examined whether a subset of Medical Priority Dispatch System (MPDS) codes could predict patient outcomes (emergency department [ED] discharge versus hospital admission/ED death). This retrospective observational cohort study analyzed requests for EMS through a single public safety answering point (PSAP) serving a mixed urban, suburban, and rural community over one year. Probabilistic matching was used to link subjects. Descriptive statistics, 95% confidence intervals (CIs), and logistic regression were calculated for the 107 codes and code groupings (9E vs. 9E1, 9E2, etc.) that were used 50 or more times during the study period. Ninety percent of PSAP records were matched to EMS records and 84% of EMS records were matched to ED data, resulting in 26,846 subjects with complete records. The average age of the cohort was 46.2 years (standard deviation [SD] 24.8); 54% were female. Of the transported patients, 70% were discharged from the ED, with nine dispatch codes demonstrating a 90% or greater predictive power. Three code groupings had more than 60% predictive power for admission/death. Subjects aged 65 years and older were found to be at increased risk for admission/death in 33 dispatch codes (odds ratio [OR] 2.0 [95% confidence interval 1.3-3.0] to 19.6 [5.3-72.6]). A small subset (8% of codes; 7% by call volume) of MPDS codes were associated with greater than 90% predictive ability for ED discharge. Older adults are at increased risk for admission/death in a separate subset of MPDS codes, suggesting that age criteria may be useful to identify higher-acuity patients within the MPDS code. These findings could assist in prehospital/hospital resource management; however, future studies are needed to validate these findings for other EMS systems and to investigate possible strategies for improvements of emergency

  17. Active Faults and Associated Tectonic Stress in the Coso Range, California.

    Science.gov (United States)

    1981-08-01

    Hulen (1978). I I7 IU NWC TP 6270 1.7 AERIAL PHOTOGRAPHY INTERPRETATION Aerial photographs of the study area were available from USGS and from NWC...California: Geological Society of America Bulletin, v. 58, p. 393-432. Hulen , J. B., 1978, Geology and alteration of the Coso geothermal area, Inyo County...Utah Research Institute, Salt Lake City, Utah (J. B. Hulen ) I Woods Hole Oceanographic Institute, Woods Hole, MA (Department of Geology and Geophysics

  18. Social associations between California sea lions influence the use of a novel foraging ground

    OpenAIRE

    Zachary A Schakner; Petelle, Matthew B.; Tennis, Mathew J.; Van der Leeuw, Bjorn K.; Stansell, Robert T.; Blumstein, Daniel T.

    2017-01-01

    Social relationships define an individual's position in its social network, which can influence the acquisition and spread of information and behavioural variants through the population. Thus, when nuisance behaviours spread through wildlife populations, identifying central individuals may provide valuable insights for problem-species management. We studied the effects of network position on California sea lion (Zalophus californianus) discovery and foraging success at a novel foraging ground...

  19. Ectopic pregnancy with associated gestational choriocarcinoma in a California sea lion (Zalophus californianus).

    Science.gov (United States)

    Fravel, Vanessa A; Lowenstine, Linda J; Koehne, Amanda

    2016-07-07

    A wild-born, captive-reared, 14 yr old, primiparous female California sea lion Zalophus californianus presented for anorexia of 14 d duration and abdominal distention. Routine complete blood cell count revealed leukocytosis with a neutrophilia, and serum chemistry revealed hypoalbumenemia and hyponatremia. Treatment with broad spectrum antibiotics and non-steroidal anti-inflammatories were started, but the animal continued to decline. Abdominal radiographs revealed a mature mineralized fetal skull and spine in the caudal abdomen and abdominal ultrasound revealed ascites but could not confirm the fetus. The patient was taken to surgery where a full term fetus was found outside of the uterus but within the fetal membranes, representing a secondary ectopic pregnancy. The patient passed away during surgery and was taken to necropsy. Gross necropsy revealed a diffuse peritonitis with yellow deposits over the serosal surfaces of the abdominal organs. The uterus appeared intact grossly and the ovaries appeared abnormal. The mesenteric, renal, and sub-lumbar nodes were enlarged and edematous. Histopathology revealed choriocarcinoma in the right uterine horn with evidence of chronic uterine rupture and protrusion of the placental tissue into the abdomen. The choriocarcinoma had metastasized locally as well as to the liver, spleen and lung. Choriocarcinoma is a highly malignant trophoblastic neoplasm that is rare in domestic animals. This case represents, to the authors' knowledge, the first report of gestational choriocarcinoma causing secondary ectopic pregnancy in a California sea lion and presents questions regarding pregnancy monitoring and management in a population of captive, minimally trained California sea lions.

  20. Faculty Collective Bargaining in the California State University. A Staff Report on the 1983-1986 Agreement between the Board of Trustees and the California Faculty Association for Unit 3--Faculty. Commission Report 84-3.

    Science.gov (United States)

    California State Postsecondary Education Commission, Sacramento.

    Features of a 1983-1986 faculty collective bargaining contract at the California State University (CSU) are described. The Congress of Faculty Associations won representation rights for the faculty bargaining unit at CSU in a 1983 election. Attention is directed to: grievance procedures; appointment, probation, tenure, and promotions; layoff;…

  1. Drug-related problems associated with self-medication and medication guided by prescription: A pharmacy-based survey.

    Science.gov (United States)

    Panda, Abinash; Pradhan, Supriya; Mohapatra, Gurukrushna; Mohapatra, Jigyansa

    2016-01-01

    The objective of this study is to identify and compare the nature of the drug-related problems (DRPs) associated with self-medication and non-self-medication (drug use guided by a prescription). The cross-sectional, observational study was conducted on 1100 adult participants at a convenience sample of six retail private pharmacy counters. The data collection form was based on the Pharmaceutical Care Network Europe version 6.2 classification for DRPs. Descriptive statistics was used to represent the prevalence of DRPs. Chi-square test was used to find out the association between the type of medication and DRPs. Odds ratio (OR) with confidence interval (CI) was computed to find the factors determining the occurrence of DRPs. P self-medication was 18.72%. The prevalence of DRPs was 17.36%. In the self-medication group, the prevalence of DRPs was high (40.78%) as compared to the non-self-medication group (11.97%). DRP related to inappropriate drug dosing was observed in 44.83% and 40.45% subjects in self-medication and non-self-medication group, respectively (P self-medication group were about 5 times likely to have a DRP (OR: 5.06, CI: 3.59-7.14, P Self-medication is associated with a higher risk of various DRPs. Since retail pharmacy outlet is often the first point of contact between the patient and the health care system in a developing country, interventions like drug information activities at the retail pharmacy is likely to bring down the DRPs associated with self-medication.

  2. Medical School Experiences Associated with Change in Implicit Racial Bias Among 3547 Students: A Medical Student CHANGES Study Report

    National Research Council Canada - National Science Library

    van Ryn, Michelle; Hardeman, Rachel; Phelan, Sean M; PhD, Diana J. Burgess; Dovidio, John F; Herrin, Jeph; Burke, Sara E; Nelson, David B; Perry, Sylvia; Yeazel, Mark; Przedworski, Julia M

    2015-01-01

    .... The impact of medical education on implicit racial bias is unknown.To examine the association between change in student implicit racial bias towards African Americans and student reports on their experiences with 1...

  3. Sentinel California sea lions provide insight into legacy organochlorine exposure trends and their association with cancer and infectious disease.

    Science.gov (United States)

    Randhawa, Nistara; Gulland, Frances; Ylitalo, Gina M; DeLong, Robert; Mazet, Jonna A K

    2015-12-01

    Organochlorine contaminants (OCs), like polychlorinated biphenyls (PCBs) and dichlorodiphenyltrichloroethanes (DDTs), are widespread marine pollutants resulting from massive historical use and environmental persistence. Exposure to and health effects of these OCs in the marine environment may be examined by studying California sea lions (Zalophus californianus), which are long lived, apex predators capable of accumulating OCs. We evaluated PCB and DDT levels in 310 sea lions sampled between 1992 and 2007: 204 individuals stranded along the coast of central California, 60 healthy males from Washington State, and 46 healthy females from southern California. Lipid-normalized contaminant concentrations were analyzed using general linear models and logistic regression to ascertain temporal trends; differences between stranded and healthy sea lions; and association of organochlorines with sex, age, and presence of cancer or fatal infectious disease. Concentrations of the contaminants in stranded adults decreased over time in the study period (adjusted for sex, as adult males had higher mean blubber concentrations than adult females and juveniles). Cancer was almost eight and six times more likely in animals with higher summed PCBs and DDTs, compared to those with lower levels (95% CI 5.55-10.51 and 4.54-7.99, respectively). Fatal infectious diseases were similarly seven and five times more likely in animals with higher contaminant burdens (95% CI 4.20-10.89 and 3.27-7.86, respectively). Mean contaminant loads were significantly higher in stranded sea lions than in healthy live captured animals (p humans and other animals eating tainted seafood. While environmental exposure to these organochlorines appears to be decreasing over time based on levels in sea lion tissues, their persistence in the environment and food web for all predators, including humans, and the associated serious health risks, warrant monitoring, possibly through sentinel species like marine mammals.

  4. Association Between Academic Medical Center Pharmaceutical Detailing Policies and Physician Prescribing.

    Science.gov (United States)

    Larkin, Ian; Ang, Desmond; Steinhart, Jonathan; Chao, Matthew; Patterson, Mark; Sah, Sunita; Wu, Tina; Schoenbaum, Michael; Hutchins, David; Brennan, Troyen; Loewenstein, George

    2017-05-02

    In an effort to regulate physician conflicts of interest, some US academic medical centers (AMCs) enacted policies restricting pharmaceutical representative sales visits to physicians (known as detailing) between 2006 and 2012. Little is known about the effect of these policies on physician prescribing. To analyze the association between detailing policies enacted at AMCs and physician prescribing of actively detailed and not detailed drugs. The study used a difference-in-differences multivariable regression analysis to compare changes in prescribing by physicians before and after implementation of detailing policies at AMCs in 5 states (California, Illinois, Massachusetts, Pennsylvania, and New York) that made up the intervention group with changes in prescribing by a matched control group of similar physicians not subject to a detailing policy. Academic medical center implementation of policies regulating pharmaceutical salesperson visits to attending physicians. The monthly within-drug class market share of prescriptions written by an individual physician for detailed and nondetailed drugs in 8 drug classes (lipid-lowering drugs, gastroesophageal reflux disease drugs, diabetes drugs, antihypertensive drugs, hypnotic drugs approved for the treatment of insomnia [sleep aids], attention-deficit/hyperactivity disorder drugs, antidepressant drugs, and antipsychotic drugs) comparing the 10- to 36-month period before implementation of the detailing policies with the 12- to 36-month period after implementation, depending on data availability. The analysis included 16 121 483 prescriptions written between January 2006 and June 2012 by 2126 attending physicians at the 19 intervention group AMCs and by 24 593 matched control group physicians. The sample mean market share at the physician-drug-month level for detailed and nondetailed drugs prior to enactment of policies was 19.3% and 14.2%, respectively. Exposure to an AMC detailing policy was associated with a

  5. Electronic medical records, nurse staffing, and nurse-sensitive patient outcomes: evidence from California hospitals, 1998-2007

    National Research Council Canada - National Science Library

    Furukawa, Michael F; Raghu, T S; Shao, Benjamin B M

    2010-01-01

    To estimate the effects of electronic medical records (EMR) implementation on medical-surgical acute unit costs, length of stay, nurse staffing levels, nursing skill mix, nurse cost per hour, and nurse-sensitive patient outcomes...

  6. Factors Associated With False-Positive Emergency Medical Services Triage for Percutaneous Coronary Intervention

    Directory of Open Access Journals (Sweden)

    Yamamoto Swan, Pamela

    2009-11-01

    Full Text Available Background: In 2005, Orange County California Emergency Medical Services (EMS initiated a field 12-lead program to minimize time to emergency percutaneous coronary intervention (PCI for field-identified acute myocardial infarction (MI. As the program matured, “false-positive” (defined as no PCI or coronary artery occlusion upon PCI field MI activations have been identified as a problem for the program.Objectives: To identify potentially correctable factors associated with false-positive EMS triage to PCI centers.Methods: This was a retrospective, outcome study of EMS 12-lead cases from February 2006 to June 2007. The study system exclusively used cardiac monitor internal interpretation algorithms indicating an acute myocardial infarction as the basis for triage. Indicators and variables were defined prior to the study. Data, including outcome, was from the Orange County EMS database, which included copies of 12-lead ECGs used for field triage. Negative odds ratios (OR of less than 1.0 for positive PCI were the statistical measure of interest.Results: Five hundred forty-eight patients were triaged from the field for PCI. We excluded 19 cases from the study because of death prior to PCI, refusal of PCI, and co-morbid illness (sepsis, altered consciousness that precluded PCI. Three hundred ninety-three (74.3% patients had PCI with significant coronary lesions found. False-positive field triages were associated with underlying cardiac rhythm of sinus tachycardia [OR = 0.38 (95% CI 0.23, 0.62]; atrial fibrillation [OR = 0.43 (95% CI = 0.20, 0.94]; an ECG lead not recorded [OR = 0.39 (95% CI = 0.20, 0.76]; poor ECG baseline [OR = 0.59 (95% CI = 0.25, 1.37]; One of three brands of monitors used in the field [OR = 0.35 (95% CI = 0.21, 0.59]; and female gender [OR = 0.50 (95% CI = 0.34, 0.75]. Age was not associated with false-positive triage as determined by ordinal regression (p=1.00.Conclusion: For the urban-suburban EMS field 12-lead program

  7. California Bioregions

    Data.gov (United States)

    California Department of Resources — California regions developed by the Inter-agency Natural Areas Coordinating Committee (INACC) were digitized from a 1:1,200,000 California Department of Fish and...

  8. Medical Humanities Coursework Is Associated with Greater Measured Empathy in Medical Students.

    Science.gov (United States)

    Graham, Jeremy; Benson, Lauren M; Swanson, Judy; Potyk, Darryl; Daratha, Kenn; Roberts, Ken

    2016-12-01

    The primary focus of the study was to determine whether coursework in the medical humanities would ameliorate students' loss of and failure to develop empathy, a problem known to be common during medical education. Students were offered an elective course in the Medical Humanities for academic credit. The Jefferson Scale of Empathy Student Version (JSE-S) was administered at the beginning and end of an academic year in which humanities courses were offered. Changes in JSE-S scores among students who studied Medical Humanities were compared with changes in student who did not take any humanities coursework. Medical humanities coursework correlated with superior empathy outcomes among the medical students. Of students not enrolled in humanities courses, 71% declined or failed to increase in JSE-S score over the academic year. Of those who took humanities coursework, 46% declined or failed to increase in JSE-S scores. The difference was statistically significant (P = .03). The medical humanities curriculum correlated with favorable empathy outcomes as measured by the JSE-S. Elective medical humanities coursework correlated with improved empathy score outcomes in a group of US medical students. This may reflect a direct effect of the humanities coursework. Alternately, students' elective choice to take medical humanities coursework may be a marker for students with a propensity to favorable empathy outcomes. Copyright © 2016 Elsevier Inc. All rights reserved.

  9. Effects of kelp forest removal on associated fish assemblages in central California

    Science.gov (United States)

    Bodkin, James L.

    1988-01-01

    Visual surveys along subtidal belt transects were used to compare fish assemblages on an experimental and a control site before and after the removal of a canopy-forming kelp forest. The giant kelp Macrocystis pyrifera (L.) C.A. Agardh was removed at the holdfast from approximately equals 1 ha of high relief structurally complex rock substratum. The abundance of seven species of fish, of which five were considered midwater species, significantly declined after the kelp was removed. Results indicate that the presence of a giant kelp forest may increase the abundance and species diversity of the fish assemblages over a high relief rocky reef in central California, U.S.A.

  10. Factors Associated with Children's Adherence to Stimulant Medication.

    Science.gov (United States)

    Firestone, Philip

    Seventy-six hyperactive children (5 to 9 years old) and their families were studied to assess adherence to stimulant medication. Twenty families rejected the offer of treatment. Of those accepting, 20% were no longer taking medication by the fourth month and 44 had ceased by the tenth month. Nonadherence was generally not due to dramatic symptom…

  11. Skin diseases in companion guinea pigs (Cavia porcellus): a retrospective study of 293 cases seen at the Veterinary Medical Teaching Hospital, University of California at Davis (1990-2015).

    Science.gov (United States)

    White, Stephen D; Guzman, David Sanchez-Migallon; Paul-Murphy, Joanne; Hawkins, Michelle G

    2016-10-01

    Guinea pigs (Cavia porcellus) are popular companion animals with reported skin diseases, but most reports are accessed from textbooks or review articles. To document skin diseases and their prevalence in companion guinea pigs in northern California, USA, and to investigate predilections for the most common conditions over a 25 year period. Two hundred and ninety three guinea pigs from the hospital population met inclusion criteria. A retrospective study was performed by searching computerized medical records seen at the Veterinary Medical Teaching Hospital (VMTH), School of Veterinary Medicine, University of California from 1 January 1990 to 31 July 2015 using key words relevant to dermatology. Of the 580 guinea pigs seen at the VMTH, 50% (293) had skin disease. Of the 293 cases, 154 (52%) presented for nondermatological reasons. Guinea pigs with skin disease were significantly older than those without skin disease (P = 0.0002); females with skin disease were more likely to have cystic ovaries (P = 0.0203), although these were not always associated with alopecia. Pododermatitis and infestation with Trixacarus caviae or lice were the most common skin diseases. Ivermectin or selamectin was used for ectoparasite treatment. Abscesses unassociated with pododermatitis were the most common nodules. Benign follicular tumours were the most common neoplasm. Despite the frequent mention of dermatophytosis in the veterinary literature, only two cases of Trichophyton mentagrophytes were diagnosed. Cutaneous conditions in companion guinea pigs in the USA are common. Clinicians should include a dermatological examination when examining these rodents regardless of the reason for presentation. © 2016 ESVD and ACVD.

  12. Association between PM2.5and PM2.5Constituents and Preterm Delivery in California, 2000-2006.

    Science.gov (United States)

    Basu, Rupa; Pearson, Dharshani; Ebisu, Keita; Malig, Brian

    2017-09-01

    Particulate matter (PM) has been documented to contribute to preterm delivery. However, few studies have investigated the relationships between individual constituents of fine PM (PM 2.5 ) and preterm delivery, and factors that may modify their associations. In this study, we examined the associations between several prenatal exposure metrics to PM 2.5 and 23 constituents of PM 2.5 and preterm delivery in California from 2000 to 2006. In a retrospective cohort study including 231 637 births, we conducted logistic regression analyses adjusting for maternal, infant, temporal, geographic, and neighbourhood characteristics. We observed increased risk for preterm delivery with full-gestational exposure for several PM 2.5 constituents. Per interquartile range increase, ammonium (21.2%, 95% confidence interval (CI) 17.1, 25.4), nitrate (18.1%, 95% CI 14.9, 21.4) and bromine (16.7%, 95% CI 13.2, 20.3) had some of the largest increased risks. Alternatively, some PM 2.5 constituents were inversely associated with preterm delivery, including chlorine (-8.2%, 95% CI -10.3, -6.0), sodium (-13.2%, 95% CI -15.2, -11.3), sodium ion (-11.9%, 95% CI -14.1, -9.6) and vanadium (-19.2%, 95% CI -25.3, -12.6). Greater associations between PM 2.5 constituents and preterm delivery were observed for Blacks and Asians, older mothers, and those with some college education compared to their reference groups, as well as for births with gestational ages from 32 to 34 weeks. PM 2.5 constituents ammonium, nitrate and bromine, often linked to traffic and biomass combustion, were most associated with increased risk of preterm delivery in California. Certain demographic subgroups may be particularly impacted. © 2017 John Wiley & Sons Ltd.

  13. Medical adhesive-related skin injuries associated with vascular access.

    Science.gov (United States)

    Hitchcock, Jan; Savine, Louise

    2017-04-27

    Establishing vascular access and preventing infection, both at insertion and during ongoing care is generally the top priority; the maintenance of optimal skin integrity is often a distant secondary consideration. Skin can react to different types of dressings or adhesives, or problems can arise relating to the securement of lines or the development of sensitivities to cleaning solutions. Clearly, these scenarios are not limited to the securement of vascular access devices; however, a patient with a long-term vascular access device may not have other options for vascular access, which makes this a very important and yet largely unrecognised area. A review of the limited literature that existed up to March 2015 showed it was typically concerned with skin tears connected with dressings and removal, and contact irritant dermatitis. The tissue viability team and vascular access team reviewed the current products associated with a typical vascular access dressing to ensure it was fit for purpose and where at all possible had good scientific literature for validation. The team worked proactively to recognise those patients at risk with the early identification of potential medical adhesive-related skin injuries (MARSI). To facilitate this an algorithm was developed that offers a step-by-step approach, clearly outlining what to do to prevent MARSI and its treatment should it develop. These reactions can result from other factors than the dressing alone, and an increase in these kinds of skin reaction in patients who are on chemotherapy regimens is being explored further. Through the implementation of an algorithm, education for both staff and patients and collaborative working between vascular access and tissue viability teams, a reduction in these phenomena has been seen despite an increasing number of at-risk patients.

  14. Prevalence of self-medication practices and its associated factors in Urban Puducherry, India

    Science.gov (United States)

    Selvaraj, Kalaiselvi; Kumar, S. Ganesh; Ramalingam, Archana

    2014-01-01

    Background and Objectives: Self medication is an important concern for health authorities at global level. This study was aimed to find the prevalence of self medication for allopathic drugs and associated factors among households of urban community. This study was also aimed at assessing the attitude of respondents who had experienced self-medication. Materials and Methods: This cross-sectional study was done in field practice area attached to a medical institution in urban Puducherry. A total of 352 subjects from 124 households were selected by random sampling. With pretested interview schedule, information regarding self-medication use in the past three months and associated sociodemographic factors, purpose, source of drug procurement, attitude toward self-medication use were collected. Results: Prevalence of self-medication was found to be 11.9%. Males, age >40 years and involving in moderate level activity of occupation, were found to be significantly associated with higher self-medication usage (P self-medication is being used. Telling the symptoms to pharmacist (38.1%) was the commonest method adopted to procure drugs by the users. Majority of the self-medication users expressed that self-medication is harmless (66.6%) and they are going to use (90%) and advice others also (73.8%) to use self-medication drugs. Conclusion: Self-medication is an important health issue in this area. Health education of the public and regulation of pharmacies may help in limiting the self-medication practices. PMID:24551585

  15. Population Structure of Xylella fastidiosa Associated with Almond Leaf Scorch Disease in the San Joaquin Valley of California.

    Science.gov (United States)

    Lin, Hong; Islam, Md Sajedul; Cabrera-La Rosa, Juan C; Civerolo, Edwin L; Groves, Russell L

    2015-06-01

    Xylella fastidiosa causes disease in many commercial crops, including almond leaf scorch (ALS) disease in susceptible almond (Prunus dulcis). In this study, genetic diversity and population structure of X. fastidiosa associated with ALS disease were evaluated. Isolates obtained from two almond orchards in Fresno and Kern County in the San Joaquin Valley of California were analyzed for two successive years. Multilocus simple-sequence repeat (SSR) analysis revealed two major genetic clusters that were associated with two host cultivars, 'Sonora' and 'Nonpareil', respectively, regardless of the year of study or location of the orchard. These relationships suggest that host cultivar selection and adaptation are major driving forces shaping ALS X. fastidiosa population structure in the San Joaquin Valley. This finding will provide insight into understanding pathogen adaptation and host selection in the context of ALS disease dynamics.

  16. The Oral History Program: II. Personal views of health sciences librarianship and the Medical Library Association.

    Science.gov (United States)

    McKenzie, D; Pifalo, V

    1998-07-01

    The Medical Library Association Oral History Program uses accepted oral history techniques to collect and preserve interviews with members. The original taped interviews and transcripts are kept in the Medical Library Association archives and made available for research purposes; edited copies of the interviews are distributed through the National Network of Libraries of Medicine, and members are encouraged to borrow and read the histories. Summaries of forty-three interviews provide personal views on health sciences librarianship and the Medical Library Association.

  17. Prevalence and Factors Associated with Smoking Tobacco among Men Recently Released from Prison in California: A Cross-Sectional Study

    Science.gov (United States)

    Howell, Benjamin A.; Guydish, Joseph; Kral, Alex H.; Comfort, Megan

    2015-01-01

    Background Over 1.5 million people are incarcerated in state and federal correctional facilities in the United States. Formerly incarcerated men have significantly higher rates of mortality and morbidity than the general population, disparities that have been partially attributed to higher rates of tobacco smoking-related illnesses such as cardiovascular disease, pulmonary disease and cancer. Methods We compared the prevalence of smoking tobacco in a sample of 172 men who were released from California state prisons to Oakland and San Francisco between 2009 and 2011 to sub-populations of respondents to the 2009 California Health Interview Survey (CHIS). Using logistic regression, we analyzed the association among lifetime history of incarceration and self-reported smoking status. Results Seventy-four percent of men recently released from prison reported being current tobacco smokers. The prevalence of smoking in a demographically similar group of men in the CHIS was twenty-four percent. We found in bivariate analysis that each additional five years of history of incarceration were associated with 1.32 times greater odds of smoking (95% CI 1.02 to 1.71). Illicit substance use was associated with a 2.47 higher adjusted odds of smoking (95% CI 1.29 to 5.39). In the multivariate model adjusting for age, income, substance use and mental health, every five years of incarceration was associated with 1.23 greater odds of smoking (95% CI 0.94 to 1.63) which was not statistically significant. Conclusions Given the high prevalence of smoking tobacco among former prisoners and the underlying high tobacco-related mortality rates, these findings suggest that a history of incarceration may be an important determinant of smoking. Prison and parole systems may be important potential settings for smoking-cessation interventions. PMID:26150399

  18. Prevalence and factors associated with smoking tobacco among men recently released from prison in California: A cross-sectional study.

    Science.gov (United States)

    Howell, Benjamin A; Guydish, Joseph; Kral, Alex H; Comfort, Megan

    2015-11-01

    Over 1.5 million people are incarcerated in state and federal correctional facilities in the United States. Formerly incarcerated men have significantly higher rates of mortality and morbidity than the general population, disparities that have been partially attributed to higher rates of tobacco smoking-related illnesses such as cardiovascular disease, pulmonary disease and cancer. We compared the prevalence of smoking tobacco in a sample of 172 men who were released from California state prisons to Oakland and San Francisco between 2009 and 2011 to sub-populations of respondents to the 2009 California Health Interview Survey (CHIS). Using logistic regression, we analyzed the association between lifetime history of incarceration and self-reported smoking status. Seventy-four percent of men recently released from prison reported being current tobacco smokers. The prevalence of smoking in a demographically similar group of men in the CHIS was 24%. We found in bivariate analysis that each additional five years of history of incarceration was associated with 1.32 times greater odds of smoking (95% CI 1.02 to 1.71). Illicit substance use was associated with a 2.47 higher adjusted odds of smoking (95% CI 1.29 to 5.39). In the multivariate model adjusting for age, income, substance use and mental health, every five years of incarceration was associated with 1.23 greater odds of smoking (95% CI 0.94 to 1.63) which was not statistically significant. Given the high prevalence of smoking tobacco among former prisoners and the underlying high tobacco-related mortality rates, these findings suggest that a history of incarceration may be an important determinant of smoking. Prison and parole systems may be important potential settings for smoking-cessation interventions. Copyright © 2015 Elsevier Ltd. All rights reserved.

  19. Libraries in California: MedlinePlus

    Science.gov (United States)

    ... this page: https://medlineplus.gov/libraries/california.html Libraries in California To use the sharing features on ... page, please enable JavaScript. Alameda Alameda Hospital Medical Library 2070 Clinton Avenue Alameda, CA 94501 510-522- ...

  20. Burnout in medical students: examining the prevalence and associated factors.

    Science.gov (United States)

    Santen, Sally A; Holt, Danielle B; Kemp, Jean D; Hemphill, Robin R

    2010-08-01

    Burnout has been described as a syndrome of emotional exhaustion, depersonalization, and decreased personal accomplishment, and may originate during medical school. The objective of this study is to determine the prevalence of burnout and contributing factors in medical students. A survey was administered to 249 medical students using a modified Maslach Burnout Inventory Human Services Survey (MBI-HSS) and scales of stressors, assessment of workload, relaxation, control, accomplishment, support systems, and demographics. Moderate or high degree of burnout was seen in 21% of the first year class, 41% of the second year class, 43% of the third year class, and 31% of the fourth year class (P burnout using multivariate analysis. Burnout progressively develops over the course of medical education, while a high level of support and low stress decreased burnout.

  1. Security risks associated with radio frequency identification in medical environments.

    Science.gov (United States)

    Hawrylak, Peter J; Schimke, Nakeisha; Hale, John; Papa, Mauricio

    2012-12-01

    Radio frequency identification (RFID) is a form of wireless communication that is used to identify assets and people. RFID has significant benefits to the medical environment. However, serious security threats are present in RFID systems that must be addressed in a medical environment. Of particular interest are threats to patient privacy and safety based on interception of messages, interruption of communication, modification of data, and fabrication of messages and devices. This paper presents an overview of these security threats present in RFID systems in a medical environment and provides guidance on potential solutions to these threats. This paper provides a roadmap for researchers and implementers to address the security issues facing RFID in the medical space.

  2. Pleuritis and suppurative pneumonia associated with a hypermucoviscosity phenotype of Klebsiella pneumoniae in California sea lions (Zalophus californianus).

    Science.gov (United States)

    Jang, Spencer; Wheeler, Liz; Carey, Roberta B; Jensen, Bette; Crandall, Claudia M; Schrader, Kimmi N; Jessup, David; Colegrove, Kathleen; Gulland, Frances M D

    2010-02-24

    The aim of this study is to document the isolation of a hypermucoviscosity (HMV) phenotype of Klebsiella pneumoniae from 25 cases of suppurative pneumonia and pleuritis and two cases of abscesses in California sea lions (Zalophus californianus) from the central California coast, representing the first report of this zoonotic pathogen from the marine environment and only the second report in non-humans. Animals died 2h to 4 days after first being observed sick on beaches. Clinical signs varied from dyspnoea to coma. Gross post-mortem examination of 25 cases revealed fibrinous pleuritis, copious pus in the pleural cavity and suppurative bronchopneumonia. K. pneumoniae isolates obtained from lung and pleural swabs and the hepatic and subcuticular abscesses were highly mucoid on blood agar culture media and were positive to the "string test". Twenty-one of the 27 isolates were examined by PCR and all were positive for rmpA and K2wyz and negative for K1magA genes. Although pneumonia and pleuritis have previously commonly been observed in marine mammals, their association with pure cultures of a zoonotic bacteria, K. pneumoniae HMV phenotype, has not. This report provides further evidence of the role marine mammals play as sentinels of health risks to humans from coastal waters. Copyright 2009 Elsevier B.V. All rights reserved.

  3. Water use in California

    Science.gov (United States)

    Brandt, Justin; Sneed, Michelle; Rogers, Laurel Lynn; Metzger, Loren F.; Rewis, Diane; House, Sally F.

    2014-01-01

    As part of the USGS National Water Use Compilation, the California Water Science Center works in cooperation with local, State, and Federal agencies as well as academic and private organizations to collect and report total water withdrawals for California. The 2010 California water use data are aggregated here, in this website, for the first time. The California Water Science Center released these data ahead of the online USGS National Water Use Compilation circular report, in response to increased interest associated with current drought conditions. The national report is expected to be released late in 2014. The data on this website represents the most current California water use data available in the USGS National Water Use Compilation. It contains a section on water use in California for 2010. Water-use estimates are compiled by withdrawal source type, use category, and county. Withdrawal source types include groundwater, both fresh and saline,

  4. Fourth Medical Biotech Forum of the Chinese Medical Biotech Association. 8-10 August 2009, Dalian, China.

    Science.gov (United States)

    Felzmann, Thomas

    2009-10-01

    The Chinese Medical Biotech Association's Fourth Medical Biotech Forum held in Dalian, China included topics covering the biotechnology industry in China and new therapeutic developments in the field of immunological approaches to cancer treatment. This conference report highlights selected presentations on China's biotechnology development policy, tumor-specific antigens, clinical applications of antitumor immune therapy, and novel photodynamic tumor therapy. Investigational therapeutics discussed include astuprotimut-r (GlaxoSmithKline plc) and the dendritic cell vaccine Trivax (Trimed Biotech).

  5. Antipsychotic medication-induced dysphoria: its meaning, association with typical vs. atypical medications and impact on adherence.

    Science.gov (United States)

    Wu, Hanjing Emily; Okusaga, Olaoluwa O

    2015-06-01

    Antipsychotic medication-induced dysphoria is a relatively under-recognized and understudied effect of antipsychotic medication. Although the term is encountered in clinical practice and in the literature, there is no consensus regarding its exact meaning. This article is a narrative review of the literature on antipsychotic medication and dysphoria based on a pubmed database search. We found that antipsychotic medication-induced dysphoria is a term used to describe a negative and unpleasant affective state which seems to be more often associated with high potency first-generation antipsychotics and could potentially lead to medication non-adherence. Though it is plausible to expect antipsychotic medication-induced dysphoria to be related to extrapyramidal symptoms, most especially akathisia, the nature of the association remains unspecified. Furthermore, there is some evidence that dopamine blockade maybe involved in the pathogenesis of antipsychotic medication-induced dysphoria. However, the limited methods of the currently available studies make it impossible to conclusively address the question of which class of antipsychotic (first- or second-generation) has a higher prevalence and severity of the syndrome.

  6. Associations of medical student personality and health/wellness characteristics with their medical school performance across the curriculum.

    Science.gov (United States)

    Haight, Scott J; Chibnall, John T; Schindler, Debra L; Slavin, Stuart J

    2012-04-01

    To assess the relationships of cognitive and noncognitive performance predictors to medical student preclinical and clinical performance indicators across medical school years 1 to 3 and to evaluate the association of psychological health/wellness factors with performance. In 2010, the authors conducted a cross-sectional, correlational, retrospective study of all 175 students at the Saint Louis University School of Medicine who had just completed their third (first clinical) year. Students were asked to complete assessments of personality, stress, anxiety, depression, social support, and community cohesion. Performance measures included total Medical College Admission Test (MCAT) score, preclinical academic grades, National Board of Medical Examiners subject exam scores, United States Medical Licensing Examination Step 1 score, clinical evaluations, and Humanism in Medicine Honor Society nominations. A total of 152 students (87%) participated. MCAT scores predicted cognitive performance indicators (academic tests), whereas personality variables (conscientiousness, extraversion, empathy) predicted noncognitive indicators (clinical evaluations, humanism nominations). Conscientiousness predicted all clinical skills, extraversion predicted clinical skills reflecting interpersonal behavior, and empathy predicted motivation. Health/wellness variables had limited associations with performance. In multivariate analyses that included control for shelf exam scores, conscientiousness predicted clinical evaluations, and extraversion and empathy predicted humanism nominations. This study identified two sets of skills (cognitive, noncognitive) used during medical school, with minimal overlap across the types of performance (e.g., exam performance versus clinical interpersonal skills) they predict. Medical school admission and evaluation efforts may need to be modified to reflect the importance of personality and other noncognitive factors.

  7. [Historical origins between National Medical Association of China and Boji Hospital in Guangzhou].

    Science.gov (United States)

    Liu, Pinming

    2015-09-01

    In 2015, National Medical Association of China, now being called the Chinese Medical Association, celebrates its centennial and Boji Hospital in Guangzhou ( also known as Canton Hospital, or the Canton Pok Tsai Hospital, and now Sun Yat-sen Memorial Hospital of Sun Yat-sen University ) marks its 180th anniversary. Three major historical events establish the role of Boji Hospital in the founding and development of the National Medical Association of China during the last 100 years, viz.: ①hosting and participating in the establishment of the Medical Missionary Association of China and its official journal: the China Medical Missionary Journal; ②holding the 11th scientific sessions of the National Medical Association of China; ③nominating Dr. Wu Lien-teh as a candidate for the Nobel Prize in Physiology or Medicine in 1935 by William Warder Cadbury, the president of Boji Hospital.

  8. Clinical relevance of and risk factors associated with medication administration time errors

    NARCIS (Netherlands)

    Teunissen, R.; Bos, J.; Pot, H.; Pluim, M.; Kramers, C.

    2013-01-01

    PURPOSE: The clinical relevance of and risk factors associated with errors related to medication administration time were studied. METHODS: In this explorative study, 66 medication administration rounds were studied on two wards (surgery and neurology) of a hospital. Data on medication errors were

  9. Medication details documented on hospital discharge: cross-sectional observational study of factors associated with medication non-reconciliation.

    LENUS (Irish Health Repository)

    Grimes, Tamasine C

    2012-02-01

    AIMS: Movement into or out of hospital is a vulnerable period for medication safety. Reconciling the medication a patient is using before admission with the medication prescribed on discharge, and documenting any changes (medication reconciliation) is recommended to improve safety. The aims of the study were to investigate the factors contributing to medication reconciliation on discharge, and identify the prevalence of non-reconciliation. METHODS: The study was a cross-sectional, observational survey using consecutive discharges from purposively selected services in two acute public hospitals in Ireland. Medication reconciliation, potential for harm and unplanned re-admission were investigated. RESULTS: Medication non-reconciliation was identified in 50% of 1245 inpatient episodes, involving 16% of 9569 medications. The majority of non-reconciled episodes had potential to result in moderate (63%) or severe (2%) harm. Handwritten rather than computerized discharges (adjusted odds ratio (adjusted OR) 1.60, 95% CI 1.11, 2.99), increasing number of medications (adjusted OR 1.26, 95% CI 1.21, 1.31) or chronic illness (adjusted OR 2.08, 95% CI 1.33, 3.24) were associated with non-reconciliation. Omission of endocrine, central nervous system and nutrition and blood drugs was more likely on discharge, whilst omission on admission and throughout inpatient care, without documentation, was more likely for obstetric, gynaecology and urinary tract (OGU) or respiratory drugs. Documentation in the discharge communication that medication was intentionally stopped during inpatient care was less likely for cardiovascular, musculoskeletal and OGU drugs. Errors involving the dose were most likely for respiratory drugs. CONCLUSIONS: The findings inform strategies to facilitate medication reconciliation on discharge from acute hospital care.

  10. Phylogenetic, Morphological, and Pathogenic Characterization of Alternaria Species Associated with Fruit Rot of Blueberry in California.

    Science.gov (United States)

    Zhu, X Q; Xiao, C L

    2015-12-01

    Fruit rot caused by Alternaria spp. is one of the most important factors affecting the postharvest quality and shelf life of blueberry fruit. The aims of this study were to characterize Alternaria isolates using morphological and molecular approaches and test their pathogenicity to blueberry fruit. Alternaria spp. isolates were collected from decayed blueberry fruit in the Central Valley of California during 2012 and 2013. In total, 283 isolates were obtained and five species of Alternaria, including Alternaria alternata, A. tenuissima, A. arborescens, A. infectoria, and A. rosae, were identified based on DNA sequences of the plasma membrane ATPase, Alt a1 and Calmodulin gene regions in combination with morphological characters of the culture and sporulation. Of the 283 isolates, 61.5% were identified as A. alternata, 32.9% were A. arborescens, 5.0% were A. tenuissima, and only one isolate of A. infectoria and one isolate of A. rosae were found. These fungi were able to grow at temperatures from 0 to 35°C, and mycelial growth was arrested at 40°C. Optimal radial growth occurred between 20 to 30°C. Pathogenicity tests showed that all five Alternaria spp. were pathogenic on blueberry fruit at 0, 4, and 20°C, with A. alternata, A. arborescens, and A. tenuissima being the most virulent species, followed by A. infectoria and A. rosae. Previously A. tenuissima has been reported to be the primary cause of Alternaria fruit rot of blueberry worldwide. Our results indicated that the species composition of Alternaria responsible for Alternaria fruit rot in blueberry can be dependent on geographical region. A. alternata, A. arborescens, A. infectoria, and A. rosae are reported for the first time on blueberry in California. This is also the first report of A. infectoria and A. rosae infecting blueberry fruit.

  11. Injuries and Traumatic Psychological Exposures Associated with the South Napa Earthquake - California, 2014.

    Science.gov (United States)

    Attfield, Kathleen R; Dobson, Christine B; Henn, Jennifer B; Acosta, Meileen; Smorodinsky, Svetlana; Wilken, Jason A; Barreau, Tracy; Schreiber, Merritt; Windham, Gayle C; Materna, Barbara L; Roisman, Rachel

    2015-09-11

    On August 24, 2014, at 3:20 a.m., a magnitude 6.0 earthquake struck California, with its epicenter in Napa County (1). The earthquake was the largest to affect the San Francisco Bay area in 25 years and caused significant damage in Napa and Solano counties, including widespread power outages, five residential fires, and damage to roadways, waterlines, and 1,600 buildings (2). Two deaths resulted (2). On August 25, Napa County Public Health asked the California Department of Public Health (CDPH) for assistance in assessing postdisaster health effects, including earthquake-related injuries and effects on mental health. On September 23, Solano County Public Health requested similar assistance. A household-level Community Assessment for Public Health Emergency Response (CASPER) was conducted for these counties in two cities (Napa, 3 weeks after the earthquake, and Vallejo, 6 weeks after the earthquake). Among households reporting injuries, a substantial proportion (48% in Napa and 37% in western Vallejo) reported that the injuries occurred during the cleanup period, suggesting that increased messaging on safety precautions after a disaster might be needed. One fifth of respondents overall (27% in Napa and 9% in western Vallejo) reported one or more traumatic psychological exposures in their households. These findings were used by Napa County Mental Health to guide immediate-term mental health resource allocations and to conduct public training sessions and education campaigns to support persons with mental health risks following the earthquake. In addition, to promote community resilience and future earthquake preparedness, Napa County Public Health subsequently conducted community events on the earthquake anniversary and provided outreach workers with psychological first aid training.

  12. Medical School Experiences Associated with Change in Implicit Racial Bias Among 3547 Students: A Medical Student CHANGES Study Report.

    Science.gov (United States)

    van Ryn, Michelle; Hardeman, Rachel; Phelan, Sean M; Burgess, Diana J; Dovidio, John F; Herrin, Jeph; Burke, Sara E; Nelson, David B; Perry, Sylvia; Yeazel, Mark; Przedworski, Julia M

    2015-12-01

    Physician implicit (unconscious, automatic) bias has been shown to contribute to racial disparities in medical care. The impact of medical education on implicit racial bias is unknown. To examine the association between change in student implicit racial bias towards African Americans and student reports on their experiences with 1) formal curricula related to disparities in health and health care, cultural competence, and/or minority health; 2) informal curricula including racial climate and role model behavior; and 3) the amount and favorability of interracial contact during school. Prospective observational study involving Web-based questionnaires administered during first (2010) and last (2014) semesters of medical school. A total of 3547 students from a stratified random sample of 49 U.S. medical schools. Change in implicit racial attitudes as assessed by the Black-White Implicit Association Test administered during the first semester and again during the last semester of medical school. In multivariable modeling, having completed the Black-White Implicit Association Test during medical school remained a statistically significant predictor of decreased implicit racial bias (-5.34, p ≤ 0.001: mixed effects regression with random intercept across schools). Students' self-assessed skills regarding providing care to African American patients had a borderline association with decreased implicit racial bias (-2.18, p = 0.056). Having heard negative comments from attending physicians or residents about African American patients (3.17, p = 0.026) and having had unfavorable vs. very favorable contact with African American physicians (18.79, p = 0.003) were statistically significant predictors of increased implicit racial bias. Medical school experiences in all three domains were independently associated with change in student implicit racial attitudes. These findings are notable given that even small differences in implicit racial attitudes have been

  13. Medical marijuana for HIV-associated sensory neuropathy: legal and ethical issues.

    Science.gov (United States)

    Larriviere, Daniel G

    2014-10-01

    The number of states legalizing medical marijuana is increasing. Medical marijuana is possibly effective therapy for HIV-associated sensory neuropathy. Despite legalization at the state level, however, the current and contradictory federal drug enforcement policy creates the risk that physicians who recommend medical marijuana to their patients will lose their ability to prescribe medications. The federal-state tension has legal and ethical implications for neurologists who receive a request for medical marijuana from their patients since neurologists must strive to both relieve suffering and obey relevant laws. Recommendation of medical marijuana by neurologists to their patients is ethically permissible but is not ethically mandatory.

  14. Associations between medical school and career preferences in Year 1 medical students in Scotland.

    Science.gov (United States)

    Cleland, Jennifer; Johnston, Peter W; French, Fiona H; Needham, Gillian

    2012-05-01

    Little is known about the relationship between the career preferences of medical students and the medical schools at which they are enrolled. Our aim was to explore this relationship early in students' medical training. Year 1 (2009-2010) medical students at the five Scottish medical schools were invited to take part in a career preference questionnaire survey. Questions were asked about demographic factors, career preferences and influencing factors. The response rate was 87.9% (883/1005). No significant differences were found among medical schools with regard to first-choice specialty. Surgery (22.5%), medicine (19.0%), general practice (17.6%) and paediatrics (16.1%) were the top career choices. Work-life balance, perceived aptitude and skills, intellectual satisfaction, and amount of patient contact were rated as the most important job-related factors by most respondents. Few differences were found among schools in terms of the impact of job-related factors on future career preferences. Students for whom the work-life balance was extremely important (odds ratio [OR]=0.6) were less likely to prefer surgery. Students for whom the work-life balance (OR=2.2) and continuity of care (OR=2.1) were extremely important were more likely to prefer general practice. Students' early career preferences were similar across the five medical schools. These preferences result from the interplay among demographic factors and the perceived characteristics of the various specialties. Maintaining a satisfactory work-life balance is very important to tomorrow's doctors, and the data hint that this may be breaking down some of the traditional gender differences in specialty choice. Longitudinal work is required to explore whether students' career preferences change as they progress through medical school and training. © Blackwell Publishing Ltd 2012.

  15. The use of sodium salt deposits in medical and medically associated industries in Ancient Egypt

    OpenAIRE

    Sapsford, M

    2009-01-01

    The utilisation of minerals in Ancient Egyptian medicine from procurement through to use is examined here in a case study investigating the role of sodium salts. The sodium salts, salt and natron are two of the three most commonly used minerals in the Egyptian pharmacopeia. The results of the project are important to medical historians and archaeomineralogists alike in that they formulate a systematic understanding of the way in which minerals were used in medical and medica...

  16. Adverse drug reactions associated with asthma medications in children

    DEFF Research Database (Denmark)

    Aagaard, Lise; Hansen, Ebba Holme

    2014-01-01

    Background Respiratory medications are frequently prescribed for use in children. Several studies have reported information on the safety of asthma medications in clinical studies in adults, but information about safety in children is scarce. Objective To review published clinical trials on the o......Background Respiratory medications are frequently prescribed for use in children. Several studies have reported information on the safety of asthma medications in clinical studies in adults, but information about safety in children is scarce. Objective To review published clinical trials...... on the occurrence and characteristics of adverse drug reactions (ADRs) in children, reported for asthma medications licensed for paediatric use. Methods We systematically reviewed the literature following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement guidelines. PubMed, Embase...... as they reported information about ADR rates from use of salmeterol, formoterol, fluticasone, montelukast, zafirlukast and budesonide/formoterol in children. The total population was approximately 3,000 children; the majority was 6- to 11-year-olds and two thirds of these were boys. The observation period varied...

  17. Study of Association of Psychological Stress and Depression among Undergraduate Medical Students in Pondicherry

    OpenAIRE

    Devi Kittu, Rohan Patil

    2013-01-01

    Background: Medical education across the globe is perceived as being inherently stressful. Studies on psychological problems such as stress, depression and anxiety among medical students have found that these disorders are under diagnosed and under treated. In this background the present study was undertaken with the objectives to assess the magni-tude of depression and its association with stress among medical students. Methods: A Cross sectional study was undertaken among 235 medical st...

  18. Coping Styles and its Association with Sources of Stress in Undergraduate Medical Students

    OpenAIRE

    Sandhya Cherkil; Gardens, Seby J.; Deepak Kuttikatt Soman

    2013-01-01

    Context: The two ubiquitous factors that have been identified in medical courses to underlie mental health are stress and different coping styles adopted to combat stress. Aim: To find the association between coping styles and stress in undergraduate medical students. Settings and Design: A medical college in Central Kerala. A cross-sectional study design was adopted. Materials and Methods: Source and Severity of Stress Scale, Medical Student Version, was used to assess the source and nature ...

  19. The association of health literacy with illness perceptions, medication beliefs, and medication adherence among individuals with type 2 diabetes.

