Demographic and medical school characteristics associated with urban versus rural dermatology practice: A national cross-sectional study.

There are significant disparities in access to dermatologists in rural areas relative to urban areas. We examined the associations between demographic and medical school characteristics and entry into dermatology practice in urban versus rural counties. All dermatologists who graduated from U.S. allopathic or osteopathic medical schools in the 2020 Centers for Medicare & Medicaid Services Physician Compare Database were assessed. Dermatology practice locations were coded as metropolitan or non-metropolitan according to the Rural-Urban Continuum Codes. Of 10,076 dermatologists, 543 (5.4%) practiced in non-metropolitan counties. Male gender (odds ratio [OR] 1.48, 95% CI 1.23-1.77), public medical school attendance (OR 1.94, 95% CI 1.61-2.34), DO degree (OR 1.84, 95% CI 1.32-2.51), medical school location in a non-metropolitan county (OR 5.41, 95% CI 3.66-7.84), and medical school rural track program (OR 1.57, 95% CI 1.07-2.26) were associated with higher odds of non-metropolitan dermatology practice. Our findings highlight that male gender, graduation from a non-metropolitan or public medical school, DO degree, and rural tracks are associated with higher likelihood of non-metropolitan dermatology practice. These results can inform efforts within the field of dermatology to strengthen the rural dermatologist workforce and suggest that rural educational experiences during medical school may increase recruitment of rural dermatologists.

Quantitative evaluation of an outreach case management model of care for urban Aboriginal and Torres Strait Islander adults living with complex chronic disease: a longitudinal study.

BACKGROUND: Chronic diseases are the leading contributor to the excess morbidity and mortality burden experienced by Aboriginal and Torres Strait Islander (hereafter, respectfully, Indigenous) people, compared to their non-Indigenous counterparts. The Home-based Outreach case Management of chronic disease Exploratory (HOME) Study provided person-centred, multidisciplinary care for Indigenous people with chronic disease. This model of care, aligned to Indigenous peoples' conceptions of health and wellbeing, was integrated within an urban Indigenous primary health care service. We aimed to determine the impact of this model of care on participants' health and wellbeing at 12 months. METHODS: HOME Study participants were Indigenous, regular patients of the primary health care service, with a diagnosis of at least one chronic disease, and complex health and social care needs. Data were collected directly from participants and from their medical records at baseline, and 3, 6 and 12 months thereafter. Variables included self-rated health status, depression, utilisation of health services, and key clinical outcomes. Participants' baseline characteristics were described using frequencies and percentages. Generalized estimating equation (GEE) models were employed to evaluate participant attrition and changes in outcome measures over time. RESULTS: 60 participants were enrolled into the study and 37 (62%) completed the 12-month assessment. After receiving outreach case management for 12 months, 73% of participants had good, very good or excellent self-rated health status compared with 33% at baseline (p < 0.001) and 19% of participants had depression compared with 44% at baseline (p = 0.03). Significant increases in appointments with allied health professionals (p < 0.001) and medical specialists other than general practitioners (p = 0.001) were observed at 12-months compared with baseline rates. Mean systolic blood pressure decreased over time (p = 0.02), but there were no significant changes in mean HbA1c, body mass index, or diastolic blood pressure. CONCLUSIONS: The HOME Study model of care was predicated on a holistic conception of health and aimed to address participants' health and social care needs. The positive changes in self-rated health and rates of depression evinced that this aim was met, and that participants received the necessary care to support and improve their health and wellbeing.

Does attending Work It Out - a chronic disease self-management program - affect the use of other health services by urban Aboriginal and Torres Strait Islander people with or at risk of chronic disease? A comparison between program participants and non-participants.

