Editorials

Disparity in demographics: A cause for concern

Thomas C. Meyer, MD, Medical Editor, WMJ

Two overarching problems are featured in this issue of the Journal—the decreasing numbers of trained health professionals and the “good news/bad news” reports of Wisconsin’s progress in reducing mortality in our residents. Both call for thought, debate, and, most important, action.


Author Affiliations: Medical Editor

Corresponding Author: Wisconsin Medical Society 330 E. Lakeside St Madison, WI 53715

A summer in public health research

Daniel J. Sklansky, BA

With an interest in government and a desire to investigate and minimize the effects of environmental toxins on public health, I spent my summer Wisconsin Medical Society Foundation fellowship with the Wisconsin Division of Public Health (DPH) researching residential pesticide use. Click here for the "Pesticide and Your Children" pamphlet.



Author Affiliations: Mr Sklansky is a second-year medical student at the University of Wisconsin Medical School and recipient of the Summer Fellowship in Government and Community Service from the Wisconsin Medical Society Foundation.


Corresponding Author: Wisconsin Medical Society 330 E. Lakeside St Madison, WI 53715

Wisconsin Medical Society Foundation purpose supports medical and health education

Sandra Osborn, MD

The Wisconsin Medical Society Foundation (Foun-dation) Board of Directors, in response to the revision/reconfirmation of the Wisconsin Medical Society evaluation of its mission, evaluated and revised its own mission. Previously, the Foundation had tried to support a variety of diverse efforts. The restated mission, intended to reflect and parallel that of the Society, is now: “The Foundation shall advance the health of the people of Wisconsin by supporting medical and health education.”

Author Affiliations: Doctor Osborn is the president of the Wisconsin Medical Society Foundation and a past president of the Society

Corresponding Author: To donate to the Foundation, call 866.442.3800 or e-mail reneer@wismed.org.

Workforce shortage mandates change . . . now

Paul Wertsch, MD

The health care worker shortage. Whether you’re already feeling its impact, or you haven’t been affected yet, there’s no doubt we are in for trouble.



Author Affiliations: Doctor Wertsch is the current president of the Wisconsin Medical Society. His presidential theme is health care workforce shortage. He previously served on the Governor’s Health Care Workforce Shortage Task Force.


Corresponding Author: Wisconsin Medical Society 330 E. Lakeside St Madison, WI 53715

Wisconsin can prepare and support rural physicians

Tim Size

The recently adopted Medicare “reform” bill includes significant assistance for physicians and hospitals in rural communities. For physicians there is a minimum payment update replacing a major cut, additional incentive payments for targeted underserved counties, and a floor of 1.00 in the Work Geographic Index.



Author Affiliations: Mr Size is the Executive Director of the Rural Wisconsin Health Cooperative, Sauk City, Wis.

Corresponding Author: Mr Size can be reached at 608.643.2343 or e-mail timsize@rwhc.com.

Original Research

Health Care Worker Shortage: Pervasive and Long-Term

Marc Kennedy, special to WMJ

A few years ago in Minneapolis, several hospital emergency rooms were forced to close. Why? Area nursing homes were short of qualified nurses and could no longer accept additional patients and care for them adequately, according to Byron Crouse, MD, University of Wisconsin Medical School Professor of Family Medicine and Associate Dean of Rural and Community Health.


Author Affiliations: Wisconsin Medical Society

Corresponding Author: Wisconsin Medical Society 330 E. Lakeside St. Madison, WI 53715

Physician shortage: misdiagnosis & prognosis

Marc Kennedy, special to WMJ

In 1970 and 1994, Council on Graduate Medical Education (COGME) advisories predicted surfeits of physicians by 70,000 and 137,000, respectively. These estimates were based partially on US Census Bureau population forecasts that were too low, which in turn projected the number of physicians per capita as too high. They were also based on what Richard Cooper, MD, refers to in a paper published in the 2002 Health Affairs as “a conceptual deficit” in these estimates:


Author Affiliations: Wisconsin Medical Society

Corresponding Author: Wisconsin Medical Society 330 E. Lakeside St Madison, WI 53715

Progress in Reducing Mortality Among Wisconsin Residents, 1980-2000: Rates Decline, but Black-White Disparities Increase

Elizabeth A. Dranger, BS; Patrick Remington, MD, MPH; Paul E. Peppard, PhD

Purpose: To assess progress towards 2 overarching public health goals—improvement in length of life and reducing health disparities.