    Science.gov (United States)

    Shiyanbola, Olayinka O; Unni, Elizabeth; Huang, Yen-Ming; Lanier, Cameron

    2017-12-13

    Beliefs in medications and illness perceptions is associated with medication adherence among individuals with diabetes and several adherence interventions focus on patients' beliefs in medicines and illnesses. Though health literacy is important in medication adherence, the relationship between health literacy and medication adherence remains inconclusive; thus raising the question as to whether health literacy has an amplifying or reducing effect on the relationship between beliefs and adherence. The study examined (1) the association between health literacy, beliefs in medicines, illness perceptions, and medication adherence in individuals with type 2 diabetes and (2) the moderating effects of health literacy (including numeracy and document literacy) on the relationship between illness perceptions, beliefs in medicines, and medication adherence. Adults ≥20 years taking oral diabetes medicines at two family medicine clinics, completed a cross-sectional survey. Participants were assessed on beliefs in medicines, illness perceptions, health literacy, self-efficacy, and medication adherence. Multiple linear regressions examined the effect of health literacy, beliefs and self-efficacy, and the moderator effect of health literacy in the relationship between beliefs and adherence. Of the 174 participants, more than half were women (57.5%) and white (67.8%). There was a significant positive association between self-efficacy and adherence (β = 0.486, p adherence (β = -0.292, p adherence and concerns beliefs (β = -0.156, p = .014) and threatening illness perceptions (β = 0.196, p = .002). The concern beliefs - adherence association was only significant at marginal and adequate literacy levels. When health literacy was separated into numeracy and document literacy, only numeracy moderated the illness perceptions - adherence relationship (β = 0.149, p = .038). Health literacy, especially numeracy, needs to be initially addressed

  20. results of a survey by the world association of medical

    African Journals Online (AJOL)

    interests of medical journal editors around the world. Design. Mail survey of senior editors at 727 .... a given country, and targeted for selection twice as many journals in countries with populations greater than 50 ..... review' - the interpretation of the term was intentionally left to the respondent for the purpose of gaining a ...

  1. Organizational factors and change strategies associated with medical home transformation.

    Science.gov (United States)

    Solberg, Leif I; Stuck, Logan H; Crain, A Lauren; Tillema, Juliana O; Flottemesch, Thom J; Whitebird, Robin R; Fontaine, Patricia L

    2015-01-01

    There is limited information about how to transform primary care practices into medical homes. The research team surveyed leaders of the first 132 primary care practices in Minnesota to achieve medical home certification. These surveys measured priority for transformation, the presence of medical home practice systems, and the presence of various organizational factors and change strategies. Survey response rates were 98% for the Change Process Capability Questionnaire survey and 92% for the Physician Practice Connections survey. They showed that 80% to 100% of these certified clinics had 15 of the 18 organizational factors important for improving care processes and that 60% to 90% had successfully used 16 improvement strategies. Higher priority for this change (P = .001) and use of more strategies (P = .05) were predictive of greater change in systems. Clinics contemplating medical home transformation should consider the factors and strategies identified here and should be sure that such a change is indeed a high priority for them. © The Author(s) 2014.

  2. Classification of medication incidents associated with information technology

    NARCIS (Netherlands)

    Cheung, Ka-Chun; van der Veen, Willem; Bouvy, Marcel L.; Wensing, Michel; van den Bemt, Patricia M. L. A.; de Smet, Peter A. G. M.

    Introduction Information technology (IT) plays a pivotal role in improving patient safety, but can also cause new problems for patient safety. This study analyzed the nature and consequences of a large sample of IT-related medication incidents, as reported by healthcare professionals in community

  3. Prevalence and associated factors of cigarette smoking among medical students at King Fahad Medical City in Riyadh of Saudi Arabia

    Directory of Open Access Journals (Sweden)

    Abdulaziz F Al-Kaabba

    2011-01-01

    Full Text Available Objective: To determine the prevalence of smoking among medical students at the medical college at King Fahad Medical City in Riyadh, and assess the association between smoking and socio-demographical factors, smoking contacts, reasons for smoking and attempts to quit. Materials and Methods: Cross-sectional survey in which anonymous, self-administered questionnaire was used to survey the cigarette smoking habits of the first- and second-year medical students in the Faculty of Medicine, King Fahad Medical City in June 2009. Results: Overall 39.8 % of the investigated students (153 had smoked before, and 17.6% were current smokers. The mean age of initiating smoking was 15.8 (΁3.3. There were significantly more males than females. The most important reasons for smoking were leisure, imitation of other people and a means of relieving psychological pressure. Reasons for not smoking were mostly health and religion-based. Smokers tended to have friends who smoked. Conclusion: Cigarettes smoking is highly prevalent among medical students in the Faculty of Medicine, King Fahad Medical City. Contact with smokers particularly friends are the major risk factors for the initiation of the habit. Health and religious considerations are important motives for not smoking, quitting or attempting to quit. These findings can be of help in designing future intervention strategies.

  4. Burnout and its related Demographic Factors among the Medical Staff working in Hospitals associated with Bushehr University of Medical Sciences.

    Science.gov (United States)

    Gashmard, Roqayeh; Bagherzadeh, Razieh; Pouladi, Shahnaz; Akaberian, Sherafat

    2015-12-01

    Burnout exerts a significant negative influence on job performance, especially in such difficult jobs as those to be found in the health care industry. This research aimed to evaluate the association between 3 dimensions of burnout and demographic factors among the medical staff working in all of the hospitals associated with Bushehr University of Medical Sciences, Iran. The research detailed herein was a descriptive, analytical cross-sectional study which was conducted on 461 medical staff working in all of the hospitals associated with Bushehr University of Medical Sciences, Iran, from April 2011 to February 2012. The data were collected using a self-response method and include demographic information as well as the Maslach Burnout Inventory. In this study, samples were selected using a stratified random sampling method. The scoring of the burnout questionnaire ranged from 0 (never) to 6 (every day), with the levels of each of the 3 dimensions of burnout (as well as burnout itself) then being categorized as being low, moderate, or high. The data were analyzed using an independent t-test, a chi-square test, ANOVA, and Pearson's correlation coefficient, all in SPSS 18. Most people had experienced moderate levels of burnout (53.6%). With regard to the 3 domains of burnout, 46.4% of the participants had experienced moderate levels of emotional exhaustion, more than half (56.4%) had experienced low levels of depersonalization, and more than half (52.5%), high levels of a diminished sense of accomplishment. Burnout was shown to be statistically significantly associated with gender, place of residence, the condition of that residence, educational level, and being or not being local (p>0.05). The research findings showed that the rate of burnout was moderate among the medical staff working in hospitals associated with Bushehr University of Medical Sciences. Probably, burnout can be reduced in the hospitals' different staff members through better and suitable planning and

  5. Association between Lifestyle and School Attendance in Japanese Medical Students: A Pilot Study

    Science.gov (United States)

    Tanaka, Masaaki; Watanabe, Yasuyoshi

    2012-01-01

    Objective: Lifestyle factors are thought to be associated with students' academic performance. Whether lifestyle factors were associated with medical students' school attendance was determined. Design: Cross-sectional design. Setting: The study group consisted of 157 healthy second-year medical students attending Osaka City University Graduate…

  6. 78 FR 17679 - Implementation of the Updated American Veterinary Medical Association Guidelines for the...

    Science.gov (United States)

    2013-03-22

    ... the American Veterinary Medical Association (AVMA) Guidelines for the Euthanasia of Animals: 2013... HUMAN SERVICES National Institutes of Health Implementation of the Updated American Veterinary Medical Association Guidelines for the Euthanasia of Animals: 2013 Edition SUMMARY: The National Institutes of Health...

  7. Factors Associated with Medication Non-adherence in Patients with End-Stage Liver Disease.

    Science.gov (United States)

    Kuo, Selena Z; Haftek, Marta; Lai, Jennifer C

    2017-02-01

    Low medication adherence is known to contribute to worse health outcomes in the general population. We aimed to evaluate the medication regimen and determine the adherence levels among patients with end-stage liver disease. We measured adherence in patients awaiting liver transplantation at a single center using the 8-item Morisky Medication Adherence Scale (MMAS-8), with a score adherence. Medication regimen complexity was assessed using the Medication Regimen Complexity Index (MRCI) tool. Factors associated with low adherence were identified by logistic regression. Of 181 patients, 33% were female, median age was 62, and model for end-stage liver disease (MELD) score was 13. The median (IQR) number of medications was 10 (7-13), and the MRCI was 19 (13-27). In total, 54 (30%) were high adherers, and 127 (70%) were low adherers. In total, 42% reported sometimes forgetting to take their medication and 22% reported intermittent adherence within the past 2 weeks. The most common reasons for low adherence were: forgetfulness (27%) and side effects (14%). Compared to high adherence, low adherence was associated with higher number of medications, medication complexity, and diabetes, but lower rates of hepatocellular carcinoma and self-perceived health. In univariable logistic regression, total medication number (OR 1.08), MRCI (OR 1.04), diabetes (OR 2.38), HCC (OR 0.38), and lower self-perceived health (OR 1.37), were statistically significant factors associated with non-adherence. In multivariate analysis, only medication number without supplements (OR 1.14) remained significantly associated with medication non-adherence. A majority of patients awaiting liver transplantation demonstrated low medication adherence. Total number of medications and regimen complexity were strong correlates of low adherence. Our data underscores the need for chronic liver disease management programs to improve medication adherence in this vulnerable population.

  8. A Multicenter Evaluation of Off-Label Medication Use and Associated Adverse Drug Reactions in Adult Medical ICUs.

    Science.gov (United States)

    Smithburger, Pamela L; Buckley, Mitchell S; Culver, Mark A; Sokol, Sarah; Lat, Ishaq; Handler, Steven M; Kirisci, Levent; Kane-Gill, Sandra L

    2015-08-01

    Prior research indicates that off-label use is common in the ICU; however, the safety of off-label use has not been assessed. The study objective was to determine the prevalence of adverse drug reactions associated with off-label use and evaluate off-label use as a risk factor for the development of adverse drug reactions in an adult ICU population. Multicenter, observational study : Medical ICUs at three academic medical centers. Adult patients (age ≥ 18 yr old) receiving medication therapy. All administered medications were evaluated for Food and Drug Administration-approved or off-label use. Patients were assessed daily for the development of an adverse drug reaction through active surveillance. Three adverse drug reaction assessment instruments were used to determine the probability of an adverse drug reaction resulting from drug therapy. Severity and harm of the adverse drug reaction were also assessed. Cox proportional hazard regression was used to identify a set of covariates that influenced the rate of adverse drug reactions. Overall, 1,654 patient-days (327 patients) and 16,391 medications were evaluated, with 43% of medications being used off-label. One hundred and sixteen adverse drug reactions were categorized dichotomously (Food and Drug Administration or off-label), with 56% and 44% being associated with Food and Drug Administration-approved and off-label use, respectively. The number of adverse drug reactions for medications administered and the number of harmful and severe adverse drug reactions did not differ for medications used for Food and Drug Administration-approved or off-label use (0.74% vs 0.67%; p = 0.336; 33 vs 31 events, p = 0.567; 24 vs 24 events, p = 0.276). Age, sex, number of high-risk medications, number of off-label medications, and severity of illness score were included in the Cox proportional hazard regression. It was found that the rate of adverse drug reactions increases by 8% for every one additional off-label medication

  9. Social associations between California sea lions influence the use of a novel foraging ground.

    Science.gov (United States)

    Schakner, Zachary A; Petelle, Matthew B; Tennis, Mathew J; Van der Leeuw, Bjorn K; Stansell, Robert T; Blumstein, Daniel T

    2017-05-01

    Social relationships define an individual's position in its social network, which can influence the acquisition and spread of information and behavioural variants through the population. Thus, when nuisance behaviours spread through wildlife populations, identifying central individuals may provide valuable insights for problem-species management. We studied the effects of network position on California sea lion (Zalophus californianus) discovery and foraging success at a novel foraging ground-the salmonids that aggregate at the Bonneville Dam tail-race, 235 km up the Columbia River. We found that an individual's centrality in their social network influenced discovery of the Bonneville Dam and whether they returned the next year. Foraging success once at the dam was independent of network position. Extensive lethal and non-lethal removal efforts have been implemented at Bonneville Dam and focused on reducing the number of individual sea lions at the dam. Since social relationships forged at the opening of the Columbia River influence both the discovery and return to the Bonneville Dam, efforts to increase salmon recovery may be enhanced by breaking apart social networks at the opening of the river.

  10. Tobacco smoking is causally associated with antipsychotic medication use and schizophrenia, but not with antidepressant medication use or depression

    DEFF Research Database (Denmark)

    Wium-Andersen, Marie Kim; Ørsted, David Dynnes; Nordestgaard, Børge Grønne

    2015-01-01

    .58-1.36) for chronic obstructive pulmonary disease (P-interaction: 0.16). Odds ratios per rs1051730 allele for schizophrenia and antipsychotic medication use in ever-smokers in the general population were 1.22 (95% CI: 0.84-1.79) and 1.06 (1.00-1.12). In the Psychiatric Genomics Consortium, the corresponding......BACKGROUND: Tobacco smoking is more common among patients with schizophrenia and depression than among healthy individuals. We tested the hypothesis that high tobacco smoking intensity is causally associated with antipsychotic medication use, schizophrenia, antidepressant medication use and....../or depression in the general population, and compared results with those for chronic obstructive pulmonary disease. METHODS: We used self-reported smoking intensity in cigarettes/day and a polymorphism in the CHRNA3 gene cluster (rs1051730) associated with smoking intensity, on 63,296 20-100-year...

  11. Annual Proceedings of Selected Research and Development Papers Presented at the Annual Convention of the Association for Educational Communications and Technology (36th, Anaheim, California, 2013). Volume 2

    Science.gov (United States)

    Simonson, Michael, Ed.

    2013-01-01

    For the thirty-sixth year, the Research and Theory Division of the Association for Educational Communications and Technology (AECT) is sponsoring the publication of these Proceedings. Papers published in this volume were presented at the annual AECT Convention in Anaheim, California. The Proceedings of AECT's Convention are published in two…

  12. Annual Proceedings of Selected Research and Development Papers Presented at the Annual Convention of the Association for Educational Communications and Technology (36th, Anaheim, California, 2013). Volume 1

    Science.gov (United States)

    Simonson, Michael, Ed.

    2013-01-01

    For the thirty-sixth year, the Research and Theory Division of the Association for Educational Communications and Technology (AECT) is sponsoring the publication of these Proceedings. Papers published in this volume were presented at the annual AECT Convention in Anaheim, California. The Proceedings of AECT's Convention are published in two…

  13. Medical insurance claims associated with international business travel.

    OpenAIRE

    Liese, B; Mundt, K A; L. D.; Nagy, L; Demure, B

    1997-01-01

    OBJECTIVES: Preliminary investigations of whether 10,884 staff and consultants of the World Bank experience disease due to work related travel. Medical insurance claims filed by 4738 travellers during 1993 were compared with claims of non-travellers. METHODS: Specific diagnoses obtained from claims were analysed overall (one or more v no missions) and by frequency of international mission (1, 2-3, or > or = 4). Standardised rate of claims ratios (SSRs) for each diagnostic category were obtain...

  14. Perceived need to take medication is associated with medication non-adherence in patients with rheumatoid arthritis

    NARCIS (Netherlands)

    Zwikker, H.E.; Dulmen, S. van; Broeder, A.A. den; Bemt, B.J.F van den; Ende, C.H.M. van den

    2014-01-01

    BACKGROUND: This is the first cross-sectional study that aims to examine associations between beliefs about medication and non-adherence in patients with rheumatoid arthritis (RA) using disease-modifying antirheumatic drugs, taking potential psychological confounders into account. METHODS: Eligible

  15. Social disparities in dental insurance and annual dental visits among medically insured patients with diabetes: the Diabetes Study of Northern California (DISTANCE) Survey.

    Science.gov (United States)

    Moffet, Howard H; Schillinger, Dean; Weintraub, Jane A; Adler, Nancy; Liu, Jennifer Y; Selby, Joe V; Karter, Andrew J

    2010-05-01

    People with diabetes are at increased risk of periodontal disease and tooth loss. Healthy People 2010 set a goal that 71% or more of people with diabetes should have an annual dental exam. We assessed dental insurance and annual dental visits among dentate respondents from the Diabetes Study of Northern California (DISTANCE) Survey cohort (N = 20,188), an ethnically stratified, random sample of patients with diabetes aged 30 to 75 years receiving medical care from Kaiser Permanente Northern California. We calculated predicted probabilities for an annual dental visit (PPADV) by using regression models that incorporated age, sex, education level, annual household income, and self-reported race/ethnicity, stratified by whether the respondent had dental insurance. Among 12,405 dentate patients, 9,257 (75%) had dental insurance. Annual dental visits were reported by 7,557 (82%) patients with dental insurance and 1,935 (61%) patients without dental insurance. The age-sex adjusted odds ratio for an annual dental visit was 2.66 (95% confidence interval, 2.33-3.03) for patients with dental insurance compared to those without dental insurance. For patients with dental insurance, the PPADV was 71% or more for all except those with the lowest household income. In contrast, for those without dental insurance, the PPADV was less than 71% for all except those with the most education or the highest income. We found some racial/ethnic subgroups were more likely than others to take advantage of dental insurance to have an annual dental visit. Patients with diabetes in this managed care population who lacked dental insurance failed to meet the Healthy People 2010 goal for an annual dental visit. An increased effort should be made to promote oral health among people with diabetes.

  16. Identification of Associations Between Prescribed Medications and Cancer

    DEFF Research Database (Denmark)

    Pottegård, Anton; Friis, Søren; Christensen, René dePont

    2016-01-01

    PURPOSE: We present a systematic screening for identifying associations between prescribed drugs and cancer risk using the high quality Danish nationwide health registries. METHODS: We identified all patients (cases) with incident cancer in Denmark during 2000-2012 (n=278,485) and matched each ca......-established associations, as well as several new signals that deserve further investigation. CONCLUSION: Our results provide the basis for future targeted studies of single associations to capture novel carcinogenic or chemopreventive effects of prescription drugs....

  17. Survey of medical examiner office computerization. From the National Association of Medical Examiners (N.A.M.E.).

    Science.gov (United States)

    Hanzlick, R

    1994-06-01

    Following a suggestion that the National Association of Medical Examiners (N.A.M.E.) develop a N.A.M.E. Information Center (NIC), N.A.M.E. conducted a survey to evaluate the current status of medical examiner office automation (computerization) in the United States. Responses were received from 80 unique reporting areas, including 75 medical examiner offices, which represent approximately 30% of the 258 medical examiner jurisdictions in the country. A total of 58 responders (65%) indicated that their office was automated. At least 38 states have one or more automated death investigation office, and electronic data exist for approximately 145,000 deaths per year, or approximately 30% of all deaths certified by medical examiners and coroners annually and approximately 6% of all deaths per year in the United States. Although computerized offices vary substantially in size and in their choice of hardware and software, a typical computerized medical examiner office (a) is in a single county with 1,000-6,000 death reports per year, (b) keeps electronic records on all cases reported, (c) uses an IBM or compatible personal computer (PC) or PC network with off-the-shelf software, (d) stores data on cause of death, manner of death, how injuries occur, and toxicology results, and (e) is interested in sharing its data. Considerable electronic death investigation data exist that can provide timely and valuable information for mortality and public health studies.

  18. The Unauthorized Residency Status Myth: Health Insurance Coverage and Medical Care Use among Mexican Immigrants in California

    Directory of Open Access Journals (Sweden)

    Enrico A. Marcelli

    2004-01-01

    Full Text Available Tomando en cuenta los avances recientes en el modelo conductual del uso de asistencia médica y la epidemiología social, este artículo utiliza datos de encuestas para estimar si el estatus de residencia no autorizada entre los mexicanos que todavía no llegan a la vejez y otros inmigrantes latinos en California influyó en la probabilidad de que tuvieran seguro de salud y recibieran asistencia médica. Se estima que el estatus de residencia no autorizada ha disminuido la probabilidad de que estuvieran asegurados y, a su vez, ha aumentado la de que recurrieran al seguro de salud pública. Sin embargo, después de controlar otras características individuales, el contexto de vecindad y el capital social, ni el seguro ni el estatus de residencia parecen haber influido en que una persona obtuviera la asistencia médica necesaria. Finalmente, el contexto de vecindad, la dificultad para encontrar un lugar de asistencia médica y el compromiso cívico parecieran ser más importantes para comprender el uso de los servicios médicos.

  19. Here or There: Recent U.S. Immigrants' Medical and Dental Tourism and Associated Factors.

    Science.gov (United States)

    Jang, Sou Hyun

    2018-01-01

    Applying Andersen's health care utilization model, this paper shows the prevalence of immigrants' medical and dental tourism and associated factors. An analysis of the 2003 New Immigrant Survey data shows that about 17% of immigrants received medical care in a foreign country, whereas about one-third obtained dental care outside the United States. Latino immigrants have a higher prevalence of both types of tourism than their Asian counterparts. Race, level of education, and health insured status are commonly associated with medical and dental tourism. The findings contribute to the scarce literature on immigrants' health care utilization and medical and dental tourism.

  20. Association between Acculturation and Binge Drinking among Asian-Americans: Results from the California Health Interview Survey

    Directory of Open Access Journals (Sweden)

    Monideepa B. Becerra

    2013-01-01

    Full Text Available Objective. Evaluate the association between acculturation and binge drinking among six Asian-American subgroups. Methods. A cross-sectional analysis of public access adult portion of 2007, 2009, and 2011/2012 California Health Interview Survey data was conducted. Univariate and multivariable logistic regression analyses were utilized with any binge drinking in the past year as the outcome variable and language spoken at home and time in USA as proxy measures of acculturation. Results. A total of 1,631 Asian-Americans (N=665,195 were identified as binge drinkers. Binge drinking was positively associated with being first generation South Asian (OR=3.05, 95% CI=1.55, 5.98 and monolingual (English only Vietnamese (OR=3.00; 95% CI=1.58, 5.70, especially among females. Other factors associated with increased binge drinking were being female (Chinese only, not being current married (South Asian only, and being an ever smoker (all subgroups except South Asians. Conclusion. First generation South Asians and linguistically acculturated Vietnamese, especially females, are at an increased risk of binge drinking. Future studies and preventive measures should address the cultural basis of such health risk behaviors among Asian-American adults.

  1. A survey study of the association between mobile phone use and daytime sleepiness in California high school students.

    Science.gov (United States)

    Nathan, Nila; Zeitzer, Jamie

    2013-09-12

    Mobile phone use is near ubiquitous in teenagers. Paralleling the rise in mobile phone use is an equally rapid decline in the amount of time teenagers are spending asleep at night. Prior research indicates that there might be a relationship between daytime sleepiness and nocturnal mobile phone use in teenagers in a variety of countries. As such, the aim of this study was to see if there was an association between mobile phone use, especially at night, and sleepiness in a group of U.S. teenagers. A questionnaire containing an Epworth Sleepiness Scale (ESS) modified for use in teens and questions about qualitative and quantitative use of the mobile phone was completed by students attending Mountain View High School in Mountain View, California (n = 211). Multivariate regression analysis indicated that ESS score was significantly associated with being female, feeling a need to be accessible by mobile phone all of the time, and a past attempt to reduce mobile phone use. The number of daily texts or phone calls was not directly associated with ESS. Those individuals who felt they needed to be accessible and those who had attempted to reduce mobile phone use were also ones who stayed up later to use the mobile phone and were awakened more often at night by the mobile phone. The relationship between daytime sleepiness and mobile phone use was not directly related to the volume of texting but may be related to the temporal pattern of mobile phone use.

  2. Prevalence of self-medication practices and its associated factors in Urban Puducherry, India

    Directory of Open Access Journals (Sweden)

    Kalaiselvi Selvaraj

    2014-01-01

    Full Text Available Background and Objectives: Self medication is an important concern for health authorities at global level. This study was aimed to find the prevalence of self medication for allopathic drugs and associated factors among households of urban community. This study was also aimed at assessing the attitude of respondents who had experienced self-medication. Materials and Methods: This cross-sectional study was done in field practice area attached to a medical institution in urban Puducherry. A total of 352 subjects from 124 households were selected by random sampling. With pretested interview schedule, information regarding self-medication use in the past three months and associated sociodemographic factors, purpose, source of drug procurement, attitude toward self-medication use were collected. Results: Prevalence of self-medication was found to be 11.9%. Males, age >40 years and involving in moderate level activity of occupation, were found to be significantly associated with higher self-medication usage (P < 0.05. Fever (31%, headache (19%, and abdominal pain (16.7% are most common illnesses where self-medication is being used. Telling the symptoms to pharmacist (38.1% was the commonest method adopted to procure drugs by the users. Majority of the self-medication users expressed that self-medication is harmless (66.6% and they are going to use (90% and advice others also (73.8% to use self-medication drugs. Conclusion: Self-medication is an important health issue in this area. Health education of the public and regulation of pharmacies may help in limiting the self-medication practices.

  3. Clinical relevance of and risk factors associated with medication administration time errors.

    Science.gov (United States)

    Teunissen, Rick; Bos, Jacqueline; Pot, Hans; Pluim, Marien; Kramers, Cornelis

    2013-06-15

    The clinical relevance of and risk factors associated with errors related to medication administration time were studied. In this explorative study, 66 medication administration rounds were studied on two wards (surgery and neurology) of a hospital. Data on medication errors were collected using the blister collection method. The emptied packaging material of medication was collected after each round and compared with each patient's medication orders. Administration time errors were defined as medication administration (actual intake) occurring more than one hour before or after the prescribed time. Generalized estimating equations analysis was performed to study the correlation between medication administration errors and risk factors. Data from 129 patients were included in the study. Among these 129 patients, 2874 opportunities for error were recorded. The majority of opportunities for error occurred during the 7 a.m. round. Within the 2874 opportunities for errors, 10 administration time errors occurred for medications that might interact with food or another medication. Time of administration (noon and 3 p.m.), route of administration (injection or infusion), and frequency of administration (if necessary) had significant protective effects against the occurrence of administration time errors. The rectal route of administration was associated with a significant increase in the frequency of administration time errors compared with the oral route. A clinically relevant administration time error occurred in 2 cases (0.07%). Analysis of medication administration rounds found time errors to be the most common medication error.

  4. Factors associated with dropping out of medical school: a literature review

    DEFF Research Database (Denmark)

    O'Neill, Lotte Dyhrberg

    2010-01-01

    of Aarhus; Jan Hartvigsen, PhD, Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark.   Title: Factors associated with dropping out of medical school: a literature review.      Background: Considerable resources are spent on medical school selection and the competition...... for places is usually fierce. Dropping out must therefore be the worst possible performance outcome in medical education. What do we know about factors associated with dropping out of medical school? Summary of work: A systematic critical literature review of the international peer-reviewed research...... literature on medical education is ongoing. Inclusion criteria are: Study population=medical students, outcome=dropout, follow up period=minimum 1 year, study designs=cohort/case-control/experimental. An experienced research librarian performed a primary search of the databases PubMed, ERIC, Psyc...

  5. Ecological factors associated with pandemic influenza A (H1N1 hospitalization rates in California, USA: a geospatial analysis

    Directory of Open Access Journals (Sweden)

    Paul J. Maliszewski

    2011-11-01

    Full Text Available The 2009 H1N1 influenza A virus subtype (H1N1 pandemic had a large impact in the United States of America (USA, causing an estimated 192,000 to 398,000 hospitalizations and 8,720 to 18,050 deaths between April 2009 and mid- March 2010. Recent research on the 2009 H1N1 pandemic has largely focused on individual, non-spatial demographic characterizations (e.g. age and race/ethnicity associated with H1N1 hospitalizations. Broader ecological factors such as transportation use, land use and other socioeconomic factors are important aspects of influenza studies that have not been empirically examined. This research explores and identifies ecological factors associated with 2009 H1N1 pandemic hospitalization rates. We conducted a spatial regression analysis of county level hospitalization rates from 3 April to 15 September, 2009 obtained via the California Department of Public Health. Hospitalization rates were found to be spatially dependent. Public transportation usage rates and agricultural land use proportions were significant environmental factors positively related to hospitalization rates. Consistent with public health official’s assumptions and existing evidence, county percentages of persons less than 18 years of age were positively associated with hospitalization. These findings help to clarify the limited consensus and dubious evidence on the role of broader ecological factors associated with pandemic influenza. A better understanding of the ecological risk factors associated with hospitalizations should also benefit public health officials with respect to their work aiming at improving emergency supply allocation and non-pharmaceutical intervention strategies in the context of an influenza pandemic.

  6. Temporal association between land-based runoff events and California sea otter (Enhydra lutris nereis) protozoal mortalities.

    Science.gov (United States)

    Shapiro, Karen; Miller, Melissa; Mazet, Jonna

    2012-04-01

    Toxoplasma gondii and Sarcocystis neurona have caused significant morbidity and mortality in threatened Southern sea otters (Enhydra lutris nereis) along the central California coast. Because only terrestrial animals are known to serve as definitive hosts for T. gondii and S. neurona, infections in otters suggest a land to sea flow of these protozoan pathogens. To better characterize the role of overland runoff in delivery of terrestrially derived fecal pathogens to the near shore, we assessed the temporal association between indicators of runoff and the timing of sea otter deaths due to T. gondii and S. neurona. Sea otter stranding records 1998-2004, from Monterey and Estero bays were reviewed and cases identified for which T. gondii or S. neurona were determined to be a primary or contributing cause of death. Precipitation and stream flow data from both study sites were used as indicators of land-based runoff. Logistic regression was applied to determine if a temporal association could be detected between protozoal mortalities and runoff indicators that occur in the 2 mo preceding mortality events. A significant association was found between S. neurona otter deaths at Estero Bay and increased stream flow that occurred 30-60 days prior to mortality events. At this site, the cause of otter mortality following increased river flows was 12 times more likely to be S. neurona infection compared with nonprotozoal causes of death. There were no significant associations between the timing of T. gondii otter deaths and indicators of overland runoff. Our results indicate that the association between overland runoff and otter mortalities is affected by geography as well as parasite type, and highlight the complex mechanisms that influence transmission of terrestrially derived pathogens to marine wildlife. Policy and management practices that aim to mitigate discharges of contaminated overland runoff can aid conservation efforts by reducing pathogen pollution of coastal

  7. The association between physical symptoms and depression among medical students in Bahrain.

    Science.gov (United States)

    Abdelaziz, Ammar M Y; Alotaibi, Khalid T; Alhurayyis, Jarah H; Alqahtani, Turky A; Alghamlas, Aamer M; Algahtani, Haifa M; Jahrami, Haitham A

    2017-12-15

    To examine the association between depression and physical symptoms among medical students in Bahrain.   The present study employed a cross-sectional design.  A total of 160 students were recruited, 41.3% were male and 58.8% female, using a convenience sampling approach. Participants completed the validated Patients Health Questionnaires (PHQs) in which they provided information about demographics, physical symptoms, and depression. Results were considered significant if p medical students in Bahrain.  Medical educators should take such symptoms seriously among medical students as it may have serious consequences on the mental health of medical students. In practice, adequate awareness initiatives should be organized and provided for medical students to help them overcome their challenges they face. Additionally, incorporating screening self-screening strategies in the medical curriculum can be beneficial for early detections of mental health problems. The Implications and limitations of the study are discussed.

  8. Stress among Medical Students and Its Association with Substance Use and Academic Performance

    OpenAIRE

    Leta Melaku; Andualem Mossie; Alemayehu Negash

    2015-01-01

    Background. Chronic stress among medical students affects academic performance of students and leads to depression, substance use, and suicide. There is, however, a shortage of such research evidence in Ethiopia. Objective. We aimed to estimate the prevalence and severity of stress and its association with substance use and academic performance among medical students. Methods. A cross-sectional survey was conducted on a sample of 329 medical students at Jimma University. Data were collected u...

  9. Knowledge of HIV and factors associated with attitudes towards HIV among final-year medical students at Hanoi medical university in Vietnam

    National Research Council Canada - National Science Library

    Platten, Michael; Pham, Ha N; Nguyen, Huy V; Nguyen, Nhu T; Le, Giang M

    2014-01-01

    .... The objective of this paper is to assess the gaps in knowledge of HIV and factors associated with discriminatory attitudes towards persons living with HIV among medical students in order to improve medical training...

  10. Medical error analysis in dermatology according to the reports of the North Rhine Medical Association from 2004-2013.

    Science.gov (United States)

    Lehmann, Lion; Wesselmann, Ulrich; Weber, Beate; Smentkowski, Ulrich

    2015-09-01

    Patient safety is a central issue of health care provision. There are various approaches geared towards improving health care provision and patient safety. By conducting a systematic retrospective error analysis, the present article aims to identify the most common complaints brought forth within the field of dermatology over a period of ten years. The reports of the Expert Committee for Medical Malpractice Claims of the North Rhine Medical Association (from 2004 to 2013) on dermatological procedures were analyzed (n =  247 reports in the field of dermatology). Expert medical assessments in the field of dermatology are most frequently commissioned for nonsurgical therapies (e.g. laser therapy, phototherapy). While suspected diagnostic errors constitute the second most common reason for complaints, presumed dermatosurgery-related errors represent the least common reason for commissioning expert medical assessments. The most common and easily avoidable sources of medical errors include failure to take a biopsy despite suspicious clinical findings, or incorrect clinicopathological correlations resulting in deleterious effects for the patient. Furthermore, given the potential for incorrect indications and the inadequate selection of devices to be used as well as their parameter settings, laser and phototherapies harbor an increased risk in the treatment of dermatological patients. The fourth major source of error leading to complaints relates to incorrect indications as well as incorrect dosage and administration of drugs. Analysis of expert medical assessment reports on treatment errors in dermatology as well as other medical specialties is helpful and provides an opportunity to identify common sources of error and error-prone structures. © 2015 Deutsche Dermatologische Gesellschaft (DDG). Published by John Wiley & Sons Ltd.

  11. The tobacco industry, state politics, and tobacco education in California.

    Science.gov (United States)

    Begay, M E; Traynor, M; Glantz, S A

    1993-01-01

    OBJECTIVES. Proposition 99 added 25 cents to the California state cigarette tax and mandated that 20% of the new revenues be spent on tobacco education and prevention programs. This paper examines the implementation of these programs and the tobacco industry's response to Proposition 99. METHODS. Political expenditure data for twelve tobacco firms and associations were gathered from California's Fair Political Practices Commission and secretary of state's Political Reform Division. Tobacco education expenditure data were collected from Governor's Budgets and the Department of Finance. RESULTS. Since Proposition 99 passed, tobacco industry political expenditures in California have risen 10-fold, from $790,050 in the 1985-1986 election to $7,615,091 in the 1991-1992 election. The tobacco industry is contributing more heavily to the California legislature than to Congress. A statistical analysis of data on campaign contributions indicates that California legislators' policy-making is influenced by campaign contributions from the tobacco industry. Since fiscal year 1989-1990, the state has ignored the voters' mandate and spent only 14.7% of the new revenues to tobacco education. Medical care programs received more money than permitted by the voters. CONCLUSIONS. The tobacco industry has become politically active in California following the passage of Proposition 99. One result may be that the state has underfunded tobacco education by $174.7 million through the 1993-1994 fiscal year. The estimated redirection of funds to medical care would essentially eliminate the tobacco education campaign by the year 2000. PMID:8362994

  12. Association of Social Support and Medication Adherence in Chinese Patients with Type 2 Diabetes Mellitus.

    Science.gov (United States)

    Gu, Linni; Wu, Shaomin; Zhao, Shuliang; Zhou, Huixuan; Zhang, Shengfa; Gao, Min; Qu, Zhiyong; Zhang, Weijun; Tian, Donghua

    2017-12-06

    The prevalence of diabetes is steadily increasing in China. When diabetes is uncontrolled, it generates dire consequences for health and well-being. Numerous studies have shown that health outcomes were associated with social support and medication adherence. Previous study confirmed that social support was associated with medication adherence in patients with heart failure, HIV diseases, and first-episode psychosis. However, the relationship between social support and medication adherence in patients with type 2 diabetes mellitus (T2DM) is remains unclear. This study aims to examine whether social support is associated with medication adherence in patients with T2DM. This study was conducted in the First Affiliated Hospital of the General Hospital of the People's Liberation Army (PLA). In Beijing, a systematic random sample of 412 patients with T2DM over 18 years was recruited at baseline, and demographic characteristics, clinical data and their assessment of social support were collected from medical records and self-reported questionnaires. 330 of these patients completed a self-report measure of medication adherence at the sixth month after baseline data collection. Regression analysis showed that social support presented a positive effect on medication adherence, additionally, support utilization and the subscale of social support exhibited a significantly strong influence on medication adherence in patients with T2DM. Although medication adherence was influenced by multiple factors, this finding confirmed that social support must be recognized as a core element in interventions aimed at improving in the management of patients with T2DM.

  13. Association between addressing antiseizure drug side effects and patient-reported medication adherence in epilepsy.

    Science.gov (United States)

    Moura, Lidia M V R; Carneiro, Thiago S; Cole, Andrew J; Hsu, John; Vickrey, Barbara G; Hoch, Daniel B

    2016-01-01

    Adherence to treatment is a critical component of epilepsy management. This study examines whether addressing antiepileptic drug (AED) side effects at every visit is associated with increased patient-reported medication adherence. This study identified 243 adults with epilepsy who were seen at two academic outpatient neurology settings and had at least two visits over a 3-year period. Demographic and clinical characteristics were abstracted. Evidence that AED side effects were addressed was measured through 1) phone interview (patient-reported) and 2) medical records abstraction (physician-documented). Medication adherence was assessed using the validated Morisky Medication Adherence Scale-4. Complete adherence was determined as answering "no" to all questions. Sixty-two (25%) patients completed the interviews. Participants and nonparticipants were comparable with respect to demographic and clinical characteristics; however, a smaller proportion of participants had a history of drug-resistant epilepsy than nonparticipants (17.7% vs 30.9%, P =0.04). Among the participants, evidence that AED side effects were addressed was present in 48 (77%) medical records and reported by 51 (82%) patients. Twenty-eight (45%) patients reported complete medication adherence. The most common reason for incomplete adherence was missed medication due to forgetfulness (n=31, 91%). There was no association between addressing AED side effects (neither physician-documented nor patient-reported) and complete medication adherence ( P =0.22 and 0.20). Among patients with epilepsy, addressing medication side effects at every visit does not appear to increase patient-reported medication adherence.

  14. Estimating Associations Between Medical Home Adoption, Utilization, and Quality: A Comparison of Evaluation Approaches.

    Science.gov (United States)

    Martsolf, Grant R; Kandrack, Ryan; Baird, Matthew; Friedberg, Mark W

    2018-01-01

    Methodological differences between evaluations of medical home adoption might complicate readers' ability to draw conclusions across studies. To study whether associations between medical home adoption and patient care are affected by methodological choices. Among 71 practices participating in the Pennsylvania Chronic Care Initiative (a medical home pilot), we estimated cross-sectional and longitudinal associations between 4 definitions of "medical home adoption" [National Committee on Quality Assurance (NCQA) recognition in year 3, Medical Home Index scores at baseline and 3, and within-practice changes in Medical Home Index scores between baseline and year 3] and utilization and quality. Six utilization and 6 quality measures. In cross-sectional analyses at year 3, NCQA recognition was associated with higher rates of nephropathy monitoring (7.23 percentage points; confidence interval, 0.45-14.02), breast cancer screening (7.48; 2.11-12.86), and colorectal cancer screening (8.43; 2.44-14.42). In longitudinal analyses, NCQA recognition was associated with increases in hospitalization rates (2.75 per 1000 patient-months; 0.52-4.98). In baseline cross-sectional analyses, higher Medical Home Index scores were associated with fewer ambulatory care-sensitive hospitalizations (-0.61 per 1000 patient per month; -1.11 to -0.11), all-cause emergency department visits (-6.80; -12.28 to -1.32), and ambulatory care-sensitive emergency department visits (-5.60; 10.32 to -0.88). There were no statistically significant associations between any other measure of medical home adoption and quality or utilization. The findings of medical home evaluations are sensitive to methodological choices. Meta-analyses, narrative reviews, and other syntheses of medical home studies should consider subdividing their findings by analytic approach.

  15. Discrepancies in Mother and Child Perceptions of Spina Bifida Medical Responsibilities During the Transition to Adolescence: Associations With Family Conflict and Medical Adherence

    Science.gov (United States)

    Psihogios, Alexandra M.

    2013-01-01

    Objective This study investigated mother–child discrepancies over perceptions of who is responsible for spina bifida (SB) medical tasks in relation to family conflict and medical adherence. Method 140 youth with SB and their mothers completed questionnaires regarding who is responsible for specific SB medical tasks, family conflict, and medical adherence. An observational measure was also used to assess family conflict. Results Although children viewed themselves as more responsible for medical management than mothers did, mother–child discrepancies were not associated with family conflict or medical adherence. Interaction effects revealed that adherence was better when family conflict was low and when parents were responsible for medical tasks. Conclusions Parental involvement in SB medical care is essential for optimal medical adherence during adolescence. The presence of family conflict also plays an influential role on SB medical adherence. Future research should evaluate the relations between discrepancies, family conflict, and medical adherence across time. PMID:23843631

  16. Medical Conditions in the First Years of Life Associated with Future Diagnosis of ASD in Children

    Science.gov (United States)

    Alexeeff, Stacey E.; Yau, Vincent; Qian, Yinge; Davignon, Meghan; Lynch, Frances; Crawford, Phillip; Davis, Robert; Croen, Lisa A.

    2017-01-01

    This study examines medical conditions diagnosed prior to the diagnosis of autism spectrum disorder (ASD). Using a matched case control design with 3911 ASD cases and 38,609 controls, we found that 38 out of 79 medical conditions were associated with increased ASD risk. Developmental delay, mental health, and neurology conditions had the strongest…

  17. Stress and Coping Styles Are Associated with Severe Fatigue in Medical Students

    Science.gov (United States)

    Tanaka, Masaaki; Fukuda, Sanae; Mizuno, Kei; Kuratsune, Hirohiko; Watanabe, Yasuyoshi

    2009-01-01

    Fatigue is a common complaint among medical students and researchers consider it to be related to poor academic outcomes. The authors' goal in the present study was to determine whether stress and coping strategies were associated with fatigue in medical students. The study group consisted of 73 second-year healthy students attending the Osaka…

  18. Relative Prevalence of Grapevine Leafroll-Associated Virus Species in Wine Grape-Growing Regions of California.

    Directory of Open Access Journals (Sweden)

    Abhineet M Sharma

    Full Text Available Some diseases manifest as one characteristic set of symptoms to the host, but can be caused by multiple pathogens. Control treatments based on plant symptoms can make it difficult to effectively manage such diseases, as the biology of the underlying pathogens can vary. Grapevine leafroll disease affects grapes worldwide, and is associated with several viral species in the family Closteroviridae. Whereas some of the viruses associated with this disease are transmitted by insect vectors, others are only graft-transmissible. In three regions of California, we surveyed vineyards containing diseased vines and screened symptomatic plants for all known viral species associated with grapevine leafroll disease. Relative incidence of each virus species differed among the three regions regions, particularly in relation to species with known vectors compared with those only known to be graft-transmitted. In one region, the pathogen population was dominated by species not known to have an insect vector. In contrast, populations in the other surveyed regions were dominated by virus species that are vector-transmissible. Our survey did not detect viruses associated with grapevine leafroll disease at some sites with characteristic disease symptoms. This could be explained either by undescribed genetic diversity among these viruses that prevented detection with available molecular tools at the time the survey was performed, or a misidentification of visual symptoms that may have had other underlying causes. Based on the differences in relative prevalence of each virus species among regions and among vineyards within regions, we expect that region and site-specific management strategies are needed for effective disease control.

  19. Characteristics associated with citation rate of the medical literature.

    Directory of Open Access Journals (Sweden)

    Abhaya V Kulkarni

    Full Text Available BACKGROUND: The citation rate for articles is viewed as a measure of their importance and impact; however, little is known about what features of articles are associated with higher citation rate. METHODOLOGY/PRINCIPAL FINDINGS: We conducted a cohort study of all original articles, regardless of study methodology, published in the Lancet, JAMA, and New England Journal of Medicine, from October 1, 1999 to March 31, 2000. We identified 328 articles. Two blinded, independent reviewers extracted, in duplicate, nine variables from each article, which were analyzed in both univariable and multivariable linear least-squares regression models for their association with the annual rate of citations received by the article since publication. A two-way interaction between industry funding and an industry-favoring result was tested and found to be significant (p = 0.02. In our adjusted analysis, the presence of industry funding and an industry-favoring result was associated with an increase in annual citation rate of 25.7 (95% confidence interval, 8.5 to 42.8 compared to the absence of both industry funding and industry-favoring results. Higher annual rates of citation were also associated with articles dealing with cardiovascular medicine (13.3 more; 95% confidence interval, 3.9 to 22.3 and oncology (12.6 more; 95% confidence interval, 1.2 to 24.0, articles with group authorship (11.1 more; 95% confidence interval, 2.7 to 19.5, larger sample size and journal of publication. CONCLUSIONS/SIGNIFICANCE: Large trials, with group authorship, industry-funded, with industry-favoring results, in oncology or cardiology were associated with greater subsequent citations.

  20. Psychological factors associated with failure of detoxification treatment in chronic headache associated with medication overuse.

    Science.gov (United States)

    Bottiroli, S; Viana, M; Sances, G; Ghiotto, N; Guaschino, E; Galli, F; Vegni, E; Pazzi, S; Nappi, G; Tassorelli, C

    2016-12-01

    The aim of this study was to evaluate the psychological factors associated with a negative outcome following detoxification in a 2-month follow-up in medication-overuse headache. All consecutive patients entering the detoxification program were analysed in a prospective, non-randomised fashion. Psychiatric conditions and personality characteristics were assessed using the Structured Clinical Interview for DSM-IV Disorders (SCID-I) and the Minnesota Multiphasic Personality Inventory (MMPI)-2. χ2 tests, one-way analyses of variance, and odds ratios (ORs) were used. A total of 248 patients completed the follow-up: 156 stopped overuse and their headaches reverted to an episodic pattern (Group A); 23 kept overusing without any benefit on headache frequency (Group B); and 51 stopped overuse without any benefit on headache frequency (Group C). The prognostic factors for the outcome of Group B were higher scores on the correction (OR 1.128; p = 0.036), depression (OR 1.071; p = 0.05), hysteria (OR 1.106; p = 0.023), and overcontrolled hostility (OR 1.182; p = 0.04) MMPI-2 scales, whereas those for Group C were psychiatric comorbidities (OR 1.502; p = 0.021) and higher scores on the hysteria scale (OR 1.125; p = 0.004). The outcome of detoxification is influenced by psychological factors that should be considered when considering treatment strategies. © International Headache Society 2016.

  1. Factors associated with medication administration errors and why nurses fail to report them.

    Science.gov (United States)

    Hammoudi, Baraa M; Ismaile, Samantha; Abu Yahya, Omar

    2017-11-22

    Patient safety is a significant challenge facing healthcare systems. The administration of medication is pivotal to patient safety, and errors in drug administration are associated with mortality and morbidity. In this study, we assessed the factors contributing to the occurrence and reporting of medication errors from the nurse's perspective. In this descriptive cross-sectional study, we distributed a validated questionnaire to 367 nurses at a large public hospital and obtained a response rate of 73.4%. The questionnaire comprised 65 questions, including 29 on the causes of medication errors, 16 on the reasons why medication errors are not reported and 20 that estimated the percentages of the different medication errors actually reported. Informed consent was obtained from all participants, and the anonymity and confidentiality of participants' information were preserved throughout the process. This study received institutional review board approval. Descriptive statistics were used for data analysis. The main factors associated with medication errors by nurses were related to medication packaging, nurse-physician communication, pharmacy processes, nurse staffing and transcribing issues. The main barriers to the reporting of errors by nurses were related to the administrative response, fear of reporting and disagreements regarding the definitions of errors. Medication errors by nurses are related to medication packaging, poor communication, unclear medication orders, workload and staff rotation. To prevent medication errors, teamwork must be improved. All healthcare settings should emphasise awareness of the culture of safety, provide support and guidance to nurses and improve communication skills. We also recommend the use of integrated health informatics, including computerised drug administration systems. The limitations of this study include the potential for nonresponse bias associated with the sampling method. Further research is required to explore the

  2. Factors associated with skipping breakfast among Inner Mongolia medical students in China

    National Research Council Canada - National Science Library

    Sun, Juan; Yi, He; Liu, Zhiyue; Wu, Yan; Bian, Jiang; Wu, Yanyan; Eshita, Yuki; Li, Gaimei; Zhang, Qing; Yang, Ying

    2013-01-01

    .... The aim of the present study was to determine the prevalence of skipping breakfast and factors associated with skipping breakfast among medical students in Inner Mongolia of China, and to assist...

  3. For Distinguished Public Service: Medical Library Association Honors FNLM and NIH MedlinePlus Magazine | NIH ...

    Science.gov (United States)

    ... Medical Library Association Honors FNLM and NIH MedlinePlus Magazine Past Issues / Summer 2011 Table of Contents MLA ... From You We want your feedback on the magazine and ideas for future issues, as well as ...

