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Poor Working Conditions For Docs May Affect Quality Of Care
"Adverse working conditions for primary care doctors, including time pressures and an unfavorable organizational culture, may lead to stress, burnout, and ultimately to lower quality patient care, a new study found," MedPage Today reports. The study, published in the July 7 issue of The Annals of Internal Medicine, found that "53.1% of primary care physicians reported time pressure during physical examinations, while 48.1% reported chaotic working environments. Only 23.7% felt that quality was strongly emphasized in their practices. ... Moreover, 48.8% described their jobs as moderately or highly stressful, while 26.5% reported burnout, and 30.1% said they were at least moderately likely to leave their practices within two years." The authors wrote that the findings "are disturbing at a time when recruitment and retention in primary care are of major concern."
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Reps. Ryan, DeLauro To Introduce Bill To Reduce Need For Abortion
Reps. Tim Ryan (D-Ohio) and Rosa DeLauro (D-Conn.) on Thursday will be joined by leaders of the Planned Parenthood Federation of America and NARAL Pro-Choice America in announcing the latest version of a bill that aims to reduce the need for abortion by preventing unintended pregnancies, among other measures, Time reports (Sullivan, Time, 7/23). Ryan and DeLauro first introduced a version of the bill in 2006 (Crary, AP/San Francisco Chronicle, 7/22). However, this version "represents a dramatic break from nearly four decades" of political debate since Roe v. Wade, as both conservative antiabortion-rights groups and abortion-rights advocates have expressed support, according to Time (Time, 7/23).The bill would increase support for comprehensive sex education programs, improve access to contraception, expand Medicaid family planning coverage, increase programs for pregnant or parenting college students, and expand adoption assistance. The Congressional Budget Office has not yet conducted a cost-analysis of the bill, the AP/San Francisco Chronicle reports (AP/San Francisco Chronicle, 7/22). In developing the bill, Ryan sought the help of Rachel Laser, director of culture programs at the policy and strategy think-tank Third Way. According to Time, Laser worked with advocates on both sides and modified the bill to help gather their support, while preventing the measure from becoming "uselessly watered down or split into two."DeLauro noted, "We had to reach a level of trust" with people on both sides and allow them time to become more receptive to the bill"s goals, adding, "Because so often this issue has been one about which there was nothing other than trying to score political points." DeLauro said she hopes the Obama administration will look to the bill for guidance as it crafts its strategy for reducing the need for abortion and preventing unintended pregnancies. President Obama is expected to make an announcement about the plan next month, according to Time (Time, 7/23).DeLauro and Ryan also noted that Rahm Emanuel, Obama"s chief of staff, endorsed an earlier version of the bill when he served in the House, which they hope could mean that Obama would support their measure. DeLauro said, "This is a bill that seems to mesh with the president"s interests," adding, "I see no reason why the White House could not endorse it."Joshua DuBois, director of the White House Office of Faith-Based and Neighborhood Partnerships, said the administration is still reviewing the information it has gathered in recent meetings with representatives on both sides of the abortion debate.Laurie Rubiner, director of Planned Parenthood"s Washington, D.C., office, said "This isn"t a radical bill," adding, "It only seems radical because it"s been so long that we could have a constructive conversation ... with both pro-choice and anti-choice groups around the table."The Rev. Joel Hunter -- an antiabortion-rights evangelical pastor in Orlando, Fla., who serves on the White House Faith-Based Advisory Council -- called the bill "a landmark bill for the culture wars -- a prototype for how we can approach things in the future." He said the bill"s strengths were in its appeals to both liberal and conservative beliefs, adding, "When you realize you need someone who"s been an adversary to help you advance your own projects, that"s a big deal" (AP/San Francisco Chronicle, 7/22).
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International Team Of Physician-astronauts Draws Upon First-hand Space Flight Experience In CMAJ Article
An international team of astronauts, including Canadian Dr. Robert Thirsk who launched into space on May 27, have just published an article in the Canadian Medical Association Journal (CMAJ) about the complex physiologic changes and psychological effects that occur in space. They draw upon first-hand experience as both physician-astronauts and crew medical officers on space missions and from NASA literature and peer-reviewed medical s.
Public Health

Indirect Transmission Can Trigger Influenza Outbreaks In Birds

New data on the persistence of avian influenza viruses in the environment has allowed a team of University of Georgia researchers to create the first model that takes into account both direct and indirect transmission of the viruses among birds. The model, which is detailed in the early online edition of the journal Proceedings of the National Academy of Sciences, has the potential to shed new light on how outbreaks begin in wild bird populations. "The environmental transmission of avian influenza among birds is quite rare, but our model shows that it can play an important role in outbreaks," said lead author Pejman Rohani, professor in the UGA Odum School of Ecology. "There are situations where ignoring the possibility of environmental transmission would cause you to significantly underestimate the probability, magnitude and duration of an outbreak." Rohani explained that current models of avian influenza only take into account the direct transmission of the virus that occurs when infected waterfowl and shorebirds shed the virus in their feces and those nearby drink contaminated water. But research in the UGA College of Veterinary Medicine has revealed that some avian influenza viruses can persist in water for up to 150 days. So even when no infected birds are present, Rohani said, virus present in the water can trigger an outbreak. Models that only take into account direct transmission, he pointed out, would incorrectly conclude that there"s no risk of an outbreak when no infected birds are present. The viruses the researchers studied are known as low-pathogenicity viruses and do not infect humans. Low-path viruses only cause mild symptoms in birds but have the potential to swap genes and give rise to high pathogenicity viruses that can cause massive die-offs in poultry and - in rare cases - can infect humans. The H5N1 avian influenza virus, for example, has a 60 percent mortality rate in humans and is responsible for 262 deaths worldwide since 2003, according to the World Health Organization. "We need to understand low-path viruses because they are a storehouse of genetic variation that can give rise to new and potentially dangerous strains," said study co-author John Drake, assistant professor of ecology. In addition to the environmental persistence of the virus, the team"s model takes into account variables such as lake size and the rate at which infected birds recover to describe likely and worse case outbreak scenarios. The model also reveals that environmental transmission extends the duration of an outbreak by infecting birds that haven"t come into contact with other birds yet have consumed contaminated water. The data on the environmental persistence of avian influenza viruses comes from the lab of David Stallknecht, associate professor in the department of population health in the UGA College of Veterinary Medicine. In a study recently published in the journal Veterinary Microbiology, Stallknecht and lead author Justin Brown determined the persistence of 12 low-path avian influenza viruses under natural ranges of pH, salinity and temperature. The researchers found that the duration of persistence varied widely among viruses, but that the viruses generally are most stable at a slightly basic pH, temperatures of less than 63 degrees Fahrenheit (17 degrees Celsius) and in fresh to slightly brackish water. "The role of the environment in the transmission of avian influenza has been almost completely undefined, and that"s what makes this research so exciting," said Brown, a post-doctoral researcher. "Migration and other factors relating to the biology of the avian host are still very important factors that drive the epidemiology of avian influenza, but now we can look at various environments and ask if they"re better or worse for the transmission of avian influenza." Sam Fahmy University of Georgia


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