Geography and Racial Health Disparities

An extensive literature has documented racial, ethnic, and socioeconomic disparities in health care and health outcomes. We argue that the influence of geography in medical practice needs to be taken seriously for both the statistical measurement of racial disparities, and in designing reforms to reduce disparities. Past research has called attention to disparities that occur within hospitals or provider groups; for example black patients who are treated differently from whites within a hospital. We focus on a different mechanism for disparities; African-Americans tend to live in areas or seek care in regions where quality levels for all patients, black and white, are lower. Thus ensuring equal access to health care at the local or hospital level may not by itself erase overall health care disparities. However, reducing geographic disparities in both the quality of care, and the quality of health care decisions by patients, could have a first-order impact on improving racial disparities in health care and health outcomes.

Bowel Perforation Secondary to Illegally Induced Abortion: a Tertiary Hospital Experience in Tanzania.

Bowel perforation though rarely reported is a serious complication of induced abortion, which is often performed illegally by persons without any medical training in developing countries. A sudden increase in the number of patients in our centre in recent years prompted the authors to analyze this problem. The study was conducted to describe our own experiences in the surgical management of these patients. This was a retrospective study involving patients who were jointly managed by the surgical and gynecological teams at Bugando Medical Centre (BMC) for bowel perforation secondary to illegally induced abortion from January 2002 to December 2011. The statistical analysis was performed using SPSS version 17.0. A total of 68 patients (representing 4.2% of cases) were enrolled in the study. Their ages ranged from 14 to 45 years with a median age of 21 years. Majority of patients were, secondary school students/leavers (70.6%), unmarried (88.2%), nulliparous (80.9%), unemployed (82.4%) and most of them were dependent member of the family. Previous history of contraceptive use was reported in only 14.7% of cases. The majority of patients (79.4%) had procured the abortion in the 2nd trimester. Dilatation and curettage (82.4%) was the most common reported method used in procuring abortion. The interval from termination of pregnancy to presentation in hospital ranged from 1 to 14 days (median 6 days ). The ileum (51.5%) and sigmoid colon (22.1%) was the most common portions of the bowel affected. Resection and anastomosis with uterine repair was the most common (86.8%) surgical procedure performed. Complication and mortality rates were 47.1% and 10.3% respectively. According to multivariate logistic regression analysis, gestational age at termination of pregnancy, delayed presentation, delayed surgical treatment and presence of complications were significantly associated with mortality (P<0.001). The overall median length of hospital stay (LOS) was 18 days (1day to 128 days ). Patients who developed complications stayed longer in the hospital, and this was statistically significant (P=0.012). Bowel perforation following illegally induced abortion is still rampant in our environment and constitutes significantly to high maternal morbidity and mortality. Early recognition of the diagnosis, aggressive resuscitation and early institution of surgical management is of paramount importance if morbidity and mortality associated with bowel perforation are to be avoided

Perceptions of the Desired Attributes of Practicing Physicians as Determined by Rural and Urban Physicians

Submitted to the Department of Administration, Foundations and Higher Education and the Faculty of the Graduate School of the University of Kansas in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosoph

The Rise of Emergency Medicine in the Sixties: Paving a New Entrance to the House of Medicine

THE RISE OF EMERGENCY MEDICINE IN THE SIXTIES: PAVING A NEW ENTRANCE TO THE HOUSE OF MEDICINE. Anne K. Merritt (Sponsored by John H. Warner). Section of the History of Medicine, Yale University, School of Medicine, New Haven, CT. This thesis investigates how emergency medicine evolved in the United States in the 1960s. Three case studies, Alexandria Hospital, Hartford Hospital, and Yale-New Haven Hospital, demonstrate the changes in emergency medicine at a small community hospital, a mid-sized teaching hospital, and an urban academic institution, respectively. The government, the media, the American public, and the medical community brought emergency medical care to the forefront of national attention in the sixties. In an era of population migration to suburbs, the rise of group practices, and medical specialization, patients relationships with their general practitioners dissolved. Emergency visits increased astronomically because patients started to use the emergency room for non-urgent health problems. Simultaneously, physicians and house staff resisted working in the emergency room. In response to rising patient loads, mounting criticism of emergency services, and staffing problems, hospital administrators devised strategies to improve the quality and efficiency of emergency care. The rise of emergency medicine in the sixties was a result of (1) advances in pre-hospital, trauma, and coronary care which distinguished a new clinical field and (2) the emergence of full-time emergency physicians at community hospitals. Urban teaching hospitals, which established triage systems and ambulatory care facilities in order to improve emergency services, resisted the idea of emergency medicine and ultimately delayed its development as a specialty

Higher Education, the Health Care Industry, and Metropolitan Regional Economic Development: What Can “Eds & Meds” Do for the Economic Fortunes of a Metro Area’s Residents?

