Sociodemographic and geographic characteristics associated with patient visits to osteopathic physicians for primary care

<p>Abstract</p> <p>Background</p> <p>Health care reform promises to dramatically increase the number of Americans covered by health insurance. Osteopathic physicians (DOs) are recognized for primary care, including a "hands-on" style with an emphasis on patient-centered care. Thus, DOs may be well positioned to deliver primary care in this emerging health care environment.</p> <p>Methods</p> <p>We used data from the National Ambulatory Medical Care Survey (2002-2006) to study sociodemographic and geographic characteristics associated with patient visits to DOs for primary care. Descriptive analyses were initially performed to derive national population estimates (NPEs) for overall patient visits, primary care patient visits, and patient visits according to specialty status. Osteopathic and allopathic physician (MD) patient visits were compared using cross-tabulations and multiple logistic regression to compute odds ratios (ORs) and 95% confidence intervals (CIs) for DO patient visits. The latter analyses were also conducted separately for each geographic characteristic to assess the potential for effect modification based on these factors.</p> <p>Results</p> <p>Overall, 134,369 ambulatory medical care visits were surveyed, representing 4.6 billion (NPE) ± 220 million (SE) patient visits when patient visit weights were applied. Osteopathic physicians provided 336 million ± 30 million (7%) of these patient visits. Osteopathic physicians provided 217 million ± 21 million (10%) patient visits for primary care services; including 180 million ± 17 million (12%) primary care visits for adults (21 years of age or older) and 37 million ± 5 million (5%) primary care visits for minors. Osteopathic physicians were more likely than MDs to provide primary care visits in family and general medicine (OR, 6.03; 95% CI, 4.67-7.78), but were less likely to provide visits in internal medicine (OR, 0.37; 95% CI, 0.24-0.58) or pediatrics (OR, 0.21; 95% CI, 0.11-0.40). Overall, patients in the pediatric and geriatric ages, Blacks, Hispanics, and persons in the South and West were less likely to utilize DOs, although there was some evidence of effect modification according to United States Census region.</p> <p>Conclusions</p> <p>Health care reform provides unprecedented opportunities for DOs to reach historically underserved populations and to overcome the "pediatric primary-care paradox."</p

Specialization training in Malawi: A qualitative study on the perspectives of medical students graduating from the University of Malawi College of Medicine

Background: There is a critical shortage of healthcare workers in sub-Saharan Africa, and Malawi has one of the lowest physician densities in the region. One of the reasons for this shortage is inadequate retention of medical school graduates, partly due to the desire for specialization training. The University of Malawi College of Medicine has developed specialty training programs, but medical school graduates continue to report a desire to leave the country for specialization training. To understand this desire, we studied medical students' perspectives on specialization training in Malawi. Methods. We conducted semi-structured interviews of medical students in the final year of their degree program. We developed an interview guide through an iterative process, and recorded and transcribed all interviews for analysis. Two independent coders coded the manuscripts and assessed inter-coder reliability, and the authors used an "editing approach" to qualitative analysis to identify and categorize themes relating to the research aim. The University of Pittsburgh Institutional Review Board and the University of Malawi College of Medicine Research and Ethics Committee approved this study and authors obtained written informed consent from all participants. Results: We interviewed 21 medical students. All students reported a desire for specialization training, with 12 (57%) students interested in specialties not currently offered in Malawi. Students discussed reasons for pursuing specialization training, impressions of specialization training in Malawi, reasons for staying or leaving Malawi to pursue specialization training and recommendations to improve training. Conclusions: Graduating medical students in Malawi have mixed views of specialization training in their own country and still desire to leave Malawi to pursue further training. Training institutions in sub-Saharan Africa need to understand the needs of the country's healthcare workforce and the needs of their graduating medical students to be able to match opportunities and retain graduating students. © 2014 Sawatsky et al.; licensee BioMed Central Ltd

Breaking bad habits by improving executive function in individuals with obesity

Background: Two primary factors that contribute to obesity are unhealthy eating and sedentary behavior. These behaviors are particularly difficult to change in the long-term because they are often enacted habitually. Cognitive Remediation Therapy has been modified and applied to the treatment of obesity (CRT-O) with preliminary results of a randomized controlled trial demonstrating significant weight loss and improvements in executive function. The objective of this study was to conduct a secondary data analysis of the CRT-O trial to evaluate whether CRT-O reduces unhealthy habits that contribute to obesity via improvements in executive function. Method: Eighty participants with obesity were randomized to CRT-O or control. Measures of executive function (Wisconsin Card Sort Task and Trail Making Task) and unhealthy eating and sedentary behavior habits were administered at baseline, post-intervention and at 3 month follow-up. Results: Participants receiving CRT-O demonstrated improvements in both measures of executive function and reductions in both unhealthy habit outcomes compared to control. Mediation analyses revealed that change in one element of executive function performance (Wisconsin Card Sort Task perseverance errors) mediated the effect of CRT-O on changes in both habit outcomes. Conclusion: These results suggest that the effectiveness of CRT-O may result from the disruption of unhealthy habits made possible by improvements in executive function. In particular, it appears that cognitive flexibil ity, as measured by the Wisconsin Card Sort task, is a key mechanism in this process. Improving cognitive flexibility may enable individuals to capitalise on interruptions in unhealthy habits by adjusting their behavior in line with their weight loss goals rather than persisting with an unhealthy choice. Trial registration: The RCT was registered with the Australian New Zealand Registry of Clinical Trials (trial id: ACTRN12613000537752)

