Beyond health care reform: immigrants and the future of medicine

Abstract

I first discuss the fundamental responsibilities of physicians and relate them to an increasingly fragmented medical system made even more complex by government regulations. I focus on trust as a vital component in the doctor–patient relationship, and note the difficult conditions surrounding the treatment of poor and marginal populations. Subsequently, I sketch the elements of a new vision to extend medical services to neglected populations. In that pursuit, the part played by physicians is only as important as the willingness of neighbourhoods and communities to support health as a public good.     

政府补偿与监管机制改革对公立医疗卫生机构科教与学科建设的影响分析

目的 分析政府补偿与监管机制改革对公立医疗卫生机构教学、科研以及学科建设的影响。方法 通过对上海市闵行区的机构调查,收集并分析2008—2012年3所公立综合性医院和12家社区卫生服务中心的医学教育、科研项目、论文发表及重点学科建设状况的相关数据。结果 闵行区公立综合性医院和社区卫生服务中心的医学教育和科研能力有所提升,重点学科建设也有所加强;但仍然存在教学能力薄弱,科研水平层次偏低,缺乏高质量的重点学科等问题。结论 政府补偿与监管机制改革在一定程度上强化了公立医疗机构的医学教育、科研能力和学科建设,但未来需进一步加大对科教和学科建设的鼓励和支持力度。     

Expanding the medical physicist curricular and professional programme to include Artificial Intelligence

PurposeTo provide a guideline curriculum related to Artificial Intelligence (AI), for the education and training of European Medical Physicists (MPs).Materials and methodsThe proposed curriculum consists of two levels: Basic (introducing MPs to the pillars of knowledge, development and applications of AI, in the context of medical imaging and radiation therapy) and Advanced. Both are common to the subspecialties (diagnostic and interventional radiology, nuclear medicine, and radiation oncology). The learning outcomes of the training are presented as knowledge, skills and competences (KSC approach).ResultsFor the Basic section, KSCs were stratified in four subsections: (1) Medical imaging analysis and AI Basics; (2) Implementation of AI applications in clinical practice; (3) Big data and enterprise imaging, and (4) Quality, Regulatory and Ethical Issues of AI processes. For the Advanced section instead, a common block was proposed to be further elaborated by each subspecialty core curriculum. The learning outcomes were also translated into a syllabus of a more traditional format, including practical applications.ConclusionsThis AI curriculum is the first attempt to create a guideline expanding the current educational framework for Medical Physicists in Europe. It should be considered as a document to top the sub-specialties’ curriculums and adapted by national training and regulatory bodies. The proposed educational program can be implemented via the European School of Medical Physics Expert (ESMPE) course modules and – to some extent – also by the national competent EFOMP organizations, to reach widely the medical physicist community in Europe.     

Attitudes,Perceptions, and Practices Among Endocrinologists Managing Obesity

ObjectiveObesity has been globally recognized as a critically important disease by professional medical organizations, in addition to the World Health Organization and American Medical Association, but health care systems, medical teams, and the public have been slow to embrace this concept.MethodsThe American Association of Clinical Endocrinology staff drafted a survey, and 2 endocrinologists independently reviewed the survey’s questions and modified the survey instrument. The survey included questions related to practice and patient demographics, awareness about obesity, treatment of obesity, barriers to improving obesity outcomes, digital health, cognitive behavioral therapy, lifestyle medicine, antiobesity medications, weight stigma, and social determinants of health. The survey was emailed to 493 endocrinologists, with 305 (62%) completing the study.ResultsOf the responders, 98% agreed that obesity is a disease, whereas 2% neither agreed nor disagreed. Of the respondents, 53% were familiar with the term “adiposity-based chronic disease” and 13% were certified by the American Board of Obesity Medicine. Of the respondents, 57% used published obesity guidelines as a resource for treating patients with obesity. Most endocrinologists recommended dietary and lifestyle changes, but fewer prescribed an antiobesity medication or recommended bariatric surgery. American Board of Obesity Medicine-certified endocrinologists were more likely to use a multidisciplinary approach.ConclusionSelf-reported knowledge and practices in the management of obesity highlight the importance of a multimodal approach to obesity and foster collaboration among health care professionals. It is necessary to raise awareness about obesity among clinicians, identify knowledge gaps, and create educational tools to address those gaps.     