  4. Associations between empathy and big five personality traits among Chinese undergraduate medical students.

    Science.gov (United States)

    Song, Yang; Shi, Meng

    2017-01-01

    Empathy promotes positive physician-patient communication and is associated with improved patient satisfaction, treatment adherence and clinical outcomes. It has been suggested that personality traits should be taken into consideration in programs designed to enhance empathy in medical education due to the association found between personality and empathy among medical students. However, the associations between empathy and big five personality traits in medical education are still underrepresented in the existing literature and relevant studies have not been conducted among medical students in China, where tensions in the physician-patient relationship have been reported as outstanding problems in the context of China's current medical reform. Thus, the main objective of this study was to examine the associations between empathy and big five personality traits among Chinese medical students. A cross-sectional study was conducted in a medical university in Northeast China in June 2016. Self-reported questionnaires including the Interpersonal Reactivity Index (IRI) and Big Five Inventory (BFI) and demographic characteristics were distributed. A total of 530 clinical medical students became our final subjects. Hierarchical regression analysis was performed to explore the effects of big five personality traits on empathy. Results of this study showed that big five personality traits accounted for 19.4%, 18.1%, 30.2% of the variance in three dimensions of empathy, namely, perspective taking, empathic concern and personal distress, respectively. Specifically, agreeableness had a strong positive association with empathic concern (β = 0.477, Pbig five personality traits were important predictors of self-reported measures of both cognitive and affective empathy among Chinese medical students. Therefore, individualized intervention strategies based on personality traits could be integrated into programs to enhance empathy in medical education.

  5. Workforce and Salary Survey Trends: Opportunities and Challenges for the American Association of Medical Dosimetrists

    Energy Technology Data Exchange (ETDEWEB)

    Mills, Michael D., E-mail: mdmill03@exchange.louisville.edu

    2015-07-01

    The American Association of Medical Dosimetrists (AAMD) designed and directed 2 surveys of the AAMD membership. The first was in 2011 and the second in 2014. There were a number of questions common to both surveys, and this article seeks to evaluate these common questions to determine trends among the professional membership of the AAMD. It is demonstrated that the observed trends are consistent with the goals and objectives established by the leadership of the AAMD and the Medical Dosimetry Certification Board (MDCB) for the medical dosimetry community. In addition, certain challenges and opportunities involving the scope of practice for the medical dosimetry profession are discussed.

  6. Medical Treatments for Endometriosis-Associated Pelvic Pain

    Directory of Open Access Journals (Sweden)

    Gabriella Zito

    2014-01-01

    Full Text Available The main sequelae of endometriosis are represented by infertility and chronic pelvic pain. Chronic pelvic pain causes disability and distress with a very high economic impact. In the last decades, an impressive amount of pharmacological agents have been tested for the treatment of endometriosis-associated pelvic pain. However, only a few of these have been introduced into clinical practice. Following the results of the controlled studies available, to date, the first-line treatment for endometriosis associated pain is still represented by oral contraceptives used continuously. Progestins represent an acceptable alternative. In women with rectovaginal lesions or colorectal endometriosis, norethisterone acetate at low dosage should be preferred. GnRH analogues may be used as second-line treatment, but significant side effects should be taken into account. Nonsteroidal anti-inflammatory drugs are widely used, but there is inconclusive evidence for their efficacy in relieving endometriosis-associated pelvic pain. Other agents such as GnRH antagonist, aromatase inhibitors, immunomodulators, selective progesterone receptor modulators, and histone deacetylase inhibitors seem to be very promising, but there is not enough evidence to support their introduction into routine clinical practice. Some other agents, such as peroxisome proliferator activated receptors-γ ligands, antiangiogenic agents, and melatonin have been proven to be efficacious in animal studies, but they have not yet been tested in clinical studies.

  7. Factors associated with the prescription of antidepressive medication to breast cancer patients

    DEFF Research Database (Denmark)

    Suppli, Nis P; Deltour, Isabelle; Damkjaer, Lars H

    2011-01-01

    We evaluated factors associated with use of antidepressant medication subsequent to a diagnosis of breast cancer. We also evaluated the effect of participation in a cancer rehabilitation program on use of antidepressants.......We evaluated factors associated with use of antidepressant medication subsequent to a diagnosis of breast cancer. We also evaluated the effect of participation in a cancer rehabilitation program on use of antidepressants....

  8. Is crime associated with over-the-counter pharmacy syringe sales? Findings from Los Angeles, California.

    Science.gov (United States)

    Stopka, Thomas J; Geraghty, Estella M; Azari, Rahman; Gold, Ellen B; DeRiemer, Kathryn

    2014-03-01

    More than 50,000 new HIV infections occur annually in the United States. Injection drug users represent twelve percent of incident HIV infections each year. Pharmacy sales of over-the-counter (OTC) syringes have helped prevent HIV transmission among injection drug users in many states throughout the United States. However, concerns exist among some law enforcement officials, policymakers, pharmacists, and community members about potential links between OTC syringe sales and crime. We used a geographic information system and novel spatial and longitudinal analyses to determine whether implementation of pharmacy-based OTC syringe sales were associated with reported crime between January 2006 and December 2008 in Los Angeles Police Department Reporting Districts. We assessed reported crime pre- and post-OTC syringe sales initiation as well as longitudinal associations between crime and OTC syringe-selling pharmacies. By December 2008, 9.3% (94/1010) of Los Angeles Police Department Reporting Districts had at least one OTC syringe-selling pharmacy. Overall reported crime counts and reported crime rates decreased between 2006 and 2008 in all 1010 Reporting Districts. Using generalized estimating equations and adjusting for potential confounders, reported crime rates were negatively associated with OTC syringe sales (adjusted rate ratio: 0.89; 95% confidence interval: 0.81, 0.99). Our findings demonstrate that OTC pharmacy syringe sales were not associated with increases in reported crime in local communities in Los Angeles during 2006-2008. Copyright © 2014 Elsevier B.V. All rights reserved.

  9. Rhizopus oryzae associated with Melanagromyza splendida and stem disease of sunflowers (Helianthus annuus) in California

    Science.gov (United States)

    In September 2012, a female parental line in a Yolo, CA in sunflower seed-production field began displaying external stem symptoms that could not be attributed to any known disease. Symptoms appeared to be associated with tunneling caused by an un-identified insect. Stems were collected and Rhizopu...

  10. Cytokine dysregulation associated with exam stress in healthy medical students.

    Science.gov (United States)

    Marshall, G D; Agarwal, S K; Lloyd, C; Cohen, L; Henninger, E M; Morris, G J

    1998-12-01

    The mechanisms of stress-related immune alterations have not been fully elucidated. Cell-mediated immune responses as well as antibody and certain cytokines are reported as being suppressed during times of high stress. However, the role of suppression vs dysregulation has not been established in human stress models. The effect of exam stress on regulatory cytokines in 16 healthy medical students was assessed by measuring type-1 (IFN-gamma) and type-2 (IL-10) cytokines from 72-h PHA/PMA-stimulated PBMC 4 weeks before and 48 h after exams. Results demonstrated decreased IFN-gamma accompanied by increased IL-10 during exam stress that resulted in a decreased IFN-gamma:IL-10 ratio. There was a significant correlation between the cytokine response to PHA/PMA and number and subjective adjustment to daily hassles. Additionally, students who reported greater levels of loneliness also reported greater numbers of and poorer subjective adjustment to hassles. The differences were consistent in both males and females but did not correlate with AM cortisol levels. Additionally, when individuals were grouped into high vs low preexam hassle levels, the type-1/type-2 shift in the IFN-gamma:IL-10 ratio occurred in the low hassles group only. These data suggest that psychologically stressful situations shift type-1/type-2 cytokine balance toward type-2 and result in an immune dysregulation rather than overall immunosuppression. This may partially explain the increased incidence of type-2-mediated conditions such as increased viral infections, latent viral expression, allergic/asthmatic reactions, and autoimmunity reported during periods of high stress. Copyright 1998 Academic Press.

  11. Association of academic stress with sleeping difficulties in medical students of a Pakistani medical school: a cross sectional survey

    Directory of Open Access Journals (Sweden)

    Ahmed Waqas

    2015-03-01

    Full Text Available Introduction. Medicine is one of the most stressful fields of education because of its highly demanding professional and academic requirements. Psychological stress, anxiety, depression and sleep disturbances are highly prevalent in medical students.Methods. This cross-sectional study was undertaken at the Combined Military Hospital Lahore Medical College and the Institute of Dentistry in Lahore (CMH LMC, Pakistan. Students enrolled in all yearly courses for the Bachelor of Medicine and Bachelor of Surgery (MBBS degree were included. The questionnaire consisted of four sections: (1 demographics (2 a table listing 34 potential stressors, (3 the 14-item Perceived Stress Scale (PSS-14, and (4 the Pittsburgh Quality of Sleep Index (PSQI. Logistic regression was run to identify associations between group of stressors, gender, year of study, student’s background, stress and quality of sleep.Results. Total response rate was 93.9% (263/280 respondents returned the questionnaire. The mean (SD PSS-14 score was 30 (6.97. Logistic regression analysis showed that cases of high-level stress were associated with year of study and academic-related stressors only. Univariate analysis identified 157 cases with high stress levels (59.7%. The mean (SD PSQI score was 8.1 (3.12. According to PSQI score, 203/263 respondents (77% were poor sleepers. Logistic regression showed that mean PSS-14 score was a significant predictor of PSQI score (OR 1.99, P < 0.05.Conclusion. We found a very high prevalence of academic stress and poor sleep quality among medical students. Many medical students reported using sedatives more than once a week. Academic stressors contributed significantly to stress and sleep disorders in medical students.

  12. Association of academic stress with sleeping difficulties in medical students of a Pakistani medical school: a cross sectional survey

    Science.gov (United States)

    Khan, Spogmai; Sharif, Waqar; Khalid, Uzma; Ali, Asad

    2015-01-01

    Introduction. Medicine is one of the most stressful fields of education because of its highly demanding professional and academic requirements. Psychological stress, anxiety, depression and sleep disturbances are highly prevalent in medical students. Methods. This cross-sectional study was undertaken at the Combined Military Hospital Lahore Medical College and the Institute of Dentistry in Lahore (CMH LMC), Pakistan. Students enrolled in all yearly courses for the Bachelor of Medicine and Bachelor of Surgery (MBBS) degree were included. The questionnaire consisted of four sections: (1) demographics (2) a table listing 34 potential stressors, (3) the 14-item Perceived Stress Scale (PSS-14), and (4) the Pittsburgh Quality of Sleep Index (PSQI). Logistic regression was run to identify associations between group of stressors, gender, year of study, student’s background, stress and quality of sleep. Results. Total response rate was 93.9% (263/280 respondents returned the questionnaire). The mean (SD) PSS-14 score was 30 (6.97). Logistic regression analysis showed that cases of high-level stress were associated with year of study and academic-related stressors only. Univariate analysis identified 157 cases with high stress levels (59.7%). The mean (SD) PSQI score was 8.1 (3.12). According to PSQI score, 203/263 respondents (77%) were poor sleepers. Logistic regression showed that mean PSS-14 score was a significant predictor of PSQI score (OR 1.99, P academic stress and poor sleep quality among medical students. Many medical students reported using sedatives more than once a week. Academic stressors contributed significantly to stress and sleep disorders in medical students. PMID:25802809

  13. Association of academic stress with sleeping difficulties in medical students of a Pakistani medical school: a cross sectional survey.

    Science.gov (United States)

    Waqas, Ahmed; Khan, Spogmai; Sharif, Waqar; Khalid, Uzma; Ali, Asad

    2015-01-01

    Introduction. Medicine is one of the most stressful fields of education because of its highly demanding professional and academic requirements. Psychological stress, anxiety, depression and sleep disturbances are highly prevalent in medical students. Methods. This cross-sectional study was undertaken at the Combined Military Hospital Lahore Medical College and the Institute of Dentistry in Lahore (CMH LMC), Pakistan. Students enrolled in all yearly courses for the Bachelor of Medicine and Bachelor of Surgery (MBBS) degree were included. The questionnaire consisted of four sections: (1) demographics (2) a table listing 34 potential stressors, (3) the 14-item Perceived Stress Scale (PSS-14), and (4) the Pittsburgh Quality of Sleep Index (PSQI). Logistic regression was run to identify associations between group of stressors, gender, year of study, student's background, stress and quality of sleep. Results. Total response rate was 93.9% (263/280 respondents returned the questionnaire). The mean (SD) PSS-14 score was 30 (6.97). Logistic regression analysis showed that cases of high-level stress were associated with year of study and academic-related stressors only. Univariate analysis identified 157 cases with high stress levels (59.7%). The mean (SD) PSQI score was 8.1 (3.12). According to PSQI score, 203/263 respondents (77%) were poor sleepers. Logistic regression showed that mean PSS-14 score was a significant predictor of PSQI score (OR 1.99, P academic stress and poor sleep quality among medical students. Many medical students reported using sedatives more than once a week. Academic stressors contributed significantly to stress and sleep disorders in medical students.

  14. Evaluation of medical research performance--position paper of the Association of the Scientific Medical Societies in Germany (AWMF).

    Science.gov (United States)

    Herrmann-Lingen, Christoph; Brunner, Edgar; Hildenbrand, Sibylle; Loew, Thomas H; Raupach, Tobias; Spies, Claudia; Treede, Rolf-Detlef; Vahl, Christian-Friedrich; Wenz, Hans-Jürgen

    2014-01-01

    The evaluation of medical research performance is a key prerequisite for the systematic advancement of medical faculties, research foci, academic departments, and individual scientists' careers. However, it is often based on vaguely defined aims and questionable methods and can thereby lead to unwanted regulatory effects. The current paper aims at defining the position of German academic medicine toward the aims, methods, and consequences of its evaluation. During the Berlin Forum of the Association of the Scientific Medical Societies in Germany (AWMF) held on 18 October 2013, international experts presented data on methods for evaluating medical research performance. Subsequent discussions among representatives of relevant scientific organizations and within three ad-hoc writing groups led to a first draft of this article. Further discussions within the AWMF Committee for Evaluation of Performance in Research and Teaching and the AWMF Executive Board resulted in the final consented version presented here. The AWMF recommends modifications to the current system of evaluating medical research performance. Evaluations should follow clearly defined and communicated aims and consist of both summative and formative components. Informed peer reviews are valuable but feasible in longer time intervals only. They can be complemented by objective indicators. However, the Journal Impact Factor is not an appropriate measure for evaluating individual publications or their authors. The scientific "impact" rather requires multidimensional evaluation. Indicators of potential relevance in this context may include, e.g., normalized citation rates of scientific publications, other forms of reception by the scientific community and the public, and activities in scientific organizations, research synthesis and science communication. In addition, differentiated recommendations are made for evaluating the acquisition of third-party funds and the promotion of junior scientists. With the

  15. Patient Experience with Care and its Association with Adherence to Hypertension Medications.

    Science.gov (United States)

    Fortuna, Robert J; Nagel, Angela K; Rocco, Thomas A; Legette-Sobers, Sharon; Quigley, Denise D

    2017-12-14

    Medication adherence is crucial to effective chronic disease management, yet little is known about the influence of the patient-provider interaction on medication adherence to hypertensive regimens. We aimed to examine the association between the patient's experience with care and medication adherence. We collected 2,128 surveys over 4 years from a convenience sample of hypertensive patients seeking care at three urban safety-net practices in upstate New York. The survey collected adherence measures using the Morisky Medication Adherence Scale (MMAS-8 ©) and patient experience measures. We used regression models to adjust for age, gender, race/ethnicity, self-reported health status and clustering by patients. The primary outcome was reporting of medium-to-high adherence (MMAS>=6) versus low adherence. A total of 62.5% of respondents reported medium-to-high medication adherence. The concern the provider demonstrated for patient questions or worries (AOR 1.4;95%CI 1.1-1.7), provider efforts to include the patient in decisions (AOR 1.5; 95%CI 1.8-1.9), information given (AOR 1.3; 95%CI 1.0-1.6), and the overall rating of care received (AOR 1.4; 95%CI 1.1-1.8) were associated with higher medication adherence. The amount of time the provider spent was not associated with medication adherence (AOR 1.2;95%CI 0.9-1.4). Medium-to-high medication adherence was in turn associated with increased hypertension control rates. Overall, better experiences with care were associated with higher adherence to hypertension regimens. However, the amount of time the provider spent with the patient was not statistically associated with medication adherence, suggesting that the quality of communication may be more important than the absolute quantity of time.

  16. Spatial and Temporal Dynamics of Fecal Coliform and Associated with Suspended Solids and Water within Five Northern California Estuaries.

    Science.gov (United States)

    Lewis, David J; Atwill, Edward R; Pereira, Maria das Graças C; Bond, Ronald

    2013-01-01

    Fecal coliform and associated with suspended solids (SS) and water in five northern California estuaries were studied to document process influences and water quality monitoring biases affecting indicator bacteria concentrations. We collected and analyzed 2371 samples during 10 sampling events for the five studied estuaries. Concentrations during wet-season stormflow conditions were greater than during wet-season base flow and dry-season base flow conditions. Results also document concentration gradients across the length of the studied estuaries and with depth of sample collection. Highest concentrations were associated with shallow samples collected furthest inland. Corresponding decreases occurred the deeper and closer to the estuary mouth a sample was collected. Results also identify direct relationships of wind speed and discharge velocity and indirect relationship of tide stage to indicator bacteria concentrations. Bacteria associated with suspended solids (SS), after conversion to the same units of measurement (mass), were three orders of magnitude greater than in the water fraction. However, the mean proportion contributed by SS to composite water sample concentrations was 8% (SE 0.3) for fecal coliform and 7% (SE 0.3) for . Bacteria from the SS proportion is related to seasonality, tide stage, and discharge velocity that are consistent with mechanisms for entrainment, transport of SS, and reduced particle settling. These results are important for both managing and monitoring these systems by improving sample spatial and temporal context and corresponding bacteria concentration values across the freshwater-saltwater interface. Copyright © by the American Society of Agronomy, Crop Science Society of America, and Soil Science Society of America, Inc.

  17. Educational and Relational Stressors Associated with Burnout in Korean Medical Students.

    Science.gov (United States)

    Seo, Ji-Hyun; Kim, Hye Jung; Kim, Bong-Jo; Lee, So-Jin; Bae, Hwa-Ok

    2015-10-01

    This study aimed to examine whether educational stressors and relational stressors are associated with burnout in medical students and to test social support as a moderator between stressors and burnout. A total of 263 medical students attending Gyeongsang National University composed the study sample. A standardized questionnaire was used to investigate educational and relational stressors, three dimensions of burnout, and social support of medical students. The findings showed that overall burnout is very high among Korean medical students, with 9.9% totally burned out. Educational and relational stressors were significantly associated with the risk of burnout in medical students after controlling for socio-demographics and health behaviors. Social support moderated educational and relational stressors on personal accomplishment, but did not moderate stressors on emotional exhaustion and depersonalization. Burnout level is substantially high among Korean medical students. Educational and relational stressors are significantly associated with burnout risk in Korean medical students. Social support had moderated educational and relational stressors on personal accomplishment. The results suggest that more social support for medical students is needed to buffer stressors on and burnout.

  18. Educational and Relational Stressors Associated with Burnout in Korean Medical Students

    Science.gov (United States)

    Seo, Ji-Hyun; Kim, Hye Jung; Kim, Bong-Jo; Lee, So-Jin

    2015-01-01

    Objective This study aimed to examine whether educational stressors and relational stressors are associated with burnout in medical students and to test social support as a moderator between stressors and burnout. Methods A total of 263 medical students attending Gyeongsang National University composed the study sample. A standardized questionnaire was used to investigate educational and relational stressors, three dimensions of burnout, and social support of medical students. Results The findings showed that overall burnout is very high among Korean medical students, with 9.9% totally burned out. Educational and relational stressors were significantly associated with the risk of burnout in medical students after controlling for socio-demographics and health behaviors. Social support moderated educational and relational stressors on personal accomplishment, but did not moderate stressors on emotional exhaustion and depersonalization. Conclusion Burnout level is substantially high among Korean medical students. Educational and relational stressors are significantly associated with burnout risk in Korean medical students. Social support had moderated educational and relational stressors on personal accomplishment. The results suggest that more social support for medical students is needed to buffer stressors on and burnout. PMID:26508955

  19. Prevalence and associated factors of stress, anxiety and depression among prospective medical students.

    Science.gov (United States)

    Yusoff, Muhamad Saiful Bahri; Abdul Rahim, Ahmad Fuad; Baba, Abdul Aziz; Ismail, Shaiful Bahari; Mat Pa, Mohamad Najib; Esa, Ab Rahman

    2013-04-01

    Many studies have reported that the prevalence of psychological distress among medical students during medical training was high. However, there are very few studies exploring on the psychological health of prospective medical students. This study aimed to determine the prevalence and associated factors for stress, anxiety and depression symptoms among the prospective medical students. A cross-sectional study was done on two cohorts of applicants to a public medical school. A total of 839 applicants were invited to participate in the study. The 21-item Depression Anxiety Stress Scale was administered to the applicants after they completed interviews. A total of 743 (92.2%) applicants took part in the study. The prevalence of moderate to extremely severe level of stress, anxiety and depression were 3.6%, 54.5% and 1.9%, respectively. Stress was significantly associated with extra-curricular activity (pstress and depression among entering medical students was low; however prevalence of anxiety was high which could be due to worry about the interviews to enter medical course. The associated factors of psychological distress among prospective medical students were related to academic, non-academic, parent education and cultural backgrounds. Copyright © 2012 Elsevier B.V. All rights reserved.

  20. Association of medical students' reports of interactions with the pharmaceutical and medical device industries and medical school policies and characteristics: a cross-sectional study.

    Directory of Open Access Journals (Sweden)

    James S Yeh

    2014-10-01

    Full Text Available Professional societies use metrics to evaluate medical schools' policies regarding interactions of students and faculty with the pharmaceutical and medical device industries. We compared these metrics and determined which US medical schools' industry interaction policies were associated with student behaviors.Using survey responses from a national sample of 1,610 US medical students, we compared their reported industry interactions with their schools' American Medical Student Association (AMSA PharmFree Scorecard and average Institute on Medicine as a Profession (IMAP Conflicts of Interest Policy Database score. We used hierarchical logistic regression models to determine the association between policies and students' gift acceptance, interactions with marketing representatives, and perceived adequacy of faculty-industry separation. We adjusted for year in training, medical school size, and level of US National Institutes of Health (NIH funding. We used LASSO regression models to identify specific policies associated with the outcomes. We found that IMAP and AMSA scores had similar median values (1.75 [interquartile range 1.50-2.00] versus 1.77 [1.50-2.18], adjusted to compare scores on the same scale. Scores on AMSA and IMAP shared policy dimensions were not closely correlated (gift policies, r = 0.28, 95% CI 0.11-0.44; marketing representative access policies, r = 0.51, 95% CI 0.36-0.63. Students from schools with the most stringent industry interaction policies were less likely to report receiving gifts (AMSA score, odds ratio [OR]: 0.37, 95% CI 0.19-0.72; IMAP score, OR 0.45, 95% CI 0.19-1.04 and less likely to interact with marketing representatives (AMSA score, OR 0.33, 95% CI 0.15-0.69; IMAP score, OR 0.37, 95% CI 0.14-0.95 than students from schools with the lowest ranked policy scores. The association became nonsignificant when fully adjusted for NIH funding level, whereas adjusting for year of education, size of school, and publicly

  1. Investment in Social Marketing Campaign to Reduce Stigma and Discrimination Associated with Mental Illness Yields Positive Economic Benefits to California.

    Science.gov (United States)

    Ashwood, J Scott; Briscombe, Brian; Collins, Rebecca L; Wong, Eunice C; Eberhart, Nicole K; Cerully, Jennifer; May, Libby; Roth, Beth; Burnam, M Audrey

    2017-01-01

    This article examines the potential impact of the California Mental Health Services Authority's stigma and discrimination reduction social marketing campaign on the use of adult behavioral health services, and it estimates the benefit-cost ratios.

  2. Substance abuse and batterer programmes in California, USA: factors associated with treatment outcomes.

    Science.gov (United States)

    Timko, Christine; Valenstein, Helen; Stuart, Gregory L; Moos, Rudolf H

    2015-11-01

    The association between substance abuse and intimate partner violence is quite robust. A promising area to improve treatment for the dual problems of substance abuse and violence perpetration is the identification of client characteristics and organisational and programme factors as predictors of health outcomes. Therefore, we examined associations of client, organisational and programme factors with outcomes in community health settings. Directors of 241 substance use disorder programmes (SUDPs) and 235 batterer intervention programmes (BIPs) reported outcomes of programme completion and substance use and violence perpetration rates at discharge; data collection and processing were completed in 2012. SUDPs having more female, non-white, younger, uneducated, unemployed and lower income clients reported lower completion rates. In SUDPs, private, for-profit programmes reported higher completion rates than public or private, non-profit programmes. SUDPs with lower proportions of their budgets from government sources, and higher proportions from client fees, reported better outcomes. Larger SUDPs had poorer programme completion and higher substance use rates. Completion rates in SUDPs were higher when clients could obtain substance- and violence-related help at one location, and programmes integrated violence-prevention contracting into care. In BIPs, few client, organisational and programme factors were associated with outcomes, but the significant factors associated with programme completion were consistent with those for SUDPs. Publicly owned and larger programmes, and SUDPs lacking staff to integrate violence-related treatment, may be at risk of poorer client outcomes, but could learn from programmes that perform well to yield better outcomes. © 2014 John Wiley & Sons Ltd.

  3. The Association of Antidepressant Medication and Body Weight Gain.

    Directory of Open Access Journals (Sweden)

    Sara Ranjbar

    2013-04-01

    Full Text Available Objective: To review the literature and discover which antidepressants are responsible for weight gain and then to discuss the areas with lack of adequate knowledge. Method: An electronic search was conducted through Medline, Pubmed, Cochrane library, and ScienceDirect. Forty nine empirical researches were identified and reviewed. Results: Amitriptyline, clomipramine, and mirtazapine have been associated with more weight gain induction in clinical studies, but not in animal-based studies. All TCAs have been reported to cause weight gain except protriptyline. MAOIs have been associated with weight gain. In SSRI group, citalopram and ecitalopram induce weight, yet mixed results exist for paroxetine and fluoxetine. Researches unanimously reported weight loss effect for bupropion. Some studies suggest contributing factors in the relationship of antidepressants with body weight changes including age, gender, base-line weights and treatment duration. Various results of different treatment durations have been reported in some cases but there are not continuous time-dependent studies for the influences of antidepressants on body weight changes. Conclusion: More studies are required to discover underlying mechanisms and the time-dependent effects of antidepressants on body weight changes.

  4. Burnout and its Associated Factors in Medical Students of Lahore, Pakistan.

    Science.gov (United States)

    Muzafar, Yumna; Khan, Hibbah H; Ashraf, Huma; Hussain, Waqas; Sajid, Hifsa; Tahir, Marium; Rehman, Abdul; Sohail, Aleena; Waqas, Ahmed; Ahmad, Waqas

    2015-11-29

    Burnout is a widely known phenomenon. It is defined as a state of prolonged physical and psychological exhaustion and is experienced virtually by every medical student due to the highly demanding nature of medical education. This study probes into the prevalence and psychosocial determinants of burnout in Pakistani medical students. A descriptive, cross-sectional study design and convenience (non-probability) sampling technique were employed in undergraduate medical students from years 1-5. A total of 777 medical students from two medical colleges were included in the study from May-August, 2014. An English version of the Copenhagen Burnout Inventory (CBI) and a series of demographic questions, intermixed with questions from other topics, were included in the questionnaire. Data was analysed by using SPSS ver.21. The majority of students were females and enrolled in the third year of MBBS. Of the medical students involved, 30.6% were found to have high/very high levels of burnout (Kristenson's burnout scoring). Although 38.7% of students said that they did not feel burned out after reading the definition of burnout given in the questionnaire, 35.9% out of these students actually had high levels of burnout according to CBI. According to the multiple regression analysis, burnout in medical students was significantly associated with age, gender, doctor parents, no help or no supportive resources (e.g., from colleagues), lack of time off, lack of belief in what you do, fear of big consequences of failure, family responsibilities, and uncertain future. Perception of teachers lacking leadership skills and doing too much study with little balance was associated with low burnout scores. There is a high prevalence of burnout in Pakistani medical students. The present study identifies several factors associated with burnout in Pakistani medical students. Although these factors are a part of daily life of medical students, their identification should prompt the use of

  5. Associations between adverse childhood experiences, student-teacher relationships, and non-medical use of prescription medications among adolescents.

    Science.gov (United States)

    Forster, Myriam; Gower, Amy L; Borowsky, Iris W; McMorris, Barbara J

    2017-05-01

    Few studies have investigated associations between adverse childhood experiences (ACE) and nonmedical use of prescription medication (NMUPM) in population-based samples of adolescents, and even fewer have examined whether promotive factors might buffer these effects. The present study assesses the direct effects of ACE and positive student-teacher relationships on NUMPD and whether positive student-teacher relationships moderate this association. Data were from the 2013 Minnesota Student Survey (MSS), an in-school survey administered every three years to students throughout Minnesota. The analytic sample (n=104,332) was comprised of 8th, 9th, and 11th graders. Approximately 3% of students acknowledged past year NMUPM, the majority of whom reported at least one ACE. The most frequently used prescription drug was Ritalin/ADHD medications (1.71%) followed by opiate-based painkillers (1.67%), tranquilizers (0.92%), and stimulants (0.75%). Students who reported any use tended to use more than one medication. For every additional ACE, there was a 56%, 51%, 47%, and 52% increase in the odds of past year stimulant use, ADHD medication, pain reliever, and tranquilizer use, respectively. The estimated rate of the number of prescription drugs used increased by 62% for every additional ACE. Positive student- teacher relationships buffered the association between ACE and NMUPD, especially at higher levels of ACEs. Our findings have important implications for prevention work. Training educators to recognize trauma symptomology and cultivating strong student-teacher relationships are important considerations for future school-based substance use prevention initiatives. Copyright © 2017 Elsevier Ltd. All rights reserved.

  6. Self-Medication Practice and Associated Factors among Residents in Wuhan, China

    Directory of Open Access Journals (Sweden)

    Xiaosheng Lei

    2018-01-01

    Full Text Available Background: This study aims to examine the prevalence and predictors associated with self-medication, and related consequences in Wuhan, China. Methods: Two-hundred-sixty residents were interviewed from randomly selected four districts of Wuhan, China. A modified version of Anderson’s health behavioral model was used in the survey to collect information of self-medication behavior. Multivariable logistic regression analyses were used to measure correlates of the prevalence of self-medication. Results: Nearly half of the respondents would select self-medication, and 39.1% would see a doctor if they felt sick. The most common self-medicated illnesses were cold and cough, cardiovascular disease and gastrointestinal disease. The main reasons for self-medication were that the illness was not severe (enough to see the doctor (45%; the patient did not think that the trouble of seeing a doctor was worth the effort (23%; the patient had no time to see the doctor (12%, and the patient did not want to pay high medical costs (15%. Logistic regression results suggested that respondents tended to select self-medication if the illness was minor or short-term (less than seven days. Conclusions: Our findings suggest that more strict regulation on over-the-counter medicines may be required to reduce health risks related to self-medication. Targeted health education on the risks of self-medication should be considered.

  7. Careers in Medical Physics and the American Association of Physicists in Medicine

    Science.gov (United States)

    Amols, Howard

    2006-03-01

    The American Association of Physicists in Medicine (AAPM), a member society of the AIP is the largest professional society of medical physicists in the world with nearly 5700 members. Members operate in medical centers, university and community hospitals, research laboratories, industry, and private practice. Medical physics specialties include radiation therapy physics, medical diagnostic and imaging physics, nuclear medicine physics, and medical radiation safety. The majority of AAPM members is based in hospital departments of radiation oncology or radiology and provide technical support for patient diagnosis and treatment in a clinical environment. Job functions include support of clinical care, calibration and quality assurance of medical devices such as linear accelerators for cancer therapy, CT, PET, MRI, and other diagnostic imaging devices, research, and teaching. Pathways into a career in medical physics require an advanced degree in medical physics, physics, engineering, or closely related field, plus clinical training in one or more medical physics specialties (radiation therapy physics, imaging physics, or radiation safety). Most clinically based medical physicists also obtain certification from the American Board of Radiology, and some states require licensure as well.

  8. The association between parental socioeconomic status (SES) and medical students' personal and professional development.

    Science.gov (United States)

    Fan, Angela P C; Chen, Chen-Huan; Su, Tong-Ping; Shih, Wan-Jing; Lee, Chen-Hsen; Hou, Sheng-Mou

    2007-09-01

    In order to commit to their mission and placement requirements, medical education policy-makers are required to understand the background and character of students in order to admit, cultivate and support them efficiently and effectively. This study sample consisted of 408 homogeneous medical students with the same level of education, occupation, school and societal environment. They differed mainly in their family background. Therefore, this study used part of a multidimensional "student portfolio system" database to assess the correlation between family status (indexed by parental education and occupation) and medical students' mental health status and characters. The controls were a group of 181 non-medical students in another university. The parents of the medical students were from a higher socioeconomic status (SES) than the parents of those in the control group. This showed the heritability of genetic and environment conditions as well as the socioeconomic forces at play in medical education. Students' personal and professional development were associated with their parents' SES. The mother's SES was associated with the student's selfreported stress, mental disturbances, attitude towards life, personality, health, discipline, internationalisation and professionalism. The fathers' SES did not show a statistically significant association with the above stress, physical and mental health factors, but showed an association with some of the personality factors. The greater the educational difference between both parents, the more stress, hopelessness and pessimism the student manifested. Medical educators need to be aware that socioeconomic factors have meaningful patterns of association with students' mental and physical health, and their characters relating to personal and professional development. Low maternal SES negatively influences medical students' personal and professional development, suggesting that medical education policy-makers need to initiate

  9. Cultural values associated with substance use among Hispanic adolescents in southern California.

    Science.gov (United States)

    Soto, Claradina; Unger, Jennifer B; Ritt-Olson, Anamara; Soto, Daniel W; Black, David Scott; Baezconde-Garbanati, Lourdes

    2011-01-01

    Cultural values can shape people's attitudes toward substance use and influence their risk of experimentation with drugs. This article examines the relationships between cultural values (familism, respeto, and machismo), fatalism (a culturally encouraged personality disposition), and substance use among Hispanic adolescents. In 2005, cross-sectional data were collected from 1,616 Hispanic ninth grade students in Los Angeles. Each cultural value was associated with lifetime substance use; however, these relationships depended on the type of substance and gender. Our findings suggest that it might be useful to incorporate the cultural values and address the personality trait of fatalism in prevention programs for Hispanic adolescents. The study's limitations are noted.

  10. Discovering medical conditions associated with periodontitis using linked electronic health records

    Science.gov (United States)

    Boland, Mary Regina; Hripcsak, George; Albers, David J.; Wei, Ying; Wilcox, Adam B.; Wei, Jin; Li, Jianhua; Lin, Steven; Breene, Michael; Myers, Ronnie; Zimmerman, John; Papapanou, Panos N.; Weng, Chunhua

    2013-01-01

    Aim To use linked electronic medical and dental records to discover associations between periodontitis and medical conditions independent of a priori hypotheses. Materials and Methods This case-control study included 2475 patients who underwent dental treatment at the College of Dental Medicine at Columbia University and medical treatment at NewYork-Presbyterian Hospital. Our cases are patients who received periodontal treatment and our controls are patients who received dental maintenance but no periodontal treatment. Chi-square analysis was performed for medical treatment codes and logistic regression was used to adjust for confounders. Results Our method replicated several important periodontitis associations in a largely Hispanic population, including diabetes mellitus type I (OR = 1.6, 95% CI 1.30–1.99, p diabetes, obesity, lipid and circulatory system conditions, alcohol and tobacco abuse. Conclusions This study contributes a high-throughput method for associating periodontitis with systemic diseases using linked electronic records. PMID:23495669

  11. The association of consumer expectations, experiences and satisfaction with newly prescribed medications.

    Science.gov (United States)

    Kumar, Ritesh N; Kirking, Duane M; Hass, Steven L; Vinokur, Amiram D; Taylor, Stephanie D; Atkinson, Mark J; McKercher, Patrick L

    2007-09-01

    To examine the association between medication expectations and subsequent experience on treatment satisfaction and intention to continue using the medication. A longitudinal study with two surveys administered to each patient. Patients prescribed a new medication were recruited in pharmacies within Michigan. Medication-related expectations were evaluated at baseline. Experiences, satisfaction and intent to continue were evaluated a month later. Analyses used included factorial ANOVA models, multiple linear regressions and structural equation modeling (SEM). Impact of satisfaction on intention to continue was evaluated using correlation analysis and SEM. A total of 344 usable responses were obtained. SEM showed that expectation scores were not associated with both experience (path coefficient = 0.10) and satisfaction (path coefficient = 0.02, NS). On the other hand, experience was strongly associated with satisfaction (path coefficient = 0.89) and satisfaction was strongly associated with intent to continue using the new medication (path coefficient = 0.81). This study empirically supports the value of the patient's experience and its contribution to satisfaction, which in turn is associated with intended continued use mainly due to greater effectiveness of the newly prescribed medication. Satisfied consumers should be more adherent, thus enhancing the probability of positive therapeutic outcomes.

  12. Online nutrition and T2DM continuing medical education course launched on state-level medical association.

    Science.gov (United States)

    Hicks, Kristen K; Murano, Peter S

    2017-01-01

    The purpose of this research study was to determine whether a 1-hour online continuing medical education (CME) course focused on nutrition for type 2 diabetes would result in a gain in nutrition knowledge by practicing physicians. A practicing physician and dietitian collaborated to develop an online CME course (both webinar and self-study versions) on type 2 diabetes. This 1-hour accredited course was launched through the state-level medical association's education library, available to all physicians. Physicians (n=43) registered for the course, and of those, 31 completed the course in its entirety. A gain in knowledge was found when comparing pre- versus post-test scores related to the online nutrition CME (POnline CME courses launched via state-level medical associations offer convenient continuing education to assist practicing physicians in addressing patient nutrition and lifestyle concerns related to chronic disease. The present diabetes CME one-credit course allowed physicians to develop basic nutrition care concepts on this topic to assist patients in a better way.

  13. Medical Expenditures Associated With Hypertension in the U.S., 2000-2013.

    Science.gov (United States)

    Zhang, Donglan; Wang, Guijing; Zhang, Ping; Fang, Jing; Ayala, Carma

    2017-12-01

    Trends of prevalence, treatment, and control of hypertension have been documented in the U.S., but changes in medical expenditures associated with hypertension over time have not been evaluated. This study analyzed these expenditures during 2000-2013 among U.S. adults. Data from the Medical Expenditure Panel Survey were analyzed in 2016. The study population was non-institutionalized men and non-pregnant women aged ≥18 years. Hypertension was defined as ever been diagnosed with hypertension or currently taking antihypertensive medications. Medical expenditures included all payments to medical care providers. Expenditures associated with hypertension were estimated by two-part regression models and adjusted into 2015 U.S. dollars. Controlling variables included sociodemographic characteristics, marital status, insurance, region, smoking status, weight status, health status, and comorbidities. Trends were analyzed using joinpoint method. Total per-person annual expenditures associated with hypertension in 2000-2001 ($1,399) were not significantly different from those in 2012-2013 ($1,494) (average annual percent change [AAPC]= -0.6%, p=0.794), but annual national spending increased significantly from $58.7 billion to $109.1 billion (AAPC=8.3%, p=0.015), mainly because of the increase in the number of people treated for hypertension. Per-person outpatient payments were 22.7% higher in 2012-2013 than in 2000-2001 ($416 vs $322, p<0.05; AAPC=0.8%, p-trend=0.826). Payments for prescription medications took up a larger proportion of the medical expenditures associated with hypertension, compared to payments for outpatient or other services (33%-46%). During 2000-2013, annual national medical expenditures associated with hypertension increased significantly. Preventing hypertension could alleviate hypertension-associated economic burden. Copyright © 2017 American Journal of Preventive Medicine. All rights reserved.

  14. A Competency-Based Clinical Chemistry Course for the Associate Degree Medical Laboratory Technician Graduate in a Medical Technology Baccalaureate Program.

    Science.gov (United States)

    Buccelli, Pamela

    Presented is a project that developed a competency-based clinical chemistry course for associate degree medical laboratory technicians (MLT) in a medical technology (MT) baccalaureate program. Content of the course was based upon competencies expected of medical technologists at career-entry as defined in the statements adopted in 1976 by the…

  15. Aquatic macroinvertebrates associated with Schoenoplectus litter in a constructed wetland in California (USA)

    Science.gov (United States)

    Nelson, S. M.; Thullen, J.S.

    2008-01-01

    Culm processing characteristics were associated with differences in invertebrate density in a study of invertebrates and senesced culm packs in a constructed treatment wetland. Invertebrate abundance differed by location within the wetland and there were differences between the two study years that appeared to be related to water quality and condition of culm material. Open areas in the wetland appeared to be critical in providing dissolved oxygen (DO) and food (plankton) to the important invertebrate culm processor, Glyptotendipes. As culm packs aged, invertebrate assemblages became less diverse and eventually supported mostly tubificid worms and leeches. It appears from this study that wetland design is vital to processing of plant material and that designs that encourage production and maintenance of high DO's will encourage microbial and invertebrate processing of material.

  16. Evaluation of medical research performance – position paper of the Association of the Scientific Medical Societies in Germany (AWMF

    Directory of Open Access Journals (Sweden)

    Herrmann-Lingen, Christoph

    2014-06-01

    Full Text Available [english] Objective: The evaluation of medical research performance is a key prerequisite for the systematic advancement of medical faculties, research foci, academic departments, and individual scientists’ careers. However, it is often based on vaguely defined aims and questionable methods and can thereby lead to unwanted regulatory effects. The current paper aims at defining the position of German academic medicine toward the aims, methods, and consequences of its evaluation. Methods: During the Berlin Forum of the Association of the Scientific Societies in Germany (AWMF held on 18 October 2013, international experts presented data on methods for evaluating medical research performance. Subsequent discussions among representatives of relevant scientific organizations and within three ad-hoc writing groups led to a first draft of this article. Further discussions within the AWMF Committee for Evaluation of Performance in Research and Teaching and the AWMF Executive Board resulted in the final consented version presented here.Results: The AWMF recommends modifications to the current system of evaluating medical research performance. Evaluations should follow clearly defined and communicated aims and consist of both summative and formative components. Informed peer reviews are valuable but feasible in longer time intervals only. They can be complemented by objective indicators. However, the Journal Impact Factor is not an appropriate measure for evaluating individual publications or their authors. The scientific “impact” rather requires multidimensional evaluation. Indicators of potential relevance in this context may include, e.g., normalized citation rates of scientific publications, other forms of reception by the scientific community and the public, and activities in scientific organizations, research synthesis and science communication. In addition, differentiated recommendations are made for evaluating the acquisition of third

  17. Acute Hyperglycemia Associated with Anti-Cancer Medication

    Directory of Open Access Journals (Sweden)

    Yul Hwangbo

    2017-03-01

    Full Text Available Hyperglycemia during chemotherapy occurs in approximately 10% to 30% of patients. Glucocorticoids and L-asparaginase are well known to cause acute hyperglycemia during chemotherapy. Long-term hyperglycemia is also frequently observed, especially in patients with hematologic malignancies treated with L-asparaginase-based regimens and total body irradiation. Glucocorticoid-induced hyperglycemia often develops because of increased insulin resistance, diminished insulin secretion, and exaggerated hepatic glucose output. Screening strategies for this condition include random glucose testing, hemoglobin A1c testing, oral glucose loading, and fasting plasma glucose screens. The management of hyperglycemia starts with insulin or sulfonylurea, depending on the type, dose, and delivery of the glucocorticoid formulation. Mammalian target of rapamycin (mTOR inhibitors are associated with a high incidence of hyperglycemia, ranging from 13% to 50%. Immunotherapy, such as anti-programmed death 1 (PD-1 antibody treatment, induces hyperglycemia with a prevalence of 0.1%. The proposed mechanism of immunotherapy-induced hyperglycemia is an autoimmune process (insulitis. Withdrawal of the PD-1 inhibitor is the primary treatment for severe hyperglycemia. The efficacy of glucocorticoid therapy is not fully established and the decision to resume PD-1 inhibitor therapy depends on the severity of the hyperglycemia. Diabetic patients should achieve optimized glycemic control before initiating treatment, and glucose levels should be monitored periodically in patients initiating mTOR inhibitor or PD-1 inhibitor therapy. With regard to hyperglycemia caused by anti-cancer therapy, frequent monitoring and proper management are important for promoting the efficacy of anti-cancer therapy and improving patients' quality of life.

  18. Medical Students' Death Anxiety: Severity and Association With Psychological Health and Attitudes Toward Palliative Care.

    Science.gov (United States)

    Thiemann, Pia; Quince, Thelma; Benson, John; Wood, Diana; Barclay, Stephen

    2015-09-01

    Death anxiety (DA) is related to awareness of the reality of dying and death and can be negatively related to a person's psychological health. Physicians' DA also may influence their care for patients approaching death. Doctors face death in a professional context for the first time at medical school, but knowledge about DA among medical students is limited. This study examined medical students' DA in relation to: 1) its severity, gender differences, and trajectory during medical education and 2) its associations with students' attitudes toward palliative care and their psychological health. Four cohorts of core science and four cohorts of clinical students at the University of Cambridge Medical School took part in a questionnaire survey with longitudinal follow-up. Students who provided data on the revised Collett-Lester Fear of Death Scale were included in the analysis (n = 790). Medical students' DA was moderate, with no gender differences and remained very stable over time. High DA was associated with higher depression and anxiety levels and greater concerns about the personal impact of providing palliative care. The associations between high DA and lower psychological health and negative attitudes toward palliative care are concerning. It is important to address DA during medical education to enhance student's psychological health and the quality of their future palliative care provision. Copyright © 2015 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

  19. The prevalence of medical student mistreatment and its association with burnout.

    Science.gov (United States)

    Cook, Alyssa F; Arora, Vineet M; Rasinski, Kenneth A; Curlin, Farr A; Yoon, John D

    2014-05-01

    Medical student mistreatment has been recognized for decades and is known to adversely impact students personally and professionally. Similarly, burnout has been shown to negatively impact students. This study assesses the prevalence of student mistreatment across multiple medical schools and characterizes the association between mistreatment and burnout. In 2011, the authors surveyed a nation ally representative sample of third-year medical students. Students reported the frequency of experiencing mistreatment by attending faculty and residents since the beginning of their clinical rotations. Burnout was measured using a validated two-item version of the Maslach Burnout Inventory. Of 960 potential respondents from 24 different medical schools, 605 (63%) completed the survey, but 41 were excluded because they were not currently in their third year of medical school. Of the eligible students, the majority reported experiencing at least one incident of mistreatment by faculty (64% [361/562]) and by residents (76% [426/562]). A minority of students reported experiencing recurrent mistreatment, defined as occurring "several" or "numerous" times: 10% [59/562] by faculty and 13% [71/562] by residents. Recurrent mistreatment (compared with no or infrequent mistreatment) was associated with high burnout: 57% versus 33% (P student mistreatment remains prevalent. Recurrent mistreatment by faculty and residents is associated with medical student burnout. Although further investigation is needed to assess causality, these data provide impetus for medical schools to address student mistreatment to mitigate its adverse consequences.

  20. Prevalence and factors associated with self-medication in rheumatology in Sub-Saharan Africa

    Science.gov (United States)

    Ouédraogo, Dieu-Donné; Zabsonré/Tiendrebeogo, Joelle W; Zongo, Enselme; Kakpovi, Kodjo Geoffroy; Kaboré, Fulgence; Drabo, Joseph Y; Guissou, Innocent Pierre

    2015-01-01

    Objective We sought to determine the prevalence of and factors associated with self-medication in patients with rheumatic diseases. Material and Methods An analytical cross-sectional study was conducted from February to July 2013 in the rheumatology department. We included all patients who consulted for a rheumatic disease during the study period and who gave their consent. Results In total, 203 patients were included; of these, 146 patients (71.92%) had practiced self-medication. Furthermore, 99 patients (48.8%) had practiced self-medication for rheumatologic problems. The mean age of the patients was 45.5 years (range: 18–75 years). State officials accounted for 44.4% of patients. Eighty-one patients were schooled. Low back pain (29.29%) was the main reason for consultation, followed by polyarthralgia (12.12%). Using a visual analogue scale, the level of pain for which patients had used self-medication was rated as >70 out of 100 in 57.6% of patients. Fifty-five patients often self-medicated and 28 patients rarely. Drugs were bought from the pharmacy in 97% of cases. The main channel of self-medication was word of mouth (43.4%). The drugs used were mainly anti-inflammatory drugs (diclofenac: 54.54% and ibuprofen: 57.57%). Ten patients were unaware of the risks of self-medication. In multivariate analysis, sex, education level, and occupation were statistically associated with self-medication. Conclusion Self-medication for a specific rheumatologic symptom appears less common than self-medication in general. The procedures for responsible self-medication should be defined in Burkina Faso in order to minimize the risks. PMID:27708926

  1. Empirical medical therapy for idiopathic male infertility: a survey of the American Urological Association.

    Science.gov (United States)

    Ko, Edmund Y; Siddiqi, Kashif; Brannigan, Robert E; Sabanegh, Edmund S

    2012-03-01

    We determined empirical medical therapy practice patterns for idiopathic infertility. We performed a survey of 7,745 practicing American Urological Association members from July to November 2010. Respondents were questioned on empirical medical therapy use, patient evaluation and selection, and preferred medications. A total of 387 urologists (5%) participated in the survey, of whom 16% had infertility fellowship training, two-thirds used empirical medical therapy and 78% treated with empirical medical therapy and surgery. Laboratory values important for identifying ideal candidates include sperm concentration, serum follicle-stimulating hormone and serum testosterone. The most common medications used were clomiphene citrate, human chorionic gonadotropin and anastrozole. Of respondents 25% would treat infertile males with testosterone while the patient actively pursued pregnancy. Overall 60.5% of respondents would treat with empirical therapy for 3 to 6 months. Of fellowship trained and general urologist respondents 70% and 47%, respectively, counseled patients that empirical medical therapy has unknown effects on pregnancy and sperm count. Empirical medical therapy is used by two-thirds of survey respondents for idiopathic male infertility. There is no clear, universal pattern to the evaluation or identification of the ideal patient for such therapy among those surveyed. There is no consensus on the optimal medication and considerable ambiguity exists as to perceived effects on fertility. Of concern is that 25% of respondents use exogenous testosterone, a medication known for its contraceptive potential, for male infertility treatment. These findings confirm the need for additional studies to establish recommendations on the empirical use of medical therapy in the setting of male infertility. Copyright © 2012 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  2. Longitudinal evaluation of medication underuse in older outpatients and its association with quality of life.

