Public health reports
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Public health reports · Mar 1994
Comparative StudyRural physician assistants: a survey of graduates of MEDEX Northwest.
Graduates of MEDEX Northwest, the physician assistant training program at the University of Washington, were surveyed to describe differences between physician assistants practicing in rural settings and those practicing in urban settings. Differences in demography, satisfaction with practice and community, practice history, and practice content were explored. Of the 341 traceable graduates, 295 (86.5 percent) responded to the mail survey. ⋯ The broader scope of practice available to primary care physician assistants in rural areas may be of particular interest to those considering rural careers, to people who train physician assistants, and to rural communities trying to recruit and retain physician assistants. Results also suggest that recruitment of students for rural practice should focus on rural residents. Some problems that rural practitioners are more likely to face than urban ones, such as unreasonable night call schedules and lack of acknowledgement and respect for them as professionals, need to be addressed if rural communities are to be able to attract and retain physician assistants.
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Bicycle helmet use in the United States has remained low despite clear demonstration of its beneficial effect on reducing the incidence of serious head injury. Several interventions have been reported, with variable results and costs. Much of the recent literature has focused on child cyclists and on demographic factors associated with helmet use. ⋯ The use of a city-type bicycle negatively predicted helmet use. For non-adults, female sex and the use of a child seat or trailer were positive predictors. Fostering peer pressure to increase helmet use may be an effective yet relatively inexpensive way to achieve the goal of widespread use of bicycle helmets.
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Public health reports · Jul 1993
Utilization of on-site primary care services by HIV-seropositive and seronegative drug users in a methadone maintenance program.
The feasibility of on-site primary care services and their use by human immunodeficiency virus HIV-seropositive and seronegative injecting drug users within an outpatient methadone maintenance program are examined. A 16-month prospective study was conducted within an ongoing cohort study of HIV infection at a New York City methadone program with on-site primary care services. The study group consisted of 212 seropositive and 264 seronegative drug injectors. ⋯ Those who were HIV-seropositive made more frequent visits than those who were seronegative (mean annual visits 8.6 versus 4.1, P < .001), which increased with declining CD4+ T-lymphocyte counts; 79 percent of those who were seropositive with CD4 counts of less than 200 cells per cubic millimeter received on-site zidovudine therapy or prophylaxis against Pneumocystis carinii pneumonia, or both. Common primary care diagnoses for patients seropositive for HIV included not only conditions specific to the human immunodeficiency virus but also bacterial pneumonia, tuberculosis, genitourinary infections, asthma, dermatologic disease, psychiatric illness, and complications of substance abuse; those who were seronegative were most frequently seen for upper respiratory infection, psychiatric illness, complications of substance abuse, musculoskeletal disease, hypertension, asthma, and diabetes mellitus. Vaginitis and cervicitis,other gynecologic diseases, and pregnancy were frequent primary care diagnoses among both seropositive and seronegative women.
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To identify risk factors predicting the involvement of boat operators in incidents resulting in at least one fatality, the authors obtained data from a mail survey of registered boat owners in the State of Ohio and from the Boating Accident Report (BAR) files for 1983-86 compiled by the Ohio Department of Natural Resources. Additionally, they reviewed Ohio death certificates for those years to identify cases missed by the BAR system. Forty percent of the fatal incidents would have been missed by a search of death certificates alone. ⋯ Canoes, kayaks, rowboats, and inflatables were associated with a higher rate of fatal incidents per million hours of use than were motorboats. Young age and lack of experience were associated independently with increased risk, explaining some of the effects associated with types of boats and with lack of training. The findings suggest that supervised experience, safety training programs aimed at young operators, and interventions specific to certain types of boats are likely to reduce boating fatalities.
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Public health reports · May 1993
Mortality patterns among the youth of a northeastern American Indian cohort.
Mortality patterns prevalent among American Indian youth have not been well documented. This investigation reports on mortality patterns among the Seneca Nation of Indians from January 1, 1955, through December 31, 1989. The study cohort consisted of 3,033 Seneca tribal members born during the study period. ⋯ Females demonstrated significantly elevated mortality from all accidents combined, for motor vehicle accidents, and for all other types of accidents. Age-specific mortality patterns also varied both by sex and by calendar time. These findings are important to consider in the design of programs aimed at reducing premature mortality among American Indian populations from preventable causes of death.