Methods: Age specific mortality rates in Wisconsin from 1980 to 2000 were obtained from the US Centers for Disease Control and Prevention WONDER database. Rates for each age group were gathered for the entire Wisconsin population and for black and white subgroups. Trends in mortality rates were plotted, change in mortality rates was estimated, and the number of “lives saved” annually from 1980-1984 to 1996-2000 was calculated. In addition, black vs white rate ratios were calculated at both the beginning and the end of the time period to determine trends in black-white mortality disparities.

Results: Mortality is decreasing in Wisconsin in every age group. The largest relative improvements in mortality rates occurred among infants <1 year (-30%), children 1-14 years (-27%), and adults 45-64 years (-23%). Comparatively little progress was seen among adults 25-44 years (-5%) and those 85 years and older (-0.5%). Black/white disparities increased in every age group. During 1996-2000, approximately 5000 fewer deaths occurred each year than expected based on mortality rates from 1980-1984.

Conclusion: Despite progress towards increasing length of life, progress towards eliminating disparities was not seen over the 1980 to 2000 time period.



Author Affiliations: Ms Dranger is a student at the University of Wisconsin Medical School’s Department of Population Health Sciences. Doctor Remington is a Professor in the Department of Population Health Sciences and Director of the Wisconsin Public Health and Health

Corresponding Author: Please address correspondence to Elizabeth Dranger, University of Wisconsin Medical School, Department of Population Health Sciences, 610 Walnut Ave, Madison, WI 53726; phone 608.265.8924; fax 608.263.2820; e-mail eadranger@students.wisc.edu.

Monitoring Infant Mortality Trends in Wisconsin, 1980 to 1999

Erika W. Hagen, BA; Flávia C. D. Andrade, MA

Using data from the National Center for Health Statistics, this paper analyzes the trends in infant, neonatal, and postneonatal mortality in Wisconsin between 1980 and 1999. The main causes of infant death are also examined. Results indicate that whites have consistently experienced a steady decline in infant mortality, from 9.2 per 1000 live births in 1980-1984 to 6.0 in 1995-1999. The rate for black infants was 19.4 in 1980-1984, fluctuated during this period, and was 17.8 in 1995-1999. Overall, infant mortality rates in Wisconsin continue to decrease, but the disparity between blacks and whites remains large and continues to increase. Death rates due to prematurity have increased by almost 82% between 1980 and 1999, while deaths from congenital anomalies have declined. Wisconsin white infant mortality rates are decreasing at rates in line with the goals for Healthy People 2010, but Wisconsin black infant mortality rates must decrease significantly in order to meet the national and state goals.



Author Affiliations: Ms Hagen is a graduate student in the Population Health Sciences Program. Ms Andrade is a graduate student in the Population Health Sciences and Sociology Programs at the University of Wisconsin-Madison. This work was conducted as part of a class project

Corresponding Author: Please address correspondence to Erika Hagen, Dept of Population Health Sciences, 662 WARF Building, 610 Walnut Ave, Madison, WI 53726; phone 608.265.6769; fax 608.263.2820; e-mail ewarkentien@students.wisc. edu.

Health Priorities in Wisconsin: A Case for Tracking Childhood Mortality

Vanessa H. Newburn; Blaise A. Nemeth, MD

Objective: To assess trends in mortality among children ages 1-14 in Wisconsin over the last 2 decades and prompt policymakers to include annual monitoring of childhood mortality in the state Health Plan for 2010. Methods: Data for all-cause and cause-specific (intentional-, unintentional-, non-injury related) mortality for 1980-1999 were obtained from WONDER, the Centers for Disease Control and Prevention’s mortality database, and stratified by black/white race and gender. Trends were assessed using the 5-year moving average method and projected to 2010 to estimate future mortality. Results: Childhood mortality rates in Wisconsin decreased 26% from 1980-1999 to 23.7/100,000 population, representing 87 lives saved annually. Throughout this period, Wisconsin’s mortality rate was lower than the national average; however, disparities have increased. Boys and blacks experienced the highest death rates and the greatest increases in rates from homicide and suicide. If trends continue, Wisconsin is predicted to have the same overall rate as the United States in 2010. Conclusions: Wisconsin has experienced slower rates of decline in childhood mortality than the United States over the past 20 years, due, in part, to increasing disparities by race and gender. To halt this phenomenon, policymakers should include annual monitoring of childhood mortality rates in the state health plan and support appropriate interventions for children at risk.