Work It Out is a holistic chronic disease self-management program for urban Aboriginal and Torres Strait Islander people in Queensland, which is part of an integrated and comprehensive system of care for chronic disease management. This study examines differences in primary healthcare services use between Work It Out participants and non-participants. This retrospective observational study of services use, analysed data extracted from the clinical medical records system and Work It Out program assessments. General practitioner and allied health services use were compared among the participants and non-participants using logistic regression models and zero-truncated Poisson and negative binomial regression models. Compared with non-participants, Work It Out participants were more likely to use GP management plans, GP team care arrangements, GP mental health consultation and subsequent allied health services. Among those who used the services more than once, Work It Out participants had higher service use rates than non-participants for Aboriginal and Torres Strait Islander health assessments, GP management plans, team care arrangements and podiatry, physiotherapy and dietetic services. Engagement in Work It Out can facilitate the use of primary healthcare services, which are important for chronic disease management for urban Aboriginal and Torres Strait Islander people.

Provision of medical abortion by midlevel healthcare providers in Kyrgyzstan: testing an intervention to expand safe abortion services to underserved rural and periurban areas.

OBJECTIVE: To demonstrate the feasibility and safety of training midlevel healthcare providers (midwives and family nurses) to provide medical abortion and postabortion contraception in underserved areas in Kyrgyzstan. STUDY DESIGN: This was an implementation study at four referral facilities and 28 Felsher Obstetric Points in two districts to train their midwives and family nurses to deliver safe and effective abortion care with co-packaged mifepristone-misoprostol and provide contraceptives postabortion. The outcome of abortion - complete abortion, incomplete abortion or o-going pregnancy - was the primary end point measured. An international consultant trained 18 midwives and 14 family nurses (with midwifery diplomas) to provide medical abortion care. Supervising gynecologists based in the referral centers and study investigators based in Bishkek provided monthly monitoring of services and collection of patient management forms. A voluntary self-administered questionnaire at the follow-up visit documented women's acceptability of medical abortion services. All study data were cross-checked and entered into an online data management system for descriptive analysis. RESULTS: Between August 2014 and September 2015, midwives provided medical abortion to 554 women with a complete abortion rate of 97.8%, of whom 62% chose to use misoprostol at home. No women were lost to follow-up. Nearly all women (99.5%) chose a contraceptive method postabortion; 61% of women receiving services completed the acceptability form, of whom more than 99% indicated a high level of satisfaction with the service and would recommend it to a friend. CONCLUSION: This study demonstrates that trained Kyrgyz midwives and nurses can provide medical abortion safely and effectively. This locally generated evidence can be used by the Kyrgyz Ministry of Health to reduce unintended pregnancy and expand safe abortion care to women in underserved periurban and rural settings. IMPLICATIONS: Success in scaling up midwife/nurse provision of medical abortion in Kyrgyzstan will require registration of mifepristone-misoprostol, regulations permanently allowing midwife/nurse provision, strengthened procurement and distribution systems to prevent stockouts of supplies, preservice training of midwives/nurses and their involvement in district level supervision, monitoring and reporting, and support from supervisors.

[The health-disease-care process from the perspective of the users of a primary care clinic in Montevideo, Uruguay: An analysis of therapeutic trajectories]. / Los procesos de salud-enfermedad-atención desde la perspectiva de los usuarios de una policlínica del primer nivel de atención en Montevideo, Uruguay: Análisis de trayectos terapéuticos.

The aim of this paper is to analyze, using an ethnographic approach, the health-disease-care experiences of the users of a multi-specialty clinic that forms part of the Metropolitan Primary Health Care Network of Uruguay's Public Health Services. The fieldwork was carried out in the northeast of Montevideo from July 2012 to November 2013, combining participant observation in social and care spaces and interviews with more than 20 users. In our analysis of care trajectories we found that people incorporate different practices and beliefs when facing their health problems. The use of biomedical health care services is predominant in Uruguay; nevertheless, people engage in self-care practices and in some cases, in the use of folk, religious/magical or alternative remedies. Medical pluralism is therefore observed in facing certain common ailments or significant experiences of disease.