    Science.gov (United States)

    Meid, Andreas D; Quinzler, Renate; Groll, Andreas; Wild, Beate; Saum, Kai-Uwe; Schöttker, Ben; Heider, Dirk; König, Hans-Helmut; Brenner, Hermann; Haefeli, Walter E

    2016-07-01

    We investigated the factors promoting prescribing omissions (medication underuse) in long-term medical care and the impact of withholding indicated medications on quality of life. In a population-based cohort study of older ambulatory patients (ESTHER), we collected data with sequential questionnaires from participants and from their GPs. Concurrently, in two consecutive home visits, trained study physicians performed comprehensive geriatric assessments and recorded all medicines currently taken. Each patient's medication was screened for underuse using the START-2 criteria. Medication underuse (absence of ≥1 indicated medication) was present in 70.3 and 73.2 % of 989 participants at two consecutive home visit assessments, respectively. Following variable selection accounting for subject-specific heterogeneity over time, multivariate results revealed that more drugs (odds ratio with 95 % confidence intervals: 0.83 [0.78;0.87] per drug) and better cognitive status (0.93 [0.87;0.99] per point on the MMSE scale) were preventive factors, while worse self-reported health status (1.33 [1.05;1.67] per point on an 5-point scale) and increasing frequency of GP consultations (1.07 [1.00;1.15] per visit within the preceding 3 months) were positively associated with medication underuse. An increase in omitted medications over time was associated with worse quality of life as determined on the EuroQuol EQ-Vas and EQ-5D scales. In addition to general and physician-related factors, also patient-related aspects, such as individual health appraisal, were associated with medication underuse. Because withholding indicated drugs was associated with substantially reduced quality of life, controlled intervention studies are necessary to confirm the notion that pharmacological appropriateness improves personal wellbeing.

  3. Survey of teaching/learning of healthcare-associated infections in UK and Irish medical schools.

    LENUS (Irish Health Repository)

    O'Brien, D

    2009-10-01

    All medical doctors have an important role to play in the diagnosis, management and prevention of healthcare-associated infection (HCAI). Strengthening the contribution of medical doctors and medical students to HCAI prevention programmes should include measures that enhance knowledge, improve practice and develop appropriate attitudes to the safety and quality of patient care. The Hospital Infection Society (HIS) funded a review of medical education on HCAI throughout medical schools in the UK and the Republic of Ireland. A questionnaire was drafted and circulated to all medical schools and 31 of 38 (82%) responded. The prevalence and transmission of HCAI were taught by 97% and 100% of medical schools, respectively, but the importance of HCAI as a quality and safety issue was covered in only 60% of medical schools. Multiple choice questions (MCQs) and objective structure clinical examinations (OSCEs) were the most popular methods of assessment. Lectures, discussion of cases and practical demonstrations were considered useful by >90% of respondents and online material and log books by 67% and 60%, respectively. More than 80% were willing to share a common pool of educational resources. An agreed curriculum should be developed for educating medical students in HCAI prevention and control, to outline optimum methods for assessment and develop a shared pool of educational resources.

  4. Association of the optic disc structure with the use of antihypertensive medications: the thessaloniki eye study.

    Science.gov (United States)

    Harris, Alon; Topouzis, Fotis; Wilson, M Roy; Founti, Panayiota; Kheradiya, Nisha Shah; Anastasopoulos, Eleftherios; Gong, Gordon; Yu, Fei; Jonescu-Cuypers, Christian P; Pappas, Theofanis; Koskosas, Archimidis; Coleman, Anne L

    2013-09-01

    To investigate the association of antihypertensive medications with optic disc structure by blood pressure (BP) level, in nonglaucoma subjects. Cross-sectional, population-based study. A subset of Thessaloniki Eye Study participants was included in this study. Subjects were interviewed for medical history and underwent extensive ophthalmic examination, BP measurement, and optic disc imaging with the Heidelberg retinal tomograph. Subjects treated for hypertension were grouped in the following groups: (1) angiotensin-converting enzyme inhibitors and/or angiotensin-receptor blockers; (2) beta blockers and/or calcium-channel blockers; (3) diuretics alone or combined with others; and (4) other combinations. Cup size and cup-to-disc (C/D) ratio in the above groups were compared with the untreated group, using regression models. Analyses were rerun for subjects with systolic BP (SBP)<140 mm Hg, SBP≥140 mm Hg, diastolic BP (DBP)<90 mm Hg, and DBP≥90 mm Hg. Among 232 subjects, 131 were receiving antihypertensive medications. In subjects with DBP<90 mm Hg, all medications groups were associated with larger cup size and higher C/D ratio compared with the untreated group. Results were similar in subjects with SBP<140 mm Hg, with the exception of the beta blockers and/or calcium-channel blockers group. None of the medications groups were associated with the Heidelberg retinal tomograph parameters in those with DBP≥90 mm Hg or SBP≥140 mm Hg. All classes of antihypertensive medications were associated with larger cup size and higher C/D ratio in subjects with either DBP<90 mm Hg or SBP<140 mm Hg. These results suggest that there is no specific medication-related effect on optic disc structure, and the associations found are mediated through the hypotensive effect of antihypertensive medications.

  5. Factors associated with medication adherence among heart failure patients and their caregivers.

    Science.gov (United States)

    Aggarwal, Brooke; Pender, Ashley; Mosca, Lori; Mochari-Greenberger, Heidi

    Reducing the rate of rehospitalization among heart failure patients is a major public health challenge; medication non-adherence is a crucial factor shown to trigger rehospitalizations. Objective: To collect pilot data to inform the design of educational interventions targeted to heart failure patients and their caregivers to improve medication adherence. Heart failure patients with an implantable cardioverter defibrillator and their family caregivers were recruited from an outpatient electrophysiology clinic at an urban university medical center (N = 10 caregiver and patient dyads, 70% race/ethnic minority, mean patient age = 63 years). Quantitative and qualitative research methods were utilized. Semi-structured individual interviews were conducted to assess patients' and caregivers' individual interest in, and access to, new medication adherence technologies. Patient adherence to medications, medication self-efficacy, and depression were assessed by validated questionnaires. Medication adherence and hospitalization rates were assessed among patients at 30-days post-clinic visit by mailed survey. At baseline, 60% of patients reported sometimes forgetting to take their medications. The most common factors associated with non-adherence included forgetfulness (50%), having other medications to take (20%), and being symptom-free (20%). At 30-day follow-up, half of patients reported non-adherence to their medications, and 1 in 10 reported being hospitalized within the past month. Dyads reported widespread access to technology, with the majority of dyads showing interest in mobile applications and text messaging. There was less acceptance of medication-dispensing technologies; caregivers and patients were concerned about added burden. The majority of etiologies of medication non-adherence were subject to intervention. Enthusiasm from patients and caregivers in new technologies to aid in adherence was tempered by potential burden, and should be considered when designing

  6. 77 FR 38631 - Request for Comments on Ethical Issues Associated with the Development of Medical Countermeasures...

    Science.gov (United States)

    2012-06-28

    ... HUMAN SERVICES Request for Comments on Ethical Issues Associated with the Development of Medical... Commission for the Study of Bioethical Issues is requesting public comment on the ethical issues associated... countermeasures in children.'' Accordingly, the Commission is examining ethical issues surrounding the development...

  7. Epidermal Nevus Syndrome Associated with Brain Malformations and Medulloblastoma

    Directory of Open Access Journals (Sweden)

    J Gordon Millichap

    2013-01-01

    Full Text Available Researchers at Juntendo University and Tokyo Women’s Medical University, Japan; and University of California, San Francisco, Ca, report a male infant with epidermal nevus syndrome associated with brainstem and cerebellar malformations and neonatal medulloblastoma.

  8. Association of Social Support and Medication Adherence in Chinese Patients with Type 2 Diabetes Mellitus

    Directory of Open Access Journals (Sweden)

    Linni Gu

    2017-12-01

    Full Text Available The prevalence of diabetes is steadily increasing in China. When diabetes is uncontrolled, it generates dire consequences for health and well-being. Numerous studies have shown that health outcomes were associated with social support and medication adherence. Previous study confirmed that social support was associated with medication adherence in patients with heart failure, HIV diseases, and first-episode psychosis. However, the relationship between social support and medication adherence in patients with type 2 diabetes mellitus (T2DM is remains unclear. This study aims to examine whether social support is associated with medication adherence in patients with T2DM. This study was conducted in the First Affiliated Hospital of the General Hospital of the People’s Liberation Army (PLA. In Beijing, a systematic random sample of 412 patients with T2DM over 18 years was recruited at baseline, and demographic characteristics, clinical data and their assessment of social support were collected from medical records and self-reported questionnaires. 330 of these patients completed a self-report measure of medication adherence at the sixth month after baseline data collection. Regression analysis showed that social support presented a positive effect on medication adherence, additionally, support utilization and the subscale of social support exhibited a significantly strong influence on medication adherence in patients with T2DM. Although medication adherence was influenced by multiple factors, this finding confirmed that social support must be recognized as a core element in interventions aimed at improving in the management of patients with T2DM.

  9. Factors associated with medication adherence in patients with epilepsy and recommendations for improvement.

    Science.gov (United States)

    Paschal, Angelia M; Rush, Sarah E; Sadler, Toni

    2014-02-01

    Although it is one of the most common neurological disorders, epilepsy continues to be a highly stigmatized and disabling chronic condition. Healthy People 2020 aims for improvement in the health-related quality of life and well-being of Americans, including these medically vulnerable patients. Efforts to research and improve medication adherence in this population and others with chronic conditions are an important step towards this end. The purpose of this study was to investigate factors associated with adherence and to provide recommendations for improvement. A cross-sectional survey research design was used in a convenience sample of patients receiving treatment at a tertiary epilepsy center. Adherence was measured by self-reported missed/skipped medication doses and seizure frequencies and by the presence of intractable seizures as indicated in patients' medical charts. Analysis was conducted with SPSS 21.0 on the data collected from the returned mailed surveys. Among the sample of 180 patients, most had some education beyond high school, household incomes of varying amounts, and health insurance coverage. Most of the participants were unemployed. Clinical records showed that 46% had intractable seizures. About 66% missed taking their medication on a monthly basis, with "forgetfulness" being the primary reason. Adherence (seizure frequency) was associated with being employed (P=.028). Adherence (complying with medication treatment plan) was also associated with "medication reminders" (P=.002) and educational attainment (P=.008). The findings indicate a continued need to explore the complex issue of adherence. The findings also highlight the need for health education and other public health and medical professionals to design effective strategies to connect patients with employment opportunities and other resources. Efforts are also needed to help provide information and build skills among patients with epilepsy that would lead to improved medication adherence

  10. Patterns of acetaminophen medication use associated with exceeding the recommended maximum daily dose.

    Science.gov (United States)

    Shiffman, Saul; Rohay, Jeffrey M; Battista, Deena; Kelly, Judith P; Malone, Mary K; Weinstein, Rachel B; Kaufman, David W

    2015-09-01

    Acetaminophen overuse has been linked to liver injury. To identify patterns of medication use associated with exceeding the recommended daily maximum dose of 4 g acetaminophen. Respondents from a national panel completed a detailed daily medication diary online for 7 days (n = 5649), identifying medications taken from a comprehensive list of over-the-counter (OTC) and prescription (Rx) acetaminophen medications. Respondents were not told the study concerned acetaminophen. Total daily intake was calculated from diary data. Generalized estimating equations assessed the association of medication patterns with exceeding 4 g per day among 3618 respondents who used acetaminophen medications (on 13,852 days) during the diary period. Acetaminophen intake exceeded 4 g on 3.1% of usage days; median intake on those days was 5.5 g. As expected, days when intake exceeded 4 g were almost always (92%) marked by deviations from label directions-exceeding the one-time dose, re-dosing too soon, and concomitant use of multiple acetaminophen medications. Re-dosing too soon was the most frequent deviation, and concomitant use was most strongly tied to exceeding the daily limit. Use of both an Rx and an OTC medication on the same day also increased the odds of exceeding 4 g on days when concomitant use occurred. Excess dosing of acetaminophen is associated with deviations from label directions and by use of both OTC and Rx medications containing acetaminophen within a single concomitant use day. Copyright © 2015 John Wiley & Sons, Ltd.

  11. Association between insurance gaps and continued antihypertension medication usage in a US national representative population.

    Science.gov (United States)

    Gai, Yunwei; Gu, Ning Yan

    2009-12-01

    Medication persistence is important for adequate control of blood pressure. In this article, we assess the association between gaps in insurance coverage and continued antihypertensive medication using a US national representative sample. We used three recent panels from the Medical Expenditure Panel Survey (MEPS). Our sample included hypertensive individuals 18-65 years of age. We identified four insurance categories: (i) continuous coverage by private insurance, (ii) continuous coverage by public insurance, (iii) single or multiple gaps in coverage, and (iv) continuously uninsured. Binary logit models were used to analyze the association between interruptions in medication and insurance after controlling for socioeconomic factors. Patients with continuous private insurance were used as the reference group. Results were weighted to adjust for oversampling and clustering in the survey. There was no statistically significant difference in the probability of medication persistence between individuals with continuous private insurance (the reference group) and individuals with continuous public insurance (adjusted odds ratio (AOR) 1.324, 95% confidence interval (CI) 0.774-2.266, P = 0.304). Compared to the reference group, individuals with insurance gaps had lower odds of continuing their medication (AOR 0.636, 95% CI 0.418-0.0.969, P = 0.035). Continuously uninsured individuals had even lower odds of medication persistence (AOR 0.462, 95% CI 0.282-0.757, P = 0.002). Age, marital status, body mass index (BMI) change, and years of education were also associated with continued medication usage. Studies focusing on current insurance status may underestimate the impact of health insurance gaps and the population at risk. Continuous insurance coverage is needed to increase continued antihypertensive medication usage.

  12. Aseptic meningitis outbreak associated with echovirus 30 among high school football players--Los Angeles County, California, 2014.

    Science.gov (United States)

    Croker, Curtis; Civen, Rachel; Keough, Kathleen; Ngo, Van; Marutani, Amy; Schwartz, Benjamin

    2015-01-02

    On August 4, 2014, the Acute Communicable Disease Control Program of the Los Angeles County Department of Public Health received a report of three aseptic meningitis cases among football players at a county high school. An investigation was conducted to determine the extent of the outbreak, identify potential exposures, and recommend control measures. An outbreak-associated aseptic meningitis case was defined as an illness of any team or family member with onset during July 28-August 11 with 1) cerebrospinal fluid pleocytosis and negative bacterial culture or 2) an emergency department visit with headache, fever, and stiff neck. Ten cases were identified; nine in males, and one in a female; patient ages ranged from 13 to 17 years. All the patients sought care at an emergency department, and five were hospitalized, resulting in 12 total hospital days. All 10 patients have recovered. Eight patients were football players, and two were siblings of football players. The most affected subgroup was the junior varsity football team, with seven cases out of 57 players (attack rate = 12.3%); the relative risk for aseptic meningitis was higher among players who were linemen than among those who were not linemen (relative risk = 5.4 [p = 0.03]). Of the 10 patients, eight tested positive by polymerase chain reaction for enterovirus, and two were not tested. Echovirus testing was performed at the California Viral and Rickettsial Disease Laboratory. Of the eight specimens testing positive for enterovirus, seven tested positive for echovirus 30, and one specimen could not be typed because of insufficient quantity.

  13. Borrelia burgdorferi sensu lato spirochetes in wild birds in northwestern California: associations with ecological factors, bird behavior and tick infestation.

    Science.gov (United States)

    Newman, Erica A; Eisen, Lars; Eisen, Rebecca J; Fedorova, Natalia; Hasty, Jeomhee M; Vaughn, Charles; Lane, Robert S

    2015-01-01

    Although Borrelia burgdorferi sensu lato (s.l.) are found in a great diversity of vertebrates, most studies in North America have focused on the role of mammals as spirochete reservoir hosts. We investigated the roles of birds as hosts for subadult Ixodes pacificus ticks and potential reservoirs of the Lyme disease spirochete B. burgdorferi sensu stricto (s.s.) in northwestern California. Overall, 623 birds representing 53 species yielded 284 I. pacificus larvae and nymphs. We used generalized linear models and zero-inflated negative binomial models to determine associations of bird behaviors, taxonomic relationships and infestation by I. pacificus with borrelial infection in the birds. Infection status in birds was best explained by taxonomic order, number of infesting nymphs, sampling year, and log-transformed average body weight. Presence and counts of larvae and nymphs could be predicted by ground- or bark-foraging behavior and contact with dense oak woodland. Molecular analysis yielded the first reported detection of Borrelia bissettii in birds. Moreover, our data suggest that the Golden-crowned Sparrow (Zonotrichia atricapilla), a non-resident species, could be an important reservoir for B. burgdorferi s.s. Of 12 individual birds (9 species) that carried B. burgdorferi s.l.-infected larvae, no birds carried the same genospecies of B. burgdorferi s.l. in their blood as were present in the infected larvae removed from them. Possible reasons for this discrepancy are discussed. Our study is the first to explicitly incorporate both taxonomic relationships and behaviors as predictor variables to identify putative avian reservoirs of B. burgdorferi s.l. Our findings underscore the importance of bird behavior to explain local tick infestation and Borrelia infection in these animals, and suggest the potential for bird-mediated geographic spread of vector ticks and spirochetes in the far-western United States.

  14. The Association between Non-Medical Prescription Drug Use and Suicidal Behavior among United States Adolescents

    OpenAIRE

    Amanda L. Divin; Zullig, Keith J.

    2014-01-01

    Adolescence represents a vulnerable time for the development of both drug use/abuse and mental illness. Although previous research has substantiated a relationship between drug use and suicidal behavior, little research has examined this relationship with non-medical prescription drug use. Given the growing prevalence of non-medical prescription drug use (NMPDU) among adolescents, this study explored the association between NMPDU and suicidal behavior. Nationally representative data were deri...

  15. Good sleep quality is associated with better academic performance among Sudanese medical students

    OpenAIRE

    Mirghani, Hyder Osman; Mohammed, Osama Salih; Almurtadha, Yahia Mohamed; Ahmed, Moneir Siddig

    2015-01-01

    Background There is increasing awareness about the association of sleep quality and academic achievement among university students. However, the relationship between sleep quality and academic performance has not been examined in Sudan; this study assessed the relationship between sleep quality and academic performance among Sudanese medical students. Methods A case?control study was conducted among 165 male and female medical students at two Sudanese universities. Excellent (A) and pass (C) ...

  16. Medication details documented on hospital discharge: cross-sectional observational study of factors associated with medication non-reconciliation.

    LENUS (Irish Health Repository)

    Grimes, Tamasine C

    2011-03-01

    Movement into or out of hospital is a vulnerable period for medication safety. Reconciling the medication a patient is using before admission with the medication prescribed on discharge, and documenting any changes (medication reconciliation) is recommended to improve safety. The aims of the study were to investigate the factors contributing to medication reconciliation on discharge, and identify the prevalence of non-reconciliation.

  17. Prevalence of self-medication and associated factors in an elderly population: a systematic review.

    Science.gov (United States)

    Jerez-Roig, Javier; Medeiros, Lucas F B; Silva, Victor A B; Bezerra, Camila L P A M; Cavalcante, Leandro A R; Piuvezam, Grasiela; Souza, Dyego L B

    2014-12-01

    The aging of the world populat ion together with changes in the epidemiological profile of diseases have led to increases in both the consumption of medicines and health expenses. In this context, self-medication has gained importance as a rapid treatment that bypasses bureaucracy and, in some instances, delays in obtaining medical assistance. Verification of self-medication prevalence and associated factors in the elderly, as well as identification of the main categories of non-prescription drugs utilized. The following databases were utilized: Cochrane, PubMed, Scopus, LILACS, SciELO, PAHO, MedCarib and WHOLIS. Studies on the prevalence of self-medication in community-dwelling elderly were included. Review studies were excluded, as well as MSc dissertations, PhD theses and research with convenience sampling. Community-dwelling individuals aged 60 years or over. A systematic review of population-based articles published up until September 1, 2014, is presented. The STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) Statement was applied for critical assessment of the articles, and those with a minimum score of 60% were selected for inclusion in the review. Thirty-six articles were selected, of which 28 were included after critical reading. The prevalence of self-medication varied between 4 and 87%, and the majority of studies reported values between 20 and 60%. The mean prevalence reported in the articles was 38%, but several criteria were utilized to measure self-medication. The most commonly utilized non-prescription drugs were analgesics and antipyretics, followed by non-hormonal anti-inflammatories, cardiovascular agents, dietary complements and alternative medicine components. The variables that presented positive associations with self-medication were female sex, visits to pharmacists, depression, functional dependency, recent hospitalization, oral pain, restriction of activities and physical inactivity. The variables with negative

  18. Causes and factors associated with reconciliation errors in medical and surgical services

    Directory of Open Access Journals (Sweden)

    L. Rentero

    2014-09-01

    Full Text Available Objective: The objective of this study was to determine the main causes of errors of medication reconciliation at hospital admission in medical and surgical department and establish factors associated with medication reconciliation errors. Material and method: Cross-sectional study. We included all patients admitted to two services and two surgical for a month. To determine the presence of error reconciliation, the pharmacist compared the medication history interview by the order physician. The factors associated with errors were identified by multivariate logistic regression analysis. Results: 221 patients were included, of which 58.4% had at least one error reconciliation. We detected 629 discrepancies, 339 (53.9% reconciliation errors. The incidence of errors in medical services was 24.3% and in the surgical services 43.0% (p <0.001 in both groups being most prevalent error of omission (46.2% and 50.8%. Regarding factors associated, the equation determines that patients older than 65 years, polymedicated and taking oral antidiabetic are more likely to have an error with a sensibility of 75.2% and a specificity of 68.5%. Conclusion: There is a high rate of error reconciliation in medical and surgical patients, which confirms the need to implement a strategy to reduce these errors. Given the difficulty of applying the process to all patients, the strategy must be directed to patients who are at increased risk of error.

  19. Medical students' conceptualizations of quality of life associated with children with IBD.

    Science.gov (United States)

    Salazar, Guadalupe; Barker, Judith C; Heyman, Melvin B

    2013-10-01

    The aim of the present study was to investigate second-year medical students' understanding of quality of life associated with childhood inflammatory bowel disease (IBD). A cross-sectional study in a major teaching institution in San Francisco was carried out. A questionnaire was administered following an hour-long gastroenterology lecture, which featured 2 young patients with pediatric-onset IBD who addressed everyday life with the disease. Analyses of numerate responses to the questionnaire were paired with a content and thematic analysis of audiotape recordings of the patients' commentaries. Medical students' responses to the patient interviews were extremely positive. Medical students gained a new awareness of the psychosocial complexities associated with living with a pediatric chronic illness and a new way of thinking about the meaning of "healthy." Despite listening to 2 healthy young patients, however, the medical students still conceptualized pediatric IBD in mostly, although not exclusively, negative terms. Medical students' perceptions of pediatric IBD improved as a result of listening to the patient interviews. Although this teaching modality effectively introduced students to a complex condition, it did not overcome their unfavorable impression of the effect of IBD on children's lives. The symptoms associated with IBD have stigma attached to them, and these stereotypes influence how medical students perceive those living with this chronic illness. More research and training in this area is necessary.

  20. 2005 Distinguished Academician Lecture: Evolution of postgraduate medical education in Singapore--role of professional associations.

    Science.gov (United States)

    Shanmugaratnam, K

    2005-12-01

    From 1910 to 1945, doctors in Singapore received postgraduate training through apprenticeship. During the early post-war period, some doctors in the public service were given scholarships to study in Britain and to obtain higher professional qualifications from the British Royal Colleges. The events that most influenced subsequent development of postgraduate education in Singapore occurred between 1956 and 1969: the formation of the Academy of Medicine and the Singapore Medical Association (SMA); organisation of courses for candidates preparing for examinations of the Royal Australasian and British Colleges; competition between the Academy and the University over responsibility for postgraduate medical education; the inauguration of the School of Postgraduate Medical Studies (SPMS); and the introduction of Master of Medicine (M Med) degrees in various medical specialties. From 1970 to 1999, there was expansion in several aspects of postgraduate medical education: SPMS awarded more than 2000 M Med degrees; the Singapore Medical Council (SMC) established a Register of Specialists and formed a Specialist Accreditation Board; the Academy formed Chapters in 10 specialties and developed Advanced Specialty Training programmes leading to Fellowship of the Academy of Medicine Singapore (FAMS); the SMA formed Societies in some 20 specialties; and a College of Family Physicians was inaugurated. There have been more developments from 2000 to 2005: the University restructured SPMS as a Division of Graduate Medical Studies within the Faculty of Medicine; the SMC implemented compulsory Continuing Medical Education; and the Academy converted 6 of its 10 Chapters into Colleges.

  1. Association between periodontitis and medical expenditure in older adults: A 33-month follow-up study.

    Science.gov (United States)

    Sato, Misuzu; Iwasaki, Masanori; Yoshihara, Akihiro; Miyazaki, Hideo

    2016-07-01

    Along with rapid aging, medical expenditure for older adults has been increasing in Japan. Research has shown that periodontitis is a useful predictor for excess medical expenditure; however, limited information is available on the elderly population after adequately considering confounding factors. The aim of the present study was to evaluate the association between periodontitis and long-term medical expenditure in elderly Japanese. Baseline health and periodontal examinations were carried out in June 2008. Japanese adults (n = 245) aged 80 years were classified into quartiles based on periodontal inflamed surface area (PISA), which quantifies the degree of periodontal inflammation. Medical care use and costs were monitored by assessment of the National Health Insurance claim files from the baseline survey through the end of February 2011. Multivariable analysis of the differences in medical expenditure among PISA quartiles was carried out using linear regression with robust standard errors. The participants in the fourth (with the largest PISA) and third quartiles had significantly higher inpatient medical expenditure compared with those of the first quartile (P periodontitis and future increase in medical expenditure, suggesting that periodontitis might be a modifiable factor for the reduction of excess medical expenditure among elderly Japanese. Geriatr Gerontol Int 2016; 16: 856-864. © 2015 Japan Geriatrics Society.

  2. California Air Basins

    Data.gov (United States)

    California Department of Resources — Air ResourcesCalifornia Air Resources BoardThe following datasets are from the California Air Resources Board: * arb_california_airbasins - California Air BasinsThe...

  3. Coping styles and its association with sources of stress in undergraduate medical students.

    Science.gov (United States)

    Cherkil, Sandhya; Gardens, Seby J; Soman, Deepak Kuttikatt

    2013-10-01

    The two ubiquitous factors that have been identified in medical courses to underlie mental health are stress and different coping styles adopted to combat stress. To find the association between coping styles and stress in undergraduate medical students. A medical college in Central Kerala. A cross-sectional study design was adopted. Source and Severity of Stress Scale, Medical Student Version, was used to assess the source and nature of stress. Brief Cope was used to find out the coping styles adopted. The statistical analysis was done using Statistical Package for Social Sciences version 20 and SAS. Chi-square analysis was used to find the association between coping styles and stress domains and with the overall stress score. There is a significant positive association between overall stress score and coping styles (P=0.001) of 'Negative cope', 'Blame', and 'Humor'. 'Positive cope' and 'Religion' has significant positive association with 'Academics' (P=0.047) and 'self Expectations' (P=0.009). 'Blame' (Pmanagement techniques in the medical school.

  4. Factors associated with the use of potentially inappropriate medications by older adults with cancer.

    Science.gov (United States)

    Reis, Cristiane Moreira; Dos Santos, Andrezza Gouvêa; de Jesus Souza, Paula; Reis, Adriano Max Moreira

    2017-07-01

    To determine the frequency and the factors associated with the use of potentially inappropriate medications (PIMs) by older adults with cancer at an onco-haematology ambulatory clinic of a teaching hospital in Brazil. Patients aged 60years or older (n=160) subjected to parenteral antineoplastic chemotherapy from May to December 2015 and treated with one or more medications in the ambulatory clinic were interviewed. Data on medications, comorbidities, oncological diagnosis, and functional status were recorded. Functionality was determined using the Vulnerable Elders Survey (VES-13). PIMs were determined using the 2015 Beers Criteria. Logistic regression was used to determine the factors associated with the use of PIMs. A total of 78 (48.1%) older adults used at least one PIM. The PIMs to be avoided by older adults were proton pump inhibitors (33.3%), antiemetics (10.5%), long-acting benzodiazepines (10.5%), and antidepressants (7.6%). Multivariate analysis indicated that PIMs were associated with the use of five or more medications (odds ratio, 3.14; 95% confidence interval, 1.4-6.6), after adjusting for the number of medications, number of comorbidities, depression, and arthritis/arthrosis. The frequency of use of PIMs by older adults at the investigated ambulatory clinic was high. Polypharmacy was positively associated with the use of PIMs. Copyright © 2017 Elsevier Ltd. All rights reserved.

  5. Factors associated with initiation of antihyperglycaemic medication in UK patients with newly diagnosed type 2 diabetes

    Directory of Open Access Journals (Sweden)

    Sinclair Alan J

    2012-03-01

    Full Text Available Abstract Aim To assess the factors associated with antihyperglycaemic medication initiation in UK patients with newly diagnosed type 2 diabetes. Methods In a retrospective cohort study, patients with newly diagnosed type 2 diabetes were identified during the index period of 2003-2005. Eligible patients were ≥ 30 years old at the date of the first observed diabetes diagnosis (referred to as index date and had at least 2 years of follow-up medical history (N = 9,158. Initiation of antihyperglycaemic medication (i.e., treatment was assessed in the 2-year period following the index date. Adjusted Cox regression models were used to examine the association between time to medication initiation and patient age and other factors. Results Mean (SD HbA1c at diagnosis was 8.1% (2.3. Overall, 51% of patients initiated antihyperglycaemic medication within 2 years (65%, 55%, 46% and 40% for patients in the 30- th, 75th percentile time to treatment initiation was 63 (8, 257 days. Of the patients with HbA1c ≥ 7.5% at diagnosis, 87% initiated treatment within 2 years. These patients with a higher HbA1c also had shorter time to treatment initiation (adjusted hazard ratio (HR = 2.44 [95% confidence interval (CI: 1.61, 3.70]; p Conclusions In this UK cohort of patients with newly diagnosed type 2 diabetes, only 51% had antihyperglycaemic medication initiated over a 2-year period following diagnosis. Older patients were significantly less likely to have been prescribed antihyperglycaemic medications. Elevated HbA1c was the strongest factor associated with initiating antihyperglycaemic medication in these patients.

  6. Associations of Pass-Fail Outcomes with Psychological Health of First-Year Medical Students in a Malaysian Medical School

    National Research Council Canada - National Science Library

    Yusoff , Muhamad S. B

    2013-01-01

    The demanding and intense environment of medical training can create excessive pressures on medical students that eventually lead to unfavorable consequences, either at a personal or professional level...

  7. Associations of anemia persistency with medical expenditures in Medicare ESRD patients on dialysis

    Directory of Open Access Journals (Sweden)

    Jiannong Liu

    2009-04-01

    Full Text Available Jiannong Liu1, Haifeng Guo1, David Gilbertson1, Robert Foley1,2, Allan Collins1,21Chronic Disease Research Group, Minneapolis Medical Research Foundation, Minneapolis, MN, USA; 2Department of Medicine, University of Minnesota, Minneapolis, MN, USAAbstract: Most end-stage renal disease (ESRD patients begin renal replacement therapy with hemoglobin levels below the recommended US National Kidney Foundation Dialysis Outcomes Quality Initiative Guidelines lower level of 110 g/L. Although most patients eventually reach this target, the time required varies substantially. This study aimed to determine whether length of time with below-target hemoglobin levels after dialysis initiation is associated with medical costs, and if so, whether intermediate factors underlie the associations. US patients initiating dialysis in 2002 were studied using the Centers for Medicare and Medicaid Services ESRD database. Anemia persistence (time in months with hemoglobin below 110 g/L was determined in a six-month entry period, and outcomes were assessed in the subsequent six-month follow-up period. The structural equation modeling technique was used to evaluate associations between persistent anemia and medical costs and to determine intermediate factors for these associations. The study included 28,985 patients. Mean per-patient-per-month medical cost was $6267 (standard deviation $5713 in the six-month follow-up period. Each additional month with hemoglobin below 110 g/L was associated with an 8.9% increment in medical cost. The increased cost was associated with increased erythropoietin use and blood transfusions, and increased rates of hospitalization and vascular access procedures in the follow-up period. Keywords: anemia persistency, end-stage renal disease, medical costs, structural equation modeling

  8. Food insecurity is associated with poor virologic response among HIV-infected patients receiving antiretroviral medications.

    Science.gov (United States)

    Wang, Emily A; McGinnis, Kathleen A; Fiellin, David A; Goulet, Joseph L; Bryant, Kendall; Gibert, Cynthia L; Leaf, David A; Mattocks, Kristin; Sullivan, Lynn E; Vogenthaler, Nicholas; Justice, Amy C

    2011-09-01

    Food insecurity negatively impacts HIV disease outcomes in international settings. No large scale U.S. studies have investigated the association between food insecurity and severity of HIV disease or the mechanism of this possible association. The objective of this study was to examine the impact of food insecurity on HIV disease outcomes in a large cohort of HIV-infected patients receiving antiretroviral medications. This is a cross-sectional study. Participants were HIV-infected patients enrolled in the Veterans Aging Cohort Study between 2002-2008 who were receiving antiretroviral medications. Participants reporting "concern about having enough food for you or your family in the past 30 days" were defined as food insecure. Using multivariable logistic regression, we explored the association between food insecurity and both low CD4 counts (500 copies/mL). We then performed mediation analysis to examine whether antiretroviral adherence or body mass index mediates the observed associations. Among 2353 HIV-infected participants receiving antiretroviral medications, 24% reported food insecurity. In adjusted analyses, food insecure participants were more likely to have an unsuppressed HIV-1 RNA (AOR 1.37, 95% CI 1.09, 1.73) compared to food secure participants. Mediation analysis revealed that neither antiretroviral medication adherence nor body mass index contributes to the association between food insecurity and unsuppressed HIV-1 RNA. Food insecurity was not independently associated with low CD4 counts. Among HIV-infected participants receiving antiretroviral medications, food insecurity is associated with unsuppressed viral load and may render treatment less effective. Longitudinal studies are needed to test the potential causal association between food insecurity, lack of virologic suppression, and additional HIV outcomes.

  9. Factors associated with skipping breakfast among Inner Mongolia Medical students in China

    Science.gov (United States)

    2013-01-01

    Background Few studies on the breakfast consumption habits of medical students in China have been carried out. The aim of the present study was to determine the prevalence of skipping breakfast and factors associated with skipping breakfast among medical students in Inner Mongolia of China, and to assist in the design of interventions to improve breakfast consumption habits of medical college students in this region. Methods From December 2010 to January 2011 a cross-sectional survey was conducted among medical students in the Inner Mongolia Medical College using a self-administered questionnaire. The prevalence of skipping breakfast in relation to lifestyle habits was described and factors associated with breakfast consumption were identified using multiple logistic regression analysis. Results The overall prevalence of skipping breakfast was 41.7% and 23.5% for males and females, respectively. The Faculty of Medicine Information Management had the highest breakfast skipping prevalence. Logistic regression models found that the main factors associated with breakfast consumption habits among medical students were gender, class years of education, monthly expenses, faculty, appetite, sleeping quality, and the learning process; monthly expenses, sleeping quality, and the learning process showed a dose-dependent relationship. Conclusions Breakfast consumption was associated with many factors, most importantly monthly expenses, sleeping quality and the learning process. The prevalence of skipping breakfast is significantly higher compared recently reported figures for medical students in western countries and other areas of China. Improvement of breakfast education should be considered for students in which higher monthly expenses, poor sleeping quality, or a laborious learning process have been identified. PMID:23327195

  10. Factors associated with skipping breakfast among Inner Mongolia Medical students in China

    Directory of Open Access Journals (Sweden)

    Sun Juan

    2013-01-01

    Full Text Available Abstract Background Few studies on the breakfast consumption habits of medical students in China have been carried out. The aim of the present study was to determine the prevalence of skipping breakfast and factors associated with skipping breakfast among medical students in Inner Mongolia of China, and to assist in the design of interventions to improve breakfast consumption habits of medical college students in this region. Methods From December 2010 to January 2011 a cross-sectional survey was conducted among medical students in the Inner Mongolia Medical College using a self-administered questionnaire. The prevalence of skipping breakfast in relation to lifestyle habits was described and factors associated with breakfast consumption were identified using multiple logistic regression analysis. Results The overall prevalence of skipping breakfast was 41.7% and 23.5% for males and females, respectively. The Faculty of Medicine Information Management had the highest breakfast skipping prevalence. Logistic regression models found that the main factors associated with breakfast consumption habits among medical students were gender, class years of education, monthly expenses, faculty, appetite, sleeping quality, and the learning process; monthly expenses, sleeping quality, and the learning process showed a dose-dependent relationship. Conclusions Breakfast consumption was associated with many factors, most importantly monthly expenses, sleeping quality and the learning process. The prevalence of skipping breakfast is significantly higher compared recently reported figures for medical students in western countries and other areas of China. Improvement of breakfast education should be considered for students in which higher monthly expenses, poor sleeping quality, or a laborious learning process have been identified.

  11. Factors associated with skipping breakfast among Inner Mongolia medical students in China.

    Science.gov (United States)

    Sun, Juan; Yi, He; Liu, Zhiyue; Wu, Yan; Bian, Jiang; Wu, Yanyan; Eshita, Yuki; Li, Gaimei; Zhang, Qing; Yang, Ying

    2013-01-17

    Few studies on the breakfast consumption habits of medical students in China have been carried out. The aim of the present study was to determine the prevalence of skipping breakfast and factors associated with skipping breakfast among medical students in Inner Mongolia of China, and to assist in the design of interventions to improve breakfast consumption habits of medical college students in this region. From December 2010 to January 2011 a cross-sectional survey was conducted among medical students in the Inner Mongolia Medical College using a self-administered questionnaire. The prevalence of skipping breakfast in relation to lifestyle habits was described and factors associated with breakfast consumption were identified using multiple logistic regression analysis. The overall prevalence of skipping breakfast was 41.7% and 23.5% for males and females, respectively. The Faculty of Medicine Information Management had the highest breakfast skipping prevalence. Logistic regression models found that the main factors associated with breakfast consumption habits among medical students were gender, class years of education, monthly expenses, faculty, appetite, sleeping quality, and the learning process; monthly expenses, sleeping quality, and the learning process showed a dose-dependent relationship. Breakfast consumption was associated with many factors, most importantly monthly expenses, sleeping quality and the learning process. The prevalence of skipping breakfast is significantly higher compared recently reported figures for medical students in western countries and other areas of China. Improvement of breakfast education should be considered for students in which higher monthly expenses, poor sleeping quality, or a laborious learning process have been identified.

  12. An assessment of factors associated with damage to tree crowns from the 1987 wildfires in northern California

    Science.gov (United States)

    C. Phillip Weatherspoon; Carl N. Skinner

    1995-01-01

    Relationships between (1) degree of damage caused by the 1987 fires in northern California and (2) prior management activities, fuelbed characteristics, and site/stand factors were studied on the Hayfork Ranger District of the Shasta-Trinity National Forests. Postfire aerial photography was used to assess scorch and consumption of tree crowns (the selected measure of...

  13. Extracurricular activities associated with stress and burnout in preclinical medical students.

    Science.gov (United States)

    Fares, Jawad; Saadeddin, Zein; Al Tabosh, Hayat; Aridi, Hussam; El Mouhayyar, Christopher; Koleilat, Mohamad Karim; Chaaya, Monique; El Asmar, Khalil

    2016-09-01

    This study aims to assess the prevalence of stress and burnout among preclinical medical students in a private university in Beirut, Lebanon, and evaluate the association between extracurricular involvement and stress and burnout relief in preclinical medical students. A cross-sectional survey was conducted on a random sample of 165 preclinical medical students. Distress level was measured using the 12-item General Health Questionnaire (GHQ-12) while that of burnout was measured through the Maslach Burnout Inventory-Student Survey (MBI-SS). The MBI-SS assesses three interrelated dimensions: emotional exhaustion, cynicism, and academic efficacy. Extracurricular activities were divided into four categories: physical exercise, music, reading, and social activities. All selected participants responded. A substantial proportion of preclinical medical students suffered from stress (62%) and burnout (75%). Bivariate and multivariate regression analyses revealed that being a female or a 1st year medical student correlated with higher stress and burnout. Music-related activities were correlated with lower burnout. Social activities or living with parents were associated with lower academic efficacy. The high stress and burnout levels call for action. Addressing the studying conditions and attending to the psychological wellbeing of preclinical medical students are recommendations made in the study. Copyright © 2015 Ministry of Health, Saudi Arabia. Published by Elsevier Ltd. All rights reserved.

  14. Recommendations of the International Medical Informatics Association (IMIA) on Education in Biomedical and Health Informatics. First Revision

    NARCIS (Netherlands)

    Mantas, John; Ammenwerth, Elske; Demiris, George; Hasman, Arie; Haux, Reinhold; Hersh, William; Hovenga, Evelyn; Lun, K. C.; Marin, Heimar; Martin-Sanchez, Fernando; Wright, Graham

    2010-01-01

    Objective: The International Medical Informatics Association (IMIA) agreed on revising the existing international recommendations in health informatics/medical informatics education. These should help to establish courses, course tracks or even complete programs in this field, to further develop

  15. Association between Internet addiction and depression in Thai medical students at Faculty of Medicine, Ramathibodi Hospital.

    Science.gov (United States)

    Boonvisudhi, Thummaporn; Kuladee, Sanchai

    2017-01-01

    To study the extent of Internet addiction (IA) and its association with depression in Thai medical students. A cross-sectional study was conducted at Faculty of Medicine, Ramathibodi Hospital. Participants were first- to fifth-year medical students who agreed to participate in this study. Demographic characteristics and stress-related factors were derived from self-rated questionnaires. Depression was assessed using the Thai version of Patient Health Questionnaire (PHQ-9). A total score of five or greater derived from the Thai version of Young Diagnostic Questionnaire for Internet Addiction was classified as "possible IA". Then chi-square test and logistic regression were used to evaluate the associations between possible IA, depression and associated factors. From 705 participants, 24.4% had possible IA and 28.8% had depression. There was statistically significant association between possible IA and depression (odds ratio (OR) 1.92, 95% confidence interval (CI): 1.34-2.77, P-value Internet use (95% CI: 1.04-2.38, P-value = 0.031). Academic problems were found to be a significant predictor of both possible IA and depression. IA was likely to be a common psychiatric problem among Thai medical students. The research has also shown that possible IA was associated with depression and academic problems. We suggest that surveillance of IA should be considered in medical schools.

  16. Factors Associated with Parental Adaptation to Children with an Undiagnosed Medical Condition

    Science.gov (United States)

    Yanes, Tatiane; Humphreys, Linda; McInerney-Leo, Aideen; Biesecker, Barbara

    2017-01-01

    Little is known about the adaptive process and experiences of parents raising a child with an undiagnosed medical condition. The present study aims to assess how uncertainty, hope, social support, and coping efficacy contributes to adaptation among parents of children with an undiagnosed medical condition. Sixty-two parents of child affected by an undiagnosed medical condition for at least two years completed an electronically self-administered survey. Descriptive analysis suggested parents in this population had significantly lower adaptation scores when compared to other parents of children with undiagnosed medical conditions, and parents of children with a diagnosed intellectual and/or physical disability. Similarly, parents in this population had significantly lower hope, perceived social support and coping efficacy when compared to parents of children with a diagnosed medical condition. Multiple linear regression was used to identify relationships between independent variables and domains of adaptation. Positive stress response was negatively associated with emotional support (B = −0.045, p ≤ 0.05), and positively associated with coping efficacy (B = 0.009, p ≤ 0.05). Adaptive self-esteem was negatively associated with uncertainty towards one's social support (B = −0.248, p ≤ 0.05), and positively associated with coping efficacy (B = 0.007, p ≤ 0.05). Adaptive social integration was negatively associated with uncertainty towards one's social support (B-0.273, p ≤ 0.05), and positively associated with uncertainty towards child's health (B = 0.323, p ≤ 0.001), and affectionate support (B = 0.110, p ≤ 0.001). Finally, adaptive spiritual wellbeing was negatively associated with uncertainty towards one's family (B = −0.221, p ≤ 0.05). Findings from this study have highlighted the areas where parents believed additional support was required, and provided insight into factors that contribute to parental adaptation. PMID:28039658

  17. Association Between Medication Use for Attention-Deficit/Hyperactivity Disorder and Risk of Motor Vehicle Crashes.

    Science.gov (United States)

    Chang, Zheng; Quinn, Patrick D; Hur, Kwan; Gibbons, Robert D; Sjölander, Arvid; Larsson, Henrik; D'Onofrio, Brian M

    2017-06-01

    Motor vehicle crashes (MVCs) are a major public health problem. Research has demonstrated that individuals with attention-deficit/hyperactivity disorder (ADHD) are more likely to experience MVCs, but the effect of ADHD medication treatment on the risk of MVCs remains unclear. To explore associations between ADHD medication use and risk of MVCs in a large cohort of patients with ADHD. For this study, a US national cohort of patients with ADHD (n = 2 319 450) was identified from commercial health insurance claims between January 1, 2005, and December 31, 2014, and followed up for emergency department visits for MVCs. The study used within-individual analyses to compare the risk of MVCs during months in which patients received ADHD medication with the risk of MVCs during months in which they did not receive ADHD medication. Dispensed prescription of ADHD medications. Emergency department visits for MVCs. Among 2 319 450 patients identified with ADHD, the mean (SD) age was 32.5 (12.8) years, and 51.7% were female. In the within-individual analyses, male patients with ADHD had a 38% (odds ratio, 0.62; 95% CI, 0.56-0.67) lower risk of MVCs in months when receiving ADHD medication compared with months when not receiving medication, and female patients had a 42% (odds ratio, 0.58; 95% CI, 0.53-0.62) lower risk of MVCs in months when receiving ADHD medication. Similar reductions were found across all age groups, across multiple sensitivity analyses, and when considering the long-term association between ADHD medication use and MVCs. Estimates of the population-attributable fraction suggested that up to 22.1% of the MVCs in patients with ADHD could have been avoided if they had received medication during the entire follow-up. Among patients with ADHD, rates of MVCs were lower during periods when they received ADHD medication. Considering the high prevalence of ADHD and its association with MVCs, these findings warrant attention to this prevalent and preventable cause of

  18. Mining association rules between abnormal health examination results and outpatient medical records.

    Science.gov (United States)

    Chao Huang, Yi

    Currently, interpretation of health examination reports relies primarily on the physician's own experience. If health screening data could be integrated with outpatient medical records to uncover correlations between disease and abnormal test results, the physician could benefit from having additional reference resources for medical examination report interpretation and clinic diagnosis. This study used the medical database of a regional hospital in Taiwan to illustrate how association rules can be found between abnormal health examination results and outpatient illnesses. The rules can help to build up a disease-prevention knowledge database that assists healthcare providers in follow-up treatment and prevention. Furthermore, this study proposes a new algorithm, the data cutting and sorting method, or DCSM, in place of the traditional Apriori algorithm. DCSM significantly improves the mining performance of Apriori by reducing the time to scan health examination and outpatient medical records, both of which are databases of immense sizes.

