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The United States' public health sector plays a crucial role in preventing illness and promoting health. Public health drove massive gains in life expectancy during the 20th century by supporting vaccination campaigns, promoting motor vehicle safety, and preventing and treating tobacco use. However, public health is underfunded and underappreciated, forcing the field to do more with fewer resources. In this position paper, the American College of Physicians (ACP) updates its 2012 policy recommendations on strengthening the nation's public health infrastructure. ACP calls for effective coordination of public health activities, robust and stable year-to-year funding of public health services, a renewed and well-supported public health workforce, action to address health-related dis- and misinformation, modernized public health data systems, and greater coordination between public health and medical sectors., Competing Interests: Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M23-0670.

The onset of the COVID-19 pandemic revealed significant gaps in the United States' pandemic and public health emergency response system. In this position paper, the American College of Physicians (ACP) offers several policy recommendations for enhancing federal, state, and local preparedness for future pandemics and public health emergencies. The onset of the COVID-19 pandemic revealed significant gaps in the United States' pandemic and public health emergency response system. At the federal level, government responses were undercut by a lack of centralized coordination, inadequately defined responsibilities, and an under-resourced national stockpile. Contradictory and unclear guidance throughout the early months of the pandemic, along with inconsistent funding to public health agencies, also created notable variance in state and local responses. The lack of a coordinated response added pressure to an already overwhelmed health care system, which was forced to resort to rationing care and personal protective equipment, creating moral distress and trauma for health care workers and their patients. Despite these severe shortcomings, the COVID-19 pandemic also highlighted successful policies and approaches, such as Operation Warp Speed, which led to the fastest development and distribution of a vaccine in history. In this position paper, the American College of Physicians (ACP) offers several policy recommendations for enhancing federal, state, and local preparedness for future pandemic and public health emergencies. This policy paper builds on various statements produced by ACP throughout the COVID-19 pandemic, including on the ethical distribution of vaccinations and resources, conditions to resume economic and social activity, and efforts to protect the health and well-being of medical professionals, among others. [ABSTRACT FROM AUTHOR]

The primary claim of this paper is that a widely used argument against obstructing, curtailing, or eliminating deep physician-industry relationships is deficient. The typical argument critiqued requires that proof that physician-industry relationships cause harm flows from randomized controlled trials. Chief among the deficiencies in this claim is the fact that this specific demand for proof of harm essentially guts the precautionary principle. In so doing, the typical argument neuters the basic justification for public health action. In place of this fallacious move, the paper argues that proof of harm can be demonstrated via evidentiary standards widely accepted within the knowledge communities of public health scientists and epidemiologists. The paper concludes by noting that while there may be good reasons to oppose curtailment of deep physician-industry relationships, the typical argument described here is not among them.

Climate change could have a devastating effect on human and environmental health. Potential effects of climate change on human health include higher rates of respiratory and heat-related illness, increased prevalence of vector-borne and waterborne diseases, food and water insecurity, and malnutrition. Persons who are elderly, sick, or poor are especially vulnerable to these potential consequences. Addressing climate change could have substantial benefits to human health. In this position paper, the American College of Physicians (ACP) recommends that physicians and the broader health care community throughout the world engage in environmentally sustainable practices that reduce carbon emissions; support efforts to mitigate and adapt to the effects of climate change; and educate the public, their colleagues, their community, and lawmakers about the health risks posed by climate change. Tackling climate change is an opportunity to dramatically improve human health and avert dire environmental outcomes, and ACP believes that physicians can play a role in achieving this goal. [ABSTRACT FROM AUTHOR]

Purpose: Despite the efforts of numerous medical schools to produce rural physicians, many rural communities in the United States still experience physician shortages. This study describes the current landscape of rural efforts in US undergraduate medical education and catalogs medical school characteristics and activities that evidence has suggested, and that many experts in rural medical education believe, may result in more graduates choosing rural practice. Methods: This is a descriptive study of publicly available and rurally relevant characteristics of all 182 allopathic and osteopathic medical schools operating in the 50 states and the District of Columbia in 2016, with rural program information for these schools updated in 2019. The authors constructed a "rural program" definition in order to systematically catalog coordinated and strategic medical school efforts to produce a rural physician workforce. Findings: Few (8.2%) medical schools expressed an explicit commitment to producing rural physicians in public mission statements. However, most (64.8%) provided rural clinical experiences and many demonstrated their commitment in other ways. Only 39 (21.4%) did so through a formal rural program. Conclusions: In establishing an explicit rural program definition and documenting other markers of rural commitment, this paper provides a baseline for future studies of rural workforce production and medical school investment in these programs, activities, and personnel. Demonstrating the effectiveness of schools' rural physician education efforts will require collaboration across institutions and more intensive evaluations of programs involving students who, though relatively few in number, have great potential for contributing to the health of rural communities across the nation. [ABSTRACT FROM AUTHOR]

