Mailing Address Research Articles

Availability of health workforce in urban and rural areas in relation to Canadian seniors.

Geographic imbalances in health human resources exist in a health care system when the composition, level, or use of health care providers does not lead to the same optimal health-system goals in all regions. This can lead to inequitable distribution of health care services, particularly for rural and remote populations. This study aims to determine to what extent the distribution of regulated health professionals and seniors in urban and rural areas of the Canadian jurisdictions is different from one another and from the national average. Data used in this study are for the 2016 calendar year. Information about physicians was obtained from the Canadian Institute for Health Information (CIHI) Scott's Medical Database. The data for nurses (nurse practitioners, registered nurses, and licensed practical nurses) were also sourced from CIHI, Health Workforce Database. Geographic information is based on the postal code of physicians' preferred mailing address, and the residence in the case of nurses and the population. Using the Statistical Area Classification from Statistics Canada, each physician and nurse was assigned to either an urban metropolitan, urban non-metropolitan, or rural/remote area. Findings indicate that there were twice as many nurses per 1000 seniors in urban Canada than in rural Canada. However, this gap was threefold in the case of physicians. Provinces with the largest and lowest gap and international comparisons are also provided. Three broad strategies are offered for policymakers in order to mitigate this health workforce imbalance and reduce the regional shortage of nurses and physicians.

Examining the cross-cultural attitudes of Qataris and expatriates in Qatar, the host country of 2022 World Cup

Purpose The purpose of this paper is to examine how residents in Qatar, the host country of the 2022 World Cup, interact, socialize and acculturate in order to create a more harmonic society, a critical factor for the event delivery and preparations. Design/methodology/approach Data were collected from Qatari nationals and expatriates residing in the country of Qatar using a survey. A stratified random sampling approach was applied using as sampling framework all households having a mailing address with the country’s electric company. In total, 2,398 Qataris were contacted and 1,020 completed the survey. From the expatriate population, 1,852 were contacted and 1,134 completed the survey. Findings The results showed Qatari nationals were favorable toward Arab and Asian expatriates but not as favorable as Arab and Asian expatriates were toward them. Both groups of residents showed high quality of life (QOL) perceptions, with the locals having slightly higher QOL. Finally, Asian expatriates were more open to socializing with the locals and Arab expatriates. Research limitations/implications The results of the study shed light into the acculturation process in host societies of mega sport events such as the 2022 World Cup in Qatar. Originality/value This is the first study that examined a mega event’s host country resident’s cultural interactions to identify potential issues that can arise and interfere with the event experience of the 2022 World Cup in a very diverse society.

Recontacting Patients with Updated Genetic Testing Recommendations for Medullary Thyroid Carcinoma and Pheochromocytoma or Paraganglioma.

No guidelines exist regarding physicians' duty to inform former patients about novel genetic tests that may be medically beneficial. Research on the feasibility and efficacy of disseminating information and patient opinions on this topic is limited. Adult patients treated at our institution from 1950 to 2010 for medullary thyroid cancer, pheochromocytoma, or paraganglioma were included if their history suggested being at-risk for a hereditary syndrome but genetic risk assessment would be incomplete by current standards. A questionnaire assessing behaviors and attitudes was mailed 6weeks after an information letter describing new genetic tests, benefits, and risks was mailed. Ninety-seven of 312 (31.1%) eligible patients with an identified mailing address returned the questionnaire. After receiving the letter, 29.2% patients discussed genetic testing with their doctor, 39.3% considered pursuing genetic testing, and 8.5% underwent testing. Nearly all respondents (97%) indicated that physicians should inform patients about new developments that may improve their or their family's health, and 71% thought patients shared this responsibility. Most patients understood the letter (84%) and were pleased it was sent (84%), although 11% found it upsetting. Patients believe it is important for physicians to inform them of potentially beneficial developments in genetic testing. However, physician-initiated letters to introduce new information appear inadequate alone in motivating patients to seek additional genetic counseling and testing. Further research is needed regarding optimal methods to notify former patients about new genetic tests and corresponding clinical and ethical implications.

