Racial and ethnic differences in physician assistant salaries.

Two recent reports using different data sets concluded that female physician assistants (PAs) earn substantially less than male PAs. Similar data comparing the effect of race and ethnicity on salary have not been compiled. This article examines the possibility of racial and ethnic salary disparities in PA salaries using data from the 2009 survey of members of the American Academy of Physician Assistants.

White on black: can white parents teach black adoptive children how to understand and cope with racism?

In this article, the authors examine White parents' endeavors toward the racial enculturation and inculcation of their transracially adopted Black children. Drawing on in-depth interviews, the authors identify and analyze themes across the specific race socialization strategies and practices White adoptive parents used to help their adopted Black children to develop a positive racial identity and learn how to effectively cope with issues of race and racism. The central aim of this article is to examine how these lessons about race help to connect family members to U.S. society's existing racial hierarchy and how these associations position individuals to help perpetuate or challenge the deeply embedded and historical structures of White supremacy. The authors use the notion of White racial framing to move outside of the traditional arguments for or against transracial adoption to instead explore how a close analysis of the adoptive parents' racial instructions may serve as a learning tool to foster more democratic and inclusive forms of family and community.

Nosocomial hepatitis C in a thoracic surgery unit; retrospective findings generating a prospective study.

We describe the transmission of hepatitis C virus (HCV) to two patients from a thoracic surgeon who was unaware of his hepatitis C infection. By partial sequencing of the non-structural 5B gene and phylogenetic analysis, the viruses from both patients were found to be closely related to genotype 1a strain from the surgeon. Two further hepatitis C cases were found in relation to the thoracic clinic. Their HCV sequences were related to each other but were of genotype 2b and the source of infection was never revealed. To elucidate the magnitude of the problem, we conducted a prospective study for a period of 17 months in which patients who were about to undergo thoracic surgery were asked to participate. Blood samples were drawn prior to surgery and at least four months later. The postoperative samples were then screened for anti-HCV and, if positive, the initial sample was also analysed. The only two patients (0.4%) identified were confirmed anti-HCV positive before surgery, and none out of 456 evaluable cases seroconverted to anti-HCV during the observation period. Despite the retrospectively identified cases, nosocomial hepatitis C is rare in our thoracic unit. The study points out the risk of transmission of hepatitis C from infected personnel and reiterates the need for universal precautions.

Racial and Gender Disparities in the Physician Assistant Profession.

OBJECTIVE: To examine whether racial, gender, and ethnic salary disparities exist in the physician assistant (PA) profession and what factors, if any, are associated with the differentials. DATA SOURCES/STUDY SETTING: We use a nationally representative survey of 15,105 PAs from the American Academy of Physician Assistants (AAPA). STUDY DESIGN: We use bivariate and multivariate statistics to analyze pay differentials from the 2009 AAPA survey. PRINCIPLE FINDINGS: Women represent nearly two-thirds of the profession but receive approximately $18,000 less in primary compensation. The differential reduces to just over $9,500 when the analysis includes a variety of other variables. According to AAPA survey, minority PAs tend to make slightly higher salaries than White PAs nationally, although the differences are not statistically significant once the control variables are included in the analysis. CONCLUSIONS: Despite the rough parity in primary salary, PAs of color are vastly underrepresented in the profession. The salaries of women lag in comparison to their male counterparts.

Long-term follow-up of successful hepatitis C virus therapy: waning immune responses and disappearance of liver disease are consistent with cure.

BACKGROUND: A sustained viral response (SVR) after interferon-based therapy of chronic hepatitis C virus (HCV) infection is regarded to represent a cure. Previous studies have used different markers to clarify whether an SVR truly represents a cure, but no study has combined a clinical work-up with highly sensitive HCV RNA detection, and the determination of immune responses. AIM: To determine clinical, histological, virological and immunological markers 5-20 years after SVR. METHODS: In 54 patients, liver biochemistry, histology and elastography were evaluated. Liver biopsies, plasma and peripheral blood mononuclear cells (PBMCs) were tested for minute amounts of HCV RNA. HCV-specific T-cell responses were monitored by ELISpot and pentamer staining, and humoral responses by measuring HCV nonstructural (NS)3-specific antibodies and virus neutralisation. RESULTS: Liver disease regressed significantly in all patients, and 51 were HCV RNA-negative in all tissues tested. There was an inverse association between liver disease, HCV-specific T-cell responses and HCV antibody levels with time from SVR, supporting that the virus had been cleared. The three patients, who all lacked signs of liver disease, had HCV RNA in PBMCs 5-9 years after SVR. All three had HCV-specific T cells and NS3 antibodies, but no cross-neutralising antibodies. CONCLUSIONS: Our combined data confirm that a SVR corresponds to a long-term clinical cure. The waning immune responses support the disappearance of the antigenic stimulus. Transient HCV RNA traces may be detected in some patients up to 9 years after SVR, but no marker associates this with an increased risk for liver disease.