This article explores the mentoring relationship between Alice Hamilton and Harriet Hardy, two female physician-researchers who had a tremendous impact on the development of the field of occupational health in the United States during the 20th century. The article relies on letters the women wrote to each other. Hamilton, the elder, supported and furthered Hardy's career by asking her to coauthor the second edition of a seminal occupational health text. After beginning this intellectual collaboration, Hamilton remained a mentor to Hardy, and a decades-long friendship ensued. The article explores their relationship within the historical, political, and social context in which the women worked and made remarkable contributions to public health. [ABSTRACT FROM AUTHOR]

This paper examines the uses of some health status indices in measuring equity of access to medical care. Empirical examples are provided using data from national surveys of the U.S. population conducted from 1964 through 1976. A simple indicator, mean number of physician visits, suggests that between 1963 and 1976 the poor improved their position relative to the rest of the population and, indeed, currently enjoy the highest level of access. However, a second measure, the use-disability ratio indicates that the poor may still receive less care relative to their need. A third measure, the symptoms-response ratio suggests how norms of appropriate behavior might be incorporated into an access measure. [ABSTRACT FROM AUTHOR]

A generalization of ordinary least squares methods is used in the analysis of physician visit data from a complex sample survey. The emphasis, in this paper, is on the valid substantive inferences to be drawn from an analysis of this type of data. The procedure is found to be useful in two ways. First, the results of a comparative sampling study are reported. (See Appendix) Second, the procedure is used to remove statistically non-significant variation from the data in order to generate fitted or smoothed estimates on which the substantive analyst may focus his attention. These fitted values are then examined for implications to physician service utilization on a national basis. It is concluded that age is an important variable while the effect of sex and race depends on age. Similarly, residence and income are important but the effect of education depends on the level of income. [ABSTRACT FROM AUTHOR]

This paper describes (1) the design, methods and baseline data of the first smoking cessation clinical trial for Chinese Americans with medical conditions - Chinese Community Smoking Cessation Project (CCSCP); (2) the collaborative process between researchers and the Chinese community; and (3) the barriers and facilitators of implementing the study. CCSCP was a culturally tailored, randomized, smoking cessation trial testing the efficacy of an intensive (physician advice, in-person counseling with nicotine replacement therapy, 5 telephone calls) compared to a minimal (physician advice and self-help manual) intervention. The study applied a community-sensitive research method involving community members in all phases of the research process in San Francisco Bay Area during 2001–2007. CCSCP recruited 464 smokers from health care facilities (79%) located in Chinese neighborhoods and through Chinese language media (21%). Baseline assessments and interventions were conducted in-person using translated and tested questionnaire and intervention materials. The majority of the participants were men (91%) with a mean age of 58.3 years, foreign born (98%), with less than high school education (58%), spoke no English (42%) and in non-skilled or semi-skilled occupations (60%) with <$20,000 household income (51%). Participants smoked regularly on an average 38.6 ± 17 years, smoked 9.1 ± 8 cigarettes per day and 85% smoked daily. Cultural tailoring of recruitment methods and intervention design led to successful enrollment and retention of participants, overcoming barriers faced by the participants. Community sensitive collaborative process facilitated implementation of study protocol in community health care settings. [ABSTRACT FROM AUTHOR]

This article details the history of Slossfield Hospital, an African American hospital and community center founded in Birmingham, Alabama, in 1937. During its New Deal-era existence it provided African American physicians institutional support for their medical practices. Additionally, as a community center, it addressed the socioeconomics of good health. This paper uses Slossfield as a case study to explore how some African Americans included the socioeconomic in their definition of public health during the New Deal, as well as to understand how these ideas were subsumed by more mainstream ideas about public health promulgated by black and white physicians and the local and federal governments. [ABSTRACT FROM AUTHOR]

As some preventive medicine physicians have been denied medical licenses for not engaging in direct patient care, this paper attempts to answer the question, "Do preventive medicine physicians practice medicine?" by exploring the requirements of licensure, the definition of "practice" in the context of modern medicine, and by comparing the specialty of preventive medicine to other specialties which should invite similar scrutiny. The authors could find no explicit licensure requirement for either a certain amount of time in patient care or a number of patients seen. No physicians board certified in Public Health and General Preventive Medicine sit on any state medical boards. The authors propose that state medical boards accept a broad standard of medical practice, which includes the practice of preventive medicine specialists, for licensing purposes. [ABSTRACT FROM AUTHOR]

This article examines the history and effect of the Consensus Development Program (CDP) at the National Institutes of Health (NIH). Introduced at a time when the relationship between the U.S. public and the medical profession was at a nadir, the CDP frequently placed the NIH in the middle of broader debates in medical practice and health policy during the last quarter of the 20th century. Drawing on published and archival sources, this paper sheds light on the challenges associated with collecting, assessing, and communicating evidence to medical professionals and convincing them to act on it in the name of improved health care. Administrators at the NIH sought a middle ground between changing medical practice and respecting professional autonomy, with varying degrees of success. This debate has continued implications today as tensions persist between scientific guidelines and the clinical medicine practiced by physicians and expected by patients. [ABSTRACT FROM AUTHOR]