ASSESSING A SUSTAINABLE DEVELOPMENT MODEL FOR ORGANIC AGRICULTURE: THE EXAMPLE OF LEISURE FARMS IN TAIWAN

This study explores the sustainable development of organic farms and organic farming in Taiwan by analyzing leisure services and the relationship between farmers and their entrepreneurial goals. Internet searches were used to identify 120 organic leisure farms in Taiwan with their own websites, which were subjected to content analysis. The researchers then mailed questionnaires to each Taiwanese organic farm for which a full mailing address could be located. A total of 403 valid questionnaires were obtained. Analysis of the results shows that the websites of Taiwan s organic leisure farms feature content related to three main areas: tourism and leisure, the farming experience, and environmental education. Three types of content important to organic farms are correlated with the business objectives of farmers: the non-economic objectives of farm operators are categorized into family relationships and individual pursuits, whereas their economic objectives are categorized into profitability and marketing opportunities. Finally, this study suggests that organic leisure farming, in addition to combining tourism and leisure, helping the environment, and fulfilling educational needs, significantly improves farm operators family relationships and individual pursuits, increases profitability, and provides additional marketing opportunities.

Identifying Homeless Medicaid Enrollees Using Enrollment Addresses.

To design and test the validity of a method to identify homelessness among Medicaid enrollees using mailing address data. Enrollment and claims data on Medicaid expansion enrollees in Hennepin and Ramsey counties who also provided self-reported information on their current housing situation in a psychosocial needs assessment. Construction of address-based indicators and comparison with self-report data. Among 1,677 enrollees, 427 (25 percent) self-reported homelessness, of whom 328 (77 percent) had at least one positive address indicator. Depending on the type of addresses included in the indicator, sensitivity to detect self-reported homelessness ranged from 30 to 76 percent and specificity from 79 to 97 percent. An address-based indicator can identify a large proportion of Medicaid enrollees who are experiencing homelessness. This approach may be of interest to researchers, states, and health systems attempting to identify homeless populations.

A Refugee Comes Home and Wonders How She Got There

A Refugee Comes Home and Wonders How She Got There Basevich Elvira (bio) The way home we seek is that condition of man's being at home in the world. —Ralph Ellison I've arrived in this country before; in this very century,maudlin cashier girls and ticket agentsminister to my physical body,my need for clothes and toothpaste and a mailing address. The miracle of walking home in the eveningto my assortment of things—a photographfallen behind a mirror, a minor constellation of notebooks,a packet of flour that I've neglected, now a bacchanalia of moths that my roommateinforms me originate from northern Europeand have learned to consume the clothes that I can't afford,the grain that I now can't use and yet, it's a stroke of luck, really—as you know—to have this little cornerof the earth: the traffic lights burst into my bedroomlike an overexcited childbefore resuming its triumphant departure into the world, the long, lapis exhalation of autumnin the floorboards and the windowpanes, obscured by half-flowered buds [End Page 343] and sparrows,the used-up rag floating in the kitchen sink— each proof that god was on our side all those years ago.That I've been elected with a keyand a bedroom window—with my own life that I can take into the city tomorrow and station in the public library for hours,writing apology letters to Sor Juana Inés de la Cruzbecause I regularly abandonmy craft, as in later tonight, when I will go out dancing in Brooklyn, and will be drunk and happy.For it's no small matter to learn to apologize a little lessfor one's own life. That a refugee crowdedinto a train car or the hold of a decrepit cargo ship was not indulging in life but belonged to it,even as her limbs disarticulate under the hard muscle of the sea,where she will remain alone in the dark, indefinitely.One day, perhaps, that darkness too might speak, maybe even go out dancing, and—who knows?—get married and throw a lavish wedding partybecause life will cast off its merchants, all of them,who elect some into the world and un-elect others, as if it were all the same, a small matter of detail.When one looks from a sufficient distance,it is hard to tell a human bone from a fish bone,a girl from her screaming ghost,and the earth from the undifferentiated darkness through which it floats. [End Page 344] Basevich Elvira Elvira Basevich is assistant professor of philosophy at the University of Michigan, Dearborn. She specializes in social and political philosophy, ethics, Africana philosophy, feminist philosophy, and the history of philosophy. She can be reached at basevich@umich.edu. Copyright © 2017 Elvira Basevich

Household Incomes in Tax Data: Using Addresses to Move from Tax Unit to Household Income Distributions

Tax return data are increasingly the standard for tracking income statistics in the United States. However, these data have traditionally been limited by their inability to capture non-filers and to identify members of separate tax units living in the same household. We overcome these obstacles and create household records directly in the tax data using mailing address information included on tax forms. We then present the first set of tax-based household income and inequality measures for the entire income distribution. When comparing household income inequality results in the tax data to those using the March CPS, we confirm previous findings that the March CPS understates the inequality of household income. However, we also find that the previous approach of using tax units in the IRS data to proxy for households leads to an overstatement of household income inequality. Finally, using households in the IRS tax records, we illustrate how focusing on tax units rather than households alters the observed distribution of tax programs such as the Earned Income Tax Credit.