Los procesos de salud-enfermedad-atención desde la perspectiva de los usuarios de una policlínica del primer nivel de atención en Montevideo, Uruguay: Análisis de trayectos terapéuticos / The health-disease-care process from the perspective of the users of a primary care clinic in Montevideo, Uruguay: An analysis of therapeutic trajectories

Desde un abordaje etnográfico, este trabajo se propone analizar las experiencias en los procesos de salud-enfermedad-atención de usuarios de una policlínica de la Red de Atención Primaria Metropolitana de la Administración de los Servicios de Salud del Estado (ASSE) en Uruguay. El trabajo de campo se desarrolló en la zona noreste de la ciudad de Montevideo, desde julio de 2012 a setiembre de 2013, y combinó observación participante en espacios asistenciales y sociales y entrevistas a más de 20 usuarios. Mediante el análisis de trayectos terapéuticos encontramos que las personas combinan diferentes prácticas y sentidos a la hora de enfrentar sus padecimientos. El uso de los servicios de salud biomédicos es predominante en nuestro país; sin embargo, observamos que las personas integran prácticas de autoatención y, en algunos casos, el uso de sistemas de atención populares y religiosos. Se evidencia un pluralismo médico al enfrentar ciertos malestares de la vida cotidiana o experiencias de enfermedad significativas.

The aim of this paper is to analyze, using an ethnographic approach, the health-disease-care experiences of the users of a multi-specialty clinic that forms part of the Metropolitan Primary Health Care Network of Uruguay's Public Health Services. The fieldwork was carried out in the northeast of Montevideo from July 2012 to November 2013, combining participant observation in social and care spaces and interviews with more than 20 users. In our analysis of care trajectories we found that people incorporate different practices and beliefs when facing their health problems. The use of biomedical health care services is predominant in Uruguay; nevertheless, people engage in self-care practices and in some cases, in the use of folk, religious/magical or alternative remedies. Medical pluralism is therefore observed in facing certain common ailments or significant experiences of disease.

Fluoride Varnish Application in the Primary Care Setting. A Clinical Study.

OBJECTIVES: The study objectives were twofold: 1. To examine how an intervention to apply fluoride varnish (FV) in a primary health setting to all young, low-income children was implemented and sustained and 2. To assess the feasibility of tracking medical care utilization in this population. STUDY DESIGN: The study included children age 1-5, insured through a government program, seen (7/1/2010-4/30/2012). Data on age, race, sex, clinic encounter, eligibility for and receipt of FV was obtained. The level of data in primary care, specialty care, urgent care and hospitalizations to assess feasibility of future patient tracking was also acquired.. RESULTS: Of 12,067 children, 85% received FV. Differences were found by age (youngest had highest rates). Small differences by race (81%-88%, highest in Blacks.) was found. No differences were found by sex. Ability to track over time was mixed. Approximately 50% had comprehensive data. However, primary care visit and hospitalization data was available on a larger percentage. CONCLUSIONS: FV programs can be introduced in the primary care setting and sustained. Further, long-term follow up is possible. Future study of such cohorts capturing health and cost benefits of oral health prevention efforts is needed.

Perspectives of Behavioral Health Clinicians in a Rural Integrated Primary Care/Mental Health Program.

PURPOSE: This study compares the perspectives of rural and urban mental health clinicians working in various Washington State Community Health Centers that have implemented an integrated primary care/mental health program. METHODS: We conducted a Web-based survey of mental health clinicians (n = 71) who work in an integrated primary care/mental health program ("the program") in 1 of 150 safety net primary care clinics in Washington State. Most participating clinics are Federally Qualified Health Centers or Rural Health Clinics. Pooled survey results from clinicians working in rural settings were compared to those working in urban settings. Semistructured interviews were conducted with a subset (n = 32) of survey respondents. Comments made during these interviews were analyzed for themes. FINDINGS: In the survey phase, both rural and urban clinicians generally agreed that the program benefitted their patients. Rural respondents were particularly appreciative of the flexibility that the program offered when planning care. Not surprisingly, social service limitations (such as housing or transportation services) were more often mentioned as program limitations. Rural clinicians were more likely to note a lack of awareness of program resources among other medical providers on the team. CONCLUSIONS: Clinicians working in rural primary care clinics value the availability and flexibility of an integrated primary care/mental health program as an option for providing mental health care for their patients. Clinicians working in rural settings could benefit from additional training and program implementation support to best meet the needs of their patients.