The fundamental problems that beset the U.S. health care system--cost, quality, and access--differ in scope and intensity in inner cities. Current trends in health care are systemwide but are more difficult to accommodate in inner cities because of scarce resources and stresses to the health care system. In this position paper, the American College of PhysiCians seeks to highlight directions and innovations in public policy for inner-city health care with renewed determination that health care problems in the United States must be solved, especially in cities, where they are most extreme. Many persons in inner cities experience an urban health penalty because of the concentration of economic decline, job loss, and major health problems. Because the problems originate in a complex interaction of socioeconomic factors, behavior, environment, and disease that is related to race and ethnicity, multifaceted approaches that extend beyond the medical model are needed to improve health status. The College argues for tackling health problems of the inner city in the context of a comprehensive urban policy that addresses the root: causes of poverty. In addition, this position paper contains more specific recommendations to improve health care delivery to inner cities. The College calls for a comprehenSiVe urban partnership initiative to address all aspects of the urban penalty-social, economic, and health-related--and recommends solutions through public and private collaborations that can be adapted to the circumstances of each Community in addition, policy recommendations address health care coverage, providers, public hearth initiatives, community involvement, and short-term improvements to such existing programs as Medicaid. [ABSTRACT FROM AUTHOR]

This article focuses on problems in the delivery of health care services in the United States. The two problems are: the difficulty of access to primary care physicians and long patient waiting times in the office or clinic. Long waiting times are dependent primarily upon poor functioning of the appointment system and secondarily on patient flow in the office or clinics. A health care facility that recognizes these problem areas and is interested in taking steps to reduce patient waiting time and to better utilize its professionals is still faced with the question of how to measure the changes. The purpose of this paper is to present two techniques--work sampling and patient flow analysis, which can serve as tools to accomplish this task.

Unlike recent studies that arc based on international cross-sectional series, this paper attempts to quantify the role of the determinants of aggregate health care expenditure per capita, using time-series data for the period of 1960-87 for the United States The paper applies the relatively new procedures of unit root testing, cointegration and error-correction modeling The evidence supports cointegration Although, the results indicate that per capita income, age of the population, number of practising physicians, and public financing of health care are important determinants, the age structure of the population and number of practising physicians emerge as the major determinants of aggregate health care expenditure in the United States [ABSTRACT FROM AUTHOR]

Histories of public health reform in Canada rarely mention New Brunswick, even though its innovative Department of Health, established in 1918, was the first full ministry of health in Canada. This paper traces the institutionalization of this public health reform by a small group of New Brunswick physicians, united by their immersion in American medical training and innovative public health ideologies. It reframes explanations of the rise of public health reform in Canada by widening an explanatory lens to encompass the exclusive influence of American models of disease and public health. It also breaks a negative regional stereotype of New Brunswick by highlighting the potential for reform and innovation in small and ostensibly less modern regions. [ABSTRACT FROM AUTHOR]

Background: The many challenges in health care today create a special need for great leadership. However, traditional criteria for physicians' advancement to leadership positions often regard academic and/or clinical accomplishments rather than the distinctive competencies needed to lead. Furthermore, physicians' training can handicap their developing leadership skills. In this context, an emerging trend is for health-care institutions to offer physician-leadership programs.Methods and Results: This paper reviews the rationale for developing physician-leaders. Factors that underscore this need include: (1) physicians may lack inclinations to collaborate and to follow, (2) health-care organizations pose challenging environments in which to lead (e.g., because of silo-based structures, etc.), (3) traditional criteria for advancement in medicine regard clinical and/or academic skills rather than leadership competencies, and (4) little attention is currently given to training physicians regarding leadership competencies.Conclusion: Definition of these competencies of ideal physician-leaders will inform the curricula and format of emerging physician leadership development programs. [ABSTRACT FROM AUTHOR]

Purpose - The purpose of this paper is to review the issues regarding direct-to-consumer advertising that have been identified in the literature from the perspective of consumers, consumer groups, physicians, the medical profession and the pharmaceutical industry. Design/methodology/approach - Literature from international sources was reviewed to identify themes relating to direct-to-consumer advertising. Findings - Direct-to-consumer advertising is expressly permitted in only two developed countries (USA and New Zealand). All other countries place various limitations on the practice. The debate surrounds whether or not the advertising provides a public health benefit. Originality/value - The debate over direct-to-consumer advertising continues in jurisdictions around the world. This paper identifies and summarizes the issues that are being considered. [ABSTRACT FROM AUTHOR]

An examination of the lives and careers of physician-activists Dorothy Boulding Ferebee (1898-1972) and Virginia M. Alexander (1899-1949) demonstrates how Black physicians in the first half of the 20th century used public health to improve the health of Black Americans and provides insights into the experiences of Black women physicians. I discuss their professional and personal backgrounds and analyze their divergent strategies to address health inequities. Ferebee used her leadership in Black women's organizations to develop public health programs and become a national advocate for Black health. Alexander, a Quaker, used her religious connections to urge Whites to combat racism in medicine. She also conducted public health research and connected it to health activism. Both were passionate advocates of health equity long before it gained prominence as a major public health issue. An analysis of their work illuminates past efforts to improve the health of Black Americans. [ABSTRACT FROM AUTHOR]

This paper analyzes the evolution of consumer-driven health care in terms of its original vision, its subsequent implementation, and the transformations it has endured as it moves into its second decade. The market is generating product designs that combine elements of consumerism with elements of managed care, but the trend is always toward a stronger role for consumer choice and a weaker role for management of those choices by physicians, insurers, employers, and regulators. [ABSTRACT FROM AUTHOR]

This article presents a paper that outlines some possible bioterror threats, possible neuromusculoskeletal symptoms and how doctors of chiropractic can be better prepared. Since the anthrax attacks of 2001, Americans have come to realize that bioterror attacks can and likely will occur on their own soil. Health care providers would be the first responders to this type of attack and hospitals could be overrun with infected persons. Chiropractic physicians and their employees could be more vulnerable to this type of attack than other providers.