  19. Association between addressing antiseizure drug side effects and patient-reported medication adherence in epilepsy

    Directory of Open Access Journals (Sweden)

    Moura LMVR

    2016-10-01

    Full Text Available Lidia M V R Moura,1 Thiago S Carneiro,1 Andrew J Cole,1 John Hsu,2,3 Barbara G Vickrey,4 Daniel B Hoch1 1Department of Neurology, 2Mongan Institute for Health Policy, Department of Medicine, Massachusetts General Hospital, 3Department of Health Care Policy, Harvard Medical School, Boston, MA, 4Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA Background and aim: Adherence to treatment is a critical component of epilepsy management. This study examines whether addressing antiepileptic drug (AED side effects at every visit is associated with increased patient-reported medication adherence.Patients and methods: This study identified 243 adults with epilepsy who were seen at two academic outpatient neurology settings and had at least two visits over a 3-year period. Demographic and clinical characteristics were abstracted. Evidence that AED side effects were addressed was measured through 1 phone interview (patient-reported and 2 medical records abstraction (physician-documented. Medication adherence was assessed using the validated Morisky Medication Adherence Scale-4. Complete adherence was determined as answering “no” to all questions.Results: Sixty-two (25% patients completed the interviews. Participants and nonparticipants were comparable with respect to demographic and clinical characteristics; however, a smaller proportion of participants had a history of drug-resistant epilepsy than nonparticipants (17.7% vs 30.9%, P=0.04. Among the participants, evidence that AED side effects were addressed was present in 48 (77% medical records and reported by 51 (82% patients. Twenty-eight (45% patients reported complete medication adherence. The most common reason for incomplete adherence was missed medication due to forgetfulness (n=31, 91%. There was no association between addressing AED side effects (neither physician-documented nor patient-reported and complete medication adherence (P=0.22 and 0.20.Discussion and

  20. Factors Associated with Medical Doctors' Intentions to Discriminate Against Transgender Patients in Kuala Lumpur, Malaysia.

    Science.gov (United States)

    Vijay, Aishwarya; Earnshaw, Valerie A; Tee, Ying Chew; Pillai, Veena; White Hughto, Jaclyn M; Clark, Kirsty; Kamarulzaman, Adeeba; Altice, Frederick L; Wickersham, Jeffrey A

    2017-12-11

    Transgender people are frequent targets of discrimination. Discrimination against transgender people in the context of healthcare can lead to poor health outcomes and facilitate the growth of health disparities. This study explores factors associated with medical doctors' intentions to discriminate against transgender people in Malaysia. A total of 436 physicians at two major university medical centers in Kuala Lumpur, Malaysia, completed an online survey. Sociodemographic characteristics, stigma-related constructs, and intentions to discriminate against transgender people were measured. Bivariate and multivariate linear regression were used to evaluate independent covariates of discrimination intent. Medical doctors who felt more fearful of transgender people and more personal shame associated with transgender people expressed greater intention to discriminate against transgender people, whereas doctors who endorsed the belief that transgender people deserve good care reported lower discrimination intent. Stigma-related constructs accounted for 42% of the variance and 8% was accounted for by sociodemographic characteristics. Constructs associated with transgender stigma play an important role in medical doctors' intentions to discriminate against transgender patients. Development of interventions to improve medical doctors' knowledge about and attitudes toward transgender people are necessary to reduce discriminatory intent in healthcare settings.

  1. Factors associated to depression and anxiety in medical students: a multicenter study.

    Science.gov (United States)

    Brenneisen Mayer, Fernanda; Souza Santos, Itamar; Silveira, Paulo S P; Itaqui Lopes, Maria Helena; de Souza, Alicia Regina Navarro Dias; Campos, Eugenio Paes; de Abreu, Benedita Andrade Leal; Hoffman Ii, Itágores; Magalhães, Cleidilene Ramos; Lima, Maria Cristina P; Almeida, Raitany; Spinardi, Mateus; Tempski, Patricia

    2016-10-26

    To evaluate personal and institutional factors related to depression and anxiety prevalence of students from 22 Brazilian medical schools. The authors performed a multicenter study (August 2011 to August 2012), examining personal factors (age, sex, housing, tuition scholarship) and institutional factors (year of the medical training, school legal status, location and support service) in association with scores of Beck Depression Inventory (BDI) and State Trait Anxiety Inventory (STAI). Of 1,650 randomly selected students, 1,350 (81.8 %) completed the study. The depressive symptoms prevalence was 41 % (BDI > 9), state-anxiety 81.7 % and trait-anxiety in 85.6 % (STAI > 33). There was a positive relationship between levels of state (r = 0,591, p anxiety and depression scores. All three symptoms were positively associated with female sex and students from medical schools located in capital cities of both sexes. Tuition scholarship students had higher state-anxiety but not trait-anxiety or depression scores. Medical students with higher levels of depression and anxiety symptoms disagree more than their peers with the statements "I have adequate access to psychological support" and "There is a good support system for students who get stressed". The factors associated with the increase of medical students' depression and anxiety symptoms were female sex, school location and tuition scholarship. It is interesting that tuition scholarship students showed state-anxiety, but not depression and trait-anxiety symptoms.

  2. An intercalated BSc degree is associated with higher marks in subsequent medical school examinations.

    Science.gov (United States)

    Cleland, Jennifer A; Milne, Andrew; Sinclair, Hazel; Lee, Amanda J

    2009-05-19

    To compare medical students on a modern MBChB programme who did an optional intercalated degree with their peers who did not intercalate; in particular, to monitor performance in subsequent undergraduate degree exams. This was a retrospective, observational study of anonymised databases of medical student assessment outcomes. Data were accessed for graduates, University of Aberdeen Medical School, Scotland, UK, from the years 2003 to 2007 (n = 861). The main outcome measure was marks for summative degree assessments taken after intercalating. Of 861 medical students, 154 (17.9%) students did an intercalated degree. After adjustment for cohort, maturity, gender and baseline (3rd year) performance in matching exam type, having done an IC degree was significantly associated with attaining high (18-20) common assessment scale (CAS) marks in three of the six degree assessments occurring after the IC students rejoined the course: the 4th year written exam (p < 0.001), 4th year OSCE (p = 0.001) and the 5th year Elective project (p = 0.010). Intercalating was associated with improved performance in Years 4 and 5 of the MBChB. This improved performance will further contribute to higher academic ranking for Foundation Year posts. Long-term follow-up is required to identify if doing an optional intercalated degree as part of a modern medical degree is associated with following a career in academic medicine.

  3. [Association of mifepristone and misoprostol for the medical management of early pregnancy failure].

    Science.gov (United States)

    Bouschbacher, L; Maatouk, A; Collin, P; Welter, E; Morel, O; de Malartic, C Mezan

    2014-12-01

    A retrospective monocentric clinical trial was performed to evaluate the efficacy of the association of mifepristone and misoprostol for the management of early pregnancy failure. Ninety-two women with early pregnancy failure or anembryonic pregnancy were first treated with 600 mg of mifepristone and 48 hours later with 400 μg of misoprostol by oral administration. Successful treatment, defined as an empty uterus, was searched at day 3, with the association of misoprostol-mifepristone alone or with complementary medical treatment, prostaglandins or ocytocine. The overall treatment success was 82% (75 of 92 women) with 69 successful cases at day 3 (75%). Six of 92 women (7%) needed a second-line medical treatment. For the last 17 women (18%), the failure of the associated tested medical treatment lead to a secondary surgery. No prognostic factor for the successful medical treatment has been highlighted. A high efficacy for the management of early pregnancy failure is demonstrated for the mifepristone and misoprostol medical treatment. The specific contribution of mifepristone, although proven in the cases of termination of evolutive pregnancies, should be further evaluated in the future for the specific management of early pregnancy failure. Nevertheless, no prognostic factor for the success of the propose treatment can be determined, as the amount of patients enrolled in this study was not sufficient. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  4. Is there an association between the duration of stay in the medical colleges and the smoking behavior among medical students? A cross-sectional study

    Directory of Open Access Journals (Sweden)

    J P Majra

    2017-01-01

    Full Text Available Background: Health-care providers must be at the forefront of tobacco cessation to ensure a downward shift in tobacco use. Medical schools constitute an important site for education and cessation efforts. Health-care professionals play a substantial role in influencing patients' lifestyle choices including tobacco cessation. Objectives: To examine the association between the duration of stay in the medical colleges and the smoking behavior among the medical students in Karnataka, India. Materials and Methods: One government and four private medical colleges were selected using stratified random sampling technique for this cross-sectional study. Sample size was 3288 medical students. A pretested self-administered questionnaire was used to collect data. SPSS version 12.0 was used for data analysis. The statistical methods used were frequencies, proportions, and Chi-square test. Results: Mean age of the study participants was 20.68 ± 2.05 years for males and 20.20 ± 1.91 years for females. Number of smokers among medical students after joining medical college increased 2.7 times. The duration of stay in the medical colleges was positively associated with the smoking behavior (P < 0.0001 among medical students, and the increase in the number of smokers reached up to 259.6% during internship. Conclusion: Smoking among medical students increases along with their stay in medical college.

  5. The association between medical education accreditation and the examination performance of internationally educated physicians seeking certification in the United States.

    Science.gov (United States)

    van Zanten, Marta

    2015-06-01

    The purpose of this study was to investigate the performance of graduates of international medical schools who seek Educational Commission for Foreign Medical Graduates certification based on accreditation of their medical education programmes. For the self-selected population who took United States Medical Licensing Examinations during the study period (2006-2010), accreditation was associated with higher first-attempt pass rates on some examinations, especially for international medical graduates from schools located in the Caribbean region. In addition, certain essential accreditation standards were associated with better performance on all examinations. This study lends support to the value of medical education accreditation.

  6. Arsenic associated with historical gold mining in the Sierra Nevada foothills: Case study and field trip guide for Empire Mine State Historic Park, California

    Science.gov (United States)

    Alpers, Charles N.; Myers, Perry A; Millsap, Daniel; Regnier, Tamsen B; Bowell, Robert J.; Alpers, Charles N.; Jamieson, Heather E.; Nordstrom, D. Kirk; Majzlan, Juraj

    2014-01-01

    The Empire Mine, together with other mines in the Grass Valley mining district, produced at least 21.3 million troy ounces (663 tonnes) of gold (Au) during the 1850s through the 1950s, making it the most productive hardrock Au mining district in California history (Clark 1970). The Empire Mine State Historic Park (Empire Mine SHP or EMSHP), established in 1975, provides the public with an opportunity to see many well-preserved features of the historic mining and mineral processing operations (CDPR 2014a).A legacy of Au mining at Empire Mine and elsewhere is contamination of mine wastes and associated soils, surface waters, and groundwaters with arsenic (As), mercury (Hg), lead (Pb), and other metals. At EMSHP, As has been the principal contaminant of concern and the focus of extensive remediation efforts over the past several years by the State of California, Department of Parks and Recreation (DPR) and Newmont USA, Ltd. In addition, the site is the main focus of a multidisciplinary research project on As bioavailability and bioaccessibility led by the California Department of Toxic Substances Control (DTSC) and funded by the U.S. Environmental Protection Agency’s (USEPA’s) Brownfields Program.This chapter was prepared as a guide for a field trip to EMSHP held on June 14, 2014, in conjunction with a short course on “Environmental Geochemistry, Mineralogy, and Microbiology of Arsenic” held in Nevada City, California on June 15–16, 2014. This guide contains background information on geological setting, mining history, and environmental history at EMSHP and other historical Au mining districts in the Sierra Nevada, followed by descriptions of the field trip stops.

  7. Low back pain and associated risk factors among undergraduate students of a medical college in Delhi.

    Science.gov (United States)

    Aggarwal, Nupur; Anand, Tanu; Kishore, Jugal; Ingle, Gopal Krishna

    2013-01-01

    Low back pain (LBP) is the most common orthopedic problem worldwide and is known to affect both younger and older adults. The stressful and time consuming curriculum of medical students predisposes them to this problem. Few statistics are available on prevalence rates of LBP among medical students in India. This study assesses the prevalence and risk factors of LBP in students of a medical college in Delhi. A cross-sectional study was carried out in a medical college in Delhi. The study subjects (n = 160; 100% participation) were selected via stratified random sampling from all undergraduate medical students (aged 17-25 years). A validated questionnaire was used to collect the data. The overall prevalence of LBP among the students over the past one year was 47.5% (n = 76) with a prevalence of 32.5% at the time of data collection. Prevalence among males and females was 45.3% and 50%, respectively. Significant associations were found between LBP in the past year and coffee drinking (Regular = 57%, Occasional = 38.9%, Never = 65.2%, χ2 = 7.24, P= 0.02), body posture (Normal = 32.6%, Abnormal = 75%, χ2 = 18.97, P work (3.9 vs. 1.8) were found to be significantly higher in group with LBP than in the non-LBP group. However, no association with LBP was seen for weight lifting, watching television/working on computers, driving, wearing heels, or body mass index. The high prevalence of LBP among medical students and its association with poor study habits, lifestyle habits, and psychological factors highlight a need for life skills training, education, counseling, and restructuring of the medical curriculum.

  8. Associations between medical student empathy and personality: a multi-institutional study.

    Directory of Open Access Journals (Sweden)

    Patrício Costa

    Full Text Available BACKGROUND: More empathetic physicians are more likely to achieve higher patient satisfaction, adherence to treatments, and health outcomes. In the context of medical education, it is thus important to understand how personality might condition the empathetic development of medical students. Single institutional evidence shows associations between students' personality and empathy. This multi-institutional study aimed to assess such associations across institutions, looking for personality differences between students with high empathy and low empathy levels. METHODS: Participants were 472 students from three medical schools in Portugal. They completed validated adaptations to Portuguese of self-report measures of the NEO-Five Factor Inventory(NEO-FFI and the Jefferson Scale of Physician Empathy(JSPE-spv. Students were categorized into two groups: "Bottom" (low empathy, N = 165 and "Top" (high empathy, N = 169 according to their empathy JSPE-spv total score terciles. Correlation analysis, binary logistic regression analysis and ROC curve analysis were conducted. RESULTS: A regression model with gender, age and university had a predictive power (pseudo R2 for belonging to the top or bottom group of 6.4%. The addition of personality dimensions improved the predictive power to 16.8%. Openness to experience and Agreeableness were important to predict top or bottom empathy scores when gender, age and university were considered." Based on the considered predictors the model correctly classified 69.3% of all students. CONCLUSIONS: The present multi-institutional cross-sectional study in Portugal revealed across-school associations between the Big5 dimensions Agreeableness and Openness to experience and the empathy of medical students and that personality made a significant contribution to identify the more empathic students. Therefore, medical schools may need to pay attention to the personality of medical students to understand how to enhance

  9. Association between antihypertensive medication use and non-cardiovascular outcomes in older men.

    Science.gov (United States)

    Agostini, Joseph V; Tinetti, Mary E; Han, Ling; Peduzzi, Peter; Foody, Joanne M; Concato, John

    2007-12-01

    Antihypertensive drugs are prescribed commonly in older adults for their beneficial cardiovascular and cerebrovascular effects, but few studies have assessed antihypertensive drugs' adverse effects on non-cardiovascular outcomes in routine clinical practice. To evaluate, among older adults, the association between antihypertensive medication use and physical performance, cognition, and mood. Prospective cohort study in a Veterans Affairs primary care clinic, with patients enrolled in 2000-2001 and assessed for medication use, comorbidities, health behaviors, and other characteristics; and followed-up 1 year later. 544 community-dwelling hypertensive men over age 65 years. Timed chair stands; Trail Making Test part B; and Centers for Epidemiologic Studies Depression (CES-D) scores. Participants had a mean age of 74.4 +/- 5.2 years and took a mean of 2.3 +/- 1.2 antihypertensive medications at baseline. After adjustment for age, comorbidities, level of blood pressure, and other confounders, each 1-unit increase in antihypertensive medication "intensity" was associated with a 0.11-second (95% confidence interval, 0.05-0.16) increase in the time required to complete the timed chair stands. No significant relationship was found between antihypertensive medication intensity and outcomes for Trail Making B or CES-D scores. A higher cumulative exposure to antihypertensive medications in community-living older men was associated with adverse effects on physical performance, but not on the cognitive or depression measures available in this study. Clinicians should consider non-cardiovascular related adverse effects when treating older males taking multiple antihypertensive medications.

  10. Cultural competency in medical education: demographic differences associated with medical student communication styles and clinical clerkship feedback.

    Science.gov (United States)

    Lee, Katherine B; Vaishnavi, Sanjeev N; Lau, Steven K M; Andriole, Dorothy A; Jeffe, Donna B

    2009-02-01

    We tested the significance of associations among students' demographics, communication styles, and feedback received during clerkships. US medical students who completed at least one required clinical clerkship were invited between April and July 2006 to complete an anonymous, online survey inquiring about demographics, communication styles (assertiveness and reticence), feedback (positive and negative), and clerkship grades. The effects of self-identified race/ethnicity, gender, and generation (immigrant, first- or second-generation American) and their 2-way interactions on assertiveness, reticence, total positive and total negative feedback comments were tested using factorial analysis of covariance, controlling for age, clerkship grades, and mother's and father's education; pairwise comparisons used simple contrasts. Two-sided P values women; 57% white). Men reported more assertiveness than women (P = .001). Reticence (P differed by race/ethnicity; in pairwise contrasts, black, East Asian, and Native American/ Alaskan students reported greater reticence than white students (P differences in students' communication styles and feedback they received highlight a need for cultural competency training to improve medical student-teacher interactions, analogous to training currently advocated to improve physician-patient interactions.

  11. Non-redundant association rules between diseases and medications: an automated method for knowledge base construction.

    Science.gov (United States)

    Séverac, François; Sauleau, Erik A; Meyer, Nicolas; Lefèvre, Hassina; Nisand, Gabriel; Jay, Nicolas

    2015-04-15

    The widespread use of electronic health records (EHRs) has generated massive clinical data storage. Association rules mining is a feasible technique to convert this large amount of data into usable knowledge for clinical decision making, research or billing. We present a data driven method to create a knowledge base linking medications to pathological conditions through their therapeutic indications from elements within the EHRs. Association rules were created from the data of patients hospitalised between May 2012 and May 2013 in the department of Cardiology at the University Hospital of Strasbourg. Medications were extracted from the medication list, and the pathological conditions were extracted from the discharge summaries using a natural language processing tool. Association rules were generated along with different interestingness measures: chi square, lift, conviction, dependency, novelty and satisfaction. All medication-disease pairs were compared to the Summary of Product Characteristics, which is the gold standard. A score based on the other interestingness measures was created to filter the best rules, and the indices were calculated for the different interestingness measures. After the evaluation against the gold standard, a list of accurate association rules was successfully retrieved. Dependency represents the best recall (0.76). Our score exhibited higher exactness (0.84) and precision (0.27) than all of the others interestingness measures. Further reductions in noise produced by this method must be performed to improve the classification precision. Association rules mining using the unstructured elements of the EHR is a feasible technique to identify clinically accurate associations between medications and pathological conditions.

  12. Adverse effects and Drug Interactions Associated with Inhaled Recreational and Medical Marijuana

    Directory of Open Access Journals (Sweden)

    Maisha Kelly Freeman

    2016-06-01

    those studies were included in this review. Several studies were located that evaluated the safety of medical marijuana; however, much of the review focused on inhaled, recreational marijuana use due to the paucity of information on inhaled medical marijuana. Since marijuana is a Schedule1 product, few clinical studies have been conducted to determine the adverse event profile of the product. As a result, several articles that characterized recreational inhaled marijuana were included. Recreational inhaled marijuana use may be associated with an increase in cardiovascular (CV/ cerebrovascular effects (CVA; however, conflicting information exists in the literature. Recreational marijuana use may also increase risky behaviors that increase the transmission of infectious diseases and respiratory diseases. Many of the studies were retrospective in nature; therefore, it was difficult to determine a cause and effect relationship between inhaled marijuana use and the development of adverse reactions or drug-drug interactions. Conclusions: There is a paucity of information related to the use of inhaled medical marijuana. Recreational marijuana use is associated with several adverse events including CV/CVA, respiratory, and transmission of infectious diseases. Theoretical literature indicates that medical marijuana may be associated with significant drug-drug interactions and adverse drug reactions. Legalization of medical marijuana may be associated with an increase in abuse/dependence and accidental exposures in children. Pharmacists need to be educated regarding the appropriate use of medical marijuana to avoid adverse reactions and potential drug-drug interactions between medical marijuana and other products.   Type: Original Research

  13. Association between medical school radiology curricula and application rates to US radiology residency programs.

    Science.gov (United States)

    Kapoor, Neena; Smith, Stacy E

    2014-11-01

    Data are limited on how radiology curricula vary across US medical schools and the association between characteristics of these curricula and application rates to radiology residency programs. The purpose of this study was to gather more information about medical school radiology curricula and to determine the association between radiology education and application rates to radiology residency programs. An anonymous web-based survey was e-mailed to residency program directors affiliated with 129 accredited US medical schools. Residency program directors were instructed to forward the survey to a radiology clerkship director or complete the survey themselves. Electronic Residency Application Service data were also obtained for 122 participating medical schools. Fifty-five of 122 schools responded, a response rate of 45%. The majority of medical schools (76%) had a dedicated radiology curriculum, which was most often offered in the third and fourth years. The majority (87%) of schools integrated radiology education into other courses throughout all 4 years. The application data revealed that application rates were similar across schools, ranging from 6% to 8%. Applications rates did not significantly vary across several characteristics of educational curricula. Although schools vary in the characteristics of radiology education, application rates to radiology residency programs are similar across schools and are not associated with specific characteristics of these educational programs. This lack of an association may be explained by universal exposure of medical students to radiology curricula and the fact that a career choice is a complex process that involves multiple factors. Copyright © 2014 American College of Radiology. Published by Elsevier Inc. All rights reserved.

  14. Associated Medical Disorders and Disabilities in Children with Autistic Disorder: A Population-Based Study

    Science.gov (United States)

    Kielinen, Marko; Rantala, Heikki; Timonen, Eija; Linna, Sirkka-Liisa; Moilanen, Irma

    2004-01-01

    A population-based survey was conducted among 152,732 Finnish children and adolescents aged under 16 years and living in northern Finland. Diagnoses and associated medical conditions were derived from the hospital and institutional records of this area. One hundred and eighty-seven children with DSM-IV autistic disorder were identified. Associated…

  15. Salivary Biomarker Levels and Diurnal Variation: Associations with Medications Prescribed to Control Children's Problem Behavior

    Science.gov (United States)

    Hibel, Leah C.; Granger, Douglas A.; Cicchetti, Dante; Rogosch, Fred

    2007-01-01

    This study examined associations between medications prescribed to control children's problem behaviors and levels of, and diurnal variation in, salivary cortisol (C), testosterone (T), and dehydroepiandrosterone (DHEA). Saliva was collected in the morning, midday, and afternoon from 432 children ages 6-13 years. Relative to a no-medication…

  16. Clinical and Non-Clinical Characteristics Associated with Medication Use among Children with Serious Emotional Disturbance

    Science.gov (United States)

    Pavkov, Thomas W.; Walrath, Christine M.

    2008-01-01

    Our study explores the clinical and non-clinical characteristics associated with medication use among children with serious emotional disturbance who are referred into community-based family-driven system of care settings. Using data collected as part of the Comprehensive Community Mental Health Services for Children and Their Families Program…

  17. Common and unique associated factors for medically unexplained chronic widespread pain and chronic fatigue.

    Science.gov (United States)

    McBeth, J; Tomenson, B; Chew-Graham, C A; Macfarlane, G J; Jackson, J; Littlewood, A; Creed, F H

    2015-12-01

    Chronic widespread pain and chronic fatigue share common associated factors but these associations may be explained by the presence of concurrent depression and anxiety. We mailed questionnaires to a randomly selected sample of people in the UK to identify participants with chronic widespread pain (ACR 1990 definition) and those with chronic fatigue. The questionnaire assessed sociodemographic factors, health status, healthcare use, childhood factors, adult attachment, and psychological stress including anxiety and depression. To identify persons with unexplained chronic widespread pain or unexplained chronic fatigue; we examined participant's medical records to exclude medical illness that might cause these symptoms. Of 1443 participants (58.0% response rate) medical records of 990 were examined. 9.4% (N=93) had unexplained chronic widespread pain and 12.6% (N=125) had unexplained chronic fatigue. Marital status, childhood psychological abuse, recent threatening experiences and other somatic symptoms were commonly associated with both widespread pain and fatigue. No common effect was found for few years of education and current medical illnesses (more strongly associated with chronic widespread pain) or recent illness in a close relative, neuroticism, depression and anxiety scores (more strongly associated with chronic fatigue). Putative associated factors with a common effect were associated with unexplained chronic widespread pain or unexplained chronic fatigue only when there was concurrent anxiety and/or depression. This study suggests that the associated factors for chronic widespread pain and chronic fatigue need to be studied in conjunction with concurrent depression/anxiety. Clinicians should be aware of the importance of concurrent anxiety or depression. Copyright © 2015 The Authors. Published by Elsevier Inc. All rights reserved.

  18. Flipping the advanced cardiac life support classroom with team-based learning: comparison of cognitive testing performance for medical students at the University of California, Irvine, United States

    Directory of Open Access Journals (Sweden)

    Megan Boysen-Osborn

    2016-02-01

    Full Text Available Purpose: It aimed to find if written test results improved for advanced cardiac life support (ACLS taught in flipped classroom/team-based Learning (FC/TBL vs. lecture-based (LB control in University of California-Irvine School of Medicine, USA. Methods: Medical students took 2010 ACLS with FC/TBL (2015, compared to 3 classes in LB (2012-14 format. There were 27.5 hours of instruction for FC/TBL model (TBL 10.5, podcasts 9, small-group simulation 8 hours, and 20 (12 lecture, simulation 8 hours in LB. TBL covered 13 cardiac cases; LB had none. Seven simulation cases and didactic content were the same by lecture (2012-14 or podcast (2015 as was testing: 50 multiple-choice questions (MCQ, 20 rhythm matchings, and 7 fill-in clinical cases. Results: 354 students took the course (259 [73.1%] in LB in 2012-14, and 95 [26.9%] in FC/TBL in 2015. Two of 3 tests (MCQ and fill-in improved for FC/TBL. Overall, median scores increased from 93.5% (IQR 90.6, 95.4 to 95.1% (92.8, 96.7, P=0.0001. For the fill-in test: 94.1% for LB (89.6, 97.2 to 96.6% for FC/TBL (92.4, 99.20 P=0.0001. For MC: 88% for LB (84, 92 to 90% for FC/TBL (86, 94, P=0.0002. For the rhythm test: median 100% for both formats. More students failed 1 of 3 tests with LB vs. FC/TBL (24.7% vs. 14.7%, and 2 or 3 components (8.1% vs. 3.2%, P=0.006. Conversely, 82.1% passed all 3 with FC/TBL vs. 67.2% with LB (difference 14.9%, 95% CI 4.8-24.0%. Conclusion: A FC/TBL format for ACLS marginally improved written test results.

  19. Associations between trace elements and clinical health parameters in the North Pacific loggerhead sea turtle (Caretta caretta) from Baja California Sur, Mexico.

    Science.gov (United States)

    Ley-Quiñónez, César Paúl; Rossi-Lafferriere, Natalia Alejandra; Espinoza-Carreon, Teresa Leticia; Hart, Catherine Edwina; Peckham, Sherwood Hoyt; Aguirre, Alfredo Alonso; Zavala-Norzagaray, Alan Alfredo

    2017-04-01

    This study investigated selected trace elements toxicity in sea turtles Caretta caretta population from Baja California Sur (BCS), Mexico, by analyzing associations among Zn, Se, Cu, As, Cd, Ni, Mn, Pb, and Hg with various biochemical parameters (packed cell volume, leukocytes, and selected blood parameters), and whether their concentrations could have an impact on the health status of sea turtles. Blood samples from 22 loggerhead (C. caretta) sea turtles from BCS, Mexico, were collected for trace elements on biochemistry parameter analyses. Significant associations among trace element levels and the biochemistry parameters were found: Cd vs ALP (R 2 = 0.874, p ˂ 0.001), As vs ALP (R 2 = 0.656, p ˂ 0.001), Mn vs ALP (R 2 = 0.834, p ˂ 0.001), and Ni vs LDH (R 2 = 0.587, p ˂ 0.001). This study is the first report of the biochemical parameters of the North Pacific loggerhead sea turtle (C. caretta) from Baja California Sur, Mexico, and it is the first to observe several associations with toxic and essential trace elements. Our study reinforces the usefulness of blood for the monitoring of the levels of contaminating elements and the results suggest that, based on the associations with health clinical parameters, high levels of Cd and As could be representing a risk to the North Pacific loggerhead population health.

  20. Efficient replication of over 180 genetic associations with self-reported medical data.

    Directory of Open Access Journals (Sweden)

    Joyce Y Tung

    Full Text Available While the cost and speed of generating genomic data have come down dramatically in recent years, the slow pace of collecting medical data for large cohorts continues to hamper genetic research. Here we evaluate a novel online framework for obtaining large amounts of medical information from a recontactable cohort by assessing our ability to replicate genetic associations using these data. Using web-based questionnaires, we gathered self-reported data on 50 medical phenotypes from a generally unselected cohort of over 20,000 genotyped individuals. Of a list of genetic associations curated by NHGRI, we successfully replicated about 75% of the associations that we expected to (based on the number of cases in our cohort and reported odds ratios, and excluding a set of associations with contradictory published evidence. Altogether we replicated over 180 previously reported associations, including many for type 2 diabetes, prostate cancer, cholesterol levels, and multiple sclerosis. We found significant variation across categories of conditions in the percentage of expected associations that we were able to replicate, which may reflect systematic inflation of the effects in some initial reports, or differences across diseases in the likelihood of misdiagnosis or misreport. We also demonstrated that we could improve replication success by taking advantage of our recontactable cohort, offering more in-depth questions to refine self-reported diagnoses. Our data suggest that online collection of self-reported data from a recontactable cohort may be a viable method for both broad and deep phenotyping in large populations.

  1. Prevalence and factors associated with depression among medical students in Cameroon: a cross-sectional study.

    Science.gov (United States)

    Ngasa, Stewart Ndutard; Sama, Carlson-Babila; Dzekem, Bonaventure Suiru; Nforchu, Kilton Neba; Tindong, Maxime; Aroke, Desmond; Dimala, Christian Akem

    2017-06-09

    Depression is an important contributor to the global burden disease that affects people of communities all over the world. With high level of demands in academics and psychosocial pressure, medical students during their course of training tend to become depressed, leading to problems later in professional life and compromising patient care. In Cameroon, there is lack of data on the prevalence of depression and its impact on medical students. To determine the prevalence and predisposing factors associated with depression among medical students in Cameroon (preclinical and clinical). We also evaluated the impact of depression on self-reported academic performance. A cross sectional study was carried out in all 4 state medical schools in 4 different regions from December 2015 to January 2016. Diagnosis of depression, major depression and its associated factors were assessed using the 9-Item-Patient Health Questionnaire (PHQ-9) and a structured questionnaire respectively. We included 618 medical students (response rate: 90.4%). About a third of them (30.6%, 95% CI: 22.8-36.7) were found to have major depressive disorder (PHQ Score ≥ 10). With regards to the severity of depression, 214 (34.6%), 163 (26.4%), 21 (3.4%), and 5 (0.80%) students were classified as having mild, moderate, moderately severe and severe depression respectively. The presence of a chronic disease (OR: 3.70, 95% CI: 1.72-7.94, p = 0.001), major life events (OR: 2.17, 95%CI: 1.32-3.58, P = 0.002), female gender (OR: 1.59, 95% CI: 1.06-2.37, p = 0.024) and being a student at the clinical level (OR: 4.26, 95% CI: 2.71-6.71, p depression. There was no association between depression and self-reported academic performance, (OR: 1.2, 95% CI: 0.9-1.7, p = 0.080). The prevalence of major depressive disorders among medical students in Cameroon is high and is associated with the presence chronic disease, major life events, female gender and being a student at the clinical level. So we recommend

  2. Factors associated with medical student clinical reasoning and evidence based medicine practice.

    Science.gov (United States)

    Vidyarthi, Arpana R; Kamei, Robert; Chan, Kenneth; Goh, Sok-Hong; Lek, Ngee

    2015-11-08

    To identify the factors associated with medical students' clinical reasoning (CR) use and evidence-based medicine (EBM) use in the clinical setting. Our cross-sectional study surveyed 44 final-year medical students at an emerging academic medical center in Singapore. We queried the students' EBM and CR value and experiences in the classroom and clinical settings. We compared this to their perceptions of supervisors' value and experiences using t-tests. We developed measures of teaching culture and practice culture by combining relevant questions into summary scores. Multivariate linear regression models were applied to identify factors associated with the students' CR and EBM clinical use. Eighty-nine percent of students responded (n=39). Students reported valuing CR (p=0.03) and EBM (p=0.001) more than their supervisors, but practiced these skills similarly (p=0.83; p=0.82). Clinical practice culture and classroom CR experience were independently associated with students' CR clinical use (p=0.05; p=0.04), and classroom EBM experience was independently associated with students' EBM clinical use (p=0.03). Clinical teaching culture was not associated with students' CR and EBM clinical use. Our study found that medical students' classroom experience and the clinical practice culture influenced their CR and EBM use. The clinical teaching culture did not. These findings suggest that in order to increase student CR and EBM use, in addition to providing classroom experience, medical educators may need to change the hospital culture by encouraging supervisors to use these skills in their clinical practice.

  3. The association between self-perceptions of aging and antihypertensive medication adherence in older Chinese adults.

    Science.gov (United States)

    Hou, Yunying; Zhang, Dandan; Gu, Jie; Xue, Feng; Sun, Yunjuan; Wu, Qing; Zhao, Xin; Wang, Xiaohua

    2016-12-01

    Approximately one billion adults worldwide are hypertensive and most aged 60 or above. Poor adherence with medication treatment is still one of the main causes of failure in achieving blood pressure control. Compared to younger individuals, aging perception may be the main factor influencing elders receiving preventive care. Some studies have investigated the impact of self-perceptions of aging on some preventive health behaviors including "followed the directions for taking prescription medications" in developed countries in the West. However, there is a scarcity of studies evaluating the self-perceptions of aging and its association with antihypertensive adherence among Chinese older adults. This study aimed to identify the association between aging perceptions and antihypertensive drug adherence among Chinese older adults. A cross-sectional investigation was conducted in wards and outpatient clinic of a University Hospital and communities in Suzhou, China. Older adults who were taking at least one antihypertensive drug currently were invited to complete a self-administered questionnaire, including basic socio-demographic and clinical information, self-reported medication adherence and self-perceptions of aging. From 585 old patients, 34.2 % was determined to have good medication adherence. Logistic regression analysis demonstrated that good adherence to antihypertensive agents was more common among those with lower scores on "timeline cyclical" (p = 0.004) and "identity" (p medication adherence, are an important starting point when conducting intervention programmes for elder patients.

  4. An analysis of lecture video utilization in undergraduate medical education: associations with performance in the courses

    Directory of Open Access Journals (Sweden)

    Chandrasekhar Arcot

    2009-01-01

    Full Text Available Abstract Background Increasing numbers of medical schools are providing videos of lectures to their students. This study sought to analyze utilization of lecture videos by medical students in their basic science courses and to determine if student utilization was associated with performance on exams. Methods Streaming videos of lectures (n = 149 to first year and second year medical students (n = 284 were made available through a password-protected server. Server logs were analyzed over a 10-week period for both classes. For each lecture, the logs recorded time and location from which students accessed the file. A survey was administered at the end of the courses to obtain additional information about student use of the videos. Results There was a wide disparity in the level of use of lecture videos by medical students with the majority of students accessing the lecture videos sparingly (60% of the students viewed less than 10% of the available videos. The anonymous student survey revealed that students tended to view the videos by themselves from home during weekends and prior to exams. Students who accessed lecture videos more frequently had significantly (p Conclusion We conclude that videos of lectures are used by relatively few medical students and that individual use of videos is associated with the degree to which students are having difficulty with the subject matter.

  5. The association between trust in health care providers and medication adherence among Black women with hypertension

    Directory of Open Access Journals (Sweden)

    Willie M. Abel

    2013-12-01

    Full Text Available Background: Black women have the highest prevalence of hypertension in the world. Reasons for this disparity are poorly understood. The historical legacy of medical maltreatment of Blacks in the U.S. provides some insight into distrust in the medical profession, refusal of treatment, and poor adherence to treatment regimens.Methods: Black women (N=80 who were prescribed antihypertensive medications were recruited from urban communities in North Carolina. Study participants completed the Trust in Physician and Hill-Bone Compliance to High Blood Pressure Therapy questionnaires. An exact discrete-event model was used to examine the relationship between trust and medication adherence.Results: Mean age of study participants was 48 ± 9.2 years. The majority of participants (67% were actively employed and 30% had incomes at or below the federal poverty level. Increasing levels of trust in the health care provider was independently associated with greater medication adherence (PTrend=0.015.Conclusions: Black women with hypertension who trusted their health care providers were more likely to be adherent with their prescribed antihypertensive medications than those who did not trust their health care providers. Findings suggest that trusting relationships between Black women and health care providers are important to decreasing disparate rates of hypertension.

  6. Adherence and persistence associated with an appointment-based medication synchronization program.

    Science.gov (United States)

    Holdford, David A; Inocencio, Timothy J

    2013-01-01

    To assess the impact of an appointment-based medication synchronization (ABMS) program on medication adherence and persistence with chronic medications. DESIGN Quasiexperimental study in which study patients were matched with control patients. Rural pharmacies in the Midwestern United States between June 30, 2011, and October 31, 2012. Individuals receiving at least two refills for one of six categories of medications to treat chronic diseases (i.e., angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, beta blockers, dihydropyridine calcium channel blockers, thiazide diuretics, metformin, statins). Patients in the ABMS program were compared with control patients receiving usual care. 1-year adherence rates using proportion of days covered (PDC) and 1-year nonpersistence rates. Depending on the drug class, patients enrolled in the medication synchronization program (n = 47-81) had adherences rates of 66.1% to 75.5% during 1 year versus 37.0% to 40.8% among control patients. Program patients had 3.4 to 6.1 times greater odds of adherence compared with control patients. Control patients were 52% to 73% more likely to stop taking their chronic medications over 1 year. An ABMS program in community pharmacies was associated with improved patient adherence and reduced likelihood of nonpersistence.

  7. [Health-care research from the German Medical Association's perspective on small-area analysis].

    Science.gov (United States)

    Zorn, U

    2014-02-01

    As early as 2003, the German medical profession realized the necessity of not only forwarding medical research, but also analyzing the process of health care itself. Approved by a decision of the 108th German Medical Assembly in 2005, an initiative on health-care research paid by contributions of the medical profession was launched. Since then several projects have been supported with the results being published continuously. From the perspective of the German Medical Association, the success of the initiative also proves the effective approach of the scientific and medical communities' self-administration. Although the current results from health-care research can be used to support health-care politics and decision making at a macro level, a focus on small-area analysis tends to be an intrinsic attribute of health-care research, keeping a local approach toward changes so as to obtain real effects. Without local settings and without data reflecting the local situation, the"last mile" of a health-care system, which is the core subject of health-care research, will not be comprehensible.

  8. Antispasmodic medications may be associated with reduced recovery during inpatient rehabilitation after traumatic spinal cord injury.

    Science.gov (United States)

    Theriault, Eric R; Huang, Vincent; Whiteneck, Gale; Dijkers, Marcel P; Harel, Noam Y

    2018-01-01

    To determine whether antispasmodic medications are associated with neurological and functional outcomes during the first year after traumatic spinal cord injury (SCI). Retrospective analysis of prospectively collected data from six inpatient SCI rehabilitation centers. Baseline-adjusted outcomes at discharge and one-year follow-up were compared using analysis of covariance between patients who received antispasmodic medication on at least 5 days during inpatient rehabilitation and patients who did not. Rasch-transformed motor subscore of the Functional Independence Measure (FIM); International Standards for Neurological Classification of Spinal Cord Injury motor scores, grade, and level. Of 1,259 patients, 59.8%, 35.4%, and 4.8% were injured at the cervical, thoracic, and lumbosacral levels, respectively. 65.6% had motor complete injury. Rasch-transformed motor FIM score at admission averaged 23.3 (95% confidence interval (CI) 22.4-24.2). Total motor score averaged 39.2 (95% CI 37.8-40.6). 685 patients (54.4%) received one or more antispasmodic medications on at least 5 days. After controlling for demographic and injury variables at admission, Rasch-transformed motor FIM scores at discharge were significantly lower (P = 0.018) in patients receiving antispasmodic medications than in those who did not. This trend persisted in secondary analyses for cervical, thoracic, and lumbosacral subgroups. Multivariate regression showed that receiving antispasmodic medication significantly contributed to discharge motor FIM outcome. At one-year follow-up, no outcomes significantly differed between patients ON or OFF antispasmodics. Antispasmodic medications may be associated with decreased functional recovery at discharge from inpatient traumatic SCI rehabilitation. Randomized prospective studies are needed to directly evaluate the effects of antispasmodic medication on recovery.

  9. Quality of Co-Prescribing NSAID and Gastroprotective Medications for Elders in The Netherlands and Its Association with the Electronic Medical Record

    NARCIS (Netherlands)

    Opondo, Dedan; Visscher, Stefan; Eslami, Saeid; Verheij, Robert A.; Korevaar, Joke C.; Abu-Hanna, Ameen

    2015-01-01

    To assess guideline adherence of co-prescribing NSAID and gastroprotective medications for elders in general practice over time, and investigate its potential association with the electronic medical record (EMR) system brand used. We included patients 65 years and older who received NSAIDs between

  10. Identifying Early Childhood Personality Dimensions Using the California Child Q-Set and Prospective Associations With Behavioral and Psychosocial Development

    OpenAIRE

    Wilson, Sylia; Schalet, Benjamin D.; Hicks, Brian M.; Zucker, Robert A.

    2013-01-01

    The present study used an empirical, “bottom-up” approach to delineate the structure of the California Child Q-Set (CCQ), a comprehensive set of personality descriptors, in a sample of 373 preschool-aged children. This approach yielded two broad trait dimensions, Adaptive Socialization (emotional stability, compliance, intelligence) and Anxious Inhibition (emotional/behavioral introversion). Results demonstrate the value of using empirical derivation to investigate the structure of personalit...

  11. GPS Time Series Analysis of Southern California Associated with the 2010 M7.2 El Mayor/Cucapah Earthquake

    Science.gov (United States)

    Granat, Robert; Donnellan, Andrea

    2011-01-01

    The Magnitude 7.2 El-Mayor/Cucapah earthquake the occurred in Mexico on April 4, 2012 was well instrumented with continuous GPS stations in California. Large Offsets were observed at the GPS stations as a result of deformation from the earthquake providing information about the co-seismic fault slip as well as fault slip from large aftershocks. Information can also be obtained from the position time series at each station.

  12. Mortalities of kelp-forest fishes associated with large oceanic waves off central California, 1982-1983

    Science.gov (United States)

    Bodkin, James L.; VanBlaricom, Glenn R.; Jameson, Ronald J.

    1987-01-01

    Observations of three incidents of the mass mortality of nearshore fishes are reported; each corresponded to periods of high-amplitude, long-period swells during the 1982-1983 El Niño event along the coast of central California. Members of the nearshore kelp forest fish assemblage, primarily of the genus Sebastes, accounted for 96% of the observed mortalities and S. mystinus (blue rockfish) alone accounted for 72%.

  13. Sentinel California sea lions provide insight into legacy organochlorine exposure trends and their association with cancer and infectious disease

    OpenAIRE

    Randhawa, Nistara; Gulland, Frances; Ylitalo, Gina M.; DeLong, Robert; Mazet, Jonna A.K.

    2015-01-01

    Background: Organochlorine contaminants (OCs), like polychlorinated biphenyls (PCBs) and dichlorodiphenyltrichloroethanes (DDTs), are widespread marine pollutants resulting from massive historical use and environmental persistence. Exposure to and health effects of these OCs in the marine environment may be examined by studying California sea lions (Zalophus californianus), which are long lived, apex predators capable of accumulating OCs. Methods: We evaluated PCB and DDT levels in 310 sea...

  14. Association Between Poorer Cognitive Function and Reduced Objectively Monitored Medication Adherence in Patients With Heart Failure.

    Science.gov (United States)

    Dolansky, Mary A; Hawkins, Misty A W; Schaefer, Julie T; Sattar, Abdus; Gunstad, John; Redle, Joseph D; Josephson, Richard; Moore, Shirley M; Hughes, Joel W

    2016-12-01

    Subclinical cognitive impairment is prevalent in heart failure (HF); however, its role in important clinical outcomes, such as HF treatment adherence, is unclear. Given the complex polypharmacy in HF treatment, cognitive deficits may be important in predicting medication management. Thus, the objective of the current study was to examine the impact of cognitive function on medication adherence among community-dwelling patients with HF using objective assessments. A prospective observational cohort design of 309 community-dwelling patients with HF (59.7% male, 68.7±9.7 years) and no history of dementia or neurological disease. Cognition was assessed using a neuropsychological battery at baseline. Medication adherence was objectively measured for 21 days using an electronic pillbox. Regression analyses tested whether attention, executive function, or memory predicted 21-day medication adherence. In unadjusted analyses, lower scores on all 3 cognitive domains predicted poorer medication adherence (β=0.52-85; P=0.001-0.009). After adjusting for demographic, clinical, and psychosocial variables, memory continued to predict medication adherence (β=0.51; P=0.008), whereas executive function (β=0.24; P=0.075) and attention were no longer a predictor (β=0.34; P=0.131). Poorer cognitive function, especially in regard to memory, predicted reduced medication adherence among patients with HF and no history of dementia. This effect remained after adjustment for factors known to predict adherence, such as depressed mood, social support, and disease severity level. Future studies should examine the link from cognitive impairment and medication nonadherence to clinical outcomes (eg, hospitalization and mortality). URL: http://www.clinicaltrials.gov. Unique identifier: NCT01461629. © 2016 American Heart Association, Inc.

  15. Exploring the association between parental rearing styles and medical students' critical thinking disposition in China.

    Science.gov (United States)

    Huang, Lei; Wang, Zhaoxin; Yao, Yuhong; Shan, Chang; Wang, Haojie; Zhu, Mengyi; Lu, Yuan; Sun, Pengfei; Zhao, Xudong

    2015-05-14

    Critical thinking is an essential ability for medical students. However, the relationship between parental rearing styles and medical students' critical thinking disposition has rarely been considered. The aim of this study was to investigate whether parental rearing styles were significant predictors of critical thinking disposition among Chinese medical students. 1,075 medical students from the first year to the fifth year attending one of three medical schools in China were recruited via multistage stratified cluster sampling. The Chinese Critical Thinking Disposition Inventory(CTDI-CV) and The Egna Minnen av Barndoms Uppfostran (EMBU) questionnaire were applied to collect data and to conduct descriptive analysis. Stepwise multiple linear regression was used to analyze the data. The critical thinking disposition average mean score was 287.44 with 632 participants (58.79%) demonstrating positive critical thinking disposition. Stepwise multiple linear regression analysis revealed that the rearing styles of fathers, including "overprotection", "emotional warmth and understanding", "rejection" and "over-interference" were significant predictors of medical students' critical thinking disposition that explained 79.0% of the variance in critical thinking ability. Rearing styles of mothers including "emotional warmth and understanding", "punishing" and "rejection" were also found to be significant predictors, and explained 77.0% of the variance. Meaningful association has been evidenced between parental rearing styles and Chinese medical students' critical thinking disposition. Parental rearing styles should be considered as one of the many potential determinant factors that contribute to the cultivation of medical students' critical thinking capability. Positive parental rearing styles should be encouraged in the cultivation of children's critical thinking skills.

