What Is the Current Status of Global Health Activities and Opportunities in US Orthopaedic Residency Programs?

BACKGROUND: Interest in developing national health care has been increasing in many fields of medicine, including orthopaedics. One manifestation of this interest has been the development of global health opportunities during residency training. QUESTIONS/PURPOSES: We assessed global health activities and opportunities in orthopaedic residency in terms of resident involvement, program characteristics, sources of funding and support, partner site relationships and geography, and program director opinions on global health participation and the associated barriers. METHODS: An anonymous 24-question survey was circulated to all US orthopaedic surgery residency program directors (n = 153) by email. Five reminder emails were distributed over the next 7 weeks. A total of 59% (n = 90) program directors responded. RESULTS: Sixty-one percent of responding orthopaedic residencies facilitated clinical experiences in developing countries. Program characteristics varied, but most used clinical rotation or elective time for travel (76%), which most frequently occurred during Postgraduate Year 4 (57%) and was used to provide pediatric (66%) or trauma (60%) care. The majority of programs (59%) provided at least some funding to traveling residents and sent accompanying attendings on all ventures (56%). Travel was most commonly within North America (85%), and 51% of participating programs have established international partner sites although only 11% have hosted surgeons from those partnerships. Sixty-nine percent of residency directors believed global health experiences during residency shape future volunteer efforts, 39% believed such opportunities help attract residents to a training program, and the major perceived challenges were funding (73%), faculty time (53%), and logistical planning (43%). CONCLUSIONS: Global health interest and activity are common among orthopaedic residency programs. There is diversity in the characteristics and geographical locations of such activity, although some consensus does exist among program directors around funding and faculty time as the largest challenges

Use of Social Media Across US Hospitals: Descriptive Analysis of Adoption and Utilization

Background: Use of social media has become widespread across the United States. Although businesses have invested in social media to engage consumers and promote products, less is known about the extent to which hospitals are using social media to interact with patients and promote health. Objective: The aim was to investigate the relationship between hospital social media extent of adoption and utilization relative to hospital characteristics. Methods: We conducted a cross-sectional review of hospital-related activity on 4 social media platforms: Facebook, Twitter, Yelp, and Foursquare. All US hospitals were included that reported complete data for the Centers for Medicare and Medicaid Services Hospital Consumer Assessment of Healthcare Providers and Systems survey and the American Hospital Association Annual Survey. We reviewed hospital social media webpages to determine the extent of adoption relative to hospital characteristics, including geographic region, urban designation, bed size, ownership type, and teaching status. Social media utilization was estimated from user activity specific to each social media platform, including number of Facebook likes, Twitter followers, Foursquare check-ins, and Yelp reviews. Results: Adoption of social media varied across hospitals with 94.41% (3351/3371) having a Facebook page and 50.82% (1713/3371) having a Twitter account. A majority of hospitals had a Yelp page (99.14%, 3342/3371) and almost all hospitals had check-ins on Foursquare (99.41%, 3351/3371). Large, urban, private nonprofit, and teaching hospitals were more likely to have higher utilization of these accounts. Conclusions: Although most hospitals adopted at least one social media platform, utilization of social media varied according to several hospital characteristics. This preliminary investigation of social media adoption and utilization among US hospitals provides the framework for future studies investigating the effect of social media on patient outcomes, including links between social media use and the quality of hospital care and services

Associations between stillbirths and maternal socioeconomic status, 1 July 2003 to 30 September 2008.

<p>Analyses conducted on mothers and infants with no missing data (n = 76 129).</p><p>Model 1 adjusted for clustering by woman.</p><p>Model 2 adjusted for health service utilisation (number of episodes of pregnancy care) and clustering by woman.</p><p>Model 3 adjusted for health service utilisation (number of episodes of pregnancy care), maternal age, ethnic group, gravidity, previous stillbirth, number of infants delivered, sex of the infant, and clustering by woman.</p

Associations between stillbirths, maternal sociodemographic characteristics and obstetric history, 1 July 2003 to 30 September 2008.

<p>Analyses conducted on mothers and infants with no missing data (n = 76 129).</p>*<p>Multivariable analyses adjusted for wealth quintile, health service utilisation (number of visits for pregnancy care), maternal age, ethnic group, gravidity, previous stillbirth, number of infants delivered, sex of the infant, clustering by woman.</p

Health service utilisation and quality by maternal socioeconomic status, 1 July 2003 to 30 September 2008.

<p>Quality of pregnancy care analyses conducted for births in which there had been at least one episode of pregnancy care and no missing data (n = 29 687).</p><p>Pregnancy care analyses conducted for births with no missing data (n = 76 129).</p><p>Site of delivery analyses conducted for births with no missing data (n = 76 073).</p>*<p>Odds ratio calculated for the binary outcome comparing those with adequate care (≥2 doses tetanus toxoid) to those with inadequate care (<2 doses tetanus toxoid) by wealth quintile, and adjusting for maternal age, ethnic group, gravidity, previous stillbirth, number of infants delivered, sex of the infant and for clustering by woman.</p>**<p>Odds ratio calculated for the binary outcome comparing those with any pregnancy care to those with no pregnancy care by wealth quintile, and adjusting for maternal age, ethnic group, gravidity, previous stillbirth, number of infants delivered, sex of the infant and for clustering by woman.</p>***<p>Odds ratio calculated for the binary outcome comparing those who delivered at a heath facility to those who delivered at home by wealth quintile, and adjusting for maternal age, ethnic group, gravidity, previous stillbirth, number of infants delivered, sex of the infant and for clustering by woman.</p

Maternal characteristics and antepartum and intrapartum stillbirths, 1 July 2003 to 30 September 2008.

<p>Stillbirths for which timing of death was unknown are not included.</p

Effect of socioeconomic deprivation and health service utilisation on antepartum and intrapartum stillbirth: population cohort study from rural Ghana.

BACKGROUND: No studies have examined the effect of socioeconomic deprivation on antepartum and intrapartum stillbirths in the poorest women in low income countries. METHODOLOGY/ PRINCIPAL FINDINGS: This study used data from a prospective population based surveillance system involving all women of childbearing age and their babies in rural Ghana. The primary objective was to evaluate associations between household wealth and risk of antepartum and intrapartum stillbirth. The secondary objective was to assess whether any differences in risk were mediated by utilisation of health services during pregnancy. Data were analysed using multivariable logistic regression. Random effect models adjusted for clustering of women who delivered more than one infant. There were 80267 babies delivered from 1 July 2003 to 30 September 2008: 77666 live births and 2601 stillbirths. Of the stillbirths 1367 (52.6%) were antepartum, 989 (38.0%) were intrapartum and 245 (9.4%) had no data on the timing of death. 94.8% of the babies born in the study (76129/80267) had complete data on all covariates and outcomes. 36 878 (48.4%) of babies were born to women in the two poorest quintiles and 3697 (4.9%) had no pregnancy care. There was no association between wealth and antepartum stillbirths. There was a marked 'dose response' of increasing risk of intrapartum stillbirth with increasing levels of socioeconomic deprivation (adjOR 1.09 [1.03-1.16] p value 0.002). Women in the poorest two quintiles had greater risk of intrapartum stillbirth (adjOR 1.19 [1.02-1.38] p value 0.023) compared to the richest women. Adjusting for heath service utilisation and other variables did not alter results. CONCLUSIONS/ SIGNIFICANCE: Poor women had a high risk of intrapartum stillbirth and this risk was not influenced by health service utilisation. Health system strengthening is required to meet the needs of poor women in our study population