This paper examines the effects of expansions in higher educational institutions and the medical service industry on the economic development of a metropolitan area. This examination pulls together previous research and provides some new empirical evidence. We provide quantitative evidence of the magnitude of economic effects of higher education and medical service industries that occur through the mechanism of providing some export-base demand stimulus to a metropolitan economy. We also provide quantitative evidence on how much higher education institutions can boost a metropolitan economy through increasing the educational attainment of local residence. We estimate that medical service industries pay above average wages, holding worker characteristics constant, whereas the higher education industry pays below average wages; the wage standards of these industries may affect overall metropolitan wages. We also discuss other mechanisms by which these two industries may boost a metropolitan economy, including: increasing local amenities, generating R&D spillovers, increasing the rate of entrepreneurship in local businesses, and helping provide local leadership on development and growth issues. Finally, the paper discusses possible effects of these two industries on disparities between the central city and suburbs in a metropolitan area.higher, education, medical, service, industry, regional, economic, development

Public Health Promotion: Autonomy of the Emergency Nurse Practitioner

The purpose of this paper is to examine several key issues in health care reform. From the Patient Protection and Affordable Care Act of 2010 to the cholera epidemic in Haiti, global health care reform is necessary to promote health and wellness among all nations. There is an International shortage of nurses and nursing faculty. Among the providers, it is also necessary to examine autonomy of the most up and coming nurse provider: the emergency nurse practitioner

The Common-Health and Beyond: New Zealand Trainee Specialists in International Medical Networks, 1945-1975

In the two to three decades that followed World War Two, approximately three-quarters of all New Zealand doctors, and up to ninety per cent of New Zealand medical specialists, travelled overseas for the purposes of obtaining post-graduate experience and qualifications. This thesis uses oral interviews, quantification techniques, and a range of textual analyses to explore the form and function of this large-scale professional migration, and to capture the experiences of those doctors who participated in it. The central argument of this thesis is that the careers of New Zealand specialists during this period cannot be understood without making reference to a complex and mutually influential international system of cultural and professional conventions, institutional rules, interpersonal networks, health related policies, and discursive formations. While powerfully centred on British medical norms and structures, this ‘Common-health’ system facilitated the transmission of people, ideas, technologies, and policies both within and between the nations of the British Commonwealth, in multiple directions by multiple means, and in doing so, was critical to the development of medical specialisation in the twentieth century. For New Zealand’s prospective specialists, the primary motivating force behind these migrations was the need to access populations that were large enough to facilitate specialist training. Britain’s much larger population and the existence of a range of cultural and institutional commonalities, derived from nineteenth-century colonisation, made Britain the default destination for thousands of New Zealand trainee specialists during the second half of the twentieth century. However, while the Common-health system was a powerful facilitator of medical interaction and migration, it also functioned as a mechanism of exclusion that severely curtailed the ability of women doctors and those of non-European heritage to participate in professional medicine on their own terms. This thesis examines this restrictive aspect of post-World War Two medical networks with relation to women by suggesting that traditional beliefs about the role of women in medicine, together with the strongly informal nature of many professional interactions, not only limited the overall participation of women doctors, but also conditioned their ability to access particular specialty fields. The thesis also examines the reconfiguration of these patterns of connection during the late 1960s and early 1970s, and in particular, the emergence of the United States and Australia as important venues for post-graduate training for New Zealand’s prospective specialists

Chinese Medicine Student Clubs in Taipei, Taiwan

This thesis focuses on a communal form of transmission of Chinese medicine in contemporary Taiwan: Chinese medicine university student clubs. Offering fundamental Chinese medicine curricula to students and the interested public, the student clubs used to serve as a direct educational steppingstone towards licensed practice. Recent changes in medical education policy, however, made a university degree in Chinese medicine a requirement, thereby pushing informal ways of knowledge transmission into the realm of lay activity. Nevertheless, the clubs remain active and still serve as a community for people interested in Chinese medicine, including those wanting to pursue it professionally. Based on field research conducted in two such university clubs in Taipei in early 2018, this thesis first outlines the challenges and tensions faced and negotiated by those club members with professional ambitions. Not (yet) enrolled in “official” Chinese medicine programs at university but already deeply engaged in learning, they constitute a group of people rarely represented in academic literature, namely those just orienting themselves towards becoming Chinese medicine physicians. These processes of orientation and becoming are shaped by organizational, economic, and epistemological pressures and embedded in transnational movements, imaginaries, and regulatory regimes. Secondly, the thesis examines the function and position of the clubs in the changing landscape of Chinese medical education in Taiwan, as well as in the wider field of transmission of Chinese medicine. I argue that they foster continued interest in Chinese medicine in an environment that has favored biomedicine since the Japanese colonial era and that they, although through paths more winded than before, still contribute to the reproduction of professional Chinese medical expertise. In addition, they provide space for communal forms of healthcare. Lastly, they contribute to the maintenance of everyday healthcare competence in the wider public, or what Arthur Kleinman (1980) has called the “popular sector of healthcare.

Illinois Nonprofit Economy Report

Donors Forum's Illinois Nonprofit Economy Report includes valuable information on the growing role that nonprofits play throughout Illinois. According to the report, last year Illinois nonprofits employed more then 427,000 workers -- providing almost as many jobs as the state's three largest Fortune 500 companies (Boeing, Walgreens, and State Farm) do together, worldwide