This paper considers the role of statistical discrimination as a potential explanation for racial and ethnic disparities in health care. The underlying problem is that a physician may have a harder time understanding a symptom report from minority patients. If so, even if there are no objective differences between Whites and minorities, and even if the physician has no discriminatory motives, minority patients will benefit less from treatment, and may rationally demand less care. After comparing these and other predictions to the published literature, we conclude that statistical discrimination is a potential source of racial/ethnic disparities, and worthy of research. [ABSTRACT FROM AUTHOR]

Background: US direct-to-consumer advertising spending for medicine has soared in recent decades. Advertising has been shown to impact drug utilization. Most Alzheimer's disease patients are above age 65 and may take a range of prescription medications for various disease states.Objective: To investigate how direct-to-consumer advertising is associated with the drug utilization of patients ≥65 years old.Methods: Using advertising expenditure data and Medicare Part D drug purchase claims, we performed regression analyses for each of the highest-spending drugs and age group, with cumulative monthly spending as the predictor variable and drug utilization as the response variable. For each drug, we ran a second set of regression analyses to determine if the spending-utilization correlation showed a significant difference between the two patient age groups (older than 65, younger than 65).Results: For all 14 drugs in our study, advertising spending is positively correlated with utilization (p < 0.01) in both age groups. For seven of the 14 drugs studied, the difference in the utilization of patients older than 65 and the utilization of patients younger than 65 is statistically significant at a p < 0.01 level. The 65-and-older age bracket exhibits significantly greater utilization for all seven of these drugs.Conclusion: We find televised advertising for certain drugs to be associated with significantly stronger drug utilization among seniors, as compared to younger patients. Alzheimer's disease physicians should be aware of this result, in light of the medications that patients may take for other disease states, particularly mood and mental health medications. [ABSTRACT FROM AUTHOR]

We used Medicare data bases and U.S. Census data to address two questions critical to the use of Medicare files for epidemiologic research. First, we examined the degree to which the population enrolled in the Medicare program is similar to the elderly resident population of the United States, as estimated by the US Census. We found small differences in the total population estimates hut substantial differences by age and race. Second, we found that among Medicare enrollees, physician claims identify a small proportion of hip fracture cases which are not documented in the hospital discharge files. This proportion varies by age region, and state within the United States. Calculation of rates based on Medicare hospital discharge data, and probably other hospital discharge data sets as well, must take these limitations into account. Use of all available Medicare data files can overcome these limitations. [ABSTRACT FROM AUTHOR]

Globally, respiratory syncytial virus (RSV) is a leading cause of hospitalization due to severe respiratory infections in infants of all gestational ages and children aged 5 years and younger, and it is associated with a substantial health care burden. Approximately, 1% to 3% of infants younger than 1 year are hospitalized with severe RSV disease in the United States. With no specific treatment or vaccine, palivizumab is the only licensed immunoprophylaxis for the prevention of severe RSV disease in high-risk pediatric populations, including infants born at or before 35 weeks' gestational age (wGA). In the United States, the American Academy of Pediatrics (AAP) periodically publishes its recommendation for the use of RSV immunoprophylaxis, which is largely followed by health care professionals and payers. In 2014, the AAP Committee on Infectious Diseases stopped recommending RSV immunoprophylaxis for otherwise healthy infants born at or after 29 wGA and stated that the RSV hospitalization rates in infants 29 to 34 wGA and full-term infants were similar. Several studies have demonstrated that a significant decline in palivizumab use following the AAP 2014 recommendations was accompanied by increases in rates of RSV hospitalization and disease severity and hospital costs in infants 29 to 34 wGA versus full-term infants. Despite the growing evidence demonstrating high RSV morbidity in infants 29 to 34 wGA, the AAP reaffirmed its 2014 policy in 2019. This article will discuss the critical roles and strategies of advocacy groups and nurses in providing the maximum protection with RSV immunoprophylaxis to all high-risk and label-eligible preterm infants. [ABSTRACT FROM AUTHOR]

Twenty-seven per cent of 6.785 employees of the Office of Mental Health. New York State, had blood pressure ≥ 140/90; 66 per cent were previously known hypertensives. Treatment of hypertension was initiated at three worksites by a nurse-physician team using a stepped-care drug protocol. Of 232 patients under treatment. 67 per cent (156) have diastolic blood pressure controlled to less than 95 mmHg. Mean length of follow up at the first established worksite was 3.7 ± 0.4 years and at all three worksites 13.5 months, (Am J Public Health 1918;71:1261-1263.) [ABSTRACT FROM AUTHOR]

