90 research outputs found
Race/ethnicity and gender differences in drug use and abuse among college students
This study examines race/ethnicity and gender differences in drug use and abuse for substances other than alcohol among undergraduate college students. A probability-based sample of 4,580 undergraduate students at a Midwestern research university completed a cross-sectional Web-based questionnaire that included demographic information and several substance use measures. Male students were generally more likely to report drug use and abuse than female students. Hispanic and White students were more likely to report drug use and abuse than Asian and African American students prior to coming to college and during college. The findings of the present study reveal several important racial/ethnic differences in drug use and abuse that need to be considered when developing collegiate drug prevention and intervention efforts.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2377408/https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2377408/Accepted manuscrip
Twoâstage model for timeâvarying effects of discrete longitudinal covariates with applications in analysis of daily process data
Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/110542/1/sim6368.pd
Program Director Opinion on the Ideal Length of Residency Training in Emergency Medicine
ObjectiveThis study sought to define expert opinion on the ideal length of training (LoT) for Accreditation Council of Graduate Medical Education (ACGME)âaccredited emergency medicine (EM) residency programs.MethodsA crossâsectional Webâbased survey was sent to program directors (PDs) at all ACGMEâaccredited EM residency programs during a study period of August to October 2014. The primary outcome of ideal LoT was determined in two ways: 1) subjects provided the ideal total LoT in months and 2) then separately selected the type and number of rotations for an ideal EM residency curriculum by month, the sum of which provided an alternative measurement of their ideal LoT. We did not include vacation time. Descriptive statistics and an analysis of variance are reported.ResultsResponse rate was 68.0% (108/159) with 72% of respondents (78/108) directing programs in the PGY 1â3 (36âmonth) format and 28% directing PGY 1â4 (48âmonth) programs. More than half of subjects (51.9%) have direct personal experience with both formats. When asked about ideal total LoT, PDs averaged 41.5 months (n = 107; SD = 5.5 months, range = 36â60 months). When asked to provide durations of individual clinical experiences for their ideal EM program, the sum total (n = 104) averaged 45.0 months. Results from a factorial analysis of variance revealed statistically significant effects of PDsâ past training experiences: participants who trained in a 36âmonth program had statistically significantly lower LoT (mean = 39.2 months) than participants who trained in a 48âmonth program (mean = 44.5 months). There was also a statistically significant effect of current program format on ideal LoT: participants who directed a 36âmonth program had statistically significantly lower LoT (mean = 39.8 months) than participants who directed a 48âmonth program (mean = 45.8 months).ConclusionsPD opinion on ideal LoT averages between 36 and 48 months, but is longer when the sum of desired clinical rotations is considered. While half of the respondents reported direct experience with both PGY 1â3 and PGY 1â4 training programs, opinions on ideal LoT through both methods corresponded strongly with the length of the program the PDs trained in and the format of the program they currently direct. PD opinions may be too biased by their own experiences to provide objective input on the ideal LoT for EM residency programs.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/133574/1/acem12968-sup-0001-DataSupplementS1.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/133574/2/acem12968.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/133574/3/acem12968_am.pd
A timeâvarying effect model for examining group differences in trajectories of zeroâinflated count outcomes with applications in substance abuse research
Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/136025/1/sim7177_am.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/136025/2/sim7177.pd
Illicit Use of Specific Prescription Stimulants Among College Students: Prevalence, Motives, and Routes of Administration
Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/90069/1/phco.26.10.1501.pd
Comparison of the Standardized Video Interview and Interview Assessments of Professionalism and Interpersonal Communication Skills in Emergency Medicine
ObjectivesThe Association of American Medical Colleges Standardized Video Interview (SVI) was recently added as a component of emergency medicine (EM) residency applications to provide additional information about interpersonal communication skills (ICS) and knowledge of professionalism (PROF) behaviors. Our objective was to ascertain the correlation between the SVI and residency interviewer assessments of PROF and ICS. Secondary objectives included examination of 1) interâ and intrainstitutional assessments of ICS and PROF, 2) correlation of SVI scores with rank order list (ROL) positions, and 3) the potential influence of gender on interview day assessments.MethodsWe conducted an observational study using prospectively collected data from seven EM residency programs during 2017 and 2018 using a standardized instrument. Correlations between interview day PROF/ICS scores and the SVI were tested. A oneâway analysis of variance was used to analyze the association of SVI and ROL position. Gender differences were assessed with independentâgroups tâtests.ResultsA total of 1,264 interviewâday encounters from 773 unique applicants resulted in 4,854 interviews conducted by 151 interviewers. Both PROF and ICS demonstrated a small positive correlation with the SVI score (r = 0.16 and r = 0.17, respectively). ROL position was associated with SVI score (p < 0.001), with mean SVI scores for topâ, middleâ, and bottomâthird applicants being 20.9, 20.5, and 19.8, respectively. No group differences with gender were identified on assessments of PROF or ICS.ConclusionsInterview assessments of PROF and ICS have a small, positive correlation with SVI scores. These residency selection tools may be measuring related, but not redundant, applicant characteristics. We did not identify gender differences in interview assessments.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/150548/1/aet210346_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/150548/2/aet210346.pd
