Self-reported influence of monetary grants in the choice of a medical residency in remote or under-served areas

Abstract Objectives To evaluate the effect of monetary grants on young physicians’ choice of remote or rural hospital-based practice. Background In late 2011, The Israeli Ministry of Health attempted to address a severe physician maldistribution, which involved severe shortages in remotely-located institutions (RLI). The policy intervention included offering monetary grants to residents who chose a residency program in a RLI. Methods A total of 222 residents from various disciplines were recruited; 114 residents from RLI and 108 residents from central-located institutions (CLI), who began their residency during 2012–2014. Participants were surveyed on demographic, academic and professional data, and on considerations in the choice of residency location. Results Residents in RLI attributed significantly more importance to the grant in their decision-making process than did residents from CLI. This effect remained significant in a multivariate model (OR 1.65, 95% CI 1.20–2.27, p = 0.002). The only parameter significantly associated with attributing importance to the grant was older age (OR 1.09, 95% CI 1.00–1.19, p = 0.049). Conclusion The choice of a RLI for residency may be influenced by monetary grants. This is consistent with real-life data showing an increase in medical staffing in these areas during the program’s duration. Further studies are needed to determine causality and physical practicality of such programs

Eco-hydrology and geomorphology of the largest floods along the hyperarid Kuiseb River, Namibia

Flood-fed aquifers along the sandy lower reach of the Kuiseb River sustain a 130-km-long green belt of lush oases across the hyperarid Namib desert. This oasis is a year-round source for water creating dense-tall woodland along the narrow corridor of the ephemeral river valley, which, in turn, supports human activity and fauna including during the long dry austral winters and multi-year droughts. Occasional floods, originating at the river's wetter headwaters, travel ∼280 km downstream, before recharging these aquifers. We analyzed the flood-aquifer-vegetation dynamics at-a-site and along the river, determining the relative impact of floods with diverse magnitude and frequency on downstream reaches. We find that flood discharge that feeds the alluvial aquifers also affects vegetation dynamics along the river. The downstream aquifers are fed only by the largest floods that allow the infrequent germination of plants; mean annual recharge volume is too low to support the aquifers level. These short-term vegetation cycles of green-up and then fast senescence in-between floods are easily detected by satellite-derived vegetation index. This index identifies historical floods and their magnitudes in arid and hyperarid regions; specifically, it determines occurrences of large floods in headwater-fed, ephemeral Namib streams as well as in other hyperarid regions. Our study reveals the importance of flood properties on the oasis life cycle, emphasizing the impact of drought and wet years on the Namib's riparian vegetation.This researc hwas funded by agrant from EU-WADE (GOCE-CT-2003-506680-WADE) and additional support from US-AIDCDRC24-026TA-MOU-04-C24-026

Bacillus Calmette-Guérin (BCG) therapy lowers the incidence of Alzheimer's disease in bladder cancer patients.

BACKGROUND:Alzheimer's disease (AD) affects one in ten people older than 65 years. Thus far, there is no cure or even disease-modifying treatment for this disease. The immune system is a major player in the pathogenesis of AD. Bacillus Calmette-Guérin (BCG), developed as a vaccine against tuberculosis, modulates the immune system and reduces recurrence of non-muscle invasive bladder cancer. Theoretical considerations suggested that treatment with BCG may decrease the risk of AD. We tested this hypothesis on a natural population of bladder cancer patients. METHODS AND FINDINGS:After removing all bladder cancer patients presenting with AD or developing AD within one-year following diagnosis of bladder cancer, we collected data on a total of 1371 patients (1134 males and 237 females) who were followed for at least one year after the diagnosis of bladder cancer. The mean age at diagnosis of bladder cancer was 68.1 years (SD 13.0). Adjuvant post-operative intra-vesical treatment with BCG was given to 878 (64%) of these patients. The median period post-operative follow-up was 8 years. During follow-up, 65 patients developed AD at a mean age of 84 years (SD 5.9), including 21 patients (2.4%) who had been treated with BCG and 44 patients (8.9%) who had not received BCG. Patients who had been treated with BCG manifested more than 4-fold less risk for AD than those not treated with BCG. The Cox proportional hazards regression model and the Kaplan-Meier analysis of AD free survival both indicated high significance: patients not treated with BCG had a significantly higher risk of developing AD compared to BCG treated patients (HR 4.778, 95%CI: 2.837-8.046, p = 4.08x10-9 and Log Rank Chi-square 42.438, df = 1, p = 7.30x10-11, respectively). Exposure to BCG did not modify the prevalence of Parkinson's disease, 1.9% in BCG treated patients and 1.6% in untreated (Fisher's Exact Test, p = 1). CONCLUSIONS:Bladder cancer patients treated with BCG were significantly less likely to develop AD at any age than patients who were not so treated. This finding of a retrospective study suggests that BCG treatment might also reduce the incidence of AD in the general population. Confirmation of such effects of BCG in other retrospective studies would support prospective studies of BCG in AD