This article documents the public positions taken by the American Academy of Pediatrics, the American College of Physicians, and the American Medical Association on five topics with implications for public health: access to care for undocumented patients, fracking, gun control, climate change, and same-sex marriage. There are stark divisions on each of these issues between political parties, and taking a strong public position on them runs the risk of alienating some members of Congress, but each of these associations has done so. At the same time, there is a clear distinction between the public positions of these organizations and the priority given to them by their offices in Washington, DC. Drawing on an organizational maintenance framework, the author argues that taking these public positions is explained, in part, by a growth in the number of women and the number of physicians that affiliate with the Democratic Party in the United States. [ABSTRACT FROM AUTHOR]

Reforming healthcare has been a priority in the United States for many years. A major part of that reform has been an expansion in the role and duties of physicians to include more management and leadership within the organization. This type of reform requires innovative changes in health science education programs. Traditionally, physician leaders were vice-presidents of medical affairs, chief medical officers, chief physicians, or head doctors. They served in advisory roles with limited responsibility and no financial authority and were unable to establish policies and make changes that systematically affected the administration and delivery of services within the organization. Out of necessity, the role of the physician leader has changed to include the following components: leading change efforts, managing care teams, integrating knowledge and resources to solve situational problems, fostering a team approach to service delivery, working collaboratively rather than individually, distributing knowledge, and working to improve operations and patient outcomes. This manuscript describes physician leadership and its goals, models of leadership, potential for cost reduction, information technology use, curricula, and organizational challenges in physician leadership programs. Additionally, the perceptions of physicians are examined following their participation in a six-month in-house leadership development program. [ABSTRACT FROM AUTHOR]

Objective: To identify factors that promote the effective performance of accountable care organizations (ACOs) in the Medicare Shared Savings Program.Data Sources/study Setting: Data come from a convenience sample of 16 Medicare Shared Savings ACOs that were organized around large physician groups. We use claims data from the Center for Medicaid and Medicare Services and data from 60 interviews at three high-performing and three low-performing ACOs.Study Design: Explanatory sequential design, using qualitative data to account for patterns observed in quantitative assessment of ACO performance.Data Collection Methods: A total of 16 ACOs were first rank-ordered on measures of cost and quality of care; we then selected three high and three low performers for site visits; interview data were content-analyzed.Principal Findings: Results identify several factors that distinguish high- from low-performing ACOs: (1) collaboration with hospitals; (2) effective physician group practice prior to ACO engagement; (3) trusted, long-standing physician leaders focused on improving performance; (4) sophisticated use of information systems; (5) effective feedback to physicians; and (6) embedded care coordinators.Conclusions: Shorter interventions can improve ACO performance-use of embedded care coordinators and local, regional health information systems; timely feedback of performance data. However, longer term interventions are needed to promote physician-hospital collaboration and skills of physician leaders. CMS and other stakeholders need realistic timelines for ACO performance. [ABSTRACT FROM AUTHOR]

Introduction: The past decade has witnessed adoption of conservative gynecologic treatments, including minimally invasive surgery (MIS), alongside steady declines in inpatient hysterectomies. It remains unclear what factors have contributed to trends in outpatient benign hysterectomy (BH), as well as whether these trends exacerbate disparities. Materials and methods: Retrospective cohort of 527,964 women ≥18 years old who underwent BH from 2008 to 2014. BH surgical approaches included: open/abdominal hysterectomy (AH), vaginal hysterectomy (VH), laparoscopic hysterectomy (LH), and robotic-assisted hysterectomy (RH). Quarterly frequencies were calculated by care setting and surgical approach. We used multilevel logistic regression (MLR) using the most recent year of data (2014) to examine the influence of patient-, physician-, and hospital-level preoperative factors and surgical approaches on outpatient migration. Results: From 2008–2014, surgical approaches for LH and RH increased, which coincided with decreases in VH and AH. Overall, a 44.2% shift was observed from inpatient to outpatient settings (P<0.0001). Among all outpatient visits MIS increased, particularly for RH (3.6% to 41.07%). We observed increases in the proportion of non-Hispanic Black and Medicaid patients who obtained MIS in 2014 vs. 2008 (P<0.001). Surgical approach (51.8%) and physician outpatient MIS experience (19.9%) had the greatest influence on predicting outpatient BH. Compared with LH, RH was associated with statistically significantly higher likelihood of outpatient BH overall (OR 1.23; 95% CI, 1.16–1.31), as well as in sub-analyses of more complex cases and hospitals that performed ≥1 RH (P<0.05). Conclusion: From 2008–2014, rates of LH and RH significantly increased. A significant shift from inpatient to outpatient setting was observed. These findings suggest that RH may facilitate the shift to outpatient BH, particularly for patients with complexities. The adoption of MIS in outpatient settings may improve access to disadvantaged patient groups. [ABSTRACT FROM AUTHOR]

It is important for clinicians and community members to receive up-todate information about the microbiological and elemental composition of local water supplies. Clinicians play an important role in helping their patients to interpret water quality data and understand the potential impact of water quality on their health. Expanding the medical school curriculum to include environmental health, public health and health disparities--including disparities related to environmental quality and waterborne hazards--is key to clinician's fulfilling this role. [ABSTRACT FROM AUTHOR]