Patient responses to research recruitment and follow-up surveys: findings from a diverse multicultural health care setting in Qatar.

BackgroundHealth care researchers working in the Arabian Gulf need information on how to optimize recruitment and retention of study participants in extremely culturally diverse settings. Implemented in Doha, Qatar in 2012 with 4 language groups, namely Arabic, English, Hindi, and Urdu, this research documents persons’ responses to recruitment, consent, follow-up, and reminder procedures during psychometric testing of the Multicultural Assessment Instrument (MAI), a novel self- or interviewer-administered survey.MethodsBilingual research assistants recruited adults in outpatient clinics by approaching persons in particular who appeared to be from a target language group. Participants completed the MAI, a second acculturation instrument used for content-validity assessment, and a demographics questionnaire. Participants were asked to take the MAI again in 2–3 weeks, in person or by post, to assess test-retest reliability. Recruitment data were analyzed by using nonparametric statistics.ResultsOf 1503 persons approached during recruitment, 400 enrolled (27 %)—100 per language group. The enrollment rates in the language groups were: Arabic-32 %; English-33 %; Hindi-18 %; Urdu-30 %. The groups varied somewhat in their preferences regarding consent procedure, follow-up survey administration, contact mode for follow-up reminders, and disclosure of personal mailing address (for postal follow-up). Over all, telephone was the preferred medium for follow-up reminders. Of 64 persons who accepted a research assistant’s invitation for in-person follow-up, 40 participants completed the interview (follow-up rate, 63 %); among 126 persons in the postal group with a deliverable address, 29 participants mailed back a completed follow-up survey (response rate, 23 %).ConclusionsResearchers in the Arabian Gulf face challenges to successfully identify, enroll, and retain eligible study participants. Although bilingual assistants—often from the persons’ own culture—recruited face-to-face, and our questionnaire contained no health care-related content, many persons were reluctant to participate. This occurrence was observed especially at follow-up, particularly among participants who had agreed to follow-up by post.

Preliminary needs assessment of mobile technology use for healthcare among homeless veterans.

Background. Homeless veterans have complex healthcare needs, but experience many barriers to treatment engagement. While information technologies (IT), especially mobile phones, are used to engage patients in care, little is known about homeless veterans’ IT use. This study examines homeless veterans’ access to and use of IT, attitudes toward health-related IT use, and barriers to IT in the context of homelessness.Methods. Qualitative interviews were conducted with 30 homeless veterans in different housing programs in Boston, MA, ranging from emergency shelters to supportive transitional housing that allow stays of up to 2 years. Interviews were conducted in person, audio recorded and then transcribed. Three researchers coded transcripts. Inductive thematic analysis was used.Results. Most participants (90%) had a mobile phone and were receptive to IT use for health-related communications. A common difficulty communicating with providers was the lack of a stable mailing address. Some participants were using mobile phones to stay in touch with providers. Participants felt mobile-phone calls or text messages could be used to remind patients of appointments, prescription refills, medication taking, and returning for laboratory results. Mobile phone text messaging was seen as convenient, and helped participants stay organized because necessary information was saved in text messages. Some reported concerns about the costs associated with mobile phone use (calls and texting), the potential to be annoyed by too many text messages, and not knowing how to use text messaging.Conclusion. Homeless veterans use IT and welcome its use for health-related purposes. Technology-assisted outreach among this population may lead to improved engagement in care.

The Results Are Only as Good as the Sample: Assessing Three National Physician Sampling Frames.