Author Affiliations: Ms Newburn is an MD/PhD candidate with the University of Wisconsin Medical School, Department of Population Health Sciences. Doctor Nemeth is a fellow in the Department of Pediatrics. This work was conducted as part of a class project in the Population He

Corresponding Author: Please address correspondence to Vanessa Newburn, University of Wisconsin Medical School, Department of Population Health Sciences, Room 667 WARF Building, 610 Walnut St, Madison, WI 53726; phone 608.265.3688; fax 608.263.2820; e-mail vnewburn@students.wi

Reducing Mortality in Adolescents and Young Adults in Wisconsin: Are We Making Progress?

David Todem, MS; Carinna Harding, MS

Objective: Has there been progress in the reduction of adolescent and young adult mortality in Wisconsin over the last 20 years? This paper addresses this question by examining the mortality trends—and disparities by race and gender—of adolescents and young adults in Wisconsin, ages 15-24. Methods: Mortality data for blacks and whites from 1980-1999 for Wisconsin and the United States were accessed from the Centers for Disease Control and Prevention’s Web-based database system CDC WONDER. Mean death rates were calculated for the 5-year spans 1980-1984 and 1995-1999. A Poisson model for rates was used to summarize the death rates and perform predictions. Results: Wisconsin and the United States have reduced mortality in the age group 15-24 by about 17% and 16%, respectively, between 1980-1984 and 1995-1999. In spite of this overall progress, significant disparities still exist between white and black older adolescents and young adults. When compared to 1980-1984, Wisconsin mortality rates for 1995-1999 were 24% lower among whites, but 73% higher among blacks. Disparities still exist when rates are analyzed by the leading causes of deaths. Deaths due to motor vehicle injuries have decreased for whites by about 31% compared to an increase of 19% for blacks. Conclusions: Wisconsin has made progress in reducing death rates in adolescents and young adults, especially in fatal motor vehicle injuries. However, significant disparities still exist between whites and blacks, males and females, and leading causes of deaths. Wisconsin should work to reduce the mortality rate in adolescents and young adults and to eliminate disparities by 2010.

Author Affiliations: Authors are in the MS program in Population Health at the University of Wisconsin-Madison. Additionally, Harding is an employee of EDS. Todem is a PhD student in the Departments of Biostatistics & Medical Informatics and Statistics.

Corresponding Author: Please address correspondence to David Todem, MS, Department of Biostatistics and Medical Informatics, University of Wisconsin Medical School, WARF Building, 610 N Walnut St, Madison, WI 53726-2397; e-mail: todem@biostat.wisc.edu.

Has There Been Progress in Reducing Mortality Among Wisconsin Adults Ages 25 to 44?

Elizabeth A. Dranger, BS; James M. Hoffman, PharmD

Wisconsin residents age 25-44 years represent an important life stage and a relatively large portion of the Wisconsin population. Focusing on the most common causes of death among Wisconsin adults 25-44 years old, we assess progress in reducing mortality, describe disparities between subgroups of this age group, and identify areas for improvement. Mortality trends and leading causes of death were examined from 1980-1999 by querying the Centers for Disease Control and Prevention’s WONDER database using the methods established by the National Vital Statistics System. Mortality rates in Wisconsin declined slightly (5%) during this time, and are consistently lower than the national rates. Mortality due to unintentional injury, cancer, and coronary heart disease declined in this age group. However, this decline was in contrast to increases in mortality due to suicide, homicide, and HIV—all preventable causes of death. Finally, disparities in mortality rates increased between black and white Wisconsin residents. In order to make progress in this age group, public health efforts need to focus on effective strategies to prevent HIV and violence.



Author Affiliations: Ms Dranger is a graduate student in the Department of Population Health Sciences, University of Wisconsin-Madison. Dr Hoffman is a research fellow in outcomes research and drug policy in the pharmacy department at the University of Wisconsin Hospital and

Corresponding Author: Please address correspondence to Elizabeth Dranger, University of Wisconsin Medical School, Department of Population Health Sciences, Room 753 WARF Building, 610 Walnut Ave, Madison, WI 53726; phone 608.265.8924; fax 608.263.2820; e-mail eadranger@student

Progress in Reducing Mortality Among Persons 65 to 74 Years of Age in Wisconsin

John Pfister, MS; Chia-Hung Chou, MS

Objectives: To assess progress in reducing mortality between 1980 and 1999 among Wisconsin residents aged 65-74, to identify disparities, and to propose future goals.