Overlooked sources of ethanol.

The case of a 55-year-old female who presented to the emergency department with acute ethanol intoxication and suicidal ideation is reported. After initiating routine management, we discovered that her serum ethanol levels remained persistently elevated as a result of the patient's secretly ingesting mouthwash. This occurred after she was searched and allowed to retain personal hygiene products. Alcohol-dependent patients may consume ethanol products that are not manufactured for ingestion. These products include cosmetics, cough and cold remedies, and personal hygiene products. The ethanol content of these nonbeverage ethanol (NBE) products exceeds that of many conventional alcoholic beverages. Financial constraints and ease of availability are factors leading to their consumption. This report serves as a reminder to be aware of the existence and popularity of NBE in order to avoid potential morbidity and even mortality associated with its use.

URBANIZATION, EDUCATION AND RACIAL INTERMARRIAGE IN BRAZIL.

Urbanization and education have brought numerous changes in societies around the world. One change is the contact of different groups, often with an attendant increase in intergroup marriage. In this paper we examine the intergroup intermarriage in Brazil in the context of changing urbanization and education. While intergroup marriage has been intensively examined in the United States, the topic has received less attention in Brazil. We use census data from 1991 and 2000, and national survey data from 2001 and 2008 to examine factors predicting intergroup marriage and the trends in intergroup marriage in Brazil. The results show higher rates of intermarriage in urban than in rural areas. Intermarriage is less common among the most educated people. While the rates of intermarriage are increasing substantially, the rates of change are diffuse across urban and rural areas, regions and education groups.

Intradermal hepatitis B vaccination in health care workers. Response rate and experiences from vaccination in clinical practise.

Health care workers at risk for hepatitis B virus infection are recommended for vaccination. Low-dose intradermal (i.d.) administration of vaccine has been suggested as a less expensive alternative to intramuscular (i.m.) inoculation. To evaluate the i.d. vaccination route, health care workers were included in a prospective study. The subjects were vaccinated with 0.1 ml (= 2 microg) recombinant vaccine (Engerix B, SmithKline Beecham) i.d. at 0, 1 and 6 months. Two months after the third vaccination, measurement of the anti-HBs level was conducted. An anti-HBs level > or =10 IU/l was considered protective. Those with an anti-HBs level <10 IU/l were given a fourth dose with new serological control after another 2 months. The results are based on the 1406 subjects that it was possible to evaluate. The seroconversion rate to protective anti-HBs level after 3 doses was 68% and after 3 or 4 doses 89%. Factors associated with a lower response rate were increasing age (p<0.05) and smoking (p<0.001). Sex or body mass index had no influence on the results. Vaccination technique seems to be of utmost importance when the i.d. route is used. Well instructed and experienced nurses are required and quality control with follow-up of overall seroconversion rate within each centre is needed.

Haplotypes comprising subtypes of the DQB1*06 allele direct the antibody response after immunisation with hepatitis B surface antigen.

Two HLA class II haplotypes, HLA-[DQB1*0602; DQA1*0102; DR15] and HLA-[DQB1*0603; DQA1*0103; DRB1*1301] were found to be less common in 52 nonresponders compared with 68 responders, P<0.025 and P<0.05 respectively, after vaccination with hepatitis B surface antigen (HBsAg). Another haplotype, HLA-[DQB1*0604; DQA1*0102; DRB1*1302], had a significantly higher frequency in the nonresponders (P<0.005). The nonresponders and responders were nonsmoking, healthy individuals with an antibody concentration of <10 IU/l and >100 IU/l respectively. The three haplotypes comprise either of three different DQB1*06 subtypes. Two of the seven amino acids that differ between the two responder alleles DQB1*0602 and *0603 and the nonresponder allele *0604 are located in the peptide-binding groove of the DQB1 molecule. In addition to this finding, amino acid 86 in the DRB1 molecule seems to determine the response against HBsAg. DRB1*1301 and DR15 in the responder haplotypes have a Val at this position while the nonresponder haplotype has a Gly. These results suggest a role for both the DQB1*06 alleles and the DRB1 alleles *1301, *1302 and DR15 to direct either a response or a nonresponse against HBsAg. Sixteen HLA class II genotypes were found to be shared by 25 nonresponders and 32 responders. This finding of HLA-identical nonresponders and responders indicates an influence of other genetic factors in addition to the HLA system in the response to HBsAg.