Databases of practicing physicians are important for studies that require sampling physicians or counting the physician population in a given area. However, little is known about how the three main sampling frames differ from each other. Our purpose was to compare the National Provider and Plan Enumeration System (NPPES), the American Medical Association Masterfile and the SK&A physician file. We randomly sampled 3000 physicians from the NPPES (500 in six specialties). We conducted two- and three-way comparisons across three databases to determine the extent to which they matched on address and specialty. In addition, we randomly selected 1200 physicians (200 per specialty) for telephone verification. One thousand, six hundred and fifty-five physicians (55 %) were found in all three data files. The SK&A data file had the highest rate of missing physicians when compared to the NPPES, and varied by specialty (50 % in radiology vs. 28 % in cardiology). NPPES and SK&A had the highest rates of matching mailing address information, while the AMA Masterfile had low rates compared with the NPPES. We were able to confirm 65 % of physicians' address information by phone. The NPPES and SK&A had similar rates of correct address information in phone verification (72-94 % and 79-92 %, respectively, across specialties), while the AMA Masterfile had significantly lower rates of correct address information across all specialties (32-54 % across specialties). None of the data files in this study were perfect; the fact that we were unable to reach one-third of our telephone verification sample is troubling. However, the study offers some encouragement for researchers conducting physician surveys. The NPPES and to a lesser extent, the SK&A file, appear to provide reasonably accurate, up-to-date address information for physicians billing public and provider insurers.

The Rate of Pregnancy Loss in Von Willebrand Disease: A Cross-Sectional Study

Pregnancy and delivery represent a major hemostatic challenge in von Willebrand disease (VWD). In addition to maintaining adequate hemostasis, von Willebrand factor (VWF) is an important regulator of angiogenesis, with angiodysplasia contributing to morbidity in patients with VWD. Placental development is complex, with vascular development important for fetal growth and viability. It has been hypothesized that antepartum bleeding or abnormal placental angiogenesis may lead to pregnancy loss in women with VWD. Large studies have reported an increased risk of postpartum bleeding in patients with VWD, however, little information is available for rates of pregnancy loss. We conducted a cross-sectional study to determine the rate of pregnancy loss in women with VWD, when compared to a control population. We invited all women with VWD followed by the Southern Alberta Rare Blood and Bleeding Disorders Comprehensive Care Program to participate in an online or paper questionnaire, along with a control group of women without VWD identified through a low-risk obstetrical clinic in Calgary, Alberta. We included patients who were 18 years of age or older with a diagnosis of VWD, defined as VWF antigen and activity levels less than 50 percent or a historical diagnosis, in combination with a bleeding score of 4 or more (condensed MCMDM-1 bleeding questionnaire). Patients were excluded if they had no past pregnancies, no mailing address, or had an alternative bleeding disorder. Our 20-item questionnaire was reviewed and pre-tested by hematologists, obstetricians and laypeople. With patient consent, data was supplemented from clinical and hospital records to verify and expand on the information collected in the questionnaire. The primary outcome was the incidence of spontaneous abortion (fetal loss <20 weeks) or late pregnancy loss (≥20 weeks) in women with VWD. The secondary outcomes were antepartum and postpartum bleeding. Data on co-morbidities including placental abnormalities were also collected. Confidence intervals for proportions were calculated using the Wilson’s score method. Groups were compared using χ2 testing, with p values < 0.05 considered significant. Of the 98 women with VWD who met the study inclusion criteria, 31 (32%) completed the questionnaire. The mean bleeding score was 10.3 in VWD patients (SD 3.6). The majority (81%) of participants were diagnosed with Type 1 VWD, with 16% and 3% diagnosed as Type 2 and 3 VWD, respectively. Twenty-two women in the control group completed the questionnaire. The mean age at recruitment was 46.1 (SD 13.7) and 32.6 (SD 4.2) in the VWD and control group, respectively. There were 83 and 48 pregnancies in the VWD and control group, respectively. Two women in the VWD group and 1 woman in the control group had an elective pregnancy termination. In women with VWD, the rate of pregnancy loss was 24.7% out of 81 pregnancies (95% confidence interval 16.6-35.1), with 17 (85%) losses occurring less than 20 weeks, and 3 (15%) with unknown timing. In contrast, the rate of pregnancy loss in the control group was 12.8% (95% CI 5.96-25.17) (p=0.106), all occurring less than 20 weeks. In 83 pregnancies, the number of antepartum bleeding episodes in VWD women was 45 (29 first trimester, 9 second trimester, 7 third trimester), compared to the control group (9 first trimester, 3 second trimester, 1 third trimester) in 48 pregnancies. More women with VWD reported excessive postpartum bleeding compared to controls (56.7% versus 13.6%, p=0.002), with more delayed (>24 hour) bleeding post-delivery in women with VWD. In VWD women with and without pregnancy loss, there was no difference in mean bleeding score (9.7 vs. 10.9). There was also no difference in cases of pre-eclampsia, placental abruption or gestational hypertension in VWD women with and without pregnancy loss. Two VWD patients with previous pregnancy loss developed gastrointestinal angiodysplasia later in life. There was no significant increase in the rate of pregnancy loss in women with VWD, however, a larger cohort study is needed to confirm the rate of pregnancy loss before further conclusions can be made. Disclosures No relevant conflicts of interest to declare.