Opioid use disorder is a serious public health problem. Management with buprenorphine is an effective, office-based, medication-assisted treatment, but 60.1% of rural counties in the United States lack a physician with a Drug Enforcement Agency waiver to prescribe buprenorphine. This national study surveyed all rural physicians who have received a waiver in the United States and found that those who were not actively prescribing buprenorphine reported significantly more barriers than those who were, regardless of whether they were treating the maximum number of patients their waiver allowed. These findings suggest the need for tailored strategies to address barriers to providing buprenorphine for opioid use disorder and to support physicians who are adding or maintaining this service. [ABSTRACT FROM AUTHOR]

Background: Shortages and imbalances in physician workforce distribution between urban and rural and among the different regions in Ethiopia are enormous. However, with the recent rapid expansion in medical education training, it is expected that the country can make progress in physician workforce supply. Therefore, the aim of this study was to examine the distribution of physician workforce in Ethiopia and assess the role of retention mechanisms in the reduction of physician migration from the public health sector of Ethiopia. Methods: This organizational survey examined physician workforce data from 119 hospitals from 5 regions (Amhara, Oromia, Southern Nations Nationalities and Peoples Region [SNNPR], Tigray, and Harari) and 2 city administrations (Addis Ababa and Dire Dawa City). Training opportunity, distribution, and turnover between September 2009 and July 2015 were analyzed descriptively. Poisson regression model was used to find the association of different covariates with physician turnover. Results: There were 2,300 medical doctors in 5 regions and 2 city administrations in ~6 years of observations. Of these, 553 (24.04%) medical doctors moved out of their duty stations and the remaining 1,747 (75.96%) were working actively. Of the actively working, the majority of the medical doctors, 1,407 (80.5%), were males, in which 889 (50.9%) were born after the year 1985, 997 (57%) had work experience of <3 years, and most, 1,471 (84.2%), were general practitioners. Within the observation period, physician turnover among specialists ranged from 21.4% in Dire Dawa to 43.3% in Amhara region. The capital, Addis Ababa, was the place of destination for 32 (82%) of the physicians who moved out to other regions from elsewhere in the country. The Poisson regression model revealed a decreased incidence of turnover among physicians born between the years 1975 and 1985 (incident rate ratio [IRR]: 0.63; 95% confidence interval [CI]: 0.51, 0.79) and among those who were born prior to 1975 (IRR: 0.24; 95% CI: 0.17, 0.34) compared to those who were born after 1985. Female physicians were 1.4 times (IRR: 1.44; 95% CI: 1.14, 1.81) more likely to move out from their duty stations compared to males. In addition, physicians working in district hospitals were 2 times (IRR: 2.14; 95% CI: 1.59, 2.89) more likely to move out and those working in general hospitals had 1.39 times (IRR: 1.39; 95% CI: 1.08, 1.78) increased rate of turnover in comparison with those who were working in referral hospitals. Physicians working in the Amhara region had 2 times (IRR: 2.01; 95% CI: 1.49, 2.73) increased risk of turnover in comparison with those who were working in the capital, Addis Ababa. The probability of migration did not show a statistically significant difference in all other regions (P>0.05). Conclusion: The public health sector physician workforce largely constituted of male physicians, young and less experienced. High turnover rate among females, the young and less experienced physicians, and those working in distant places (district hospitals) indicate the need for special attention in devising human resources management and retention strategies. [ABSTRACT FROM AUTHOR]

Objectives. To evaluate recent levels and trends in trust in sources of health information on e-cigarettes in the United States. Methods. We obtained data from nationally representative samples of adults in 2015 (n = 5389), 2016 (n = 5273), and 2017 (n = 5389) that reported trust in 13 sources of health information on e-cigarettes in the United States. We used weighted linear regression models to examine temporal trends in trust levels. Results. Doctors, health organizations, the Centers for Disease Control and Prevention (CDC), health experts and scientists, the National Institutes of Health (NIH), the Food and Drug Administration (FDA), and family and friends were trusted, whereas news media, e-cigarette users, social media, vape shop employees, and e-cigarette and cigarette companies were distrusted. From 2015 to 2017, trust significantly increased for CDC, FDA, health experts and scientists, and news media (P s <.01). Trust also increased for NIH between 2016 and 2017 (P <.01). Conclusions. US adults trust public health sources and distrust entities with commercial interest in e-cigarettes. This suggests that evidence-based messaging and information on health effects of e-cigarettes from public health professionals can effectively counter e-cigarette promotion and improve public understanding about e-cigarettes. [ABSTRACT FROM AUTHOR]