Widespread non-adherence to evidence-based maternity care guidelines: a population-based cluster randomised household survey.

OBJECTIVE: To assess the quality of maternity care in an Indian metropolitan city. STUDY DESIGN: Three-stage cluster randomised cross-sectional survey. SETTING: Sixty selected colonies of Delhi. POPULATION: One thousand eight hundred and one subjects (of 2286 eligible) were enrolled from 118 446 houses. Women who had delivered a live viable birth in the past 6 months were selected for the study. METHODS: In stage 1, 20 wards (of 150) were selected using a probability-proportionate-to-size systematic method. In stage 2, one colony from each income stratum (high, middle and low) was selected from each ward by simple random sampling. In stage 3, a house-to-house survey was conducted to recruit 30 women for administering a peer-reviewed and pilot-trialled questionnaire. MAIN OUTCOME MEASURES: Caesarean section rate, induction rate and episiotomy rate. RESULTS: National health targets such as iron supplementation advice (>96%), tetanus vaccination (>81%), and ≥3 antenatal visits (>90%) were largely achieved across health care facilities but not in home deliveries. Interventions were lower in public than private hospitals: caesarean section [23.7% (20.2-27.7) versus 53.8% (49.3-58.3)], induction [20.6% (17.5-24.25) versus 30.8% (26.8-33.2)] and episiotomy [57.8% (52.3-63.1) versus 79.4% (71.0-85.9)]. Private hospitals achieved better labour support rates [1.1% (0.5-2.2) versus 14.6% (8.5-24.1)] and pain relief [0.9% (0.4-2.0) versus 9.9 (6.5-14.8)]. Pubic hair shaving [16.2% (11.5-22.5) versus 36.4% (29.9-43.4)], enema [20.2% (15.5-26.0) versus 57.3% (49.5-64.8)], and IV fluids during labour [44.0% (36.2-52.2) versus 38.7% (29.3-49.1)] were widely prevalent in public and private hospitals. CONCLUSION: Present practices fall short of evidence-based guidelines, with relative overuse of interventions in private hospitals and deficiency of patient-centred practices such as labour support in public hospitals.

Perspectives on healthcare, chronic non-communicable disease, and healthworlds in an urban and rural setting.

BACKGROUND: Amidst diverging discourses describing chronic non-communicable disease (NCD) and healthcare access, the hermeneutical tradition within sociology, particularly as exemplified in the work of Jurgen Habermas, provides a starting point for exploring and interpreting the experiences of chronic illness and healthcare access. In this study, we aimed to understand how women living with NCDs experience their illness and access healthcare in an urban and rural context. METHODS: This study was a mixed-methods comparative case study of the healthcare access experiences of women with NCDs in an urban and rural area in South Africa. The core of the study methodology was a comparative qualitative case study, with quantitative methods serving to contextualise the findings. RESULTS: The cross-sectional survey describes a low resource population with a high prevalence of NCDs. Slightly over half the respondents in urban Soweto (50.7%) reported having at least one NCD. Only around a third (33.3%) of these participants reported accessing formal healthcare services in the past 6 months. Similar trends were found in the review of research carried out in rural Agincourt. The qualitative case study in Soweto is characterised by a preoccupation with how medicine from the clinic interacts with the body. The Agincourt qualitative case study highlights the importance of church membership, particularly of African Christian Churches, as the strongest factor motivating against the open use of traditional medicine. DISCUSSION: A consideration of the findings suggests five broad themes for further research: 1) processes of constructing body narratives; 2) encounters with purposive-rational systems; 3) encounters with traditional medicine; 4) encounters with contemporary informal medicine; and 5) religion and healthcare. These five themes constitute the beginning of a comprehensive schema of the lifeworld/healthworld.