P-cadherin expression in breast cancer: a review

P-cadherin is frequently over-expressed in high-grade invasive breast carcinomas and has been reported to be an enhancer of migration and invasion of breast cancer cells, being correlated with tumour aggressiveness. In addition, expression of P-cadherin is well established as an indicator of poor prognosis in human breast cancer, which has stimulated our interest in studying its role in this setting. This review describes the most important findings on P-cadherin expression and function in normal mammary tissue and breast cancer cells, emphasizing that further research is required to elucidate the role played by this protein in human mammary tumours

Transancestral GWAS of alcohol dependence reveals common genetic underpinnings with psychiatric disorders

Liability to alcohol dependence (AD) is heritable, but little is known about its complex polygenic architecture or its genetic relationship with other disorders. To discover loci associated with AD and characterize the relationship between AD and other psychiatric and behavioral outcomes, we carried out the largest genome-wide association study to date of DSM-IV-diagnosed AD. Genome-wide data on 14,904 individuals with AD and 37,944 controls from 28 case-control and family-based studies were meta-analyzed, stratified by genetic ancestry (European, n = 46,568; African, n = 6,280). Independent, genome-wide significant effects of different ADH1B variants were identified in European (rs1229984; P = 9.8 x 10(-13)) and African ancestries (rs2066702; P = 2.2 x 10(-9)). Significant genetic correlations were observed with 17 phenotypes, including schizophrenia, attention deficit-hyperactivity disorder, depression, and use of cigarettes and cannabis. The genetic underpinnings of AD only partially overlap with those for alcohol consumption, underscoring the genetic distinction between pathological and nonpathological drinking behaviors.Peer reviewe

Extratropical circulation indices in the Southern Hemisphere based on station data

Zonal and meridional pressure gradient indices of the Southern Hemisphere (SH) circulation are analysed in the mid-to-high (35-65°S) latitude zone. The dearth of land regions, and hence long pressure records, means that these are restricted to the southern South American and New Zealand sectors. The Trans Polar Index (TPI) is the only large-scale station pressure based extratropical SH index that has been proposed, and is based on the normalised pressure difference between Hobart, Tasmania and Stanley, Falklands. This index is compared with variants which involve stations in the vicinity of New Zealand and southern South America. The index shows considerable year-to-year and some decadal-scale variability and is a measure of wavenumber 1 of the SH pressure field. Significant correlations (r ~ -0.3 to -0.5) occur between the TPI and southern South American temperatures in the austral summer and autumn seasons. Similar size correlations of the opposite sign occur in New Zealand but only in the austral summer season. In New Zealand and southern South America, temperature series are strongly affected by the strength of the local meridional circulation (r values ~ -0.4 to -0.7 over New Zealand depending on season and period and values of ~ -0.2 to -0.4 for southern South America). In both regions there is no concomitant increase in northerly flow or decrease in southerly flow to explain the long-term increase in temperatures. The relationships are mostly at the interannual rather than the decadal and longer timescales. The decadal temperature rise, therefore, reflects a general warming of the Southern Ocean, rather than decadal-scale variations in the circulation

Nonstationary Australasian Teleconnections and Implications for Paleoclimate Reconstructions

The stationarity of relationships between local and remote climates is a necessary, yet implicit, assumption underlying many paleoclimate reconstructions. However, the assumption is tenuous for many seasonal relationships between interannual variations in the El Niño–Southern Oscillation (ENSO) and the southern annular mode (SAM) and Australasian precipitation and mean temperatures. Nonstationary statistical relationships between local and remote climates on the 31–71-yr time scale, defined as a change in their strength and/or phase outside that expected from local climate noise, are detected on near-centennial time scales from instrumental data, climate model simulations, and paleoclimate proxies.The relationships between ENSO and SAM and Australasian precipitation were nonstationary at 21%–37% of Australasian stations from 1900 to 2009 and strongly covaried, suggesting common modulation. Control simulations from three coupled climate models produce ENSO-like and SAM-like patterns of variability, but differ in detail to the observed patterns in Australasia. However, the model teleconnections also display nonstationarity, in some cases for over 50% of the domain. Therefore, nonstationary local–remote climatic relationships are inherent in environments regulated by internal variability. The assessments using paleoclimate reconstructions are not robust because of extraneous noise associated with the paleoclimate proxies.Instrumental records provide the only means of calibrating and evaluating regional paleoclimate reconstructions. However, the length of Australasian instrumental observations may be too short to capture the near-centennial-scale variations in local–remote climatic relationships, potentially compromising these reconstructions. The uncertainty surrounding nonstationary teleconnections must be acknowledged and quantified. This should include interpreting nonstationarities in paleoclimate reconstructions using physically based frameworks