Background: There is sufficient evidence that monetary incentives are effective in increasing survey response rates in the general population as well as with physicians. The objective of this study was to assess the impact of a monetary incentive intended for administrative assistants on the survey response rate of physicians in leadership positions.Methods: This was an ancillary study to a national survey of chairs of academic Departments of Medicine in the United States about measuring faculty productivity. We randomized survey participants to receive or not receive a $5 gift card enclosed in the survey package. The cover letter explained that the gift card was intended for the administrative assistants as a "thank you for their time." We compared the response rates between the 2 study arms using the Chi-square test.Results: Out of 152 participants to whom survey packages were mailed to, a total of 78 responses were received (51 % response rate). The response rates were 59 % in the incentive arm and 46 % in the no incentive arm. The relative effect of the incentive compared to no monetary incentive was borderline statistically significant (relative risk (RR) = 1.36, 95 % confidence interval (CI) 0.99 to 1.87; p = 0.055).Conclusion: Monetary incentives intended for administrative assistants likely increase the response rate of physicians in leadership positions. [ABSTRACT FROM AUTHOR]

Background: Inhalant use by adolescents is cause for concern due to the early age of inhalant use initiation and the many short- and long-term health consequences that can occur concurrently with and subsequent to use. However, inhalant use research has been limited relative to the literature available on other drug use.Objectives: The present research examined long-term trends in inhalant use prevalence, demographic risk factors of inhalant use, and median grade level of first use.Methods: Monitoring the Future data from 1991 to 2011, which includes information drawn from United States eighth, tenth, and twelfth graders, were examined. The total sample comprised more than one million participants. Results were examined descriptively with figures and quantitatively with mixed-effects regression models of the effect of time on use rates.Results: Inhalant use prevalence rates generally declined over the selected period. Though rates of use by males and females decreased significantly, the proportion of females among lifetime users increased significantly. Whites, Hispanics, and members of uncategorized “other” ethnicities showed the highest prevalence rates. Although the proportion of Whites among lifetime users decreased significantly, the proportion of Hispanics and “other” ethnicities increased significantly. The median first use was between sixth and ninth grade.Conclusions/Importance: Results suggest a need to tailor inhalant use treatment and prevention programs to the needs of specific demographic groups and to target interventions early to prevent youth inhalant use. Strengths, limitations, and directions for future research are discussed. [ABSTRACT FROM PUBLISHER]

The article discusses issues concerning public health and clinical issues associated with expedited partner therapy in the U.S.

The objective of this study was to estimate the dollar amount of nongovernment philanthropic spending on public health activities in the United States. Health expenditure data were derived from the US National Health Expenditures Accounts and the US Census Bureau. Results reveal that spending on public health is not disaggregated from health spending in general. The level of philanthropic spending is estimated as, on average, 7% of overall health spending, or about $150 billion annually according to National Health Expenditures Accounts data tables. When a point estimate of charity care provided by hospitals and office-based physicians is added, the value of nongovernment philanthropic expenditures reaches approximately $203 billion, or about 10% of all health spending annually. [ABSTRACT FROM AUTHOR]

The article discusses ethical aspects related to the Tuskegee Syphilis Study that was initiated in the U.S. in 1932. In the study, over 400 African-American men with late stage syphilis were never told they were in a 40 year long,1932-72, experiment sponsored by the United States Public Health Service to study "untreated syphilis in the male Negro." The men were not directly offered treatment, even though they were told that the aspirins, tonics, and rubs were to help cure their "bad blood". With the support of community based physicians and nurses, the local standard of "no care" in Alabama's "black belt" became an orchestrated reality, even after penicillin became widely available in the late 1940s.

Starting in the 1950s, physicians and researchers began to debate the exact nature of the relationship among blood cholesterol, diet, and cardiovascular risk. Using professional medical, public health, and scientific journals, this article examines the history of a series of intense and sustained debates regarding the credibility of the diet-heart hypothesis, which proposed that diet was causally linked to coronary artery disease. Brought about by intellectual disagreements and illuminated by personal quarrels, these debates created a profound professional rift among researchers who debated whether observational data could be used to prove that dietary intake caused heart disease and who sought to differentiate between "good" and "bad" science. But while the debate persisted into the early 1980s, Americans had begun to adopt the diet-heart hypothesis as public health truth as early as the 1960s, embracing cookbooks promoting "heart healthy" diets that promised to prevent coronary artery disease. Although critics and advocates of diet-heart continued to debate the theory' s finer points, the widespread adoption of diet-heart in American homes meant that the debate had become almost moot by the time the National Heart, Lung, and Blood Institute officially endorsed the hypothesis in the 1980s. [ABSTRACT FROM AUTHOR]

Data from a national probability sample of drug stores show that condom sales rose from 240 million annually in 1986 to 299 million in 1988. The greatest increase occurred in 1987 after the Surgeon General's report on AIDS was released. Sales of latex condoms with spermicide rose 116 percent. Sales of other types of condoms increased less. These data suggest that Americans are using more condoms and probably more effective condoms in response to AIDS education. (Am J Public Health 1990; 80:607-608.) [ABSTRACT FROM AUTHOR]