Survey of women's experiences of care in a new freestanding midwifery unit in an inner city area of London, England: 2. Specific aspects of care.

OBJECTIVE: to describe and compare women's experiences of specific aspects of maternity care before and after the opening of the Barkantine Birth Centre, a new freestanding midwifery unit in an inner city area. DESIGN: telephone surveys undertaken in late pregnancy and about six weeks after birth. Two separate waves of interviews were conducted, Phase 1 before the birth centre opened and Phase 2 after it had opened. SETTING: Tower Hamlets, a deprived inner city borough in east London, 2007-2010. PARTICIPANTS: 620 women who were resident in Tower Hamlets and who satisfied the Barts and the London Trust's eligibility criteria for using the birth centre. Of these, 259 women were recruited to Phase 1 and 361 to Phase 2. MEASUREMENTS AND FINDINGS: the replies women gave show marked differences between the model of care in the birth centre and that at the obstetric unit at the Royal London Hospital with respect to experiences of care and specific practices. Women who initially booked for birth centre care were more likely to attend antenatal classes and find them useful and were less likely to be induced. Women who started labour care at the birth centre in spontaneous labour were more likely to use non-pharmacological methods of pain relief, most notably water and less likely to use pethidine than women who started care at the hospital. They were more likely to be able to move around in labour and less likely to have their membranes ruptured or have continuous CTG. They were more likely to be told to push spontaneously when they needed to rather than under directed pushing and more likely to report that they had been able to choose their position for birth and deliver in places other than the bed, in contrast to the situation at the hospital. The majority of women who had a spontaneous onset of labour delivered vaginally, with 28.6 per cent of women at the birth centre but no one at the hospital delivering in water. Primiparous women who delivered at the birth centre were less likely to have an episiotomy. Most women who delivered at the birth centre reported that they had chosen whether or not to have a physiological third stage, whereas a worrying proportion at the hospital reported that they had not had a choice. A higher proportion of women at the birth centre reported skin to skin contact with their baby in the first two hours after birth. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: significant differences were reported between the hospital and the birth centre in practices and information given to the women, with lower rates of intervention, more choice and significant differences in women's experiences. This case study of a single inner-city freestanding midwifery unit, linked to the Birthplace in England Research Programme, indicates that this model of care also leads to greater choice and a better experience for women who opted for it.

Survey of women's experiences of care in a new freestanding midwifery unit in an inner city area of London, England. 1: Methods and women's overall ratings of care.

OBJECTIVE: to describe and compare women's choices and experiences of maternity care before and after the opening of the Barkantine Birth Centre, a new freestanding midwifery unit in an inner city area. DESIGN: telephone surveys undertaken in late pregnancy and about six weeks after birth in two separate time periods, Phase 1 before the birth centre opened and Phase 2 after it had opened. SETTING: Tower Hamlets, a deprived inner city borough in east London, England, 2007-2010. PARTICIPANTS: 620 women who were resident in Tower Hamlets and who satisfied the Barts and the London NHS Trust's eligibility criteria for using the birth centre. Of these, 259 women were recruited to Phase 1 and 361 to Phase 2. MEASUREMENTS AND FINDINGS: women who satisfied the criteria for birth centre care and who booked antenatally for care at the birth centre were significantly more likely to rate their care as good or very good overall than corresponding women who also satisfied these criteria but booked initially at the hospital. Women who started labour care in spontaneous labour at the birth centre were significantly more likely to be cared for by a midwife they had already met, have one to one care in labour and have the same midwife with them throughout their labour. They were also significantly more likely to report that the staff were kind and understanding, that they were treated with respect and dignity and that their privacy was respected. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: this survey in an inner city area showed that women who chose the freestanding midwifery unit care had positive experiences to report. Taken together with the findings of the Birthplace Programme, it adds further weight to the evidence in support of freestanding midwifery unit care for women without obstetric complications.