  16. The national assessment of shoreline change: a GIS compilation of vector cliff edges and associated cliff erosion data for the California coast

    Science.gov (United States)

    Hapke, Cheryl; Reid, David; Borrelli, Mark

    2007-01-01

    The U.S. Geological Survey has generated a comprehensive data clearinghouse of digital vector cliff edges and associated rates of cliff retreat along the open-ocean California coast. These data, which are presented herein, were compiled as part of the U.S. Geological Survey's National Assessment of Shoreline Change Project. Cliff erosion is a chronic problem along many coastlines of the United States. As coastal populations continue to grow and community infrastructures are threatened by erosion, there is increased demand for accurate information including rates and trends of coastal cliff retreat. There is also a critical need for these data to be consistent from one region to another. One objective of this work is to a develop standard, repeatable methodology for mapping and analyzing cliff edge retreat so that periodic, systematic, and internally consistent updates of cliff edge position and associated rates of erosion can be made at a national scale. This data compilation for open-ocean cliff edges for the California coast is a separate, yet related study to Hapke and others, 2006 documenting shoreline change along sandy shorelines of the California coast, which is itself one in a series that includes the Gulf of Mexico and the Southeast Atlantic coast (Morton and others, 2004; Morton and Miller, 2005). Future reports and data compilations will include coverage of the Northeast U.S., the Great Lakes, Hawaii and Alaska. Cliff edge change is determined by comparing the positions of one historical cliff edge digitized from maps with a modern cliff edge derived from topographic LIDAR (light detection and ranging) surveys. Historical cliff edges for the California coast represent the 1920s-1930s time-period; the most recent cliff edge was delineated using data collected between 1998 and 2002. End-point rate calculations were used to evaluate rates of erosion between the two cliff edges. Please refer to our full report on cliff edge erosion along the California

  17. Premenstrual dysphoric disorder in medical students residing in hostel and its association with lifestyle factors.

    Science.gov (United States)

    Mishra, Amrita; Banwari, Girish; Yadav, Priyanka

    2015-01-01

    There is scant research on premenstrual syndrome (PMS) and its more severe counterpart, premenstrual dysphoric disorder (PMDD) in Indian females. This study aimed to evaluate symptoms of PMS in medical students and to find the association of sociodemographic variables and lifestyle factors with PMDD. A total of 179 medical students residing in the hostel of an Indian medical college and its affiliated teaching hospital were approached, of which 100 (55.8%) returned the completed questionnaires. Data related to lifestyle factors was collected. Self-screening quiz for Diagnostic and Statistical Manual of Mental Disorders-IV-Text Revision PMDD and Shortened Premenstrual Assessment Form were used for diagnosis of PMDD and detection of symptomatology, respectively. PMDD was present in 37% of the respondents. It was found at a higher rate in older and postgraduate students. PMDD was significantly associated with lifestyle factors, namely, sleep, physical activity, total tea/coffee intake, and change in tea/coffee and food intake under stress. The most common physical and psychological symptoms were body ache/joint pain and feeling depressed/blue, respectively. PMDD is fairly common in Indian medical students residing in hostel although cultural factors may influence symptom expression. This study suggests that PMDD is associated with lifestyle factors in young, professional, urban women. Modification in lifestyle may thus be an important approach for management of PMS/PMDD. Prospective studies with larger representative samples are needed to validate these findings.

  18. Premenstrual dysphoric disorder in medical students residing in hostel and its association with lifestyle factors

    Directory of Open Access Journals (Sweden)

    Amrita Mishra

    2015-01-01

    Full Text Available Context: There is scant research on premenstrual syndrome (PMS and its more severe counterpart, premenstrual dysphoric disorder (PMDD in Indian females. This study aimed to evaluate symptoms of PMS in medical students and to find the association of sociodemographic variables and lifestyle factors with PMDD. Subjects and Methods: A total of 179 medical students residing in the hostel of an Indian medical college and its affiliated teaching hospital were approached, of which 100 (55.8% returned the completed questionnaires. Data related to lifestyle factors was collected. Self-screening quiz for Diagnostic and Statistical Manual of Mental Disorders-IV-Text Revision PMDD and Shortened Premenstrual Assessment Form were used for diagnosis of PMDD and detection of symptomatology, respectively. Results: PMDD was present in 37% of the respondents. It was found at a higher rate in older and postgraduate students. PMDD was significantly associated with lifestyle factors, namely, sleep, physical activity, total tea/coffee intake, and change in tea/coffee and food intake under stress. The most common physical and psychological symptoms were body ache/joint pain and feeling depressed/blue, respectively. Conclusions: PMDD is fairly common in Indian medical students residing in hostel although cultural factors may influence symptom expression. This study suggests that PMDD is associated with lifestyle factors in young, professional, urban women. Modification in lifestyle may thus be an important approach for management of PMS/PMDD. Prospective studies with larger representative samples are needed to validate these findings.

  19. Personality Traits Are Associated with Academic Achievement in Medical School: A Nationally Representative Study.

    Science.gov (United States)

    Sobowale, Kunmi; Ham, Sandra A; Curlin, Farr A; Yoon, John D

    2017-08-04

    This nationally representative study sought to identify personality traits that are associated with academic achievement in medical school. Third-year medical students, who completed an initial questionnaire in January 2011, were mailed a second questionnaire several months later during their fourth year. Controlling for sociodemographic characteristics and burnout, the authors used multivariate logistic regressions to determine whether Big Five personality traits were associated with receiving honors/highest grade in clinical clerkships, failing a course or rotation, and being selected for the Alpha Omega Alpha or Gold Humanism Honor Society. The adjusted response rates for the two surveys were 61 (n = 564/919) and 84% (n = 474/564). The personality trait conscientiousness predicted obtaining honors/highest grade in all clinical clerkships. In contrast, students high in neuroticism were less likely to do well in most specialties. Students with higher conscientiousness were more likely to be inducted into the Alpha Omega Alpha Honor Society, while students high in openness or agreeableness traits were more likely to be inducted into the Gold Humanism Honor Society. Burnout was not associated with any clinical performance measures. This study suggests the importance of personality traits, particularly conscientiousness, in predicting success during the clinical years of medical school. Medical educators should consider a nuanced examination of personality traits and other non-cognitive factors, particularly for psychiatry.

  20. Skipping Breakfast is Associated with Academic Achievement, Unhealthy Behaviors, and Sense of Coherence Among Medical Students

    OpenAIRE

    Midori, Nishiyama; Erina, Suzuki; Michiyo, Hashimoto; Nobuko, Takaoka; Michiyo, Inaba; Nozomu, Tadokoro; Mitsuko, Kumakura; Teruhito, Furuichi; Yuichiro, Kamikawa; Education Support Center, Dokkyo Medical University : Division of Education for Community Medicine, Dokkyo Medical University; Department of Preventive Medicine, St. Marianna University School of Medicine; Education Support Center, Dokkyo Medical University; Education Support Center, Dokkyo Medical University : Department of Obstetrics and Gynecology, Dokkyo Medical University; Education Support Center, Dokkyo Medical University : Department of Home Caring, Dokkyo Medical University School of Nursing; Education Support Center, Dokkyo Medical University : Department of Rehabilitation Medicine, Dokkyo Medical University School of Medicine

    2013-01-01

    Few previous studies have examined the relationship between breakfast-skipping and sense of coherence(SOC). This study investigated whether breakfast-skipping was associated with academic achievement, unhealthybehavior, and SOC among medical students. The participants in this cross-sectional one-year cohortstudy were 92 first-year students( 57 men, 35 women;mean age, 19.6±1.6 years) at Dokkyo Medical University.They completed two self-evaluation questionnaires:the first comprised 26 items reg...

  1. Factors Associated with Medication Nonadherence among Hypertensives in Ghana and Nigeria

    Directory of Open Access Journals (Sweden)

    Vincent Boima

    2015-01-01

    Full Text Available Background. Blood pressure (BP control is poor among hypertensives in many parts of sub-Saharan Africa. A potentially modifiable factor for control of BP is medication nonadherence (MNA; our study therefore aimed to determine factors associated with MNA among hypertensives in Ghana and Nigeria. Methodology. We conducted a multicenter cross-sectional study. Patients were recruited from Korle-Bu Hospital (n=120, Ghana; and University of Port Harcourt Teaching Hospital, (n=73 Apapa General Hospital Lagos (n=79 and University College Hospital Ibadan (n=85, Nigeria. Results. 357 hypertensive patients (42.6% males participated. MNA was found in 66.7%. Adherence showed correlation with depression (r=-0.208, P<0.001, concern about medications (r=-0.0347, P=0.002, and knowledge of hypertension (r=0.14, P=0.006. MNA was associated with formal education (P=0.001 and use of herbal preparation (P=0.014. MNA was found in 61.7% of uninsured participants versus 73.1% of insured participants (P=0.032. Poor BP control was observed in 69.7% and there was significant association between MNA and poor BP control (P=0.006. Conclusion. MNA is high among hypertensives in Ghana and Nigeria and is associated with depression, concern about hypertensive medications, formal education, and use of herbal preparations. The negative association between health insurance and MNA suggests interplay of other factors and needs further investigation.

  2. Brazilian Medical Association guidelines for the diagnosis and differential diagnosis of panic disorder

    Directory of Open Access Journals (Sweden)

    Michelle Nigri Levitan

    2013-12-01

    Full Text Available Objective: To present the most relevant findings regarding the Brazilian Medical Association guidelines for the diagnosis and differential diagnosis of panic disorder. Methods: We used the methodology proposed by the Brazilian Medical Association for the Diretrizes Project. The MEDLINE (PubMed, Scopus, Web of Science, and LILACS online databases were queried for articles published from 1980 to 2012. Searchable questions were structured using the PICO format (acronym for “patient” [or population], “intervention” [or exposure], “comparison” [or control], and “outcome”. Results: We present data on clinical manifestations and implications of panic disorder and its association with depression, drug abuse, dependence and anxiety disorders. In addition, discussions were held on the main psychiatric and clinical differential diagnoses. Conclusions: The guidelines are proposed to serve as a reference for the general practitioner and specialist to assist in and facilitate the diagnosis of panic disorder.

  3. Medical Cannabis Use Is Associated With Decreased Opiate Medication Use in a Retrospective Cross-Sectional Survey of Patients With Chronic Pain.

    Science.gov (United States)

    Boehnke, Kevin F; Litinas, Evangelos; Clauw, Daniel J

    2016-06-01

    Opioids are commonly used to treat patients with chronic pain (CP), though there is little evidence that they are effective for long term CP treatment. Previous studies reported strong associations between passage of medical cannabis laws and decrease in opioid overdose statewide. Our aim was to examine whether using medical cannabis for CP changed individual patterns of opioid use. Using an online questionnaire, we conducted a cross-sectional retrospective survey of 244 medical cannabis patients with CP who patronized a medical cannabis dispensary in Michigan between November 2013 and February 2015. Data collected included demographic information, changes in opioid use, quality of life, medication classes used, and medication side effects before and after initiation of cannabis usage. Among study participants, medical cannabis use was associated with a 64% decrease in opioid use (n = 118), decreased number and side effects of medications, and an improved quality of life (45%). This study suggests that many CP patients are essentially substituting medical cannabis for opioids and other medications for CP treatment, and finding the benefit and side effect profile of cannabis to be greater than these other classes of medications. More research is needed to validate this finding. This article suggests that using medical cannabis for CP treatment may benefit some CP patients. The reported improvement in quality of life, better side effect profile, and decreased opioid use should be confirmed by rigorous, longitudinal studies that also assess how CP patients use medical cannabis for pain management. Copyright © 2016 American Pain Society. Published by Elsevier Inc. All rights reserved.

  4. Stressful life events, ethnic identity, historical trauma, and participation in cultural activities: Associations with smoking behaviors among American Indian adolescents in California.

    Science.gov (United States)

    Soto, Claradina; Baezconde-Garbanati, Lourdes; Schwartz, Seth J; Unger, Jennifer B

    2015-11-01

    American Indian (AI) adolescents have the highest prevalence of commercial tobacco use of any ethnic group in the United States. This study examines ethnic identity (EI), participation in cultural activities, and stressful life events (SLEs) as correlates of smoking and examines historical trauma (HT) as a mediator of these associations. California AI youth (N = 969, ages 13-19, recruited from 49 tribal youth organizations and cultural activities in urban and reservation areas in California) completed a tobacco survey. Structural equation modeling was used to test a model examining HT as a potential mediator of the associations of EI, participation in cultural activities, and SLEs with cigarette smoking. Model fit was adequate. EI, participation in cultural activities, and SLEs predicted HT. HT mediated the associations of participation in cultural activities and SLEs with past-month smoking. Stronger EI predicted greater past-month smoking and this effect was mediated by greater HT. The direct effects from HT to both smoking outcomes were positive and the direct effect from EI to past-month smoking was negative. HT is a risk factor for cigarette smoking both directly and in mediating the links of EI, cultural activities, and SLEs. More efforts are needed to help AI youth to process these thoughts and empower themselves to contribute to their own lives and those of their families and communities without resorting to unhealthy addictive behaviors such as commercial tobacco use. Published by Elsevier Ltd.

  5. Factors associated with emergency medical services scope of practice for acute cardiovascular events.

    Science.gov (United States)

    Williams, Ishmael; Valderrama, Amy L; Bolton, Patricia; Greek, April; Greer, Sophia; Patterson, Davis G; Zhang, Zefeng

    2012-01-01

    To examine prehospital emergency medical services (EMS) scope of practice for acute cardiovascular events and characteristics that may affect scope of practice; and to describe variations in EMS scope of practice for these events and the characteristics associated with that variability. In 2008, we conducted a telephone survey of 1,939 eligible EMS providers in nine states to measure EMS agency characteristics, medical director involvement, and 18 interventions authorized for prehospital care of acute cardiovascular events by three levels of emergency medical technician (EMT) personnel. A total of 1,292 providers responded to the survey, for a response rate of 67%. EMS scope of practice interventions varied by EMT personnel level, with the proportion of authorized interventions increasing as expected from EMT-Basic to EMT-Paramedic. Seven of eight statistically significant associations indicated that EMS agencies in urban settings were less likely to authorize interventions (odds ratios fire department-based EMS agencies were two to three times more likely to authorize interventions for EMT-Intermediate personnel. Volunteer EMS agencies were more than twice as likely as nonvolunteer agencies to authorize interventions for EMT-Basic and EMT-Intermediate personnel but were less likely to authorize any one of the 11 interventions for EMT-Paramedics. Greater medical director involvement was associated with greater likelihood of authorization of seven of the 18 interventions for EMT-Basic and EMT-Paramedic personnel but had no association with EMT-Intermediate personnel. We noted statistically significant variations in scope of practice by rural vs. urban setting, medical director involvement, and type of EMS service (fire department-based/non-fire department-based; volunteer/paid). These variations highlight local differences in the composition and capacity of EMS providers and offer important information for the transition towards the implementation of a national

  6. Organizational change in the Medical Library Association: evolution of the continuing education program.

    Science.gov (United States)

    Mayfield, M K; Palmer, R A

    1987-10-01

    "Change" is a critical dimension of contemporary experience. Library associations are not exempt, and they change in ways similar to other organizations. According to some authorities, four phases typify the process: diagnosis, design, implementation, and incorporation. Focusing on changes in the Medical Library Association's longstanding program of continuing education, the authors utilize the "phase framework" to chart that association's movement from a management system depending primarily upon volunteers to one in which professional staff figure prominently. The historical review serves a heuristic purpose for individuals and institutions in identifying characteristic features of the change process.

  7. Association of Bariatric Surgery vs Medical Obesity Treatment With Long-term Medical Complications and Obesity-Related Comorbidities.

    Science.gov (United States)

    Jakobsen, Gunn Signe; Småstuen, Milada Cvancarova; Sandbu, Rune; Nordstrand, Njord; Hofsø, Dag; Lindberg, Morten; Hertel, Jens Kristoffer; Hjelmesæth, Jøran

    2018-01-16

    The association of bariatric surgery and specialized medical obesity treatment with beneficial and detrimental outcomes remains uncertain. To compare changes in obesity-related comorbidities in patients with severe obesity (body mass index ≥40 or ≥35 and at least 1 comorbidity) undergoing bariatric surgery or specialized medical treatment. Cohort study with baseline data of exposures from November 2005 through July 2010 and follow-up data from 2006 until death or through December 2015 at a tertiary care outpatient center, Vestfold Hospital Trust, Norway. Consecutive treatment-seeking adult patients (n = 2109) with severe obesity assessed (221 patients excluded and 1888 patients included). Bariatric surgery (n = 932, 92% gastric bypass) or specialized medical treatment (n = 956) including individual or group-based lifestyle intervention programs. Primary outcomes included remission and new onset of hypertension based on drugs dispensed according to the Norwegian Prescription Database. Prespecified secondary outcomes included changes in comorbidities. Adverse events included complications retrieved from the Norwegian Patient Registry and a local laboratory database. Among 1888 patients included in the study, the mean (SD) age was 43.5 (12.3) years (1249 women [66%]; mean [SD] baseline BMI, 44.2 [6.1]; 100% completed follow-up at a median of 6.5 years [range, 0.2-10.1]). Surgically treated patients had a greater likelihood of remission and lesser likelihood for new onset of hypertension (remission: absolute risk [AR], 31.9% vs 12.4%); risk difference [RD], 19.5% [95% CI, 15.8%-23.2%], relative risk [RR], 2.1 [95% CI, 2.0-2.2]; new onset: AR, 3.5% vs 12.2%, RD, 8.7% [95% CI, 6.7%-10.7%], RR, 0.4 [95% CI, 0.3-0.5]; greater likelihood of diabetes remission: AR, 57.5% vs 14.8%; RD, 42.7% [95% CI, 35.8%-49.7%], RR, 3.9 [95% CI, 2.8-5.4]; greater risk of new-onset depression: AR, 8.9% vs 6.5%; RD, 2.4% [95% CI, 1.3%-3.5%], RR, 1.5 [95% CI, 1.4-1.7]; and

  8. Valuing morbidity effects of wildfire smoke exposure from the 2007 Southern California wildfires

    Science.gov (United States)

    Ikuho Kochi; Patricia A. Champ; John B. Loomis; Geoffrey H. Donovan

    2016-01-01

    This study estimated the economic costs associated with morbidity from the wildfires that occurred in 2007 in southern California. We used the excess number of hospital admissions and emergency department visits to quantify the morbidity effects and used medical costs to estimate the economic impact. With data from 187 hospital facilities and 140 emergency departments...

  9. Data for calculating population, collision and displacement vulnerability among marine birds of the California Current System associated with offshore wind energy infrastructure

    Science.gov (United States)

    Adams, Josh; Kelsey, Emily; Felis, Jonathan J.; Pereksta, David M.

    2016-01-01

    The U.S. Geological Survey, Western Ecological Research Center (USGS-WERC) was requested by the Bureau of Ocean Energy Management (BOEM) to create a database for marine birds of the California Current System (CCS) that would allow quantification and species ranking regarding vulnerability to offshore wind energy infrastructure (OWEI). This was needed so that resource managers could evaluate potential impacts associated with siting and construction of OWEI within the California Current System section of the Pacific Offshore Continental Shelf, including California, Oregon, and Washington. Along with its accompanying Open File Report (OFR), this comprehensive database can be used (and modified or updated) to quantify marine bird vulnerability to OWEIs in the CCS at the population level. For 81 marine bird species present in the CCS, we generated numeric scores to represent three vulnerability indices associated with potential OWEI: population vulnerability, collision vulnerability, and displacement vulnerability. The metrics used to produce these scores includes global population size, proportion of the population in the CCS, threat status, adult survival, breeding score, annual occurrence in the CCS, nocturnal and diurnal flight activity, macro-avoidance behavior, flight height, and habitat flexibility; values for these metrics can be updated and adjusted as new data become available. The scoring methodology was peer-reviewed to evaluate if the metrics identified and the values generated were appropriate for each species considered. The numeric vulnerability scores in this database can readily be applied to areas in the CCS with known species distributions and where offshore renewable energy development is being considered. We hope that this information can be used to assist meaningful planning decisions that will impact seabird conservation. These data support the following publication: Adams, J., Kelsey, E.C., Felis J.J., and Pereksta, D.M., 2016

  10. Ethical orientation, functional linguistics, and the codes of ethics of the Canadian Nurses Association and the Canadian Medical Association.

    Science.gov (United States)

    Hadjistavropoulos, Thomas; Malloy, David C; Douaud, Patrick; Smythe, William E

    2002-09-01

    The literature on codes of ethics suggests that grammatical and linguistic structures as well as the theoretical ethical orientation conveyed in codes of ethics have implications for the manner in which such codes are received by those bound by them. Certain grammatical and linguistic structures, for example, tend to have an authoritarian and disempowering impact while others can be empowering. The authors analyze and compare the codes of ethics of the Canadian Nurses Association (CNA) and the Canadian Medical Association (CMA) in terms of their ethical orientation and grammatical/linguistic structures. The results suggest that the two codes differ substantially along these two dimensions. The CNA code contains proportionally more statements that provide a rationale for ethical behaviour; the statements of the CMA code tend to be more dogmatic. Functional grammar analysis suggests that both codes convey a strong deontological tone that does not enhance the addressee's ability to engage in discretionary decision-making. The nurses' code nonetheless implies a collaborative relationship with the client, whereas the medical code implies that the patient is the recipient of medical wisdom. The implications of these findings are discussed.

  11. An Exploration of Factors Associated With Ageist Stereotype Threat in a Medical Setting.

    Science.gov (United States)

    Phibbs, Sandi; Hooker, Karen

    2017-03-28

    Experiencing stereotype threat in a medical setting may be triggered by routine clinical activities, and may be detrimental to healthcare processes and outcomes. This study estimated the prevalence of, and identified factors associated with, reporting ageist stereotype threat in a medical setting using a nationally representative dataset. Participants were community-dwelling adults aged 50 and older who had visited the doctor at least once in the past 2 years (n = 1,662). We analyzed data from the Health and Retirement Study using multivariate logistic regression. 8.31% of participants felt worry or fear that they were judged by medical staff because of their age. Previous experiences of age discrimination (adjusted odds ratio [AOR] = 2.47, p age discrimination and to improve self-perceptions of aging and individual control over health protect against experiencing ageist stereotype threat in healthcare settings.

  12. Associations between adult attachment characteristics, medical burden, and life satisfaction among older primary care patients.

    Science.gov (United States)

    Kirchmann, Helmut; Nolte, Tobias; Runkewitz, Kristin; Bayerle, Lisa; Becker, Simone; Blasczyk, Verena; Lindloh, Julia; Strauss, Bernhard

    2013-12-01

    We investigated whether attachment security, measured by the Adult Attachment Prototype Rating (AAPR), was correlated with life satisfaction, independent of sociodemographic characteristics, medical burden, and age-related coping strategies in a sample of 81 patients (69-73 years) recruited from the register of a general primary care practice. Furthermore, we examined whether patients classified as AAPR-secure reported better adjustment to medical burden in terms of higher life satisfaction than did insecure patients. Attachment security was independently related to life satisfaction. Moreover, the association between medical burden and lower life satisfaction was significantly stronger for insecure than for secure participants. Our findings indicate that interventions to improve attachment security or coping processes related to attachment could help older adults retain life satisfaction. PsycINFO Database Record (c) 2013 APA, all rights reserved.

  13. [Direct costs involved in providing medical attention associated with traffic accidents in Bogotá].

    Science.gov (United States)

    Gómez-Restrepo, Carlos; Quitian, Hoover; Maldonado, Patricia; Naranjo-Lujan, Salomé; Rondón, Martín; Acosta, Andrés; Arango-Villegas, Carlos; Hurtado, Jaime; Hernández, Juan C; Angarita, María Del Pilar; Peña, Marcela; Saavedra, Miguel Á

    2014-01-01

    To determine the cost of medical attention associated with traffic accidents in Bogotá, Colombia. Prospective observational study with data from adult patients attended to in the emergency centers of 6 hospitals. Average total cost per patient was $1'112.000 COP. Average daily cost of hospitalized patients was $1'200.000 COP. Average cost of ambulatory treated patients ascended to $247.400 COP. Cost per accident calculated was $2'333.700 COP. In the whole city during study period, total medical costs were around $2.301'028.200 COP. All data was expressed in 2011 Colombian pesos. The medical cost of transit accidents is a significant economic burden.

  14. Association between patients' beliefs and oral antidiabetic medication adherence in a Chinese type 2 diabetic population

    Directory of Open Access Journals (Sweden)

    Wu P

    2016-06-01

    Full Text Available Ping Wu,1 Naifeng Liu2 1Department of Clinical Pharmacy, School of Basic Medical Sciences and Clinical Pharmacy, China Pharmaceutical University, 2Institute of Cardiovascular Disease, Southeast University Medical School, Nanjing, People’s Republic of China Purpose: The objective of this study was to identify, using the theory of planned behavior (TPB, patients’ beliefs about taking oral antidiabetic drugs (OADs as prescribed, and to measure the correlations between beliefs and medication adherence.Patients and methods: We performed a cross-sectional study of type 2 diabetic patients using structured questionnaires in a Chinese tertiary hospital. A total of 130 patients were enrolled to be interviewed about TPB variables (behavioral, normative, and control beliefs relevant to medication adherence. Medication adherence was assessed using the eight-item Morisky Medication Adherence Scale (MMAS-8. Spearman’s rank correlation was used to assess the association between TPB and MMAS-8. Logistic regression analysis was performed to examine the relationship between different variables and MMAS-8, with statistical significance determined at P<0.05.Results: From 130 eligible Chinese patients with an average age of 60.6 years and a male proportion of 50.8%, a nonsignificant relationship between behavioral, normative, and the most facilitating control beliefs and OAD adherence was found in our study. Having the OADs on hand (P=0.037 was the only facilitating control belief associated with adherence behavior. Being away from home or eating out (P=0.000, not accepting the disease (P=0.000, ignorance of life-long drug adherence (P=0.038, being busy (P=0.001, or poor memory (P=0.008 were control belief barriers found to be correlated with poor adherence. TPB is the only important determinant influencing OAD adherence among all the factors (P=0.011.Conclusion: The results indicate that the TPB model could be used to examine adherence to OADs. One

  15. Medical student researchers in Colombia and associated factors with publication: a cross-sectional study.

    Science.gov (United States)

    Bonilla-Escobar, Francisco Javier; Bonilla-Velez, Juliana; Tobón-García, Daniel; Ángel-Isaza, Ana María

    2017-12-15

    Gaps between evidence-based research and clinical-public health practice have been evident for decades. One of the aims of medical student research is to close this gap. Accordingly, evaluating individual and environmental factors that influence participation of medical students in research are needed to understand and identify potential targets for action. This study aims to identify characteristics of medical student researchers in Colombia and the associated factors with scientific publications. A cross-sectional study of Colombian medical students involved in research using a validated, self-administered, online survey. The survey was distributed through the Colombian Association of Medical Students' Associations (ASCEMCOL). Data sets were analyzed using descriptive and summary statistics. Bivariate analysis and a multiple logistic regression model were conducted to identify predictors of scientific publications. A total of 133 responses were analyzed from students at 12 Colombian cities and 20 higher-education institutions. Although 94% of responders had at least one research proposal, only 57% had completed a project, and 17% had published their findings. Barriers for undertaking research included time restrictions and a lack of mentorship. Motivational factors included opportunity to publish findings and good mentorship. Students planning to do a specialization (OR = 3.25; 95% Confidence interval [CI] = 1.27-8.30), innovators (OR = 3.52; 95%CI = 1.30-9.52) and committed (OR = 3.39; 95%CI = 1.02-11.29), those who had previously published their findings (OR 9.13 IC95% 2.57-32.48), and were further in their medical education (OR 2.26 IC95% 1.01-5.07), were more likely to publish scientific papers. Our findings describe medical students understanding of the process of conducting research in Colombia. Although there appears to be motivation to participate in research, very few students achieve publication. Barriers such as time constraints

  16. Association between Internet addiction and depression in Thai medical students at Faculty of Medicine, Ramathibodi Hospital.

    Directory of Open Access Journals (Sweden)

    Thummaporn Boonvisudhi

    Full Text Available To study the extent of Internet addiction (IA and its association with depression in Thai medical students.A cross-sectional study was conducted at Faculty of Medicine, Ramathibodi Hospital. Participants were first- to fifth-year medical students who agreed to participate in this study. Demographic characteristics and stress-related factors were derived from self-rated questionnaires. Depression was assessed using the Thai version of Patient Health Questionnaire (PHQ-9. A total score of five or greater derived from the Thai version of Young Diagnostic Questionnaire for Internet Addiction was classified as "possible IA". Then chi-square test and logistic regression were used to evaluate the associations between possible IA, depression and associated factors.From 705 participants, 24.4% had possible IA and 28.8% had depression. There was statistically significant association between possible IA and depression (odds ratio (OR 1.92, 95% confidence interval (CI: 1.34-2.77, P-value <0.001. Logistic regression analysis illustrated that the odds of depression in possible IA group was 1.58 times of the group of normal Internet use (95% CI: 1.04-2.38, P-value = 0.031. Academic problems were found to be a significant predictor of both possible IA and depression.IA was likely to be a common psychiatric problem among Thai medical students. The research has also shown that possible IA was associated with depression and academic problems. We suggest that surveillance of IA should be considered in medical schools.

  17. Prevalence of Body Dysmorphic Disorder and its Association With Body Features in Female Medical Students.

    Science.gov (United States)

    Shaffi Ahamed, Shaik; Enani, Jawaher; Alfaraidi, Lama; Sannari, Lujain; Algain, Rihaf; Alsawah, Zainah; Al Hazmi, Ali

    2016-06-01

    Body dysmorphic disorder (BDD) is a distressing psychiatric disorder. So far there have not been any studies on BDD in Saudi Arabia. The aim of this study was to determine the prevalence of body dysmorphic disorder in female medical students and to investigate whether there is an association between BDD and body features of concern, social anxiety and symptoms of BDD. A cross sectional study was carried out on female medical students of the college of medicine, King Saud University, Riyadh, Saudi Arabia during January to April, 2015. Data were collected using the body image disturbance questionnaire, Body dysmorphic disorder symptomatology and social interaction anxiety scale. Descriptive statistics, bivariate and multivariate analysis were used to analyze the results. Out of 365 students who filled out the questionnaire, 4.4% (95% confidence intervals (CI): 2.54% to 7.04%) were positive for BDD with skin (75%) and fat (68.8%) as the most frequent body features of concern. Ten features (skin, fat, chest, hips, buttocks, arms, legs, lips, fingers, and shoulders) out of twenty-six were significantly associated with BDD. Arms and chest were independently associated with BDD. The odds of presence of body concern related to "arms" was 4.3 (95% C.I: 1.5, 12.1) times more in BDD subjects than non-BDD subjects, while concern about "chest" was 3.8 (1.3, 10.9) times more when compared to non-BDD subjects. No statistically significant association was observed between BDD and social anxiety (P = 0.13). This was the first study conducted in Kingdom of Saudi Arabia (KSA) on female medical students, which quantified the prevalence of BDD and identified the body features associated with it. Body dysmorphic disorder is prevalent in female medical students but it is relatively rare and an unnoticed disorder.

  18. Personal, professional, and work factors associated with Australian clinical medical practitioners' experiences of workplace aggression.

    Science.gov (United States)

    Hills, Danny J; Joyce, Catherine M

    2013-08-01

    This study examined the extent to which a range of personal, professional, and work factors are associated with workplace aggression experienced by medical practitioners in Australian clinical practice settings. An exploratory, descriptive study of cross-sectional, self-report survey design was undertaken in the third wave of the Medicine in Australia: Balancing Employment and Life survey during 2010-2011. Of 16 327 medical practitioners sampled, 9951 (60.9%) responded and 9449 (57.9%) worked in clinical practice. Logistic regression was undertaken to detect statistically significant associations between a suite of personal, professional, and work variables and eight binary outcome variables measuring exposure to verbal or written and physical aggression from patients, patients' relatives or carers, co-workers and others external to the workplace during the previous year. Age was consistently negatively associated and external control orientation was consistently positively associated with workplace aggression exposure from each source. Key variables related to work conditions (total hours worked, unpredictable work hours, a poor support network of other doctors, patients with unrealistic expectations, patients with complex health and social problems) and the presence of workplace aggression prevention and minimization strategies (alerts to high risk of aggression, restricting or withdrawing access for aggressive persons and optimized patient waiting) were also associated with aggression exposure. A broader implementation of strategies to prevent and minimize the likelihood and consequences of workplace aggression is required and needs to take account of both the individual and sub-group profiles of medical practitioners. Strategies need to mitigate the more challenging aspects of medical work, including excessive work hours, inadequate access to professional support networks, and larger caseloads of patients with complex conditions.

  19. Mercury Contamination and Bioaccumulation Associated with Historical Gold Mining in the Bear and Yuba River Watersheds, Sierra Nevada, California

    Science.gov (United States)

    Alpers, C. N.; Hunerlach, M. P.; Hothem, R. L.; May, J. T.; Taylor, H. E.; DeWild, J. F.; Olson, M. L.; Krabbenhoft, D. P.; Marvin-DiPasquale, M.

    2001-12-01

    Extensive use of mercury in the mining and recovery of gold during the late 19th and early 20th centuries has led to widespread mercury contamination of water, sediment, and biota in the Sierra Nevada foothills of California. The watersheds of the Bear and Yuba Rivers were selected for study by the U.S. Geological Survey and other federal, state, and local agencies on the basis of (1) results of previous studies of bioaccumulation, (2) observations of visible elemental mercury at numerous mine sites and in river sediments, and (3) extensive historical mining on federal lands and adjacent private lands. Of 53 unfiltered water samples analyzed for total recoverable mercury (Hg-T), 17 samples (32 percent) had concentrations in excess of the U.S. Environmental Protection Agency (EPA) aquatic-life criterion of 50 nanograms per liter (ng/L). Water flowing from two separate tunnels in one mining district had Hg-T concentrations greater than 100,000 ng/L, exceeding the EPA drinking-water standard of 2,000 ng/L. Monthly sampling of the Bear River near its mouth revealed monomethylmercury (MeHg) concentrations in unfiltered water samples greater than 0.4 ng/L during July-August 1999 and January 2000. Game fish were collected from 5 reservoirs and 14 stream sites during 1999 to assess the distribution of mercury in the food chain and to examine the potential risk for humans and wildlife. Of 141 fish fillet samples of black basses (Micropterus spp.), sunfish (Lepomis macrochirus and Lepomis cyanellus), black crappie (Poxomis nigromaculatus), channel catfish (Ictularus punctatus), brown trout (Salmo trutta), and rainbow trout (Oncorhynchus mykiss) analyzed for Hg-T, 52 percent exceeded the EPA criterion of 0.3 parts per million (ppm), wet basis. Eighty-nine percent of the bass had Hg-T greater than 0.3 ppm total mercury. Based on these data, three counties issued a public health notification recommending limited consumption of game fish from the Bear and Yuba watersheds

  20. Medication beliefs are associated with phosphate binder non-adherence in hyperphosphatemic haemodialysis patients.

    Science.gov (United States)

    Wileman, Vari; Farrington, Ken; Wellsted, David; Almond, Mike; Davenport, Andrew; Chilcot, Joseph

    2015-09-01

    Patients with end-stage kidney disease receiving haemodialysis (HD) are at risk of cardiovascular disease and bone disorders related to high levels of serum phosphate. We studied the association between medication beliefs and depressive symptoms, with non-adherence to phosphate binding medication in a group of HD patients at risk of complications due to hyperphosphatemia. Cross-sectional design. Baseline data from 112 patients participating in a randomized controlled trial, evaluating an adherence intervention, are presented. All patients had serum phosphate levels >1.6 mmol/l at baseline. Adherence was measured by (1) serum phosphate and (2) Medication Adherence Report Scales (MARS). Beliefs about Medicines (BMQ) and depressive symptoms (PHQ-9) were also evaluated. Beliefs about Medicines Questionnaire necessity, but not concerns, beliefs were found to correlate with serum phosphate (r = -.23, p adherence (r = .35, p adherence (β = .30, p ≤ .01). Both BMQ concerns and depressive symptoms were not related to non-adherence. Patients' beliefs about the necessity of their prescribed phosphate binding medications explain variation in non-adherence levels, measured both subjective and objectively. Dialysis patient's medication beliefs are potentially modifiable targets for future interventions. © 2014 The British Psychological Society.

  1. The Association Between Peer and Self-Assessments and Professionalism Lapses Among Medical Students.

    Science.gov (United States)

    Hoffman, Leslie A; Shew, Ronald L; Vu, T Robert; Brokaw, James J; Frankel, Richard M

    2017-06-01

    Peer and self-assessments are widely used to assess professionalism during medical school as part of a multisource feedback model. The purpose of this study was to examine the associations between peer and self-assessments and professionalism lapses at a large medical school. A retrospective case-control study design was used to compare peer and self-assessment scores from Years 1 to 3 of medical school for students who had been cited for professionalism lapses during medical school (case group; n = 78) with those of a randomly selected control group ( n = 230). Students in the case group had significantly lower peer assessment scores than students in the control group during all 3 years. Year 3 peer assessment scores showed the greatest difference (cases = 7.81 ± 0.65, controls = 8.22 ± 0.34, p peer assessment scores were also significantly more likely to have been cited for a professionalism lapse (odds ratio = 6.25, 95% CI [3.13, 11.11], p peer assessments of professionalism, which may be useful to help identify students who may be at risk for professionalism lapses during medical school.

  2. Report on the American Association of Medical Physics Undergraduate Fellowship Programs.

    Science.gov (United States)

    Smilowitz, Jennifer B; Avery, Stephen; Gueye, Paul; Sandison, George A

    2013-01-07

    The American Association of Physicists in Medicine (AAPM) sponsors two summer undergraduate research programs to attract top performing undergraduate students into graduate studies in medical physics: the Summer Undergraduate Fellowship Program (SUFP) and the Minority Undergraduate Summer Experience (MUSE). Undergraduate research experience (URE) is an effective tool to encourage students to pursue graduate degrees. The SUFP and MUSE are the only medical physics URE programs. From 2001 to 2012, 148 fellowships have been awarded and a total of $608,000 has been dispersed to fellows. This paper reports on the history, participation, and status of the programs. A review of surveys of past fellows is presented. Overall, the fellows and mentors are very satisfied with the program. The efficacy of the programs is assessed by four metrics: entry into a medical physics graduate program, board certification, publications, and AAPM involvement. Sixty-five percent of past fellow respondents decided to pursue a graduate degree in medical physics as a result of their participation in the program. Seventy percent of respondents are currently involved in some educational or professional aspect of medical physics. Suggestions for future enhancements to better track and maintain contact with past fellows, expand funding sources, and potentially combine the programs are presented.

  3. Use of attribute association error probability estimates to evaluate quality of medical record geocodes.

    Science.gov (United States)

    Klaus, Christian A; Carrasco, Luis E; Goldberg, Daniel W; Henry, Kevin A; Sherman, Recinda L

    2015-09-15

    The utility of patient attributes associated with the spatiotemporal analysis of medical records lies not just in their values but also the strength of association between them. Estimating the extent to which a hierarchy of conditional probability exists between patient attribute associations such as patient identifying fields, patient and date of diagnosis, and patient and address at diagnosis is fundamental to estimating the strength of association between patient and geocode, and patient and enumeration area. We propose a hierarchy for the attribute associations within medical records that enable spatiotemporal relationships. We also present a set of metrics that store attribute association error probability (AAEP), to estimate error probability for all attribute associations upon which certainty in a patient geocode depends. A series of experiments were undertaken to understand how error estimation could be operationalized within health data and what levels of AAEP in real data reveal themselves using these methods. Specifically, the goals of this evaluation were to (1) assess if the concept of our error assessment techniques could be implemented by a population-based cancer registry; (2) apply the techniques to real data from a large health data agency and characterize the observed levels of AAEP; and (3) demonstrate how detected AAEP might impact spatiotemporal health research. We present an evaluation of AAEP metrics generated for cancer cases in a North Carolina county. We show examples of how we estimated AAEP for selected attribute associations and circumstances. We demonstrate the distribution of AAEP in our case sample across attribute associations, and demonstrate ways in which disease registry specific operations influence the prevalence of AAEP estimates for specific attribute associations. The effort to detect and store estimates of AAEP is worthwhile because of the increase in confidence fostered by the attribute association level approach to the

  4. Stress among Medical Students and Its Association with Substance Use and Academic Performance

    Directory of Open Access Journals (Sweden)

    Leta Melaku

    2015-01-01

    Full Text Available Background. Chronic stress among medical students affects academic performance of students and leads to depression, substance use, and suicide. There is, however, a shortage of such research evidence in Ethiopia. Objective. We aimed to estimate the prevalence and severity of stress and its association with substance use and academic performance among medical students. Methods. A cross-sectional survey was conducted on a sample of 329 medical students at Jimma University. Data were collected using the General Health Questionnaire (GHQ-12, Medical Students Stress Questionnaire (MSSQ-20, and Drug Abuse Surveillance Test (DAST. Data were analyzed using SPSS version 20.0. Logistic regression analysis and Student’s t-test were applied. Results. The mean age of the respondents was 23.02 (SD = 2.074 years. The current prevalence of stress was 52.4%. Academic related stressor domain was the main source of stress among 281 (88.6% students. Stress was significantly associated with khat chewing [AOR = 3.03, 95% CI (1.17, 7.85], smoking [AOR = 4.55, 95% CI (1.05, 19.77], and alcohol intake [AOR = 1.93, 95% CI (1.03, 3.60]. The prevalence of stress was high during the initial three years of study. Stress was significantly (p=0.001 but negatively (r=-0.273 correlated with academic achievement. Conclusion. Stress was a significant problem among medical students and had a negative impact on their academic performance. Year of study, income, and substance use were associated with stress. Counseling and awareness creation are recommended.

  5. Policing the social boundaries of the American Medical Association, 1847-70.

    Science.gov (United States)

    Haynes, Douglas M

    2005-04-01

    In May 1870 the American Medical Association (AMA) voted to deny the admission of black delegates and their white colleagues to the national meeting in Washington, D.C. Historians of race and medicine have customarily viewed this decision as marking a crucial milestone in the formation of the nexus between racism and the development of the American medical profession in the era after the Civil War (1861-64). This study recasts this narrative by locating the 1870 decision in relation to the antebellum practices of the association and their social consequences for American medicine. It argues that the viability of the AMA as the national voice of the profession was critically dependent on rejecting racial equality. Indeed, at a moment when the question of the abolition of slavery polarized the nation, the AMA was founded in 1847 to create a voluntary professional organization, national in scope, dedicated to raising the standards of medical training and practice. To this end, the AMA elected presidents and selected host cities for annual meetings in the North, South, and West. Seven out of the fourteen meetings and six out of fourteen presidents were from slave and/or border states. These institutional practices together with the representation of blacks as different and enjoying an appropriate status as slaves grounded the national identity of the profession in black subordination. Similarly, the gendered discourses about healing and practices of female exclusion privileged medical authority as male by drawing on and reinforcing patriarchy. In the wake of the war, leaders hoped to restore the national character of the organization by resuming antebellum practices. In response to the new possibilities for blacks in medicine--as represented by the biracial National Medical Society--the AMA took steps to vigorously police the racial boundaries of the national profession. As this study will show, the 1870 decision reflected the logic of the racial politics at the heart

  6. Association of maternal self-medication and over-the-counter analgesics for children.

    Science.gov (United States)

    Jensen, Janne Fangel; Gottschau, Mathilde; Siersma, Volkert Dirk; Graungaard, Anette Hauskov; Holstein, Bjørn Evald; Knudsen, Lisbeth Ehlert

    2014-02-01

    Self-medication with over-the-counter (OTC) analgesics, such as paracetamol (PCM), among children and adolescents is increasing and constitutes an important public health issue internationally. Reasons for this development are unclear; parental influence is suggested. Our objective was to examine whether self-medication with OTC analgesics among school-aged children is influenced by maternal self-reported health and medicine use, taking the child's frequency of pain into account. A quantitative cross-sectional survey was conducted on 131 children aged 6 to 11 years and their mothers in the framework of the Demonstration Of A Study To Coordinate And Perform Human Biomonitoring On A European Scale (DEMOCOPHES) European project. Participants were selected from 1 urban and 1 rural area of Denmark, and equally distributed in age and gender. Data were collected through structured interviews with all children and self-report questionnaires for mothers regarding health, pain, and medicine use. After adjusting for several sociodemographic and health parameters, maternal use of OTC analgesics was significantly associated with self-medication with OTC analgesics, particularly PCM, in our population of schoolchildren, even when the child's pain was adjusted for (odds ratio 3.00, P = .008). A clear association between child pain and OTC analgesic use was not found. Additionally, maternal health (self-rated health, chronic pain, chronic disease, daily medicine intake) did not significantly influence child use of OTC analgesics. Maternal self-medication with OTC analgesics is associated with self-medication of OTC analgesics, predominantly PCM, among school-aged children, perhaps more than the child's pain. Maternal health seems of less importance. Information to parents about pain self-management is important to promote appropriate PCM use among schoolchildren.

  7. Factors associated to depression and anxiety in medical students: a multicenter study

    Directory of Open Access Journals (Sweden)

    Fernanda Brenneisen Mayer

    2016-10-01

    Full Text Available Abstract Background To evaluate personal and institutional factors related to depression and anxiety prevalence of students from 22 Brazilian medical schools. Methods The authors performed a multicenter study (August 2011 to August 2012, examining personal factors (age, sex, housing, tuition scholarship and institutional factors (year of the medical training, school legal status, location and support service in association with scores of Beck Depression Inventory (BDI and State Trait Anxiety Inventory (STAI. Results Of 1,650 randomly selected students, 1,350 (81.8 % completed the study. The depressive symptoms prevalence was 41 % (BDI > 9, state-anxiety 81.7 % and trait-anxiety in 85.6 % (STAI > 33. There was a positive relationship between levels of state (r = 0,591, p < 0.001 and trait (r = 0,718, p < 0.001 anxiety and depression scores. All three symptoms were positively associated with female sex and students from medical schools located in capital cities of both sexes. Tuition scholarship students had higher state-anxiety but not trait-anxiety or depression scores. Medical students with higher levels of depression and anxiety symptoms disagree more than their peers with the statements “I have adequate access to psychological support” and “There is a good support system for students who get stressed”. Conclusions The factors associated with the increase of medical students’ depression and anxiety symptoms were female sex, school location and tuition scholarship. It is interesting that tuition scholarship students showed state-anxiety, but not depression and trait-anxiety symptoms.

  8. Sleep Disorders and Associated Medical Comorbidities in Active Duty Military Personnel

    Science.gov (United States)

    Mysliwiec, Vincent; McGraw, Leigh; Pierce, Roslyn; Smith, Patrick; Trapp, Brandon; Roth, Bernard J.

    2013-01-01

    Study Objectives: Describe the prevalence of sleep disorders in military personnel referred for polysomnography and identify relationships between demographic characteristics, comorbid diagnoses, and specific sleep disorders. Design: Retrospective cross-sectional study. Setting: Military medical treatment facility. Participants: Active duty military personnel with diagnostic polysomnogram in 2010. Measurements: Primary sleep disorder rendered by review of polysomnogram and medical record by a board certified sleep medicine physician. Demographic characteristics and conditions of posttraumatic stress disorder (PTSD), mild traumatic brain injury (mTBI), anxiety, depression, and pain syndromes determined by medical record review. Results: Primary sleep diagnoses (n = 725) included: mild obstructive sleep apnea (OSA), 207 (27.2%); insomnia, 188 (24.7%); moderate-to-severe OSA, 183 (24.0 %); and paradoxical insomnia,39 (5.1%); behaviorally induced insufficient sleep syndrome, 68 (8.9%) and snoring, 40 (5.3%) comprised our control group. Short sleep duration (military personnel who undergo polysomnography with significant associations between PTSD, pain syndromes, and insomnia. Despite having sleep disorders, almost half reported short sleep duration. Multidisciplinary assessment and treatment of military personnel with sleep disorders and service-related illnesses are required. Citation: Mysliwiec V; McGraw L; Pierce R; Smith P; Trapp B; Roth BJ. Sleep disorders and associated medical comorbidities in active duty military personnel. SLEEP 2013;36(2):167-174. PMID:23372263

  9. Prevalence of Irritable Bowel Syndrome and its Associated Factors Among Medical Students

    Directory of Open Access Journals (Sweden)

    Muneer Almutairi

    2017-02-01

    Full Text Available Background and aim: Irritable bowel syndrome (IBS is a common functional gastrointestinal disorder and is the most commonly diagnosed one by gastroenterologists. In this study, we aim to explore the frequency of IBS among medical students in Qassim, and the factors associated with this disorder among them. Materials and methods: A cross sectional study was carried out among medical students of all academic levels in three local universities in Qassim region; Qassim University, Unizah as well as Alrajhi colleges of medicine. Data for the study were collected throughout the 1st semester of the academic year 2015-2016 using a validated, self-administered, and anonymous paper questionnaire. The questionnaire included three main sections: Demographics, Rome III criteria and hospital anxiety and depression scale (HADS. Results: Among 511 students completed the study and of those 70 (13.7% had IBS. Senior medical students are 3.61 times more likely to have IBS than juniors (p<0.001. Depression was significantly associated with IBS (p=0.042. Stepwise logistic regression showed that chronic health problems, more advanced academic level and personal history of IBS were significant predictors for IBS. Conclusion: The prevalence of IBS is 13.7% among medical students in Qassim region. Depression, age, living situation, advanced academic years, family or personal history, or an episode of travellers’ diarrhoea were the main predictors of IBS. Offering psychological and emotional support along with stress management courses in order to deal with stress is recommended.

  10. Factors associated with medical student test anxiety in objective structured clinical examinations: a preliminary study.

    Science.gov (United States)

    Kim, Kyong-Jee

    2016-12-29

    To investigate attributes of medical students associated with their test anxiety on Objective Structured Clinical Examinations (OSCEs). A cross-sectional study using a self-administered questionnaire was conducted of all Year 3 and 4 students at a private medical school in South Korea in 2014. This 53-item questionnaire consisted of factors pertaining to test anxiety on the OSCE identified from a review of relevant literature, which included students' motivational beliefs and achievement emotions, perceived values of the OSCE, and attitude and orientation towards patients. Participants' test anxiety levels were measured using the Korean Achievement Emotions Questionnaire. Participants rated their responses using a five-point Likert-type scale. Univariate analysis was performed to examine relationships between the variables. A total of 94 students completed the questionnaire (a 93% response rate). No differences in the participants' test anxiety scores were observed across genders, entry-levels, or years in medical school. Participants' test anxiety on the OSCE showed moderate association with their class-related achievement emotions (i.e., anxiety and boredom), where r = 0.46 and 0.32, p study found some non-cognitive factors related to medical students' test anxiety on the OSCE. These findings have implications for developing effective educational interventions for helping students cope with such a stress by enhancing our understanding of the various factors that influence their test anxiety in OSCEs.