Nitrate associated health risks from groundwater of Kadava River Basin Nashik,Maharashtra, India

Abstract

The present study was carried out to evaluate the nitrate contamination in groundwater and ascertain the associated health risks to rural populations in the agricultural area of the Kadava River basin. A total of (80) eighty representative samples from rural habitat located in agricultural fields were collected during pre- and postmonsoon seasons of 2011, which are mainly used for drinking and irrigation. The chemical results confirm that, 52.5 and 65% groundwater samples from pre- and postmonsoon season are unfit for drinking because of high nitrate contents exceeding the limit of nitrate (>45?mg L^?1) recommended by the BIS. The oral and dermal exposure pathways were calculated for different age group based on US EPA and ICMR standards. HQ₁ is much higher than the critical limit of 1 which increases the risk from 92.5 to 95% groundwater samples, while value of HQ₂ is far below to the critical value of 1; hence, all age groups free from risk. THQ values depicts that, children were at greater risk followed by infants and adults. Therefore, it is immensely important to regulate the use of nitrogen complex fertilizer and groundwater management practices should be implemented to prevent the associated risks to human health.     

The disadvantaged child: A product of the culture of poverty,his education,and his life chances

Abstract

This study concerns the fertility of Sherpa and Tibetan women living at altitudes over 3,400 meters in Nepal. The average completed fertility (4.77 live births) and estimated crude birth rate (31 to 33 per 1,000) are low relative to low altitude peasant populations as well as to high altitude Andean peasants. Environmental phenomena (hypoxia, iodine deficiency) may be associated with retarded menarchial age and high infant mortality; but the major factors causing the low fertility appear to be cultural rather than environmental. Traditional ceremonial requirements delay the age at marriage until the mid or late twenties. Religious practices promote male and female celibacy. Migrant females and women married to migrant males report reduced fertility, probably because of poor nutrition and health care. Nonmigrant women living in villages that participate extensively in the cash economy have greater access to the growing market economy, health care, and education and report higher numbers of live births and fewer child deaths.     

Pre-diagnosis lifestyle,health history and psychosocial factors associated with stage at breast cancer diagnosis – Potential targets to shift stage earlier

BackgroundEarly detection of breast cancer improves survival, so identifying factors associated with stage at diagnosis may help formulate cancer prevention messages tailored for higher risk women. The goal of this study was to evaluate associations between multiple potential risk factors, including novel ones, measured before a breast cancer diagnosis and stage at diagnosis in women from Alberta, Canada.MethodsWomen enrolled in Alberta’s Tomorrow Project completed health and lifestyle questionnaires on average 7 years before their breast cancer diagnosis. The association of previously identified and novel predictors with stage (I, II and III + IV) at diagnosis were simultaneously evaluated in partial proportional odds ordinal (PPO) regression models.ResultsThe 492 women in this study were predominantly diagnosed in Stage 1 (51.4%), had college or university education (75.4%), were married or had a partner (74.6%), had been pregnant (90.2%), had taken birth control pills for any reason (86.8%), and had an average body mass index of 26.6. Most had at least one mammogram (83%) with five mammograms the average number. Nearly all reported previously having a breast health examination from a medical practitioner (92.5%). Statistically significant factors identified in the PPO model included protective ones (older age at diagnosis, high household income, parity, smoking, spending time in the sun during high ultraviolet times, having a mammogram and high daily protein intake) and ones that increased risk of later stage at diagnosis (a comorbidity, current stressful situations and high daily caloric intake).ConclusionShifting breast cancer stage at diagnosis downwards may potentially be achieved through cancer prevention programs that target higher risk groups such as women with co-morbidities, non-smokers and younger women who may be eligible for breast cancer screening.     

Comparative analysis of cell therapy infusion workflows at clinical sites

Background aimsCell therapies are an emerging treatment option for a variety of diseases, especially with the success of chimeric antigen receptor T-cell therapies. With 18 FDA-approved cell therapy products as of December 2020 and a growing number in clinical trials, standards for most aspects of the cell therapy lifecycle are well-established by professional organizations like AABB and FACT; however, there are limited standardized protocols regarding the day-of infusion.MethodsInfusions were observed at three academic medical centers in the United States, and the workflows were analyzed and compared based on factors including facility layout, product verification processes, cryobag design, timing restrictions, and use of electronic medical records.ResultsVariations between the facilities were identified with product thawing location and cell therapy lab location being the most important factors in time from thaw to infusion.ConclusionsBased on this analysis, opportunities were identified for standardization and streamlining the infusion workflow which may help facilitate adoption of new and existing cell therapies at a wider range of hospitals.     

Health in exchange: teachers,doctors, and the strength of informal practices in Russia

This article explores teachers' and doctors' informal medical exchange practices in the context of the transforming health care system in post-Soviet Russia. Despite the advent of a medical marketplace, most Russians have low incomes and cannot buy the goods and services the market offers. Instead, they bypass the formal market mechanisms (such as obtaining cheaper medicine through personal connections) and official procedures (such as obtaining free or cheaper health care services despite the emergence of paid services) by using their social networks. This paper uses a network perspective to investigate how doctors' and teachers' mutual relations are formed and what resources form the basis of these informal exchange practices. Drawing on structured diary data and qualitative interviews with 20 teachers, in addition to interviews with eight doctors in St. Petersburg, the study goes beyond mere statistics on health care and attempts to depict from below the implications health and illness have for survival in contemporary Russia.     

