• OUR MISSION

    Improve the health of the people of Wisconsin by supporting and strengthening physicians' ability to practice high-quality patient care in a changing environment.

Volume 102, Issue 8 (2003)


 
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Editorials

Thomas C. Meyer, MD, Medical Editor, WMJ
Disparity in demographics: A cause for concern
(full text PDF)

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.

Daniel J. Sklansky, BA
A summer in public health research
(full text PDF)

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.

Sandra Osborn, MD
Wisconsin Medical Society Foundation purpose supports medical and health education
(full text PDF)

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.”

Paul Wertsch, MD
Workforce shortage mandates change . . . now
(full text PDF)

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.

Tim Size
Wisconsin can prepare and support rural physicians
(full text PDF)

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.

Original Research

Marc Kennedy, special to WMJ
Health Care Worker Shortage: Pervasive and Long-Term
(full text PDF)

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.

Marc Kennedy, special to WMJ
Physician shortage: misdiagnosis & prognosis
(full text PDF)

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:

Elizabeth A. Dranger, BS; Patrick Remington, MD, MPH; Paul E. Peppard, PhD
Progress in Reducing Mortality Among Wisconsin Residents, 1980-2000: Rates Decline, but Black-White Disparities Increase
(full text PDF)

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. Erika W. Hagen, BA; Flávia C. D. Andrade, MA
Monitoring Infant Mortality Trends in Wisconsin, 1980 to 1999
(full text PDF)

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.

Vanessa H. Newburn; Blaise A. Nemeth, MD
Health Priorities in Wisconsin: A Case for Tracking Childhood Mortality
(full text PDF)

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.

David Todem, MS; Carinna Harding, MS
Reducing Mortality in Adolescents and Young Adults in Wisconsin: Are We Making Progress?
(full text PDF)

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.

Elizabeth A. Dranger, BS; James M. Hoffman, PharmD
Has There Been Progress in Reducing Mortality Among Wisconsin Adults Ages 25 to 44?
(full text PDF)

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.

John Pfister, MS; Chia-Hung Chou, MS
Progress in Reducing Mortality Among Persons 65 to 74 Years of Age in Wisconsin
(full text PDF)

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.

Daniel J. Sklansky, BA; Marlon P. Mundt, MS; Murray L. Katcher, MD, PhD
Pesticides and Your Children: A Randomized Controlled Evaluation of a Pamphlet
(full text PDF)

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)

Your Practice

Wisconsin Medical Journal
Index to Articles: 2003
(full text PDF)

Index of Articles

Profession

Michael J. Dunn, MD, Dean and Executive Vice President, Medical College of Wisconsin
Impending physician shortage needs decisive remediation
(full text PDF)

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.

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