  11. Medication Adherence in Children and Adolescents with HIV Infection: Associations with Behavioral Impairment

    Science.gov (United States)

    Williams, Paige; Montepiedra, Grace; McCabe, Marie; Nichols, Sharon; Sirois, Patricia A.; Storm, Deborah; Farley, John; Kammerer, Betsy

    2011-01-01

    Abstract The impact of behavioral functioning on medication adherence in children with perinatally acquired HIV infection is not well-explored, but has important implications for intervention. This report addresses the relationship between behavioral functioning and child self-report or caregiver report of medication adherence among children and adolescents enrolled in Pediatric AIDS Clinical Trials Group Protocol 219C (conducted 2000–2007). A total of 1134 participants, aged 3–17 years, received a behavioral evaluation and adherence assessment. Complete adherence was defined as taking 100% of prescribed antiretroviral medications during three days preceding the study visit. Multivariable logistic regression models were used to evaluate associations between adherence and behavioral functioning, adjusting for potential confounders, including demographic, psychosocial, and health factors. Children demonstrated higher than expected rates of behavioral impairment (≈7% expected with T > 65) in the areas of conduct problems (14%, z = 7.0, p stressful life events and higher HIV RNA levels, were also associated with nonadherence. Knowledge of behavioral, health, and social influences affecting the child and family should guide the development of appropriate, evidence-based interventions for medication adherence. PMID:21323533

  12. Factors Associated with Word Memory Test Performance in Persons with Medically Documented Traumatic Brain Injury.

    Science.gov (United States)

    Sherer, Mark; Davis, Lynne C; Sander, Angelle M; Nick, Todd G; Luo, Chunqiao; Pastorek, Nicholas; Hanks, Robin

    2015-01-01

    (1) To examine the rate of poor performance validity in a large, multicenter, prospectively accrued cohort of community dwelling persons with medically documented traumatic brain injury (TBI), (2) to identify factors associated with Word Memory Test (WMT) performance in persons with TBI. This was a prospective cohort, observational study of 491 persons with medically documented TBI. Participants were administered a battery of cognitive tests, questionnaires on emotional distress and post-concussive symptoms, and a performance validity test (WMT). Additional data were collected by interview and review of medical records. One hundred and seventeen participants showed poor performance validity using the standard cutoff. Variable cluster analysis was conducted as a data reduction strategy. Findings revealed that the 10 cognitive tests and questionnaires could be summarized as 4 indices of emotional distress, speed of cognitive processing, verbal memory, and verbal fluency. Regression models revealed that verbal memory, emotional distress, age, and injury severity (time to follow commands) made unique contribution to prediction of poor performance validity. Poor performance validity was common in a research sample of persons with medically documented TBI who were not evaluated in conjunction with litigation, compensation claims, or current report of symptoms. Poor performance validity was associated with poor performance on cognitive tests, greater emotional distress, lower injury severity, and greater age. Many participants expected to have residual deficits based on initial injury severity showed poor performance validity.

  13. The prevalence and association of stress with sleep quality among medical students.

    Science.gov (United States)

    Almojali, Abdullah I; Almalki, Sami A; Alothman, Ali S; Masuadi, Emad M; Alaqeel, Meshal K

    2017-09-01

    Medical students tend to reduce their sleep, in an effort to adjust and cope with their workload and stressful environment. This study estimated the prevalence of and the relationship between poor sleep quality and stress among medical students. This cross-sectional study was conducted using a stratified random sample of male and female medical students in King Saud bin Abdulaziz University for Health Sciences in Riyadh, Saudi Arabia. A self-administered questionnaire was distributed to assess sleep quality using the Pittsburgh Sleep Quality Index, and the stress level by using the Kessler Psychological Distress Scale. A high prevalence of poor sleep quality (76%) and stress (53%) were found, with a statistically significant association (pstudents who are not suffering from stress are less likely to have poor sleep quality (OR=0.28, pstudents whose cumulative grade point average (GPA) is less than 4.25 (OR=3.83, p=0.01). The study documents a statistically significant association between stress and poor sleep quality. A recommendation for the management of medical college is to establish academic counseling centers focusing in promoting good sleep hygiene and strengthening students' study skills and coping with their stressful environment. Copyright © 2017 Ministry of Health, Saudi Arabia. Published by Elsevier Ltd. All rights reserved.

  14. Association of QT-Prolonging Medication Use in CKD with Electrocardiographic Manifestations.

    Science.gov (United States)

    Snitker, Soren; Doerfler, Rebecca M; Soliman, Elsayed Z; Deo, Rajat; St Peter, Wendy L; Kramlik, Susan; Fischer, Michael J; Navaneethan, Sankar; Delafontaine, Patrice; Jaar, Bernard G; Ojo, Akinlolu; Makos, Gail K; Slaven, Anne; Weir, Matthew R; Zhan, Min; Fink, Jeffrey C

    2017-08-09

    Several drugs used in CKD can prolong electrocardiographic conduction. We examined the use of electrocardiogram QT-prolonging medications in predialysis CKD and their association with QT duration. In total, 3252 Chronic Renal Insufficiency Cohort participants with at least one study electrocardiogram between 2003 and 2011 were included. QT-prolonging medications used in 100 or more visits (n=16,451 visits) along with diuretics and proton pump inhibitors, given their potential for electrolyte disturbances, were examined for QT interval prolongation. Mean QT interval corrected for heart rate was at 414±21 (±SD) milliseconds and prolonged (≥450 milliseconds) in 4.6% of electrocardiograms. QT interval corrected for heart rate was inversely related to serum potassium and calcium. Medications classified as QT prolonging were taken at 76% of visits, with two or more of these taken at 33% of visits. Of 30 medications examined, eight were associated with statistically significant QT interval corrected for heart rate prolongation after adjustment for comorbidities, potassium, and calcium, including amiodarone (+10±2 milliseconds), metolazone (+7±2 milliseconds), fluoxetine (+4±1 milliseconds), citalopram (+4±1 milliseconds), hydroxyzine (+4±1 milliseconds), escitalopram (+3±2 milliseconds), venlafaxine (+3±1 milliseconds), and furosemide (+3±0 milliseconds). Potassium-depleting diuretics were associated with minimal decrements in potassium (between 0.1 and 0.3 mEq/L) and smaller changes in calcium. Diuretics associated with a change in QT interval corrected for heart rate before adjustment for potassium and calcium were metolazone (+8±3 milliseconds), furosemide (+4±1 milliseconds), and spironolactone (-3±3 milliseconds). Most of the QT prolongation associated with metolazone and furosemide, but not spironolactone, remained after adjustment for potassium and calcium. Proton pump inhibitors were not associated with QT prolongation. Use of medications associated

  15. The Association between Non-Medical Prescription Drug Use and Suicidal Behavior among United States Adolescents

    Directory of Open Access Journals (Sweden)

    Amanda L. Divin

    2014-11-01

    Full Text Available Adolescence represents a vulnerable time for the development of both drug use/abuse and mental illness. Although previous research has substantiated a relationship between drug use and suicidal behavior, little research has examined this relationship with non-medical prescription drug use. Given the growing prevalence of non-medical prescription drug use (NMPDU among adolescents, this study explored the association between NMPDU and suicidal behavior. Nationally representative data were derived from 16, 410 adolescents who completed the 2009 National Youth Risk Behavior Survey. Approximately 19.8% of participants reported lifetime NMPDU. NMPDU was associated with significantly increased odds of suicidal behavior (P < 0.01, with seriously considering attempting suicide and making a plan about attempting suicide representing the strongest correlates for males and females. Results suggest the importance of 1 continued reinforcement of drug education programs in high school begun at earlier ages and 2 mental health care and screenings among adolescents.

  16. Non-medical use of psychoactive prescription drugs is associated with fatal poisoning.

    Science.gov (United States)

    Haukka, Jari; Kriikku, Pirkko; Mariottini, Claudia; Partonen, Timo; Ojanperä, Ilkka

    2017-08-25

    The aims of this study were to estimate the prevalence and predictors of non-medical substance use, and to assess the association between non-medical substance use and fatal poisoning or history of drug abuse in Finland. Retrospective cohort study of all medico-legally investigated death cases in Finland. The postmortem toxicology database was linked together with the register on reimbursed prescription medicines. All postmortem cases between 2011 and 2013 positive for one or more of the following drugs: oxycodone, fentanyl, tramadol, clonazepam, gabapentin, pregabalin, tizanidine, olanzapine, quetiapine, risperidone, alprazolam, zolpidem, mirtazapine and bupropion, n = 2974. Non-medical use of substance was the outcome variable. Predictors were the following: gender, residence at the time of death, place of death, blood alcohol concentration, age, drug abuse, number of prescriptions of any psychoactive drugs in last year and proportion of prescriptions issued by psychiatrist in last year. In 50.4% of the studied cases, at least one drug was detected without a prescription. Clonazepam, alprazolam and tramadol were the most prevalent non-medical findings in these cases (6.6, 6.1 and 5.6%, respectively). The risk of non-medical use of prescription drugs was especially high in cases with history of drug abuse (88.5%) and in fatal poisonings (71.0%). The proportion of non-medical use of the studied substances varied between 5.9% [95% confidence interval (CI) = 3.1-10.1%)] for risperidone and 55.7% for fentanyl (95% CI = 44.1-66.9%). Valid prescription for one or more of any psychoactive drug was associated with lower odds for non-medical use of the studied substances. Additionally, the higher the proportion of psychoactive drugs prescribed by a psychiatrist, the lower the probability of non-medical use. Non-prescribed psychoactive drugs are found commonly at postmortem in drug poisoning deaths in Finland, with history of drug abuse being a major contributing

  17. Disorders of fuel metabolism: medical complications associated with starvation, eating disorders, dietary fads, and supplements.

    Science.gov (United States)

    Judge, Bryan S; Eisenga, Bernard H

    2005-08-01

    Disorders of fuel metabolism as they relate to abnormal fuel intake,abnormal fuel expenditure, and dietary supplements are the focus of this article. The emergency physician should be aware of the medical complications that can occur as a result of starvation states,eating disorders, fad diets, hypermetabolic states, and ergogenic aids. Knowledge and understanding of the complications associated with these disorders will facilitate the diagnosis and management of patients who present to the emergency department with any of the disorders reviewed.

  18. The Medical Library Association: promoting new roles for health information professionals.

    Science.gov (United States)

    Homan, J Michael; McGowan, Julie J

    2002-01-01

    As the Medical Library Association (MLA) enters its second century, its role in providing leadership and focus for the education of health information professionals in a changing environment will be critical. MLA members face dramatic changes in the health care environment as well as significant opportunities and must position themselves to thrive in the new environment. This paper examines new roles for health information professionals, new approaches to education and training, and related issues of credentialing, certification/and licensure.

  19. A Code of Professional Ethical Conduct for the American Medical Informatics Association

    Science.gov (United States)

    Hurdle, John F.; Adams, Samantha; Brokel, Jane; Chang, Betty; Embi, Peter; Petersen, Carolyn; Terrazas, Enrique; Winkelstein, Peter

    2007-01-01

    The AMIA Board of Directors has decided to periodically publish AMIA’s Code of Professional Ethical Conduct for its members in the Journal of the American Medical Informatics Association. The Code also will be available on the AMIA Web site at www.amia.org as it continues to evolve in response to feedback from the AMIA membership. The AMIA Board acknowledges the continuing work and dedication of the AMIA Ethics Committee. AMIA is the copyright holder of this work. PMID:17460125

  20. Nonadherence to antihypertensive medications and associated factors in general medicine clinics

    Directory of Open Access Journals (Sweden)

    Al Ghobain M

    2016-08-01

    Full Text Available Mohammed Al Ghobain,1,2 H Alhashemi,1,2 A Aljama,3 S Bin Salih,1,2 Z Assiri,4 A Alsomali,4 Gamal Mohamed5 1Department of Medicine, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, 2King Abdullah International Medical Research Centre, 3Department of Medicine, King Abdulaziz Medical City, 4College of Nursing, 5College of Public Health, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia Objectives: Nonadherence to antihypertensive medications has not been assessed in the Saudi population. The aim of this study was to address and evaluate the magnitude of nonadherence among hypertensive patients and the risk factors associated with it. Methods: A cross-sectional survey was conducted on hypertensive patients who attended the general internal medicine clinics at King Abdulaziz Medical City, Riyadh, Saudi Arabia, using a questionnaire that was modified after reviewing the literature. Hypertensive patients were labeled as nonadherent if they missed their medications for a total of 7 days during the previous month. Results: A total of 302 patients participated in the study, of whom 63% were females with a mean age of 64 years, and 64% were illiterate. The prevalence of nonadherence to medications among hypertensive patients was found to be 12.3%. Poor disease knowledge was reported in 80% of patients, while 66% of the patients had poor monitoring of their disease. Younger age (≤65 years, poor monitoring, and uncontrolled blood pressure (BP ≥140/90 mmHg were the predictor factors associated with nonadherence (odds ratio [OR] =2.04, P=0.025; OR=2.39, P=0.004; and OR=2.86, P=0.003, respectively. Conclusion: Nonadherence to antihypertensive medications is lower than that previously reported in the literature. Younger age, uncontrolled BP, and poor monitoring are the main risk factors associated with nonadherence. Keywords: nonadherence, hypertension, Saudi Arabia, uncontrolled blood

  1. Strengthening professionals: a chapter-level formative evaluation of the Medical Library Association mentoring initiative*†

    OpenAIRE

    Kwasik, Hanna; Fulda, Pauline O.

    2006-01-01

    Objective: The main objective was to determine to what extent the Medical Library Association (MLA) mentoring initiative was implemented in the South Central Chapter of the Medical Library Association (SCC/ MLA) and to identify the needs, improvements, and adjustments in mentoring services for the future to improve the practice of librarianship.

  2. Symptom experience associated with immunosuppressive drugs after liver transplantation in adults : possible relationship with medication non-compliance?

    NARCIS (Netherlands)

    Drent, Gerda; Moons, P.; De Geest, S.; Kleibeuker, J. H.; Haagsma, E. B.

    2008-01-01

    Symptom experience (occurrence and perceived distress) associated with side effects of immunosuppressive medications in organ transplant patients may well be associated with poorer quality of life and medication non-compliance. The aims of this study were: first, to assess symptom experience in

  3. Inadequate Sleep and Exercise Associated with Burnout and Depression Among Medical Students.

    Science.gov (United States)

    Wolf, Megan R; Rosenstock, Jason B

    2017-04-01

    The authors studied whether low levels of exercise or inadequate sleep correlated with higher levels of burnout and depression in medical students. Medical students of all years at the University of Pittsburgh School of Medicine, Pittsburgh, PA, USA, were invited to participate in an anonymous online survey in Fall 2012 and Winter 2013. Validated measures were used to assess exercise, sleep, burnout, and depression. Response rates were 28.7 % at the beginning of the school year and 22.6 % at the middle of the school year. Burnout rates overall were 22.4 % at the beginning of the year and 19.2 % in the middle of the year. Eight percent of students screened positive for depression at the beginning of the year and 9.3 % in the middle of the year. Decreased exercise frequency was significantly correlated with lower professional efficacy. Pathological sleepiness was significantly associated with a higher prevalence of burnout. Inadequate sleep correlated with significantly lower professional efficacy and higher exhaustion scores. Burnout was associated with a positive depression screen. Positive depression screening, pathological sleepiness, and sleeping less than 7 h a night were independent predictors of burnout. Sleep habits, exercise, and a positive depression screen were associated with burnout risk within the medical student population.

  4. Medical School Factors Associated with Higher Rates of Recruitment into Psychiatry.

    Science.gov (United States)

    Spollen, John J; Beck Dallaghan, Gary L; Briscoe, Gregory W; Delanoche, Nancy D; Hales, Deborah J

    2017-04-01

    The medical school a student attends appears to be a factor in whether students eventually match into psychiatry. Knowledge of which factors are associated with medical schools with higher recruitment rates into psychiatry may assist in developing strategies to increase recruitment. Psychiatry leaders in medical student education in the 25 highest and lowest recruiting US allopathic schools were surveyed concerning various factors that could be important such as curriculum, educational leadership, and presence of anti-psychiatry stigma. The relationship between the survey results of high recruiting schools versus those of low recruiting schools was evaluated using Mann-Whitney U tests. Factors significantly associated (p psychiatry department and residents, perceived higher respect for psychiatry among non-psychiatry faculty, less perception that students dissuaded other students from pursuing psychiatry, and longer clerkship length. Educational culture and climate factors may have a significant impact on psychiatry recruitment rates. Clerkship length was associated with higher recruiting schools, but several previous studies with more complete samples have not shown this.

  5. Determinants and associated factors influencing medication adherence and persistence to oral anticancer drugs: a systematic review.

    Science.gov (United States)

    Verbrugghe, M; Verhaeghe, S; Lauwaert, K; Beeckman, D; Van Hecke, A

    2013-10-01

    The use of oral anticancer drugs has increased in modern oncology treatment. The move from intravenous treatments towards oral anticancer drugs has increased the patients' own responsibility to take oral anticancer drugs as being prescribed. High rates of non-adherence to oral anticancer drugs have been reported. A systematic literature review was conducted to gain insight into determinants and associated factors of non-adherence and non-persistence in patients taking oral anticancer therapy. PubMed, Cochrane, Web of Science and Cinahl were systematically searched for studies focusing on determinants and associated factors of medication non-adherence and non-persistence to oral anticancer drugs. The methodological quality of the included studies was assessed by two independent reviewers. No studies were excluded based on the quality assessment. Twenty-five studies were included and systematically reviewed. The quality of the studies was moderate. Associated factors influencing medication non-adherence and non-persistence to oral anticancer drugs are multifactorial and interrelated. Older and younger age, and the influence of therapy related side effects were found to be predominant factors. Non-adherence and non-persistence to oral anticancer drug therapy are complex phenomena. More qualitative research is needed to facilitate the development of patient tailored complex interventions by exploring patients' needs and underlying processes influencing medication non-adherence and non-persistence to oral anticancer drugs. Copyright © 2013 Elsevier Ltd. All rights reserved.

  6. Associations of traffic noise with self-rated health and psychotropic medication use.

    Science.gov (United States)

    Halonen, Jaana I; Lanki, Timo; Yli-Tuomi, Tarja; Turunen, Anu W; Pentti, Jaana; Kivimäki, Mika; Vahtera, Jussi

    2014-05-01

    Road traffic noise is a common environmental nuisance, which has been thought to increase the risk of many types of health problems. However, population-level evidence often remains scarce. This study examined whether road traffic noise is associated with self-rated health and use of psychotropic medication in a cohort of public sector employees. Data are from the Finnish Public Sector Study cohort. Geographical information system (GIS) was used to link modeled outdoor road traffic noise levels (L den) to residential addresses of 15 611 men and women with cross-sectional survey responses on self-rated health and register-based information on the use of antidepressants, anxiolytics, and hypnotics. High trait anxiety scores were used to identify potentially vulnerable individuals. The analyses were run with logistic regression models adjusting for individual and area-level variables. All participants were blind to the aim of the study. Mean level of road traffic noise at participants' home addresses was 52 decibels (dB) (standard deviation 8.1). Noise level >60 dB versus ≤45 dB was associated with poor self-rated health in men [odds ratio (OR) 1.58, 95% confidence interval (95% CI) 1.14-2.21]. Further stratification revealed that the association was evident only among men with high trait anxiety scores (OR 2.23, 95% CI 1.28-3.89). No association was found with psychotropic medication use or among women. Exposure to road traffic noise was not associated with increased use of psychotropic medication, although it was associated with weakened self-rated health among men.

  7. Mercury exposure associated with altered plasma thyroid hormones in the declining western pond turtle (Emys marmorata) from California mountain streams

    Science.gov (United States)

    Meyer, Erik; Eagles-Smith, Collin A.; Sparling, Donald; Blumenshine, Steve

    2014-01-01

    Mercury (Hg) is a global threat to wildlife health that can impair many physiological processes. Mercury has well-documented endocrine activity; however, little work on the effects of Hg on the thyroid hormones triiodothyronine (T3) and thyroxine (T4) in aquatic wildlife exists despite the fact that it is a sensitive endpoint of contaminant exposure. An emerging body of evidence points to the toxicological susceptibility of aquatic reptiles to Hg exposure. We examined the endocrine disrupting potential of Hg in the western pond turtle (Emys marmorata), a long-lived reptile that is in decline throughout California and the Pacific Northwest. We measured total Hg (THg) concentrations in red blood cells (RBCs) and plasma T3 and T4 of turtles from several locations in California that have been impacted by historic gold mining. Across all turtles from all sites, the geometric mean and standard error THg concentration was 0.805 ± 0.025 μg/g dry weight. Sampling region and mass were the strongest determinants of RBC THg. Relationships between RBC THg and T3 and T4 were consistent with Hg-induced disruption of T4 deiodination, a mechanism of toxicity that may cause excess T4 levels and depressed concentrations of biologically active T3.

  8. Burnout and its association with extracurricular activities among medical students in Saudi Arabia.

    Science.gov (United States)

    Almalki, Sami A; Almojali, Abdullah I; Alothman, Ali S; Masuadi, Emad M; Alaqeel, Meshal K

    2017-04-26

    To assess levels of burnout in medical students, and to explore the influence of extracurricular activities on burnout at a medical school in Saudi Arabia. This cross-sectional study was conducted with first to fourth year medical students at King Saud bin Abdulaziz University for Health Sciences (KSAU-HS) in Riyadh, Saudi Arabia. Socio-demographic, burnout level (the Maslach Burnout Inventory-Student Survey, MBI-SS) and participation in extracurricular activities data were collected using a self-administered questionnaire. Statistical analyses were performed using the Pearson's chi-square test and binary logistic regression. From the 306 medical students approached, 249 (81.4%) completed the questionnaire. The level of high burnout was 67.1% (n=167). The study revealed that the majority (62.3%, n=155) of students had high levels of cynicism, 58.6% (n=146) had high levels of emotional exhaustion, and 60.2% (n=150) had low levels of professional efficacy. Most of the students (73.5%, n=183) participated in extracurricular activities, and 112 (45%) students were organizers of extracurricular activities. No significant association was found between burnout levels and the frequency of involvement in extracurricular activities (χ2=2.2, df=2, p=0.333). However, students who were organizing extracurricular activities were less likely to have low professional efficacy (OR=0.51, 95% CI: 0.27- 0.96). High levels of burnout were reported at this medical school. Although the burnout level is not significantly associated with the frequency of involvement in extracurricular activities, leading and organizing extracurricular activities might result in lower levels of burnout. Therefore, improving the students' leadership skills should be considered in curriculum planning, and greater emphasis should be placed on the quality of involvement in extracurricular activities rather than the quantity.

  9. Perceived stress in first year medical students - associations with personal resources and emotional distress.

    Science.gov (United States)

    Heinen, Ines; Bullinger, Monika; Kocalevent, Rüya-Daniela

    2017-01-06

    Medical students have been found to report high levels of perceived stress, yet there is a lack of theoretical frameworks examining possible reasons. This cross-sectional study examines correlates of perceived stress in medical students on the basis of a conceptual stress model originally developed for and applied to the general population. The aim was to identify via structural equation modeling the associations between perceived stress and emotional distress (anxiety and depression), taking into account the activation of personal resources (optimism, self-efficacy and resilient coping). Within this cross-sectional study, 321 first year medical students (age 22 ± 4 years, 39.3% men) completed the Perceived Stress Questionnaire (PSQ-20), the Self-Efficacy Optimism Scale (SWOP) and the Brief Resilient Coping Scale (BRCS) as well as the Patient Health Questionnaire (PHQ-4). The statistical analyses used t-tests, ANOVA, Spearman Rho correlation and multiple regression analysis as well as structural equation modeling. Medical students reported higher levels of perceived stress and higher levels of anxiety and depression than reference samples. No statistically significant differences in stress levels were found within the sample according to gender, migration background or employment status. Students reported more self-efficacy, optimism, and resilient coping and higher emotional distress compared to validation samples and results in other studies. Structural equation analysis revealed a satisfactory fit between empirical data and the proposed stress model indicating that personal resources modulated perceived stress, which in turn had an impact on emotional distress. Medical students' perceived stress and emotional distress levels are generally high, with personal resources acting as a buffer, thus supporting the population-based general stress model. Results suggest providing individual interventions for those students, who need support in dealing with the

  10. High mercury seafood consumption associated with fatigue at specialty medical clinics on Long Island, NY

    Directory of Open Access Journals (Sweden)

    Shivam Kothari

    2015-01-01

    Full Text Available We investigated the association between seafood consumption and symptoms related to potential mercury toxicity in patients presenting to specialty medical clinics at Stony Brook Medical Center on Long Island, New York. We surveyed 118 patients from April–August 2012 about their seafood consumption patterns, specifically how frequently they were eating each type of fish, to assess mercury exposure. We also asked about symptoms associated with mercury toxicity including depression, fatigue, balance difficulties, or tingling around the mouth. Of the 118 adults surveyed, 14 consumed high mercury seafood (tuna steak, marlin, swordfish, or shark at least weekly. This group was more likely to suffer from fatigue than other patients (p = 0.02. Logistic regression confirmed this association of fatigue with frequent high mercury fish consumption in both unadjusted analysis (OR = 5.53; 95% CI: 1.40–21.90 and analysis adjusted for age, race, sex, income, and clinic type (OR = 7.89; 95% CI: 1.63–38.15. No associations were observed between fish intake and depression, balance difficulties, or tingling around the mouth. Findings suggest that fatigue may be associated with eating high mercury fish but sample size is small. Larger studies are needed to determine whether fish intake patterns or blood mercury tests warrant consideration as part of the clinical work-up in coastal regions.

  11. High mercury seafood consumption associated with fatigue at specialty medical clinics on Long Island, NY.

    Science.gov (United States)

    Kothari, Shivam; Kruse, Danielle; Karimi, Roxanne; Silbernagel, Susan; Gursoy, Nurcan; Jaber, Raja; Roppelt, Heidi; Awan, Rina; Gold, Avram; Meliker, Jaymie R

    2015-01-01

    We investigated the association between seafood consumption and symptoms related to potential mercury toxicity in patients presenting to specialty medical clinics at Stony Brook Medical Center on Long Island, New York. We surveyed 118 patients from April-August 2012 about their seafood consumption patterns, specifically how frequently they were eating each type of fish, to assess mercury exposure. We also asked about symptoms associated with mercury toxicity including depression, fatigue, balance difficulties, or tingling around the mouth. Of the 118 adults surveyed, 14 consumed high mercury seafood (tuna steak, marlin, swordfish, or shark) at least weekly. This group was more likely to suffer from fatigue than other patients (p = 0.02). Logistic regression confirmed this association of fatigue with frequent high mercury fish consumption in both unadjusted analysis (OR = 5.53; 95% CI: 1.40-21.90) and analysis adjusted for age, race, sex, income, and clinic type (OR = 7.89; 95% CI: 1.63-38.15). No associations were observed between fish intake and depression, balance difficulties, or tingling around the mouth. Findings suggest that fatigue may be associated with eating high mercury fish but sample size is small. Larger studies are needed to determine whether fish intake patterns or blood mercury tests warrant consideration as part of the clinical work-up in coastal regions.

  12. Association between mental health screening by self-report questionnaire and insomnia in medical students

    Directory of Open Access Journals (Sweden)

    Loayza H. Maria Paz

    2001-01-01

    Full Text Available Epidemiological research points to the high prevalence of psychiatric disorders among insomniacs. We carried out a cross-sectional study with medical students with the aim of evaluating the association between insomnia and suspicion of psychiatric disorder; 302 medical students were included (184 males and 118 females; mean age = 20.47±1.89 years. The main association was tested by logistic regression analysis. The overall prevalence of positivity in a screening test for psychiatric disorder was 22.19%; and of insomnia, 28.15%. Difficulty initiating sleep (OR=3.45, difficulty maintaining sleep (OR=7.61, falling asleep later (OR=1.99 and waking up earlier (OR=1.91 were associated with suspicion of psychiatric disorder. As a group, the variables difficulty initiating sleep, difficulty maintaining sleep, falling asleep after 11 pm, and waking up before 6 am presented an odds ratio of 5.96 for positivity in the screening for psychiatric disorder. Furthermore, difficulty maintaining sleep (OR=2.24 was associated with "being female," and falling asleep later (OR=0.43 was associated with "being male". These results underscore the importance of determining in what cases difficulty sleeping may have severe clinical repercussions or affect performance.

  13. Discovering disease associations by integrating electronic clinical data and medical literature.

    Science.gov (United States)

    Holmes, Antony B; Hawson, Alexander; Liu, Feng; Friedman, Carol; Khiabanian, Hossein; Rabadan, Raul

    2011-01-01

    Electronic health record (EHR) systems offer an exceptional opportunity for studying many diseases and their associated medical conditions within a population. The increasing number of clinical record entries that have become available electronically provides access to rich, large sets of patients' longitudinal medical information. By integrating and comparing relations found in the EHRs with those already reported in the literature, we are able to verify existing and to identify rare or novel associations. Of particular interest is the identification of rare disease co-morbidities, where the small numbers of diagnosed patients make robust statistical analysis difficult. Here, we introduce ADAMS, an Application for Discovering Disease Associations using Multiple Sources, which contains various statistical and language processing operations. We apply ADAMS to the New York-Presbyterian Hospital's EHR to combine the information from the relational diagnosis tables and textual discharge summaries with those from PubMed and Wikipedia in order to investigate the co-morbidities of the rare diseases Kaposi sarcoma, toxoplasmosis, and Kawasaki disease. In addition to finding well-known characteristics of diseases, ADAMS can identify rare or previously unreported associations. In particular, we report a statistically significant association between Kawasaki disease and diagnosis of autistic disorder.

  14. Discovering disease associations by integrating electronic clinical data and medical literature.

    Directory of Open Access Journals (Sweden)

    Antony B Holmes

    Full Text Available Electronic health record (EHR systems offer an exceptional opportunity for studying many diseases and their associated medical conditions within a population. The increasing number of clinical record entries that have become available electronically provides access to rich, large sets of patients' longitudinal medical information. By integrating and comparing relations found in the EHRs with those already reported in the literature, we are able to verify existing and to identify rare or novel associations. Of particular interest is the identification of rare disease co-morbidities, where the small numbers of diagnosed patients make robust statistical analysis difficult. Here, we introduce ADAMS, an Application for Discovering Disease Associations using Multiple Sources, which contains various statistical and language processing operations. We apply ADAMS to the New York-Presbyterian Hospital's EHR to combine the information from the relational diagnosis tables and textual discharge summaries with those from PubMed and Wikipedia in order to investigate the co-morbidities of the rare diseases Kaposi sarcoma, toxoplasmosis, and Kawasaki disease. In addition to finding well-known characteristics of diseases, ADAMS can identify rare or previously unreported associations. In particular, we report a statistically significant association between Kawasaki disease and diagnosis of autistic disorder.

  15. Associations among pain, non-medical prescription opioid use, and drug overdose history.

    Science.gov (United States)

    Bonar, Erin E; Ilgen, Mark A; Walton, Maureen; Bohnert, Amy S B

    2014-01-01

    Recently, use of prescription opioids (POs) has increased; non-medical PO (NMPO) use is linked to overdose. NMPO use is common among individuals prescribed opioids for pain, and those in substance use disorder (SUD) treatment with pain could be at increased risk for unintentional overdose due to NMPO use. We examined associations between pain, NMPO use, and overdose among SUD treatment patients. Among 342 patients at a residential SUD treatment center, logistic regression examined the association of overdose with pain, adjusting for substance use, suicide attempts, and demographics. Pain was positively related to NMPO use. Heroin use, suicide attempts, pain, and NMPO use were positively associated with overdose; but NMPO use attenuated the pain-overdose relationship. The relationship between pain and overdose among substance users may be, in part, explained by the association between pain and heavy NMPO use. © American Academy of Addiction Psychiatry.

  16. Hospital lighting and its association with sleep, mood and pain in medical inpatients.

    Science.gov (United States)

    Bernhofer, Esther I; Higgins, Patricia A; Daly, Barbara J; Burant, Christopher J; Hornick, Thomas R

    2014-05-01

    To describe light exposure, sleep-wake patterns, mood, pain and their relationships in adult medical inpatients. The hospital environment may contribute to patient discomfort by providing a lighting structure that interferes with circadian rhythmicity, sleep, mood and pain. A descriptive correlational design was used in this preliminary study. Between May 2011-April 2012, data were collected from a convenience sample of 23 women and 17 men admitted to a large academically affiliated hospital in the United States. Over 72 hours, light exposure and sleep-wake patterns were continuously measured with wrist actigraph/light meters for each participant. Mood was measured daily using the Profile Of Mood States Brief™ Form. Subjective pain scores were abstracted from medical records. Light exposure levels were low: mean daytime light intensity was 104·80 lux. Sleep time was fragmented and low: mean 236·35 minutes of sleep/night. Intra-daily stability scores indicated little sleep-wake synchronization with light. Fatigue and total mood disturbance scores were high and inversely associated with light. Pain levels were also high and positively associated with fatigue, but not directly with light exposure. Low light exposure significantly predicted fatigue and total mood disturbance. Medical inpatients were exposed to light levels insufficient for circadian entrainment. Nevertheless, higher light exposure was associated with less fatigue and lower total mood disturbance in participants with pain, suggesting the need for further investigation to determine if manipulating light exposure for medical inpatients would be beneficial in affecting sleep-wake disturbances, mood and pain. © 2013 John Wiley & Sons Ltd.

  17. Association between poor sleep, fatigue, and safety outcomes in emergency medical services providers.

    Science.gov (United States)

    Patterson, P Daniel; Weaver, Matthew D; Frank, Rachel C; Warner, Charles W; Martin-Gill, Christian; Guyette, Francis X; Fairbanks, Rollin J; Hubble, Michael W; Songer, Thomas J; Callaway, Clifton W; Kelsey, Sheryl F; Hostler, David

    2012-01-01

    To determine the association between poor sleep quality, fatigue, and self-reported safety outcomes among emergency medical services (EMS) workers. We used convenience sampling of EMS agencies and a cross-sectional survey design. We administered the 19-item Pittsburgh Sleep Quality Index (PSQI), 11-item Chalder Fatigue Questionnaire (CFQ), and 44-item EMS Safety Inventory (EMS-SI) to measure sleep quality, fatigue, and safety outcomes, respectively. We used a consensus process to develop the EMS-SI, which was designed to capture three composite measurements of EMS worker injury, medical errors and adverse events (AEs), and safety-compromising behaviors. We used hierarchical logistic regression to test the association between poor sleep quality, fatigue, and three composite measures of EMS worker safety outcomes. We received 547 surveys from 30 EMS agencies (a 35.6% mean agency response rate). The mean PSQI score exceeded the benchmark for poor sleep (6.9, 95% confidence interval [CI] 6.6, 7.2). More than half of the respondents were classified as fatigued (55%, 95% CI 50.7, 59.3). Eighteen percent of the respondents reported an injury (17.8%, 95% CI 13.5, 22.1), 41% reported a medical error or AE (41.1%, 95% CI 36.8, 45.4), and 90% reported a safety-compromising behavior (89.6%, 95% CI 87, 92). After controlling for confounding, we identified 1.9 greater odds of injury (95% CI 1.1, 3.3), 2.2 greater odds of medical error or AE (95% CI 1.4, 3.3), and 3.6 greater odds of safety-compromising behavior (95% CI 1.5, 8.3) among fatigued respondents versus nonfatigued respondents. In this sample of EMS workers, poor sleep quality and fatigue are common. We provide preliminary evidence of an association between sleep quality, fatigue, and safety outcomes.

  18. Guideline-recommended medications: variation across Medicare Advantage plans and associated mortality.

    Science.gov (United States)

    Selim, Alfredo J; Fincke, Benjamin G; Rogers, William H; Qian, Shirley; Selim, Bernardo J; Kazis, Lewis E

    2013-03-01

    To evaluate variation in the prescription of guideline-recommended medications across Medicare Advantage (MA) plans and to determine whether such variation is associated with increased mortality. Observational study of 111,667 patients aged 65 years or older receiving care in 203 MA plans. We linked data from the Medicare Health Outcomes (HOS) Survey cohort 9 (April 2006-May 2008) with the Medicare Part D prescription benefit files (January 1, 2006-December 31, 2007) to examine variation in treatment across MA plans and its association with differences in observed (O)/expected (E) mortality ratio for 5 high-volume chronic conditions: diabetes, coronary artery disease (CAD), congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD)/asthma, and depression. Analysis of variance confirmed that the 203 MA plans differed significantly in their use of guideline-recommended treatment (P≤0.02). Those MA plans with higher use of angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers (r=-0.40; Pratios. Those MA plans with higher use of multiple guideline-recommended medications were significantly associated with lower O/E mortality ratios in CHF (r=-0.45; Pratios in patients with CAD and COPD/asthma. Those MA plans with higher use of antidepressant medications had significantly higher O/E mortality ratios (r=0.28, P<0.0001). There was wide variation across MA plans in the prescription of guideline-recommended medications that had a measurable relationship to the mortality of elderly patients with CHF and diabetes. These findings can serve to both motivate and target quality improvement programs.

  19. The association between chronotype and perceived academic stress to depression in medical students.

    Science.gov (United States)

    Romo-Nava, Francisco; Tafoya, Silvia A; Gutiérrez-Soriano, Joaquín; Osorio, Yanik; Carriedo, Pilar; Ocampo, Bárbara; Bobadilla, Rosa I; Heinze, Gerhard

    2016-01-01

    Depression is a multifactorial illness that is highly prevalent among medical students (MS). Chronotypes, which reflect circadian preference in humans, as well as academic stress have been associated with depression in different populations. However, it is not known how chronotype and stress might alone or in combination, associate with depression in MS. Thus, we aimed to evaluate the association between stress, chronotype and depression in MS. In a cross-sectional study, we evaluated a total of 1068 medical students from a public Medical School in Mexico City. The Patient Health Questionnaire-9 (PHQ-9) was used to evaluate depressive symptom severity and the presence of a current depressive episode with a cutoff score of 10 or higher. The Morning-Evening Questionnaire (MEQ) was used to establish chronotype and the Academic Stress Inventory was used to measure perceived academic stress (PAS). We observed that depressive symptom severity was higher in non-morning chronotypes and moderate/severe PAS groups. A factorial ANOVA showed an association between PAS groups and depressive symptom severity. Linear regression showed an association between depressive symptom severity and variables such as PAS scores (p = 0.001), family history of depression (p = 0.001), gender (p = 0.001) and academic year (p = 0.029). Logistic regression analysis showed that evening chronotype (OR: 2.3, 95% CI: 1.2-4.3, p = 0.01) and severe PAS (OR: 4.4, 95% CI: 2.8-7.0, p = 0.0001) were associated with depression. Further, MS with the combination of severe PAS and morning (OR: 5.9, 95% CI: 1.6-22.2, p = 0.01), intermediate (OR: 7.5, 95% CI: 2.3-24.4, p = 0.001) or evening (OR: 10.6, 95% CI: 2.8-40.0, p = 0.001) chronotypes showed a greater association with depression than any PAS or chronotype group alone. Being female, perceiving restricted or limited economic resources, having severe scores of academic stress, and evening chronotype were associated with an increased probability to suffer a

  20. Individual differences in aversion to ambiguity regarding medical tests and treatments: association with cancer screening cognitions.

    Science.gov (United States)

    Han, Paul K J; Williams, Andrew E; Haskins, Amy; Gutheil, Caitlin; Lucas, F Lee; Klein, William M P; Mazor, Kathleen M

    2014-12-01

    Aversion to "ambiguity"-uncertainty about the reliability, credibility, or adequacy of information-about medical tests and treatments is an important psychological response that varies among individuals, but little is known about its nature and extent. The purpose of this study was to examine how individual-level ambiguity aversion relates to important health cognitions related to different cancer screening tests. A survey of 1,074 adults, ages 40 to 70 years, was conducted in four integrated U.S. healthcare systems. The Ambiguity Aversion in Medicine (AA-Med) scale, a measure of individual differences in aversion to ambiguity (AA) about medical tests and treatments, was administered along with measures of several cancer screening-related cognitions: perceived benefits and harms of colonoscopy, mammography, and PSA screening, and ambivalence and future intentions regarding these tests. Multivariable analyses were conducted to assess the associations between AA-Med scores and cancer screening cognitions. Individual-level AA as assessed by the AA-Med scale was significantly associated (P < 0.05) with lower perceived benefits, greater perceived harms, and greater ambivalence about all three screening tests, and lower intentions for colonoscopy but not mammography or PSA screening. Individual-level AA is broadly and simultaneously associated with various pessimistic cognitive appraisals of multiple cancer screening tests. The breadth of these associations suggests that the influence of individual-level AA is insensitive to the degree and nonspecific with respect to the causes of ambiguity. Individual-level AA constitutes a measurable, wide-ranging cognitive bias against medical intervention, and more research is needed to elucidate its mechanisms and effects. ©2014 American Association for Cancer Research.

  1. Psychiatric consultations and the management of associated comorbid medical conditions in a regional referral hospital

    Directory of Open Access Journals (Sweden)

    Nkokone S Z Tema

    2015-05-01

    Full Text Available Background. Psychiatrists are often called upon to evaluate patients with a medical condition and psychiatric symptoms, either as a complication thereof or initial presenting symptoms. There are often grey areas with regard to neuropsychiatric disorders in which psychiatrists and specialists from other clinical disciplines would need to co-manage or share ideas on the comprehensive treatment of a presenting patient. Objectives. This study was undertaken to provide a demographic and clinical profile of all patients consulted by the consultation-liaison psychiatry (CLP service at the Helen Joseph Hospital (HJH in Johannesburg, and to describe the clinical management of patients admitted with a diagnosis of a mental disorder associated with a comorbid medical condition, including delirium, dementia and a mood or psychotic disorder due to a general medical condition. Methods. A retrospective record review of all patients referred to the HJH CLP team over a 6-month period. Results. A total of 884 routine and emergency consultations were done for 662 patients (males n=305; females n=357 between the ages of 13 and 90 years who were referred from various other clinical departments. The most common documented reason for referral was a request for assessment (n=182; 27.5%, which consisted of mental state assessment, reconsultation and assessing capacity. A total of 63 patients (10.0% of cases consulted were admitted to either the medical or psychiatric wards with a confirmed diagnosis of delirium, dementia and/or a mood or psychotic disorder due to a general medical condition (although admission wards were identified in 55 files only. The medical wards admitted the majority (n=37; 67.3% mostly for delirium (n=28; 50.9%. HIV was identified as the most common systemic aetiological factor (n=23; 67.7%. Conclusion. In this study, a female patient between 31 and 45 years of age was slightly more likely to be referred to the HJH CLP service for assessment, and

  2. Medications Associated with Geriatric Syndromes (MAGS) and their Prevalence in Older Hospitalized Adults Discharged to Skilled Nursing Facilities

    Science.gov (United States)

    Saraf, Avantika A.; Peterson, Alec W.; Simmons, Sandra F.; Schnelle, John F.; Bell, Susan P.; Kripalani, Sunil; Myers, Amy P.; Mixon, Amanda S.; Long, Emily A.; Jacobsen, J. Mary Lou; Vasilevskis, Eduard E.

    2016-01-01

    Background More than half of the hospitalized older adults discharged to skilled nursing facilities (SNFs) have more than three geriatric syndromes. Pharmacotherapy may be contributing to geriatric syndromes in this population. Objectives Develop a list of medications associated with geriatric syndromes and describe their prevalence in patients discharged from acute care to skilled nursing facilities (SNFs) Design Literature review and multidisciplinary expert panel discussion, followed by cross-sectional analysis. Setting Academic Medical Center in the United States Participants 154 hospitalized Medicare beneficiaries discharged to SNFs Measurements Development of a list of medications that are associated with six geriatric syndromes. Prevalence of the medications associated with geriatric syndromes was examined in the hospital discharge sample. Results A list of 513 medications was developed as potentially contributing to 6 geriatric syndromes: cognitive impairment, delirium, falls, reduced appetite or weight loss, urinary incontinence, and depression. Medications included 18 categories. Antiepileptics were associated with all syndromes while antipsychotics, antidepressants, antiparkinsonism and opioid agonists were associated with 5 geriatric syndromes. In the prevalence sample, patients were discharged to SNFs with an overall average of 14.0 (±4.7) medications, including an average of 5.9 (±2.2) medications that could contribute to geriatric syndromes, with falls having the most associated medications at discharge, 5.5 (±2.2). Conclusions Many commonly prescribed medications are associated with geriatric syndromes. Over 40% of all medications ordered upon discharge to SNFs were associated with geriatric syndromes and could be contributing to the high prevalence of geriatric syndromes experienced by this population. PMID:27255830

  3. Chronic Pain, Comorbid Medical Conditions, and Associated Risk Factors in Kuwait: Gender and Nationality Differences.

    Science.gov (United States)

    Deeny, Maureen C; Al Hamdan, Elham; Ross, Edgar L; Edwards, Robert R; Huang, Chuan-Chin; Jamison, Robert N

    2015-11-01

    Chronic pain is an international health problem that imposes enormous costs on societies around the world. There is good reason to suspect that chronic pain is a serious health issue in Kuwait and is associated with comorbid medical conditions like diabetes. The aim of this study is to examine the report of pain and incidence of medical comorbidities among a large convenience sample of patients treated at a private rehabilitation center in Kuwait and to examine differences in patient groups based on age, gender, and Kuwaiti nationality. This study examined intake data from 2,103 patients treated at a rehabilitation center in Kuwait. Most of the subjects were female (55.4%) and averaged 43.3 years of age (±14.5, range 18-88). Sixty nine percent were Kuwaiti citizens and 57.9% were employed. Marked differences in pain and health-related conditions were found between Kuwaiti nationals and non-Kuwaitis, with significantly increased incidences of hypertension, osteoarthritis, diabetes, asthma, osteoporosis, and cardiac and respiratory problems among the Kuwaitis (P gender differences were also identified with women reporting more intense, widespread pain, and reporting more comorbid medical problems compared with men (P role of cultural factors in contributing to pain and comorbid medical conditions. This information is critical in organizing resources to implement adequate healthcare services and behavioral interventions in Kuwait and other Arab countries to improve pain and health-related conditions. Wiley Periodicals, Inc.

  4. Factors associated with the choice of general medicine as a career among Japanese medical students.

    Science.gov (United States)

    Kawamoto, Ryuichi; Ninomiya, Daisuke; Kasai, Yoshihisa; Kusunoki, Tomo; Ohtsuka, Nobuyuki; Kumagi, Teru; Abe, Masanori

    2016-01-01

    In Japan, there is a shortage of young physicians in various specialties; the present situation of general medicine or family medicine (GM/FM) in particular is risky. The factors influencing the career choice of Japanese medical students are poorly understood. This study aims to identify factors related to choosing GM/FM as a career. The study was designed as a cross-sectional survey. Students at one medical school in Japan filled out a questionnaire. Students were asked to state their intended medical specialty, and they rated the importance of specific individual and occupational aspects using a 4-point likert scale. Factor analysis was performed on the variables. Reliability of the factor scores was estimated using Cronbach's alpha coefficients; biserial correlations between the factors and career choices were calculated. Furthermore, multiple linear regression analysis was performed using career choice (GM/FM vs. others) as the criterion variable and the factors plus demographic characteristics as confounding variables. Factor analysis produced six factors that explained future career plans. Medical students in this study had a positive and realistic idea about GM/FM, but only 18.8% of them chose GM/FM first as a career. The significant variables associated with choosing GM/FM first as a career were: 'Admission from hometown' (β=0.189, P=0.001), 'Student preparing for the entrance exam' (β=0.172; P=0.001), 'Intent for rural practice' (β=0.123, P=0.016), and 'Work-life balance' (β=0.126, P=0.013). While significant variables that were negatively associated with choosing GM/FM were 'Presence of medical relatives' (β=-0.107, P=0.037) and 'Scientific orientation' (β=-0.125, P=0.013). Strategies have been suggested, such as recruiting medical students with significant variables that were associated with choosing GM/FM first as a career. By engaging students early in their choice of career, we may be able to increase enthusiasm for this specialty.