Prevalence of Illicit Use and Abuse of Prescription Stimulants, Alcohol, and Other Drugs Among College Students: Relationship with Age at Initiation of Prescription Stimulants
Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/90112/1/phco.27.5.666.pd
Cardiopulmonary ultrasound for critically ill adults improves diagnostic accuracy in a resourceĂą limited setting: the AFRICA trial
ObjectiveTo assess the effects of a cardiopulmonary ultrasound (CPUS) examination on diagnostic accuracy for critically ill patients in a resourceĂą limited setting.MethodsApproximately half of the emergency medicine resident physicians at the Komfo Anokye Teaching Hospital (KATH) in Kumasi, Ghana, were trained in a CPUS protocol. Adult patients triaged to the resuscitation area of the emergency department (ED) were enrolled if they exhibited signs or symptoms of shock or respiratory distress. Patients were assigned to the intervention group if their treating physician had completed the CPUS training. The physicianâs initial diagnostic impression was recorded immediately after the history and physical examination in the control group, and after an added CPUS examination in the intervention group. This was compared to a standardised final diagnosis derived from post hoc chart review of the patientâs care at 24 h by two blinded, independent reviewers using a clearly defined and systematic process. Secondary outcomes were 24Ăą h mortality and use of IV fluids, diuretics, vasopressors and bronchodilators.ResultsOf 890 patients presenting during the study period, 502 were assessed for eligibility, and 180 patients were enrolled. Diagnostic accuracy was higher for patients who received the CPUS examination (71.9% vs. 57.1%, Ă 14.8% [CI 0.5%, 28.4%]). This effect was particularly pronounced for patients with a Ăą cardiacĂą diagnosis, such as cardiogenic shock, congestive heart failure or acute valvular disease (94.7% vs. 40.0%, Ă 54.7% [CI 8.9%, 86.4%]). Secondary outcomes were not different between groups.ConclusionsIn an urban ED in Ghana, a CPUS examination improved the accuracy of the treating physicianâs initial diagnostic impression. There were no differences in 24Ăą h mortality and a number of patient care interventions.ObjectifEvaluer les effets de lâexamen Ă©chographique cardioĂą pulmonaire (CPUS) sur la prĂ©cision du diagnostic chez les patients gravement malades dans un cadre Ă ressource limitĂ©e.MĂ©thodesEnviron la moitiĂ© des mĂ©decins rĂ©sidents en mĂ©decine dâurgence Ă la Komfo Anokye Teaching HĂÂŽpital (KATH) Ă Kumasi, au Ghana ont Ă©tĂ© formĂ©s pour un protocole de CPUS. Les patients adultes triĂ©s dans lâunitĂ© de ressuscitation des soins intensifs ont Ă©tĂ© inscrits sâils prĂ©sentaient des signes ou des symptĂÂŽmes de choc ou dâune dĂ©tresse respiratoire. Les patients ont Ă©tĂ© assignĂ©s au groupe dâintervention si leur mĂ©decin traitant avait suivi la formation CPUS. Le diagnostic initial du mĂ©decin a Ă©tĂ© enregistrĂ© immĂ©diatement aprĂšs lâanamnĂšse et lâexamen physique dans le groupe tĂ©moin, et aprĂšs un examen CPUS ultĂ©rieur dans le groupe dâintervention. Cela a Ă©tĂ© comparĂ© Ă un diagnostic final standard dĂ©rivĂ© de lâanalyse postĂą hoc en aveugle des dossiers de soins du patient Ă 24 heures par deux examinateurs indĂ©pendants, au moyen dâun processus clairement dĂ©fini et systĂ©matique. Les rĂ©sultats secondaires Ă©taient la mortalitĂ© de 24 heures et lâutilisation de fluides en IV, de diurĂ©tiques, de vasopresseurs et de bronchodilatateurs.RĂ©sultatsSur 890 patients prĂ©sentĂ©s au cours de la pĂ©riode dĂą Ă©tude, 502 ont Ă©tĂ© Ă©valuĂ©s pour lĂą Ă©ligibilitĂ© et 180 patients ont Ă©tĂ© inscrits. La prĂ©cision du diagnostic Ă©tait plus Ă©levĂ©e chez les patients ayant reçu lâexamen CPUS (71,9% contre 57,1%, Ă 14,8% [IC: 0,5% Ă 28.4%]). Cet effet Ă©tait particuliĂšrement marquĂ©e pour les patients avec un diagnostic Ă«cardiaqueĂ», tel que le choc cardiogĂ©nique, lâinsuffisance cardiaque congestive ou une maladie aiguĂ« valvulaire (94,7% contre 40,0%, Ă 54,7% [IC: 8,9% Ă 86,4%]). Les rĂ©sultats secondaires nĂą Ă©taient pas diffĂ©rents entre les groupes.ConclusionsDans un service de soins intensifs urbain au Ghana, un examen CPUS amĂ©liorait la prĂ©cision du diagnostic initial du mĂ©decin traitant. Il nây avait aucune diffĂ©rence dans la mortalitĂ© de 24 heures et dans le nombre des interventions de soins.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/141626/1/tmi12992.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/141626/2/tmi12992_am.pd
Determination of freedom-from-rabies for small Indian mongoose populations in the United States Virgin Islands, 2019â2020
Mongooses, a nonnative species, are a known reservoir of rabies virus in the Caribbean region. A cross-sectional study of mongooses at 41 field sites on the US Virgin Islands of St. Croix, St. John, and St. Thomas captured 312 mongooses (32% capture rate). We determined the absence of rabies virus by antigen testing and rabies virus exposure by antibody testing in mongoose populations on all three islands. USVI is the first Caribbean state to determine freedom-from-rabies for its mongoose populations with a scientifically-led robust cross-sectional study. Ongoing surveillance activities will determine if other domestic and wildlife populations in USVI are rabies-free
New Approaches to Enforcement and Compliance with Labour Regulatory Standards: The Case of Ontario, Canada
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