As the US health care delivery system undergoes rapid transformation, there is an urgent need to define a comprehensive, evidence-based role for the family physician. A Role Definition Group made up of members of seven family medicine organizations developed a statement defining the family physician's role in meeting the needs of individuals, the health care system, and the country. The Role Definition Group surveyed more than 50 years of foundational manuscripts including published works from the Future of Family Medicine project and Keystone III conference, external reviews, and a recent Accreditation Council on Graduate Medical Education Family Medicine Milestones definition. They developed candidate definitions and a "foil" definition of what family medicine could become without change. The following definition was selected: "Family physicians are personal doctors for people of all ages and health conditions. They are a reliable first contact for health concerns and directly address most health care needs. Through enduring partnerships, family physicians help patients prevent, understand, and manage illness, navigate the health system and set health goals. Family physicians and their staff adapt their care to the unique needs of their patients and communities. They use data to monitor and manage their patient population, and use best science to prioritize services most likely to benefit health. They are ideal leaders of health care systems and partners for public health." This definition will guide the second Future of Family Medicine project and provide direction as family physicians, academicians, clinical networks, and policy-makers negotiate roles in the evolving health system. [ABSTRACT FROM AUTHOR]

We review how the IDSA Emerging Infections Network contributes to clinical infectious disease and public health investigations while linking investigators from both fields. We describe future directions and outline opportunities to close the gap between clinical medicine and public health.In 1995, the Centers for Disease Control and Prevention granted a Cooperative Agreement Program award to the Infectious Diseases Society of America to develop a provider-based emerging infections sentinel network, the Emerging Infections Network (EIN). Over the past 17 years, the EIN has evolved into a flexible, nationwide network with membership representing a broad cross-section of infectious disease physicians. The EIN has an active electronic mail conference (listserv) that facilitates communication among infectious disease providers and the public health community, and also sends members periodic queries (short surveys on infectious disease topics) that have addressed numerous topics relevant to both clinical infectious diseases and public health practice. The article reviews how the various functions of EIN contribute to clinical care and public health, identifies opportunities to further link clinical medicine and public health, and describes future directions for the EIN. [ABSTRACT FROM AUTHOR]

In 1988, Surgeon General C. Everett Koop published “Understanding AIDS,” the nation's first and only direct mailing sent to every private home in the country. His appeals therein were driven by what we label authoritative metaphors. Communicated by and/or attributed to persons of authority, authoritative metaphors capitalize on the symbolic force of sanctioned power by appealing to the ethos of office. In “Understanding AIDS,” we find that Koop drew from his positions as a surgeon and a general, respectively, to equate AIDS with an unprecedented plague and an unprecedented war. He created new authoritative metaphors out of the vestiges of familiar metaphors related to disease and public health and thereby portrayed AIDS as a recognizable but decisively unique dilemma requiring distinct preventative behaviors. [ABSTRACT FROM PUBLISHER]

Background: The United States Department of Defense participates in more than 500 missions every year, including humanitarian assistance and disaster relief, as part of medical stability operations. This study assessed perceptions of active-duty physicians regarding these activities and related these findings to the retention and overall satisfaction of healthcare professionals. Methods and Findings: An Internet-based survey was developed and validated. Of the 667 physicians who responded to the survey, 47% had participated in at least one mission. On a 7-point, Likert-type response scale, physicians reported favorable overall satisfaction with their participation in these missions (mean  = 5.74). Perceived benefit was greatest for the United States (mean  = 5.56) and self (mean  = 5.39) compared to the target population (mean  = 4.82). These perceptions were related to participants' intentions to extend their military medical service (total model R2  = .37), with the strongest predictors being perceived benefit to self (β = .21, p<.01), the U.S. (β = .19, p<.01), and satisfaction (β = .18, p<.05). In addition, Air Force physicians reported higher levels of satisfaction (mean  = 6.10) than either Army (mean  = 5.27, Cohen's d = 0.75, p<.001) or Navy (mean  = 5.60, Cohen's d  = 0.46, p<.01) physicians. Conclusions: Military physicians are largely satisfied with humanitarian missions, reporting the greatest benefit of such activities for themselves and the United States. Elucidation of factors that may increase the perceived benefit to the target populations is warranted. Satisfaction and perceived benefits of humanitarian missions were positively correlated with intentions to extend time in service. These findings could inform the larger humanitarian community as well as military medical practices for both recruiting and retaining medical professionals. [ABSTRACT FROM AUTHOR]

Given the rapidly changing demographics of the Unites States population, the diversification of the health care workforce is essential for providing all residents with culturally and linguistically appropriate care. Community health centers (CHCs) play a critical role in the provision of health care to the most needy U.S. residents, and their patient populations typically include multiple ethnic minority groups as well as new immigrants. As such, CHCs are not only particularly aware of the challenges inherent in developing and managing a diverse workforce that reflects those they serve, but they have also developed many promising practices to overcome these challenges. In the process of documenting these challenges and best practices in a sample of Massachusetts CHCs a number of valuable insights emerged which we present herein. Specifically, we suggest six propositions, grounded in a social ecological framework, to guide future research endeavors aimed at further understanding the intricate diversity dynamics in the health care workforce. [ABSTRACT FROM AUTHOR]

The article presents a discussion of the moral obligations that physicians have to work towards the elimination of social inequities and health disparities that adversely effect public health. A discussion of the implications that the moral obligations have on medical education and on medical ethics education is presented. Research which has investigated the moral and ethical obligations of physicians is discussed.