Treatment and survival disparities in lung cancer: the effect of social environment and place of residence.

OBJECTIVE: The purpose of this study was to measure the extent to which geographic residency status and the social environment are associated with disease stage at diagnosis, receipt of treatment, and five-year survival for patients diagnosed with non-small cell lung cancer (NSCLC). METHODS AND MATERIALS: This study was a retrospective cohort study of the Georgia Comprehensive Cancer Registry (GCCR) for incident cases of NSCLC diagnosed in the state. Multilevel logistic models were employed for five outcome variables: unstaged and late stage disease at diagnosis; receipt of treatment (surgery, chemotherapy, and radiation); and survival following diagnosis. The social and geographical variables of interest were census tract (CT) poverty level, CT-level educational attainment, and CT-level geographic residency status. RESULTS: Compared to urban residents, rural and suburban residents had increased odds of unstaged disease (suburban OR=1.23, 95% CI: 1.11-1.37; rural OR=1.63, 95% CI: 1.45-1.83). In this study, rural participants had lower odds of receiving radiotherapy (OR=0.89, 95% CI: 0.82-0.96) and chemotherapy (OR=0.92, 95% CI: 0.85-0.99). Living in CTs with lower educational levels was associated with decreasing odds of receiving both surgery (lowest educational level OR=0.67, 95% CI: 0.59-0.75) and chemotherapy (lowest educational level OR=0.74, 95% CI: 0.68-0.81). Living in areas with higher concentration of deprivation (high level of deprivation HR=1.04, 95% CI: 1.01-1.09) and lower levels of education (lowest educational level HR=1.12, 95% CI: 1.07-1.17) was associated with poorer survival. Rural residents did not show poorer survival when treatment was controlled and they even presented a lower risk of death for early stage disease (HR=0.90, 95% CI: 0.82-0.99). CONCLUSION: This study concludes that where NSCLC patients live can, to some extent, explain treatment and prognostic disparities. Public health practitioners and policy makers should be cognizant of the importance of where people live and shift their efforts to improve lung cancer outcomes in rural areas and neighborhoods with concentrated poverty.

Look local: the value of cancer surveillance and reporting by American Indian clinics.

INTRODUCTION: Cancer incidence and mortality rates for American Indians in the Northern Plains region of the United States are among the highest in the nation. Reliable cancer surveillance data are essential to help reduce this burden; however, racial data in state cancer registries are often misclassified, and cases are often underreported. METHODS: We used a community-based participatory research approach to conduct a retrospective ascertainment of cancer cases in clinic medical records over a 9-year period (1995-2003) and compared the results with the state cancer registry to evaluate missing or racially misclassified cases. Six tribal and/or urban Indian clinics participated in the study. The project team consisted of participating clinics, a state cancer registry, a comprehensive cancer center, an American Indian/Alaska Native Leadership Initiative on Cancer, and a set of diverse organizational partners. Clinic personnel were trained by project staff to accurately identify cancer cases in clinic records. These records were then matched with the state cancer registry to assess misclassification and underreporting. RESULTS: Forty American Indian cases were identified that were either missing or misclassified in the state registry. Adding these cases to the registry increased the number of American Indian cases by 21.3% during the study period (P = .05). CONCLUSIONS: Our results indicate that direct reporting of cancer cases by tribal and urban Indian health clinics to a state cancer registry improved the quality of the data available for cancer surveillance. Higher-quality data can advance the efforts of cancer prevention and control stakeholders to address disparities in Native communities.

[Access to pediatric cancer care in Brazil: mapping origin-destination flows]. / Assistência ao câncer entre crianças e adolescentes: mapeamento dos fluxos origem-destino no Brasil.