Epidural Analgesia Use in Women with Von Willebrand Disease

▪There is little safety data available on the use of epidural analgesia during pregnancy in women with von Willebrand disease (VWD), a common disorder comprising up to 0.1% of the population. Despite physiological increases in von Willebrand factor antigen and activity levels to normal or near levels during third trimester in Type 1 VWD patients, epidural analgesia use is varied and often withheld. We conducted a cross-sectional questionnaire in order to further characterize the local practice and provide additional safety data on epidural use in the VWD population.We invited all women with VWD followed by the Southern Alberta Rare Blood and Bleeding Disorders Comprehensive Care Program to participate in an online or paper questionnaire. The questionnaire was part of a larger study identifying pregnancy complications in VWD, with additional questions collected on the diagnosis and severity of VWD, epidural use and associated outcomes, as well as the perceived contraindications of epidural analgesia. All questions were pre-tested by hematologists, obstetricians and laypeople. With patient consent, supplemental data was collected from clinic and hospital records. We included patients who were 18 years of age or older with a diagnosis of VWD, defined as von Willebrand factor (VWF) antigen and activity levels less than 50 percent or a historical diagnosis, in combination with a bleeding score of 4 or more (condensed MCMDM-1 bleeding questionnaire). Patients were excluded if they had no past pregnancies, no mailing address, or had an alternative bleeding disorder. Confidence intervals for proportions were calculated using the Wilson’s score method.Of the 98 women with VWD who met the study inclusion criteria, 31 (32%) completed the questionnaire. There were 25 (81%) diagnosed with Type 1, 5 (16%) with Type 2, and 1 (3%) with Type 3 VWD. The mean bleeding score was 10.3 (SD 3.6). There were a total of 83 pregnancies (mean 2.7, range 1-6), with 60 deliveries assessed because of 20 pregnancy losses, 2 elective terminations, and 1 patient currently pregnancy. Of the 60 deliveries, the rate of epidural use was 28.3% (95% confidence interval 18.5-40.8, n=17). All epidural analgesia use was reported in women with Type 1 VWD. Of the 43 pregnancies without an epidural, the stated reasons were as follows: 10 because of concern for bleeding (23.3%), 25 because of personal preference (58.1%), 7 'other’ (16.3%), and 1 participant without a response (2.3%). In the 10 pregnancies where an epidural was not used due to bleeding concerns, 6 patients had Type 1 VWD and 1 patient had Type 2N VWD.The outcome of epidural use in the VWD population was reassuring, 2 women reported their epidural analgesia to be ineffective, and 4 women reported neurological symptoms such as numbness, tingling or weakness. All neurological symptoms were temporary with no persistent deficits or documented complication of bleeding.Due to the retrospective nature of this study, VWF antigen and activity levels at the time of delivery were not available, limiting the conclusions that can be made on the safety of epidural use based on VWF levels. It is our local practice to proceed with epidural analgesia if a patient’s VWF antigen and activity levels measured in third trimester are greater than 50%. For VWF levels less than 50%, epidural analgesia would only be considered with appropriate DDAVP or factor concentrate replacement.In summary, our local rate of epidural use was close to 30% in the VWD population, which was primarily composed of Type 1 VWD patients. Outcome data is reassuring, but a larger cohort study is needed to further quantify rare risks such as neuraxial bleeding. DisclosuresNo relevant conflicts of interest to declare.

It Makes a Village: Residential Relocation after Charter School Admission

Although numerous studies investigate how student achievement is impacted by educational vouchers and charter schools, there appears to be no research on how these programs impact the surrounding environment. This study examines residential relocation of families whose children attend a charter school. We develop a conceptual model that predicts where relocating families are likely to move, given ex ante distance and direction to the school. The model is parameterized using data from student mailing address changes. We find that families are almost twice as likely to relocate toward the school as would be expected if the school did not exert any attraction. Moreover, although families are not required to live near the school, the child's school exerts a significantly stronger attraction than parent workplaces. This result may have important implications for mitigating urban sprawl, fostering urban renewal and promoting sustainable real estate development.