Beliefs Underlying Dog Owners' Health Care Behaviors: Results from a Large,Self-Selected,Internet Sample

ABSTRACT

Various behaviors must be performed by owners to promote good health for their dogs. The aim in this study was to use the results of an online survey, completed by 1,016 self-selected, Australian dog owners, to investigate relationships between demographic factors, beliefs, dog–owner relationship variables, and the performance of health-promoting behaviors. Specific behaviors examined included the provision of annual vaccinations and health checkups by a veterinarian, regular grooming and exercise, and the provision of a nutritionally balanced diet. Reported compliance was high in the self-selected sample, ranging between 77.8% for annual vaccinations and 98.8% for the provision of a nutritious diet. Regression analyses revealed that all of the behaviors we measured could be predicted from beliefs relating to health care practices and dog–owner relationship variables independently of demographic factors. The extent of dog and owner interactions, as well as the extent to which owners perceived important others to be supportive of the behaviors, emerged as particularly important variables. These statistically robust findings have implications for campaigns encouraging pet health promotion by owners.     

湖北省公立医院医护人员薪酬制度调查分析

目的 分析湖北省公立医院医护人员薪酬制度问题,提出解决策略。方法 以湖北省12家公立医院的1 155名医护人员为调查对象,利用描述性统计与χ²检验等方法对数据进行统计分析。结果 湖北省公立医院医护人员薪酬与市场价值背离;半数左右的医护人员认为薪酬制度不科学、不满意当前收入。结论 当前湖北省公立医院医护人员薪酬制度在一定程度上并不科学。     

手术医疗收费结构比例分析及对策探讨

目的 通过分析手术医疗收费结构比例,找出医疗收费结构中的缺陷。方法 对639例手术医疗收费情况进行数据处理,分析不同类别手术费用间价格的差异性。结果 在手术及麻醉医疗消费中,药品、耗材的费用在医疗消费中所占比例较大,医务人员的劳动价值在费用中未合理体现。结论 医疗费用的合理管控需要采取科学有效的措施作为保障,医务人员劳动价值需要公平合理的体现在医疗费用中。     

The status of medical physics in radiotherapy in China

PurposeTo present an overview of the status of medical physics in radiotherapy in China, including facilities and devices, occupation, education, research, etc.Materials and methodsThe information about medical physics in clinics was obtained from the 9-th nationwide survey conducted by the China Society for Radiation Oncology in 2019. The data of medical physics in education and research was collected from the publications of the official and professional organizations.ResultsBy 2019, there were 1463 hospitals or institutes registered to practice radiotherapy and the number of accelerators per million population was 1.5. There were 4172 medical physicists working in clinics of radiation oncology. The ratio between the numbers of radiation oncologists and medical physicists is 3.51. Approximately, 95% of medical physicists have an undergraduate or graduate degrees in nuclear physics and biomedical engineering. 86% of medical physicists have certificates issued by the Chinese Society of Medical Physics. There has been a fast growth of publications by authors from mainland of China in the top international medical physics and radiotherapy journals since 2018.ConclusionsDemand for medical physicists in radiotherapy increased quickly in the past decade. The distribution of radiotherapy facilities in China became more balanced. High quality continuing education and training programs for medical physicists are deficient in most areas. The role of medical physicists in the clinic has not been clearly defined and their contributions have not been fully recognized by the community.     

Survey of Lifestyle,Past Medical History and Complementary and Alternative Medicine Use Among Adult Patients Participating in the National Cancer Institute's Exceptional Responders Initiative

IntroductionThe Exceptional Responders Initiative (ERI) at the National Cancer Institute attempts to correlate unusually good outcomes in patients with cancer with genetic targets in tumors and the therapies the patients received. It is not known if other factors might contribute to exceptional responses or outcomes. We explored aspects of the medical history, lifestyle changes, complementary and alternative medicine (CAM) use and communication between health care practitioners and patients who experienced an exceptional response following cancer treatment.MethodsAll subjects whose case was submitted to the ERI were eligible to participate in the survey. A 121-question survey questionnaire was developed to assess aspects of the subject's past medical history, lifestyle (e.g., diet, exercise, spirituality) and use of CAM.ResultsThirty subjects completed and returned the questionnaire from approximately 88 patients invited to participate (approximate response rate = 34%). Approximately 68% were female and 32% were male. Fifty percent of subjects changed their diet after their cancer diagnosis. Eighteen patients (60%) reported using a CAM therapy (not including oral vitamins/minerals or spiritual practices) during their Exceptional Response (ER).ConclusionMultiple factors, including features of the tumor itself, the patient, or the environment, could affect tumor response or patient survival, either solely or in combination with the treatments received. Many patients use other medications, change their diet or physical activity or use CAM interventions after their cancer diagnosis. Investigators attempting to understand the exceptional response phenomenon should acquire rich data sets of their subjects that include information about these factors.     