OBJECTIVE: To analyze fl ows of travel between place of residence and health care services by children and adolescents with cancer. METHODS: The flows of travel between place of residence and the health care service for children and adolescents receiving care in Brazil's Unifi ed Health System (SUS) were monitored between 2000 and 2007. The unit of analysis was the health care district. The geographical information system data and network methodology, by type of treatment received (chemotherapy and radiotherapy) and hospital admissions were used. RESULTS: The SUS made 465,289 authorizations for chemotherapy, 29,151 for radiotherapy and 383,568 for hospital admissions for the treatment of children and adolescents with a diagnosis of cancer. The dominant fl ow formed 48 networks for chemotherapy, 53 for radiotherapy and 112 for hospital admissions. Most of the volume of treatment occurred in the health districts of Brazil's 12 largest cities (with strong links between them and each having an extensive area of direct infl uence accompanying the structure of the Brazilian urban system. CONCLUSIONS: Identifying the networks formed by utilization of SUS facilities providing care for children and adolescents with cancer shows that overall most patients are covered by the existing networks. However, about 10% of travel occurs outside the dominant structure, indicating the need for alternative regionalization. These results show the importance of planning the distribution of services to meet the population's needs.

Characteristics of Northern Plains American Indians seeking substance abuse treatment in an urban, non-tribal clinic: a descriptive study.

Because few data exist on substance abuse rates in American Indian (AI) communities, the Methamphetamine and Other Drug project was developed and implemented by five nodes within the National Institute on Drug Abuse Clinical Trials Network (NIDA CTN). This article presents findings from AI clients in a Northern Plains urban non-Native substance abuse treatment setting. Alcohol and marijuana were used earlier, longer, and by more clients, followed by stimulants and prescription opioids. Most regularly smoked tobacco. Differences in substance use patterns were associated with age of onset and victimization. Age of onset was correlated with victimization, gender, cognitive impairment, and suicidal behavior. Despite considerable health and economic disparities, most clients found support for recovery in relationships and elements of Native culture.

Alternative careers in pediatric dentistry: a survey of pediatric dental residents.

Pediatric dentistry has enjoyed growing popularity in recent years, yet there remains a need for leadership in academe, research, and public health. In November 2008, the first Maternal and Child Health Bureau-sponsored regional Leadership in Pediatric Dentistry convocation was held at the Columbia University College of Dental Medicine. Seventy-two pediatric dentistry trainees from thirteen programs in the New York City area participated in interactive presentations and exercises. Of the sixty- seven participants who completed a pre-event survey, 93 percent stated they would likely or very likely pursue careers that involved, at least in part, private practice, 55 percent in care of children in Medicaid, 51 percent academics, 36 percent dental public health, and 12 percent research. Barriers related to finances, competence, or work environment/location were perceived by 83 percent for careers involving research, 73 percent for dental public health, 66 percent for providing care to children in Medicaid, 46 percent for academics, and 9 percent for private practice. Results of a pair of pre-event and post-event surveys completed by sixty-three attendees showed no change in reported likelihood to pursue a career alternative except for an increase in the likelihood of working in a practice that accepts Medicaid. The challenge before dental educators is to provide consistent and meaningful opportunities throughout training that encourage residents to consider all career options and to discover how their individual interests mesh with their clinical learning.

Arab American immigrants in New York: health care and cancer knowledge, attitudes, and beliefs.

Arab immigrants living in the United States total between 1.5 million and 3.5 million, and have been growing in number each decade. New York's Arab population, at 405,000, ranks third in the U.S. after California and Michigan. Despite the large numbers, little health research has focused on this population. Data about the cancer incidence, mortality, and screening practices of Arab Americans is overwhelmingly lacking. To better understand the health care and cancer knowledge, attitudes, and beliefs of Arab American immigrants, five single-gender focus groups were convened with Arab men and women in New York City. Attention was given to factors that act as barriers to utilization of general health care services, and of cancer prevention, treatment, and support services. The data revealed the importance of providing culturally and linguistically appropriate health interventions in partnership with trusted community leaders, and the need for follow-up research of this understudied immigrant population.