Abstract A20: Wii Can: Merging technology and support from community health advisors

Abstract Introduction and Purpose: Despite the benefits of physical activity, many cancer survivors fail to meet activity recommendations. Moreover, African American cancer survivors are less active than other survivor racial/ethnic groups. To address this disparity, we designed an intervention (Wii Can). Wii Can combines the appeal of emerging technology (Nintendo Wii) with the strength of social support from community health advisors (CHAs). The purpose of the current abstract is to describe the recruitment and retention of CHAs and African American cancer survivors to Wii Can. Methods: CHAs from the NCI-funded Deep South Network (DSN) for Cancer Control were identified and recruited to participate. CHAs completed training to deliver a 12 week intervention to increase physical activity in survivors. The intervention was based on Self Determination Theory. African American colorectal cancer survivors 45 to 75 years old who were not physically active, were recruited primarily through a hospital registry. Results: 10 CHAs were successfully recruited and trained as interventionists. Their mean age was 59.9 ± 3.9 years, 70% were female, 40% had some college, 40% had BA or BS, 20% had associate degrees. On average, they had been a DSN CHA for 3.1 ± 0.99 years. Reasons for deciding to participate in our study as a Wii Can CHA included: Family or friend with cancer; believe physical activity is important in general or for cancer survivors; helping others and being a role model; and encourage black people to participate in studies. All CHAs trained for the study have been retained. 170 letters were mailed to African American CRC survivors to invite their participation in the study. We were able to reach and screen 40 survivors. Incorrect mailing address, deceased, disconnected/incorrect telephone, or lack of interest were some of the reasons we were unable to screen a larger number. Of those screened, 25 were eligible. Of this group, 6 withdrew prior to enrollment (most common reason was lack of time to participate), 16 have received medical clearance to participate in the study (13 of these have enrolled and have been randomized; mean age of enrollees is 61 years). Three participants remain in the recruitment pipeline. The most common reason for ineligibility was currently receiving treatment. Only 2 individuals were ineligible due to already being too physically active. Study participants have been 100% adherent with baseline and follow-up assessments in addition to 100% adherent to receiving the planned intervention sessions (home visits and phone calls). Conclusions: A technology-based physical activity intervention is both acceptable to community health advisors who were trained to deliver the intervention and to African American CRC survivors. Challenges remain for some, as almost one quarter of those interested and eligible later determined that lack of time for the study was a barrier. Further, lack of accurate contact information provided by a hospital registry precluded optimal recruitment. Researchers need to identify efficient ways to engage African American survivors in health promotion interventions if we are to significantly impact the burden of this disease. Funding Acknowledgement: NCI: 1U54CA153719 Citation Format: Michelle Y. Martin, Hon Yuen, Claudia M. Hardy, Maria Pisu. Wii Can: Merging technology and support from community health advisors. [abstract]. In: Proceedings of the Sixth AACR Conference: The Science of Cancer Health Disparities; Dec 6–9, 2013; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2014;23(11 Suppl):Abstract nr A20. doi:10.1158/1538-7755.DISP13-A20

The Impact of Personal Resilience Resources on Psychosocial Outcomes in Parents of Children with Cancer (SA509-C)