Lifestyle factors and quality of life among primary health care physicians in Madinah,Saudi Arabia

BackgroundPhysicians are considered to be a high-risk population for a poor quality of life (QoL), but few studies of lifestyle factors include the QoL among them.ObjectivesThis study aimed to investigate the relationship between lifestyle factors and a positive QoL among primary health care (PHC) physicians.MethodsA cross-sectional study was conducted at 20 primary healthcare centers in Madinah, Saudi Arabia. A self-administered questionnaire was used, including sociodemographic characteristics, lifestyle data, and the short version of the World Health Organization Quality of Life questionnaire. Appropriate statistical analyses were used, including multivariate logistic regression models.ResultsThe response rate was 85.7% (72/84) physicians. The mean score of the total QoL and its four studied domains (physical, psychological, social, and environmental) was relatively high, with no statistically significant difference between the consultants and general practitioners. The positive total QoL in this study was significantly lower among physicians with obesity (OR = 0.55, 95%CI = 0.25–0.97), those using butter and animal fat for cooking (OR = 0.10, 95%CI = 0.02–0.81), and those eating meals out > 3 times per week (OR = 0.30, 95%CI = 0.10–0.90). Although non-significant, vegetable consumption and a high level of physical activity were associated with a positive QoL, with adjusted ORs of 2.5 (95%CI = 0.82–7.58) and 1.5 (95%CI = 0.33–6.65), respectively.ConclusionThe findings indicate a relatively good QoL among the participating physicians; however, a lower QoL was associated with unhealthy lifestyle factors. QoL was significantly associated with obesity, cooking practices, and eating meals from restaurants.     

广西壮族自治区县级医疗卫生资源配置的公平性研究

目的 对广西县级医疗卫生资源配置的公平性进行分析。方法 采用洛伦茨曲线和基尼系数等方法,从人口和地理分布对广西91个县域医疗卫生资源(床位、卫生技术人员、医生)的配置公平性进行分析。结果 广西县级医疗卫生资源中床位、卫生技术人员、医生按人口分布的基尼系数分别为0.230 3、0.239 6、0.250 4,按地理分布的基尼系数分别为0.346 1、0.353 4、
0.352 3。结论 广西县级医疗卫生资源配置的公平性较好,其中人口分布优于地理分布,床位分布优于卫生人力资源分布。广西县级医疗卫生资源配置的公平性低于广西总体水平,但优于城区医疗卫生资源的配置。应进一步加大县级医疗卫生资源的投入,不断缩小城乡差距,提高县级医疗卫生资源在人口和地理配置的公平性。     

Bonding or bridging? Professional network organizations of second-generation Turks in the Netherlands and France

ABSTRACT

This article analyses network organizations founded by descendants of Turkish migrants in the Netherlands and France. By surveying members of two such organizations and interviewing several of their board members, we learn how these organizations function, their success in building and extending social networks, and their efficacy at improving labour market prospects for young second-generation professionals of Turkish descent. Our findings reveal a hybrid structure, whereby the organizations gear many of their activities towards mainstream society. In comparison to traditional immigrant organizations, their attitude is more open to other social groups, yet they still have a clear stronghold in the ethnic immigrant community. We conclude that ethnicity is not the main element in the successful second generation’s organizing process. Factors such as educational trajectories, professional ambitions, feelings of responsibility for other members and newly acquired socioeconomic status are the main reasons for this group to organize.     

Spring phenology shows genetic variation among and within populations in seedlings of Scots pine (Pinus sylvestris L.) in the Scottish Highlands

Background: Genetic differentiation in phenotypic traits is often observed among forest tree populations, but less is known about patterns of adaptive variation within populations. Such variation is expected to enhance the survival likelihood of extant populations under climate change.

Aims: Scots pine (Pinus sylvestris) occurs over a spatially and temporally heterogeneous landscape in Scotland. Our goal was to examine whether populations had differentiated genetically in timing of bud flush in response to spatial heterogeneity and whether variation was also maintained within populations.

Methods: Two common-garden studies, involving maternal families of seedlings from 21 native pinewoods, were established and variation in the trait was measured at the beginning of the second growing season.

Results: Populations showed genetic differences in the trait correlated with the length of growing season at their site of origin, but the majority of variation was observed within populations. Populations also differed in their levels of variation in the trait; a pattern that may be influenced by spatial variation in the extent of temporal climate variability.

Conclusions: Our findings suggest that populations have adapted to their home environments and that they also have substantial ability to adapt in situ to changes in growing season length.