Methods: Mortality rates for 1980-1984 were compared to those from 1995-1999 using data obtained from the Centers for Disease Control and Prevention’s WONDER database. Percent change in rates were calculated and projected to 2010, and annual numbers of lives saved were estimated.

Results: The mortality rate for persons aged 65-74 has decreased 12.4%—17.5% in men and 6.3% in women. However, no reductions were observed for blacks. An estimated 1325 fewer deaths occur each year, with white men accounting for >80% of these savings. Mortality rates decreased for heart disease (-38%) and stroke (-26%), but increased for cancer (+6%).

Conclusions: Significant progress has been made in reducing mortality among Wisconsin residents aged 65-74, but not among blacks. Most of the progress is due to decreased deaths from heart disease and stroke, particularly for white men.



Author Affiliations: The authors are from the University of Wisconsin-Madison. Mr Pfister is an epidemiologist at the Wisconsin State Laboratory of Hygiene and a PhD student in the Department of Population Health Sciences. Mr Chou is a PhD student in the School of Pharmacy Di

Corresponding Author: Please address correspondence to John R. Pfister, MS, Wisconsin State Laboratory of Hygiene, University of Wisconsin-Madison, 465 Henry Mall, Madison, WI 53706; phone 608.262.7404; e-mail jp@slh.wisc.edu.

Pesticides and Your Children: A Randomized Controlled Evaluation of a Pamphlet

Daniel J. Sklansky, BA; Marlon P. Mundt, MS; Murray L. Katcher, MD, PhD

Background: Maternal and pediatric residential pesticide exposure has been identified as a risk factor for birth defects, pediatric cancers, and neurological damage, and it may play a role in other disease processes.

Objective: To examine whether the use of a pamphlet with a brief educational message in a clinic setting would increase the knowledge and/or change the attitudes of pregnant women and mothers about pesticide use and alternatives, as well as promote pesticide safety.

Methods: A group of 103 women currently pregnant and/or with children less than 6 years of age were recruited at 2 Special Supplemental Nutrition Program for Women, Infants and Children (WIC) clinics for the study. Participants were given a 16-question true/false oral survey testing their baseline knowledge about pesticide safety and safer alternatives to pesticide use. Participants were then randomly assigned to a control group or to the intervention group, which received the pamphlet and a 2-minute scripted overview of its contents. Approximately 2 to 3 weeks later, all participants received a follow-up telephone call by a researcher blinded to the original group assignment, and the original survey questions were repeated.

Results: Follow-up assessments were completed for 73 (71%) of the participants. The mean improvement in correct responses on the follow-up survey was +0.39 for the control group and +3.1 for the intervention group (p<.001). Item analysis revealed that the intervention produced a significantly higher number of correct answers to 9 of the 16 survey questions.

Conclusions: Providing mothers and pregnant women with a pamphlet and a brief message about pesticide safety and safer alternatives to pesticides in a clinic setting may be effective in improving knowledge and beliefs about pesticides. Click here for the "Pesticide and Your Children" pamphlet. (requires Adobe)



Author Affiliations: Mr Sklansky is a second-year medical student, University of Wisconsin Medical School and recipient of the Summer Fellowship in Government and Community Service from the Wisconsin Medical Society Foundation. Mr Mundt is a Programmer Analyst in the Departme

Corresponding Author: Please address correspondence to Murray L. Katcher, MD, PhD, Wisconsin Division of Public Health, 1 West Wilson St, Room 243, Madison, WI 53701-2659; phone 608.266.5818; fax 608.266.3125; e-mail katchml@dhfs.state.wi.us.

Your Practice

Index to Articles: 2003

Wisconsin Medical Journal

Index of Articles

Author Affiliations: Wiscosnin Medical Society


Corresponding Author: Wisconsin Medical Society

Your Profession

Impending physician shortage needs decisive remediation

Michael J. Dunn, MD, Dean and Executive Vice President, Medical College of Wisconsin

Identifying a shortage of water or gasoline is a straightforward case of supply and demand with immediate, recognizable consequences. A future shortage of physicians is a more complex and difficult crisis to ascertain and, as a result, opinions on the subject have varied greatly.


Author Affiliations: Medical College of Wisconsin

Corresponding Author: Wisconsin Medical Society 330 E. Lakeside St Madison, WI 53715