1.To understand the relationship between current parent-reported resilience resources and psychosocial outcomes, including psychological distress, health behaviors, social and family function, and communication with the medical team.2.To describe potential and novel interventions designed to target and promote resilience, and subsequently improve patient/family outcomes. Parent psychosocial function can impact the well-being of the entire family. An approach to improving outcomes may be to promote resilience. To evaluate the relationships between parent-reported resilience resources and outcomes such as psychological distress, health behaviors, family function, and communication with the medical team. We hypothesized that lower resilience resources, as measured by the 10-item Connor-Davidson Resilience scale, would be associated with worse outcomes. In this cross-sectional, survey-based study (the “Understanding Resilience in Parents of Children with Cancer” study), comprehensive surveys were mailed to consecutive parents of children with cancer who were treated at Seattle Children's Hospital and had completed therapy or died between 01/01/2009 and 12/31/2010. Parents or legal guardians were eligible if their child had completed therapy or died at least 6 months prior to enrollment, they were English-speaking, and had a valid mailing address. Linear and logistic regression models were used to evaluate the relationships between resilience resources and the following outcomes: parent psychological distress, health-related behaviors, social and family function, and perceived communication with the medical team. One hundred twenty parents (82% of contactable) completed the survey, including 24 bereaved, and 96 non-bereaved. Respondents were mostly mothers. Compared with population norms, non-bereaved parents had lower resilience resources, higher psychological distress, and more commonly reported binge drinking. Conversely, they reported higher social support and family adaptability (P<0.001-0.006). Bereaved parents had similar resilience resources, but higher levels of psychological distress, sleep difficulties, and financial hardship (P<0.05). Among non-bereaved parents, adjusted for sex, lower resilience resources were associated with higher psychological distress, lower social support, and lower family function (P<0.001-0.007). Parents in the lowest quartile of resilience resources had higher odds of reporting frequent sleep difficulties (OR, 5.19; 95% CI, 1.74, 15.45), lower health satisfaction (OR, 5.71; 95% CI, 2.05, 15.92), and decreased ability to express their hopes (OR, 3.08; 95% CI, 1.12, 8.49) or worries (OR, 4.00; 95% CI, 1.43, 11.18) to the medical team. Parents of children with cancer are at risk for poor psychosocial outcomes and those with low resilience resources may be at greater risk.

Prospective effects of the built environment on walking and weight gain

Background: Research shows that the built environment is associated with walking and weight, as land use, density, and transportation systems determine the proximity of destinations and the feasibility of walking to them. Few studies have shown prospective associations between the built environment and these outcomes. Aims: To assess the prospective association between the built environment and changes in walking and weight. Methods: We used 1986-2008 data from the Nurses’ Health Study, a US-based nationwide prospective cohort of female nurses. Using Census and geographic information systems (GIS) data, we created measures of residential density, business counts (as a proxy for land use mix), and intersection counts (as a proxy for street connectivity) based on 1200m line-based buffers around the participant mailing address at each biennial questionnaire. Self-reported weight (in lbs) and walking (converted to metabolic equivalent hours per week (MET hrs/wk)) was asked on each questionnaire. We ran multilevel longitudinal analyses on the relationship between built environment measures and weight or walking. Results: Of 102,885 participants, mean weight at baseline was 147.2 lbs and mean walking was 6.5 MET hrs/wk. After adjusting for age, race, smoking, individual socioeconomic status, and Census tract income and household value, the highest quintile of intersection count, business count, and population density was associated with a -0.09 (95% confidence interval -0.17, -0.02), -0.12 (-0.19, -0.04), and -0.06 (-0.14, 0.02) change in MET hrs/wk of walking per year compared to the lowest quintile, respectively. The highest quintile of intersection count, business count, and population density was associated with a 0.03 (0.01, 0.04), 0.02 (0.00, 0.03), and 0.00 (-0.02, 0.02) lb weight gain per year compared to the lowest quintile, respectively. Conclusions: We found that higher levels of intersection count, business count, and population density were associated with lower levels of walking and higher levels of weight gain.

Racial/Ethnic Differences in Cancer Prevention Beliefs: Applying the Health Belief Model Framework

An understanding of each racial/ethnic group's beliefs about cancer prevention is important for designing/implementing interventions to reduce cancer-health disparities. The Health Belief Model was used to examine racial/ethnic differences in beliefs about cancer and cancer prevention. The data were from the 2007 Health Information National Trends Survey, a biennial, cross-sectional survey using a random-digit-dial telephone frame and a mailing address frame. A weighted, nationally representative sample of American adults. The sample consisted of 7452 individuals. Model construct variables (perceived susceptibility; perceived severity; perceived benefits; perceived barriers; cues to action; self-efficacy) and race/ethnicity were assessed. The Rao-Scott χ(2) test and multivariate logistic regression assessed racial/ethnic differences. The constructs self-efficacy, perceived benefits, and perceived susceptibility were significantly associated with race/ethnicity. The remaining three constructs were not statistically significant. Multivariate analysis revealed Hispanics were less likely to believe they could lower their chances of getting cancer than did African-Americans and whites. Hispanics, Asians, and African-Americans were more likely to believe they had a lower chance of getting cancer in the future than did whites. Culturally relevant health education/promotion interventions need to be developed and tailored to (1) empower Hispanics regarding their ability to prevent cancer and (2) educate racial/ethnic minorities about their susceptibility and risk perception for cancer.