  5. Factors associated with the choice of general medicine as a career among Japanese medical students

    Directory of Open Access Journals (Sweden)

    Ryuichi Kawamoto

    2016-05-01

    Full Text Available Background: In Japan, there is a shortage of young physicians in various specialties; the present situation of general medicine or family medicine (GM/FM in particular is risky. The factors influencing the career choice of Japanese medical students are poorly understood. This study aims to identify factors related to choosing GM/FM as a career. Methods: The study was designed as a cross-sectional survey. Students at one medical school in Japan filled out a questionnaire. Students were asked to state their intended medical specialty, and they rated the importance of specific individual and occupational aspects using a 4-point likert scale. Factor analysis was performed on the variables. Reliability of the factor scores was estimated using Cronbach‘s alpha coefficients; biserial correlations between the factors and career choices were calculated. Furthermore, multiple linear regression analysis was performed using career choice (GM/FM vs. others as the criterion variable and the factors plus demographic characteristics as confounding variables. Results: Factor analysis produced six factors that explained future career plans. Medical students in this study had a positive and realistic idea about GM/FM, but only 18.8% of them chose GM/FM first as a career. The significant variables associated with choosing GM/FM first as a career were: ‘Admission from hometown’ (β=0.189, P=0.001, ‘Student preparing for the entrance exam’ (β=0.172; P=0.001, ‘Intent for rural practice’ (β=0.123, P=0.016, and ‘Work–life balance’ (β=0.126, P=0.013. While significant variables that were negatively associated with choosing GM/FM were ‘Presence of medical relatives’ (β=−0.107, P=0.037 and ‘Scientific orientation’ (β=−0.125, P=0.013. Conclusions: Strategies have been suggested, such as recruiting medical students with significant variables that were associated with choosing GM/FM first as a career. By engaging students early in their

  6. Psychological and Drug Abuse Symptoms Associated with Non-medical Use of Opioid Analgesics among Adolescents

    Science.gov (United States)

    Boyd, Carol J; Young, Amy; McCabe, Sean E

    2014-01-01

    Background This exploratory study examined the psychological and substance abuse symptoms and motivations associated with adolescents’ medical and nonmedical use of opioid analgesics. We compared three groups of adolescents: 1) those who never used an opioid analgesic; 2) those who used a prescribed opioid analgesic (medical users); and 3) those who used someone else’s opioid analgesics (nonmedical users). Nonmedical use was defined as using someone else’s opioid analgesic medication. Comparisons among the groups were made on psychological and substance abuse symptoms as well as motivations to engage in nonmedical use. Methods A web-based survey, the Secondary Student Life Survey (SSLS) was administered to a sample of students who attended one of five secondary schools in southeastern Michigan. The sample included 2,627 respondents and was evenly distributed by sex and grade. Sixty-five percent (65.0%) were White/Caucasian and 29.5% African-American. The average age was 14.8 years (SD=1.9). Results Seventy percent (70.4%, n=1850) reported never using opioid analgesics in their lifetimes. Of the remaining 24.5% (n=644) of opioid analgesic users, most were medical users. However, 3.5% (n=92) were classified as nonmedical users who used someone else’s medication for pain relief only, and 1.6% (n=41) were classified as nonmedical users for reasons other than for pain relief (e.g. to get high). In contrast to never users, both medical users and nonmedical users reported more substance abuse symptoms and symptoms associated with pain. Further, those nonmedical users who used opioids to sensation seek had greater odds of having psychological symptoms. Conclusions These data: 1) provide additional support for the existence of distinct subgroups of adolescent opioid analgesic users; 2) provide evidence of psychological symptoms associated with nonmedical use; and 3) highlight the psychological differences among nonmedical users who self-treat for pain versus

  7. Jockey Falls, Injuries, and Fatalities Associated With Thoroughbred and Quarter Horse Racing in California, 2007-2011.

    Science.gov (United States)

    Hitchens, Peta L; Hill, Ashley E; Stover, Susan M

    2013-01-01

    Despite the popularity of the horse racing industry in the United States and the wide recognition that horse racing is one of the most hazardous occupations, little focused research into the prevention of falls by and injuries to jockeys has been conducted. To describe the incidence rates and characteristics of falls and injuries to Thoroughbred and Quarter Horse racing jockeys in the state of California. Descriptive epidemiology study. Data on race-day falls and injuries were extracted from jockey accident reports submitted to the California Horse Racing Board from January 2007 to December 2011. Denominator data, number of jockey race rides, were obtained from commercial and industry databases. Jockey fall, injury, and fatality incidence rates and ratios in Thoroughbred and Quarter Horse flat races were estimated using Poisson regression. Characteristics of falls and injuries are described and compared. In Thoroughbred races, 184 jockey injuries occurred from 360 reported jockey falls, 180,646 race rides, 23,500 races, and 3350 race meetings. In Quarter Horse races, 85 jockey injuries occurred from 145 jockey falls, 46,106 race rides, 6320 races, and 1053 race meetings. Jockey falls occurred at a rate of 1.99 falls per 1000 rides in Thoroughbred races, with 51% of falls resulting in jockey injury, and 3.14 falls per 1000 rides in Quarter Horse races, with 59% of falls resulting in jockey injury. The majority of falls occurred during a race, with catastrophic injury or sudden death of the horse reported as the most common cause in both Thoroughbred (29%) and Quarter Horse (44%) races. During the period studied, 1 jockey fatality resulted from a fall. Jockey fall rates were lower but injury rates were comparable to those reported internationally. On average, a licensed jockey in California can expect to have a fall every 502 rides in Thoroughbred races and every 318 rides in Quarter Horse races. While jockey fall rates were lower, injury rates were similar to those

  8. What price medical malpractice insurance?

    Science.gov (United States)

    SADUSK, J F

    1955-11-01

    The Medical Review and Advisory Board has been established as a committee of the Commission on Professional Welfare of the California Medical Association to make studies and recommendations toward solution of the growing problems of professional liability insurance and malpractice actions in California. The members of the Board are: Joseph F. Sadusk, Jr., Oakland, Chairman; Wilbur Bailey, M.D., Los Angeles, vice-chairman; Howard W. Bosworth, M.D., Los Angeles; H. I. Burtness, M.D., Santa Barbara; Paul W. Frame, Jr., M.D., Sacramento; Verne G. Ghormley, M.D., Fresno; Carl M. Hadley, M.D., San Bernardino; Joseph J. O'Hara, M.D., San Diego; William F. Quinn, M.D., Los Angeles; Rees B. Rees, M.D., San Francisco; and Bernard Silber, M.D., Redwood City; Mr. Rollen Waterson, 564 Market Street, San Francisco 4, is executive secretary, and Mr. Howard Hassard is legal counsel.

  9. Improving adequacy of hemodialysis in Northern California ESRD patients: a final project report. Provider Participants and Medical Review Board of the TransPacific Renal Network.

    Science.gov (United States)

    Brown, J; Josephson, M

    2000-10-01

    The National Core Indicators Project, initiated in 1994, has brought progressive changes in adequacy of dialysis for end-stage renal disease (ESRD) patients in the TransPacific Renal Network and across the United States. The 1998 Core Indicator Project showed each Network's standing for percentage of patients with urea reduction ratio (URR) > or = 0.65 and average URR. The TransPacific Renal Network ranked 12(th) among the 18 Networks for this adequacy measure. The goals of this project were to improve the Network standing in the United States for the percent of patients with URR > or = 0.65, eliminate or reduce the barriers to achieving adequate dialysis, and evaluate URR versus KT/V data and the variances occurring with these measures. In January 1999, data were collected from all 113 Northern California hemodialysis facilities for quarter 4, 1998, to evaluate adequacy. Each facility provided patient population (N) for KT/V and URR samples, facility averages for KT/V and URR, number of patients with KT/V > or = 1.2 and URR > or = 0.65, and data on post-blood-urea-nitrogen (BUN) sampling methods. A random selection of 10% (12) providers with data below the US and Network standards was selected for an intensive assessment. Using baseline measurements, on-site data were collected from a random selection of the patient population. Chart data were reviewed, analyzed, and discussed in an exit interview with the facility management. On-site visits were performed in July/June 1999. The primary focus included adequacy data and process of care that affect adequacy outcomes, concurrent review of patients receiving treatment at the time of the site visit, and general medical record review. In Phase I, only 12 facilities showed an average URR below 0.65. All facilities reported an average KT/V greater than the DOQI target of 1.2. Forty-two facilities had their percentage of patients with a URR below the national benchmark; only 18 facilities had their percentage of patients

  10. [Reader survey of the Journal of the Norwegian Medical Association 2007].

    Science.gov (United States)

    Aasland, Olaf Gjerløw

    2008-06-26

    Upon request, The Research Institute of the Norwegian Medical Association conducted a reader survey for the Journal of the Norwegian Medical Association (JNMA) during the autumn of 2007. Three probability samples of 1,500 active doctors, 250 medical students and 250 retired doctors were given a questionnaire that could be completed and returned by ordinary mail or electronically. 48% of the students, 54% of the doctors, and 76% of the retired doctors responded. 54% of the readers spend 30 min or more on each issue. 20% of the retired doctors, 9% of the active doctors, and 7% of the students spend two hours or more. The declared aims of being a membership journal and a source for professional update were fulfilled significantly better than the other three declared aims; to stimulate research, support professional attitudes and promote health policy debate. The readers wanted more review articles, news from other journals and situations to learn from; and fewer advertisements, articles on "medicine and art" and a shorter language column. The website was particularly used to search for previously published articles, but also to read articles on screen. 32% of the students, 19% of the doctors, and 59% of the retired doctors did not use the JNMA's website. With regard to layout, the paper quality and the quality of the illustrations were praised. All in all the readers found many interesting articles in the JNMA and did not think it was too compact.

  11. Burnout Syndrome and associated factors among medical students: a cross-sectional study.

    Science.gov (United States)

    Costa, Edméa Fontes de Oliva; Santos, Shirley Andrade; Santos, Ana Teresa Rodrigues de Abreu; Melo, Enaldo Vieira de; Andrade, Tarcísio Matos de

    2012-01-01

    To assess the prevalence and levels of burnout syndrome among medical students at the Universidade Federal de Sergipe-Brazil and to identify associated factors. A cross-sectional study was performed with randomly selected students in 2009. The Maslach Burnout Inventory/Student Survey (MBI-SS) and a structured questionnaire on socio-demographic characteristics, the educational process, and individual aspects were used. Statistical evaluation of multiple variables was performed through backward stepwise logistic regression analysis. The prevalence of burnout was 10.3% (n = 369). The prevalence was higher among those who did not have confidence in their clinical skills (Odds Ratio-OR = 6.47), those who felt uncomfortable with course activities (OR = 5.76), and those who did not see the coursework as a source of pleasure (OR = 4.68). There was a significant prevalence of burnout among the medical students studied. Three variables, in particular, were associated with burnout and were directly related to the medical education process. Preventive and intervention measures must be adopted, and longitudinal studies should be conducted.

  12. Prevalence of depression, anxiety and their associated factors among medical students in Karachi, Pakistan.

    Science.gov (United States)

    Khan, Muhammad S; Mahmood, Sajid; Badshah, Areef; Ali, Syed U; Jamal, Yasir

    2006-12-01

    To estimate the prevalence of anxiety, depression and their associated risk factors among students of a public medical college in Karachi, Pakistan. A cross sectional study was done on the students of a public sector, who had spent more than six months in the medical college and had no physical or mental illness other than anxiety and depression. A self administered questionnaire was given out to students who were randomly selected from the list of names obtained from the college administration. Primary outcome was anxiety and depression which was defined as a cut of score 19 or above on AKUADS. Multivariable models were built and logistic regression analysis was performed to determine the factors independently associated with the primary. The mean (SD) age of the students was 21.3 (1.88) years. Majority of the students were females. A very high prevalence of anxiety and depression (70%) was found among students. Students using substance abuse, having family history of depression and anxiety and those who had lost a relative in last 1 year were 2.66, 2.35, 3.4 times more likely to be depressed and suffered from anxiety, respectively. This study suggests that there are certain risk factors other than academic stressors which predispose a medical student to psychological morbidity such as anxiety and depression.

  13. Burnout Syndrome and associated factors among medical students: a cross-sectional study

    Directory of Open Access Journals (Sweden)

    Edméa Fontes de Oliva Costa

    2012-01-01

    Full Text Available OBJECTIVES: To assess the prevalence and levels of burnout syndrome among medical students at the Universidade Federal de Sergipe-Brazil and to identify associated factors. METHODS: A cross-sectional study was performed with randomly selected students in 2009. The Maslach Burnout Inventory/Student Survey (MBI-SS and a structured questionnaire on socio-demographic characteristics, the educational process, and individual aspects were used. Statistical evaluation of multiple variables was performed through backward stepwise logistic regression analysis. RESULTS: The prevalence of burnout was 10.3% (n = 369. The prevalence was higher among those who did not have confidence in their clinical skills (Odds Ratio-OR = 6.47, those who felt uncomfortable with course activities (OR = 5.76, and those who did not see the coursework as a source of pleasure (OR = 4.68. CONCLUSION: There was a significant prevalence of burnout among the medical students studied. Three variables, in particular, were associated with burnout and were directly related to the medical education process. Preventive and intervention measures must be adopted, and longitudinal studies should be conducted.

  14. Polysaccharide-Based Materials Associated with or Coordinated to Gold Nanoparticles: Synthesis and Medical Application.

    Science.gov (United States)

    Facchi, Débora P; da Cruz, Joziel A; Bonafé, Elton G; Pereira, Antonio G B; Fajardo, André R; Venter, Sandro A S; Monteiro, Johny P; Muniz, Edvani C; Martins, Alessandro F

    2017-01-01

    Gold nanoparticles (AuNPs) have enormous potential for application in imaging, diagnosis, and therapies in the medical field. AuNPs are renowned for their localized surface plasmon resonance (LSPR) properties, large surface area, and biocompatibility with body fluids. Further, AuNPs have featured prominently in new methodologies for cancer treatments, like photothermal and imaging therapies. Although AuNPs present enormous potential for application in the medical field, their instability under physiological conditions prevents further uses. However, this limitation may be overcome by associating AuNPs with biopolymers. To the best of our knowledge, a revision paper rationalizing the structure/property relationship and applications of AuNPspolysaccharide composites in the medical field has not been published yet. This manuscript discusses the most relevant aspects and state-of-art concepts surrounding the synthesis of AuNPs based on green chemistry and their association with polysaccharides that can efficiently function both as stabilizing and reducing agents of Au nanoparticles. Even more, polysaccharide devices may inhibit non-specific interactions between AuNPs and biological macromolecules, suppressing unsuitable "protein corona" formations on AuNP surfaces, thereby increasing the potential of AuNP composites of being employing as drug delivery matrices and wound-healing devices as well as in photothermal/ imaging purposes for cancer treatments and biosensors. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

  15. Association of medication errors with drug classifications, clinical units, and consequence of errors: Are they related?

    Science.gov (United States)

    Muroi, Maki; Shen, Jay J; Angosta, Alona

    2017-02-01

    Registered nurses (RNs) play an important role in safe medication administration and patient safety. This study examined a total of 1276 medication error (ME) incident reports made by RNs in hospital inpatient settings in the southwestern region of the United States. The most common drug class associated with MEs was cardiovascular drugs (24.7%). Among this class, anticoagulants had the most errors (11.3%). The antimicrobials was the second most common drug class associated with errors (19.1%) and vancomycin was the most common antimicrobial that caused errors in this category (6.1%). MEs occurred more frequently in the medical-surgical and intensive care units than any other hospital units. Ten percent of MEs reached the patients with harm and 11% reached the patients with increased monitoring. Understanding the contributing factors related to MEs, addressing and eliminating risk of errors across hospital units, and providing education and resources for nurses may help reduce MEs. Copyright © 2016 Elsevier Inc. All rights reserved.

  16. Identification and Treatment of Symptoms Associated with Inflammation in Medically Ill Patients

    Science.gov (United States)

    Dantzer, Robert; Capuron, Lucile; Irwin, Michael R.; Miller, Andrew H.; Ollat, Helene; Perry, Victor Hugh; Rousey, Sarah; Yirmiya, Raz

    2008-01-01

    Medically ill patients present with a high prevalence of non-specific comorbid symptoms including pain, sleep disorders, fatigue and cognitive and mood alterations that is a leading cause of disability. However, despite major advances in the understanding of the immune-to-brain communication pathways that underlie the pathophysiology of these symptoms in inflammatory conditions, little has been done to translate this newly acquired knowledge to the clinics and to identify appropriate therapies. In a multidisciplinary effort to address this problem, clinicians and basic scientists with expertise in areas of inflammation, psychiatry, neurosciences and psychoneuroimmunology were brought together in a specialized meeting organized in Bordeaux, France, on May 28–29, 2007. These experts considered key questions in the field, in particular those related to identification and quantification of the predominant symptoms associated with inflammation, definition of systemic and central markers of inflammation, possible domains of intervention for controlling inflammation associated symptoms, and relevance of animal models of inflammation associated symptoms. This resulted in a number of recommendations that should improve the recognition and management of inflammation-associated symptoms in medically ill patients. PMID:18061362

  17. Identifying Early Childhood Personality Dimensions Using the California Child Q-Set and Prospective Associations With Behavioral and Psychosocial Development.

    Science.gov (United States)

    Wilson, Sylia; Schalet, Benjamin D; Hicks, Brian M; Zucker, Robert A

    2013-08-01

    The present study used an empirical, "bottom-up" approach to delineate the structure of the California Child Q-Set (CCQ), a comprehensive set of personality descriptors, in a sample of 373 preschool-aged children. This approach yielded two broad trait dimensions, Adaptive Socialization (emotional stability, compliance, intelligence) and Anxious Inhibition (emotional/behavioral introversion). Results demonstrate the value of using empirical derivation to investigate the structure of personality in young children, speak to the importance of early-evident personality traits for adaptive development, and are consistent with a growing body of evidence indicating that personality structure in young children is similar, but not identical to, that in adults, suggesting a model of broad personality dimensions in childhood that evolve into narrower traits in adulthood.

  18. Association between potentially inappropriate medications and anxiety in Japanese older patients.

    Science.gov (United States)

    Masumoto, Shoichi; Sato, Mikiya; Maeno, Takami; Ichinohe, Yumiko; Maeno, Tetsuhiro

    2017-08-31

    The use of potentially inappropriate medications (PIMs) for older patients is a major public health problem. However, there is little information regarding PIMs in Japanese primary care settings, and the association between psychological problems and PIMs is unknown. The present study was carried out to explore the prevalence of PIMs among older patients in a primary care setting in Tokyo, and to assess the association between PIMs and depression and anxiety. A cross-sectional study in a Japanese outpatient clinic providing primary care was carried out. Data were collected from January 2016 to March 2016. A total of 740 patients aged ≥65 years with chronic diseases were enrolled. Information regarding sociodemographic status, comorbidities, and prescription and psychological status was collected using a questionnaire that patients were required to complete, and by reviewing the patients' medical records. The Screening Tool of Older Person's Prescriptions criteria version 2 revealed PIM prescription for 32.3% of patients. Benzodiazepines, hypnotic Z-drugs and proton pump inhibitors accounted for a majority of PIMs. After adjusting for age, sex, comorbidities, estimated glomerular filtration rate and the number of medications, anxiety was identified as a predictor for PIMs. PIMs among older patients are common in Japanese primary care settings, and prescription of benzodiazepines or hypnotic Z-drugs and proton pump inhibitors was frequent as PIMs. PIMs might be associated with anxiety; therefore, their association should be focused on and addressed to reduce PIMs. Geriatr Gerontol Int 2017; ••: ••-••. © 2017 Japan Geriatrics Society.

  19. Risk factors associated with uncomplicated peptic ulcer and changes in medication use after diagnosis.

    Directory of Open Access Journals (Sweden)

    Antonio González-Pérez

    Full Text Available Few epidemiologic studies have investigated predictors of uncomplicated peptic ulcer disease (PUD separately from predictors of complicated PUD.To analyze risk factors associated with uncomplicated PUD and medication use after diagnosis.Patients diagnosed with uncomplicated PUD (n = 3,914 were identified from The Health Improvement Network database among individuals aged 40-84 years during 1997-2005, with no previous history of PUD. Prescription records for the year after the date of diagnosis were reviewed and a nested case-control analysis was performed to calculate the odds ratios for the association of potential risk factors with PUD.Medications associated with developing uncomplicated PUD included current use of acetylsalicylic acid (ASA, nonsteroidal anti-inflammatory drugs (NSAIDs, paracetamol, selective serotonin reuptake inhibitors, antidepressants, antihypertensives or acid suppressants. Uncomplicated PUD was significantly associated with being a current or former smoker and having had a score of at least 3 on the Townsend deprivation index. Approximately 50% of patients who were users of ASA (19% of patients or chronic users of NSAIDs (7% of patients at diagnosis did not receive another prescription of the medication in the 60 days after diagnosis, and 30% were not represcribed therapy within a year. Among patients who were current users of ASA or chronic NSAIDs at the time of the PUD diagnosis and received a subsequent prescription for their ASA or NSAID during the following year, the vast majority (80-90% also received a proton pump inhibitor coprescription.Our results indicate that several risk factors for upper gastrointestinal bleeding are also predictors of uncomplicated PUD, and that some patients do not restart therapy with ASA or NSAIDs after a diagnosis of uncomplicated PUD. Further investigation is needed regarding the consequences for these patients in terms of increased cardiovascular burden due to discontinuation of

  20. Epiphytic diatoms associated with red mangrove (Rhizophora mangle prop roots in Bahía Magdalena, Baja California Sur, Mexico

    Directory of Open Access Journals (Sweden)

    D.A Siqueiros Beltrones

    2006-06-01

    Full Text Available The first floristic inventory of benthic diatoms is provided for the Bahía Magdalena- Bahía Almejas lagoon system. Samplings were carried out during November of 1999. The oxydized samples were mounted permanently. Eighty six diatom taxa were identified, out of which 59 are new records for the Bahía Magdalena area, and 12 taxa are new for the Baja California peninsula. Taxa recorded previously as rare in other substrata are common or abundant on the epiphytic macroalgae of mangrove prop roots. Other species are mainly epipelic forms, while 24 are commonly found as tychoplankton in the area. Certain taxa appear to be characteristic of mangrove systems in general. Rev. Biol. Trop. 54(2: 287-297. Epub 2006 Jun 01.Se presenta el primer inventario florístico de diatomeas bénticas para el Sistema Lagunar Bahía Magdalena-Bahía Almejas. Se hicieron muestreos en noviembre de 1999. En las muestras oxidadas y montadas permanentemente, se identificaron 86 táxones, de los cuales 59 son nuevos registros para el área de Bahía Magdalena, y 12 son nuevos para la península de Baja California. Táxones previamente registrados como escasos en otros sustratos son comunes o abundantes sobre macroalgas epífitas de raíces primarias de mangle. Otras species son principalmente formas epipélicas, mientras que 24 son constituyentes comunes del ticoplancton del área. Ciertos táxones parecen ser característicos de sistemas de manglar en general.

  1. Lactate is associated with increased 10-day mortality in acute medical patients

    DEFF Research Database (Denmark)

    Haidl, Felix; Brabrand, Mikkel; Henriksen, Daniel P

    2015-01-01

    An increased lactate level is related to increased mortality in subpopulations of critically ill patients. The aim of this study was to investigate whether lactate was related to mortality in an emergency department (ED) setting of undifferentiated medical patients. All adult patients admitted from......-90 years). The median lactate level was 1.2 mmol/l (5-95% percentiles 0.6-3.8 mmol/l, range 0.2-22 mmol/l). Lactate was associated with 10-day mortality independent of age, comorbidity and presence of hypotension, with an odds ratio of 1.54 (95% confidence interval 1.44-1.63) per 1 mmol/l increase. Lactate...... is an independent predictor of 10-day mortality among patients admitted to a medical ED....

  2. Association of American Veterinary Medical Colleges (AAVMC): 50 Years of History and Service.

    Science.gov (United States)

    Maccabe, Andrew T; Crawford, Lester; Heider, Lawrence E; Hooper, Billy; Mann, Curt J; Pappaioanou, Marguerite

    2015-01-01

    The mission of the Association of American Veterinary Medical Colleges (AAVMC) is to advance the quality of academic veterinary medicine. Founded in 1966 by the 18 US colleges of veterinary medicine and 3 Canadian colleges of veterinary medicine then in existence, the AAVMC is celebrating 50 years of public service. Initially, the AAVMC comprised the Council of Deans, the Council of Educators, and the Council of Chairs. In 1984, the tri-cameral structure was abandoned and a new governing structure with a board of directors was created. In 1997, the AAVMC was incorporated in Washington, DC and a common application service was created. Matters such as workforce issues and the cost of veterinary medical education have persisted for decades. The AAVMC is a champion of diversity in the veterinary profession and a strong advocate for One Health. The AAVMC has adopted a global perspective as more international colleges of veterinary medicine have earned COE accreditation and become members.

  3. Introducing DVM: DiVersity Matters (an Association of American Veterinary Medical Colleges Initiative).

    Science.gov (United States)

    Greenhill, Lisa M

    2007-01-01

    Now more than ever, colleges of veterinary medicine (CVMs) are challenged to improve the educational experience, build environments that support long-term student and faculty success, and create a diverse and competitive workforce. Additionally, the nation's fast-evolving racial and ethnic demographics demand that the veterinary medical profession be responsive to the emerging needs of this changing population. In March 2005, during the 15th Iverson Bell Symposium, the Association of American Veterinary Medical Colleges (AAVMC) unveiled its DiVersity Matters (DVM) initiative, designed to bring the CVMs closer to achieving these goals. Several key objectives of the initiative and their possible long-term significance to success of the DiVersity Matters initiative are explored here, and CVMs are encouraged to expand efforts to increase racial and ethnic diversity in academic veterinary medicine.

  4. Computer vision syndrome and associated factors among medical and engineering students in chennai.

    Science.gov (United States)

    Logaraj, M; Madhupriya, V; Hegde, Sk

    2014-03-01

    Almost all institutions, colleges, universities and homes today were using computer regularly. Very little research has been carried out on Indian users especially among college students the effects of computer use on the eye and vision related problems. The aim of this study was to assess the prevalence of computer vision syndrome (CVS) among medical and engineering students and the factors associated with the same. A cross-sectional study was conducted among medical and engineering college students of a University situated in the suburban area of Chennai. Students who used computer in the month preceding the date of study were included in the study. The participants were surveyed using pre-tested structured questionnaire. Among engineering students, the prevalence of CVS was found to be 81.9% (176/215) while among medical students; it was found to be 78.6% (158/201). A significantly higher proportion of engineering students 40.9% (88/215) used computers for 4-6 h/day as compared to medical students 10% (20/201) (P engineering students compared with medical students. Students who used computer for 4-6 h were at significantly higher risk of developing redness (OR = 1.2, 95% CI = 1.0-3.1,P = 0.04), burning sensation (OR = 2.1,95% CI = 1.3-3.1, P computer for less than 4 h. Significant correlation was found between increased hours of computer use and the symptoms redness, burning sensation, blurred vision and dry eyes. The present study revealed that more than three-fourth of the students complained of any one of the symptoms of CVS while working on the computer.

  5. Translating genome wide association study results to associations among common diseases: in silico study with an electronic medical record.

    Science.gov (United States)

    Anand, Vibha; Rosenman, Marc B; Downs, Stephen M

    2013-09-01

    To develop a map of disease associations exclusively using two publicly available genetic sources: the catalog of single nucleotide polymorphisms (SNPs) from the HapMap, and the catalog of Genome Wide Association Studies (GWAS) from the NHGRI, and to evaluate it with a large, long-standing electronic medical record (EMR). A computational model, In Silico Bayesian Integration of GWAS (IsBIG), was developed to learn associations among diseases using a Bayesian network (BN) framework, using only genetic data. The IsBIG model (I-Model) was re-trained using data from our EMR (M-Model). Separately, another clinical model (C-Model) was learned from this training dataset. The I-Model was compared with both the M-Model and the C-Model for power to discriminate a disease given other diseases using a test dataset from our EMR. Area under receiver operator characteristics curve was used as a performance measure. Direct associations between diseases in the I-Model were also searched in the PubMed database and in classes of the Human Disease Network (HDN). On the basis of genetic information alone, the I-Model linked a third of diseases from our EMR. When compared to the M-Model, the I-Model predicted diseases given other diseases with 94% specificity, 33% sensitivity, and 80% positive predictive value. The I-Model contained 117 direct associations between diseases. Of those associations, 20 (17%) were absent from the searches of the PubMed database; one of these was present in the C-Model. Of the direct associations in the I-Model, 7 (35%) were absent from disease classes of HDN. Using only publicly available genetic sources we have mapped associations in GWAS to a human disease map using an in silico approach. Furthermore, we have validated this disease map using phenotypic data from our EMR. Models predicting disease associations on the basis of known genetic associations alone are specific but not sensitive. Genetic data, as it currently exists, can only explain a fraction

  6. Characteristics and Factors Associated With Antihypertensive Medication Use in Patients Attending Peruvian Health Facilities

    Science.gov (United States)

    Mejia, Christian R; Failoc-Rojas, Virgilio E; Cervantes, Carmen; Aspajo, Antonio J; Leandro, Jesus Galileo; Cordova-De La Cruz, Jhomar; Charri, Julio C; García-Auqui, Kevin E; Coronel-Chucos, Lelis Gabriela; Justo-Pinto, Luz Delia; Mamani-Apaza, Marisol Stefanie; Paz-Campos, Neil Arón; Correa, Ricardo

    2017-01-01

    Introduction  Hypertension is a very common disease worldwide, and medication is needed to prevent its short-term and long-term complications. Our objective was to determine the characteristics and factors associated with antihypertensive medication use in patients attending Peruvian health facilities. Materials & Methods We performed a multicenter, cross-sectional study with secondary data. We obtained self-reported antihypertensive medication from patients attending health facilities in 10 departments of Peru. We looked for associations of the antihypertensive treatment according to sociopathological factors and obtained p values using generalized linear models. Results Of the 894 patients with hypertension, 61% (547) were women and 60% (503) were on antihypertensive treatment, of which 82% (389) had monotherapy and 52% (258) had recently taken their medication. Antihypertensive treatment was positively correlated with the patient's age (adjusted prevalence ratio [aPR]: 1.01; 95% confidence interval [CI]: 1.007 to 1.017; p value < 0.001), diabetes (aPR: 1.31; 95% CI: 1.11 to 1.55; p value = 0.001) and cardiovascular disease (aPR: 1.38; 95% CI: 1.26 to 1.51; p value < 0.001). Conversely, the frequency of antihypertensive treatment decreases with physical activity (aPR: 0.80; 95% CI: 0.70 to 0.92; p value = 0.001). Conclusion Patients who have comorbidities and advanced age are more likely to be on antihypertensive treatment. In contrast, patients with increased physical activity have a lower frequency of antihypertensive treatment. It is important to consider these factors for future preventive programs and to improve therapeutic compliance. PMID:28331773

  7. Brown v. Plata: prison overcrowding in California.

    Science.gov (United States)

    Newman, William J; Scott, Charles L

    2012-01-01

    California's prisons are currently designed to house approximately 85,000 inmates. At the time of the U.S. Supreme Court's 2011 decision in Brown v. Plata, the California prison system housed nearly twice that many (approximately 156,000 inmates). The Supreme Court held that California's prison system violated inmates' Eighth Amendment rights. The Court upheld a three-judge panel's order to decrease the population of California's prisons by an estimated 46,000 inmates. They determined that overcrowding was the primary cause of the inmates' inadequate medical and mental health care. As a result, the California Department of Corrections and Rehabilitation (CDCR) has been working to redistribute inmates and parolees safely and decrease the overall population to the mandated levels. These large-scale adjustments to California's penal system create potential opportunities to study the long-term effects on affected inmates.

  8. Statistical trends in the Journal of the American Medical Association and implications for training across the continuum of medical education.

    Science.gov (United States)

    Arnold, Lauren D; Braganza, Melissa; Salih, Rondek; Colditz, Graham A

    2013-01-01

    Statistical training across the continuum of medical education may not have advanced at the pace of statistical reporting in the medical literature, yet a comprehensive understanding of statistical concepts most commonly presented in current research is critical to the effective practice of Evidence Based Medicine. The objective of this content analysis was to describe statistical techniques used in a leading medical journal, JAMA, across a 20-year period, with a focus on implications for medical education. Two issues of JAMA published each month in 1990, 2000, and 2010 were randomly selected; from these, 361 articles were reviewed. Primary focus, study design, and statistical components were abstracted and examined by year of publication. The number of published RCTs and cohort studies differed significantly across years of interest, with an increasing trend of publication. The most commonly reported statistics over the 20-year period of interest included measures of morbidity and mortality, descriptive statistics, and epidemiologic outcomes. However, between 1990 and 2010, there was an increase in reporting of more advanced methods, such as multivariable regression, multilevel modeling, survival analysis, and sensitivity analysis. While this study is limited by a focus on one specific journal, a strength is that the journal examined is widely read by a range of clinical specialties and is considered a leading journal in the medical field, setting standards for published research. The increases in frequency and complexity of statistical reporting in the literature over the past two decades may suggest that moving beyond basic statistical concepts to a more comprehensive understanding of statistical methods is an important component of clinicians' ability to effectively read and use the medical research. These findings provide information to consider as medical schools and graduate medical education training programs review and revise their statistical training

  9. Statistical trends in the Journal of the American Medical Association and implications for training across the continuum of medical education.

    Directory of Open Access Journals (Sweden)

    Lauren D Arnold

    Full Text Available BACKGROUND: Statistical training across the continuum of medical education may not have advanced at the pace of statistical reporting in the medical literature, yet a comprehensive understanding of statistical concepts most commonly presented in current research is critical to the effective practice of Evidence Based Medicine. The objective of this content analysis was to describe statistical techniques used in a leading medical journal, JAMA, across a 20-year period, with a focus on implications for medical education. METHODS AND FINDINGS: Two issues of JAMA published each month in 1990, 2000, and 2010 were randomly selected; from these, 361 articles were reviewed. Primary focus, study design, and statistical components were abstracted and examined by year of publication. The number of published RCTs and cohort studies differed significantly across years of interest, with an increasing trend of publication. The most commonly reported statistics over the 20-year period of interest included measures of morbidity and mortality, descriptive statistics, and epidemiologic outcomes. However, between 1990 and 2010, there was an increase in reporting of more advanced methods, such as multivariable regression, multilevel modeling, survival analysis, and sensitivity analysis. While this study is limited by a focus on one specific journal, a strength is that the journal examined is widely read by a range of clinical specialties and is considered a leading journal in the medical field, setting standards for published research. CONCLUSIONS: The increases in frequency and complexity of statistical reporting in the literature over the past two decades may suggest that moving beyond basic statistical concepts to a more comprehensive understanding of statistical methods is an important component of clinicians' ability to effectively read and use the medical research. These findings provide information to consider as medical schools and graduate medical education

  10. Association of interruptions with an increased risk and severity of medication administration errors.

    Science.gov (United States)

    Westbrook, Johanna I; Woods, Amanda; Rob, Marilyn I; Dunsmuir, William T M; Day, Richard O

    2010-04-26

    Interruptions have been implicated as a cause of clinical errors, yet, to our knowledge, no empirical studies of this relationship exist. We tested the hypothesis that interruptions during medication administration increase errors. We performed an observational study of nurses preparing and administering medications in 6 wards at 2 major teaching hospitals in Sydney, Australia. Procedural failures and interruptions were recorded during direct observation. Clinical errors were identified by comparing observational data with patients' medication charts. A volunteer sample of 98 nurses (representing a participation rate of 82%) were observed preparing and administering 4271 medications to 720 patients over 505 hours from September 2006 through March 2008. Associations between procedural failures (10 indicators; eg, aseptic technique) and clinical errors (12 indicators; eg, wrong dose) and interruptions, and between interruptions and potential severity of failures and errors, were the main outcome measures. Each interruption was associated with a 12.1% increase in procedural failures and a 12.7% increase in clinical errors. The association between interruptions and clinical errors was independent of hospital and nurse characteristics. Interruptions occurred in 53.1% of administrations (95% confidence interval [CI], 51.6%-54.6%). Of total drug administrations, 74.4% (n = 3177) had at least 1 procedural failure (95% CI, 73.1%-75.7%). Administrations with no interruptions (n = 2005) had a procedural failure rate of 69.6% (n = 1395; 95% CI, 67.6%-71.6%), which increased to 84.6% (n = 148; 95% CI, 79.2%-89.9%) with 3 interruptions. Overall, 25.0% (n = 1067; 95% CI, 23.7%-26.3%) of administrations had at least 1 clinical error. Those with no interruptions had a rate of 25.3% (n = 507; 95% CI, 23.4%-27.2%), whereas those with 3 interruptions had a rate of 38.9% (n = 68; 95% CI, 31.6%-46.1%). Nurse experience provided no protection against making a clinical error and was

  11. Video Laryngoscopic Techniques Associated with Intubation Success in a Helicopter Emergency Medical Service System.

    Science.gov (United States)

    Naito, Hiromichi; Guyette, Francis X; Martin-Gill, Christian; Callaway, Clifton W

    2016-01-01

    Video laryngoscopy (VL) is a technical adjunct to facilitate endotracheal intubation (ETI). VL also provides objective data for training and quality improvement, allowing evaluation of the technique and airway conditions during ETI. Previous studies of factors associated with ETI success or failure are limited by insufficient nomenclature, individual recall bias and self-report. We tested whether the covariates in prehospital VL recorded data were associated with ETI success. We also measured association between time and clinical variables. Retrospective review was conducted in a non-physician staffed helicopter emergency medical service system. ETI was typically performed using sedation and neuromuscular-blockade under protocolized orders. We obtained process and outcome variables from digitally recorded VL data. Patient characteristics data were also obtained from the emergency medical service record and linked to the VL recorded data. The primary outcome was to identify VL covariates associated with successful ETI attempts. Among 304 VL recorded ETI attempts in 268 patients, ETI succeeded for 244 attempts and failed for 60 attempts (first-pass success rate, 82% and overall success rate, 94%). Laryngoscope blade tip usually moved from a shallow position in the oropharynx to the vallecula. In the multivariable logistic regression analysis, attempt time (p = 0.02; odds ratio [OR] 0.99), Cormack-Lehane view (p Cormack-Lehane view, and longer ETI attempt time were negatively associated with successful ETI attempts. Initially shallow blade tip position may associate with longer ETI time. VL is useful for measuring and describing multiple factors of ETI and can provide valuable data.

  12. Gestational Diabetes Mellitus and Associated Risk Factors in Patients Attending Diabetic Association Medical College Hospital in Faridpur

    Directory of Open Access Journals (Sweden)

    Poly Begum

    2017-09-01

    Full Text Available Background: The prevalence of gestational diabetes mellitus (GDM is increasing all over the world and varies widely depending on the region of the country, dietary habits and socio-economic status. The prevalence of GDM with its associated risk factors has important health complications for both mother and child. Objectives: The aim of this study was to evaluate the prevalence of GDM and risk factors associated with it in women attending Diabetic Association Medical College Hospital in Faridpur for ante-natal care. Materials and Methods: In this cross-sectional study, screening for GDM was performed in 303 pregnant women. Women who consented to participate underwent a standardized 2-hour 75 gm oral glucose tolerance test (OGTT. A proforma containing general information on demographic characteristics, socio-economic status, education level, parity, family history of diabetes and past history of GDM etc. was filled in. American Diabetes Association (ADA criteria for 75 gm 2-hour OGTT was used for diagnosing GDM. Results: A total of 303 women participated in the study and GDM was diagnosed in 22 (7.3% women. A single abnormal value was observed in additional 33 (10.89% women. On bivariate analysis risk factors found to be significantly associated with GDM were age, household income, parity, educational level, socio-economic status, hypertension, BMI, weight gain, acanthosis nigricans, family history of diabetes and past history of GDM; but on multivariate analysis only upper middle class and presence of acanthosis nigricans were found to be significantly associated with GDM. Conclusion: This study demonstrates a high prevalence of GDM in Bangladesh. These estimates for GDM may help for new suggestions to prevent and manage gestational diabetes.

  13. Mediation effects of medication information processing and adherence on association between health literacy and quality of life.

    Science.gov (United States)

    Song, Sunmi; Lee, Seung-Mi; Jang, Sunmee; Lee, Yoon Jin; Kim, Na-Hyun; Sohn, Hye-Ryoung; Suh, Dong-Churl

    2017-09-16

    To examine whether medication related information processing defined as reading of over-the-counter drug labels, understanding prescription instructions, and information seeking-and medication adherence account for the association between health literacy and quality of life, and whether these associations may be moderated by age and gender. A sample of 305 adults in South Korea was recruited through a proportional quota sampling to take part in a cross-sectional survey on health literacy, medication-related information processing, medication adherence, and quality of life. Descriptive statistics and structural equation modeling (SEM) were performed. Two mediation pathways linking health literacy with quality of life were found. First, health literacy was positively associated with reading drug labels, which was subsequently linked to medication adherence and quality of life. Second, health literacy was positively associated with accurate understanding of prescription instructions, which was associated with quality of life. Age moderation was found, as the mediation by reading drug labels was significant only among young adults whereas the mediation by understanding of medication instruction was only among older adults. Reading drug labels and understanding prescription instructions explained the pathways by which health literacy affects medication adherence and quality of life. The results suggest that training skills for processing medication information can be effective to enhance the health of those with limited health literacy.

  14. Text mining facilitates database curation - extraction of mutation-disease associations from Bio-medical literature.

    Science.gov (United States)

    Ravikumar, Komandur Elayavilli; Wagholikar, Kavishwar B; Li, Dingcheng; Kocher, Jean-Pierre; Liu, Hongfang

    2015-06-06

    Advances in the next generation sequencing technology has accelerated the pace of individualized medicine (IM), which aims to incorporate genetic/genomic information into medicine. One immediate need in interpreting sequencing data is the assembly of information about genetic variants and their corresponding associations with other entities (e.g., diseases or medications). Even with dedicated effort to capture such information in biological databases, much of this information remains 'locked' in the unstructured text of biomedical publications. There is a substantial lag between the publication and the subsequent abstraction of such information into databases. Multiple text mining systems have been developed, but most of them focus on the sentence level association extraction with performance evaluation based on gold standard text annotations specifically prepared for text mining systems. We developed and evaluated a text mining system, MutD, which extracts protein mutation-disease associations from MEDLINE abstracts by incorporating discourse level analysis, using a benchmark data set extracted from curated database records. MutD achieves an F-measure of 64.3% for reconstructing protein mutation disease associations in curated database records. Discourse level analysis component of MutD contributed to a gain of more than 10% in F-measure when compared against the sentence level association extraction. Our error analysis indicates that 23 of the 64 precision errors are true associations that were not captured by database curators and 68 of the 113 recall errors are caused by the absence of associated disease entities in the abstract. After adjusting for the defects in the curated database, the revised F-measure of MutD in association detection reaches 81.5%. Our quantitative analysis reveals that MutD can effectively extract protein mutation disease associations when benchmarking based on curated database records. The analysis also demonstrates that incorporating

  15. Gender Associated with the Intention to Choose a Medical Specialty in Medical Students: A Cross-Sectional Study in 11 Countries in Latin America.

    Directory of Open Access Journals (Sweden)

    Luis Fernando Ng-Sueng

    Full Text Available The selection of a medical specialty has been associated with multiple factors, such as personal preferences, academic exposure, motivational factors and sociodemographic factors, such as gender. The number of women in the medical field has increased in recent years. In Latin America, we have not found any studies that explore this relationship.To determine whether there is an association between gender and the intention to choose a medical specialty in medical students from 11 countries in Latin America.Secondary analysis of the Collaborative Working Group for the Research of Human Resources for Health (Red-LIRHUS data; a multi-country project of students in their first year and fifth year of study, from 63 medical schools in 11 Latin American countries. All students who referred intention to choose a certain medical specialty were considered as participants.Of the 11073 surveyed students, 9235 indicated the name of a specific specialty. The specialties chosen most often in the fifth year were General Surgery (13.0%, Pediatrics (11.0%, Internal Medicine (10.3% and Obstetrics/Gynecology (9.0%. For women, the top choices were Pediatrics (15.8%, Obstetrics/Gynecology (11.0%, Cardiology (8.7%, General Surgery (8.6%, and Oncology (6.4%. In the adjusted analysis, the female gender was associated with the choice of Obstetrics/Gynecology (RP: 2.75; IC95%: 2.24-3.39; Pediatric Surgery (RP: 2.19; IC95%: 1.19-4.00, Dermatology (RP: 1.91; IC95%:1.24-2.93, Pediatrics (RP: 1.83; IC95%: 1.56-2.17, and Oncology (RP: 1.37; IC95%: 1.10-1.71.There is an association between the female gender and the intention to choose Obstetrics/Gynecology, Pediatrics, Pediatric Surgery, Dermatology, and Oncology. We recommend conducting studies that consider other factors that can influence the choice of a medical specialty.

  16. [Which medical errors do general practitioners make? Data from the Expert Arbitration and Advisory Board of the Baden-Württemberg State Medical Association].

    Science.gov (United States)

    Moßhammer, D; Eissler, M

    2014-05-01

    In Germany, medical error reporting systems are well established. They collect information reported principally by physicians. Systematic data collection concerning medical errors is also performed by expert arbitration and advisory boards of the German State Medical Associations. Data base MERS (Medical Error Reporting System); cases from the Expert Arbitration and Advisory Board of the State Baden-Württemberg from the years 2004-2011 (8,042 cases) were evaluated as follows: extraction of the cases from general practitioners (n=307, 4%); categorisation of the type of error and degree of severity; classification according to ICD-10 (International Classification of Diseases); overview of confirmed cases including commentaries of the above board; logistic regression analysis of factors potentially associated with confirmed cases. In 26% (n=80) the board confirmed medical errors. 55% of the errors were assigned to the category "diagnosis" (n=44), 21% to "general therapy" (n=17), 8% to "operative therapy" ("minor surgical operations") (n=6) and 10% to "injections" (n=8). 29% of cases (n=23) were associated with permanent damage or death. The majority of cases could be assigned to ICD-10 categories "I" (cardiovascular system, n=20) and "S-T" or "V-Y" (consequences of external causes or external causes of morbidity and mortality, n=34). No significant associations were found by logistic regression analysis. The rate of confirmed cases corresponds with the rate of all medical disciplines. The presented overview is illustrative and may be of help to avoid errors by using it for continuing medical education. © Georg Thieme Verlag KG Stuttgart · New York.

  17. Medical signs and symptoms associated with disability, pain, and psychosocial adjustment in systemic sclerosis.

    Science.gov (United States)

    Malcarne, Vanessa L; Hansdottir, Ingunn; McKinney, Ann; Upchurch, Renn; Greenbergs, Helen L; Henstorf, Gretchen H; Furst, Daniel E; Clements, Philip J; Weisman, Michael H

    2007-02-01

    To examine physician-assessed medical signs and patient-reported medical symptoms as correlates of 3 quality of life (QOL) outcomes in patients with systemic sclerosis (SSc): disability, pain, and psychosocial adjustment. One hundred fourteen patients with SSc underwent a comprehensive clinical examination including determination of skin thickening [Modified Rodnan Skin Score (MRSS)]. Patients reported current symptoms and completed standardized questionnaires assessing disability and pain (Health Assessment Questionnaire) and psychosocial adjustment (Psychosocial Adjustment to Illness Scale). Regression analysis was used to examine physician-determined and patient-reported correlates of the 3 outcomes. MRSS was a significant correlate of all outcomes, although it explained only a small amount of the variance in psychosocial adjustment. Patient-reported postprandial bloating was the strongest correlate of psychosocial adjustment, explaining more than twice as much variance as MRSS. After accounting for MRSS, patient-reported dependent edema significantly correlated with all outcomes. For disability, significant correlates were physician-determined joint tenderness and number of tender points, and patient-reported joint pain on motion, joint contracture, extremity ulcers other than digital, and dyspnea. Patient-reported joint tenderness was significantly associated with pain. Regression analysis supported a model in which disability and pain mediated the relationship between MRSS and psychosocial adjustment. Skin score is strongly associated with disability and pain, but only weakly associated with psychosocial adjustment. Dependent edema has negative implications across quality-of-life outcomes. Disability and pain mediate the relationship between disease severity and psychosocial adjustment to disease. Assessment (including self-report of patient symptoms) of specific medical signs and symptoms may indicate SSc patients experiencing diminished QOL.

  18. EUROmediCAT signal detection: an evaluation of selected congenital anomaly-medication associations.

    Science.gov (United States)

    Given, Joanne E; Loane, Maria; Luteijn, Johannes M; Morris, Joan K; de Jong van den Berg, Lolkje T W; Garne, Ester; Addor, Marie-Claude; Barisic, Ingeborg; de Walle, Hermien; Gatt, Miriam; Klungsoyr, Kari; Khoshnood, Babak; Latos-Bielenska, Anna; Nelen, Vera; Neville, Amanda J; O'Mahony, Mary; Pierini, Anna; Tucker, David; Wiesel, Awi; Dolk, Helen

    2016-10-01

    To evaluate congenital anomaly (CA)-medication exposure associations produced by the new EUROmediCAT signal detection system and determine which require further investigation. Data from 15 EUROCAT registries (1995-2011) with medication exposures at the chemical substance (5th level of Anatomic Therapeutic Chemical classification) and chemical subgroup (4th level) were analysed using a 50% false detection rate. After excluding antiepileptics, antidiabetics, antiasthmatics and SSRIs/psycholeptics already under investigation, 27 associations were evaluated. If evidence for a signal persisted after data validation, a l