Social exclusion and self-esteem: The impact of the identity – bureaucracy nexus on employed people experiencing homelessness in Calgary, Canada

This article argues that homelessness in Calgary, Canada is entrenched, in part, due to a systemic cycle of exclusion and defensive tactics carried out by those who are homeless and employed. A major proportion of this systemic exclusion occurs via a number of societal institutions: the provincial welfare structure in place to assist those in need; the provincial registry system for identification and licensing; the banking system, employment service providers; and the civil society organizations that provide shelter. Through one-to-one interviews with employed people experiencing homelessness in Calgary (n = 61) we found four identifiers that contribute to maintaining the adverse situation facing those who find themselves homeless: security of, and access to, replacement identification; access to banking; access to a mailing address; and accessibility to stable, permanent employment. Without access to these elements re-establishing social inclusion and navigating the transition to stable housing and non-vulnerable employment is far more difficult.

Availability of Child Passenger Safety Resources to Emergency Physicians Practicing in Emergency Departments Within Pediatric, Adult, and Nontrauma Centers

More can be done to eliminate preventable motor vehicle collision (MVC)-related injuries through correct and consistent use of child passenger restraints. This study sought to determine emergency physician awareness of and referral patterns to child passenger safety resources and to compare awareness and referrals by practice setting. This was a cross-sectional mailed survey of a national random sample of 1200 emergency physicians drawn from the American Medical Association Physician Masterfile. Responses were returned by 638 (64%) of 1000 of physicians with a valid mailing address. Fifty-two percent reported working in an emergency department (ED) within a pediatric trauma center, 23% in an adult trauma center, and 25% in a nontrauma center. Police or fire department car seat installation programs were most frequently available (65% pediatric, 56% adult, 48% nontrauma center), and free/reduced-price booster seat programs least frequently available (46% pediatric, 30% adult, 23% nontrauma center) (P < 0.001). Half of pediatric trauma center physicians would always recommend replacement of a 3-year-old's car seat following a roll-over MVC compared with one third of adult and nontrauma center physicians (P < 0.001). There were no significant differences by practice setting for distribution of discharge instructions containing child passenger safety information or referrals to available resources. Availability of child passenger safety resources for children discharged from EDs following an MVC varies by practice setting. Pediatric injury prevention outreach to general EDs is needed to increase the number of children who are benefiting from existing community child passenger resources.

Gender Differences in the Salaries of Physician Researchers

It is unclear whether male and female physician researchers who perform similar work are currently paid equally. To determine whether salaries differ by gender in a relatively homogeneous cohort of physician researchers and, if so, to determine if these differences are explained by differences in specialization, productivity, or other factors. A US nationwide postal survey was sent in 2009-2010 to assess the salary and other characteristics of a relatively homogeneous population of physicians. From all 1853 recipients of National Institutes of Health (NIH) K08 and K23 awards in 2000-2003, we contacted the 1729 who were alive and for whom we could identify a mailing address. The survey achieved a 71% response rate. Eligibility for the present analysis was limited to the 800 physicians who continued to practice at US academic institutions and reported their current annual salary. A linear regression model of self-reported current annual salary was constructed considering the following characteristics: gender, age, race, marital status, parental status, additional graduate degree, academic rank, leadership position, specialty, institution type, region, institution NIH funding rank, change of institution since K award, K award type, K award funding institute, years since K award, grant funding, publications, work hours, and time spent in research. The mean salary within our cohort was $167,669 (95% CI, $158,417-$176,922) for women and $200,433 (95% CI, $194,249-$206,617) for men. Male gender was associated with higher salary (+$13,399; P = .001) even after adjustment in the final model for specialty, academic rank, leadership positions, publications, and research time. Peters-Belson analysis (use of coefficients derived from regression model for men applied to women) indicated that the expected mean salary for women, if they retained their other measured characteristics but their gender was male, would be $12,194 higher than observed. Gender differences in salary exist in this select, homogeneous cohort of mid-career academic physicians, even after adjustment for differences in specialty, institutional characteristics, academic productivity, academic rank, work hours, and other factors.