Gender of Physician as the Usual Source of Care and Patient Health Care Utilization and Mortality.
Gender of physician as the usual source of care and patient health care utilization and mortality.
J Am Board Fam Med. 2013 Mar; 26(2): 138-48
Jerant A, Bertakis KD, Fenton JJ, Franks P
Practice styles differ by provider gender, but whether provider gender influences health care utilization and mortality is unknown. The objective of this study was to examine associations of the gender of a patient’s usual source of health care (USOC) with health care utilization and mortality.This was a prospective observational study employing data from respondents aged ?18 years entering the 2002 to 2008 United States Medical Expenditure Panel Surveys, reporting a USOC at entry, and participating for 2 years (N = 21,365). Analyses examined the association of gender of the USOC in survey participation year 1 with the following health care utilization outcomes in participation year 2: total health care expenditures, prescription drug expenditures, and number of office visits (Poisson regressions) and having more than one emergency visit and more than one hospitalization (logistic regressions). A Cox regression examined survival (ascertained via linkage with the National Death Index) through 2006 for the subset of respondents enrolled from 2002 to 2006 (n = 11,328). All analyses were adjusted for respondent sociodemographic and health characteristics and USOC specialty and race/ethnicity.Reporting a female USOC was associated with being younger, female, and urban. There were no significant adjusted associations of female USOC status with total expenditures (parameter estimate of increase [PE], 4.56%; 95% confidence interval [CI], -3.04 to 12.76), prescription expenditures (PE, 3.33% ; 95% CI, -4.32 to 11.59), number of office visits (PE, 1.28%; 95% CI, -3.30 to 6.08), having more than one emergency visit (odds ratio, 0.98; 95% CI, 0.87-1.11), having more than one hospitalization (odds ratio, 0.98; 95% CI, 0.87-1.11), or mortality (hazard ratio, 0.94; 95% CI, 0.64-1.38).Gender of the USOC was not associated with health care utilization or mortality. These findings suggest reported gender of the USOC may not have nationally important effects on health care utilization and mortality. HubMed – drug
Successful behavioral interventions, international comparisons, and a wonderful variety of topics for clinical practice.
J Am Board Fam Med. 2013 Mar; 26(2): 105-7
Bowman MA, Neale AV
This is the issue of successful behavioral interventions and international comparisons that support the need for better primary health care in the United States. Men’s preconception care is considered, and the issue rounds out with articles about the radiologic findings of fluid in the mastoid bone, sex of physicians and mortality rates, a diabetes drug review, and, as usual, some informative brief case reports. HubMed – drug
Functional analysis of a zebrafish myd88 mutant identifies key transcriptional components of the innate immune system.
Dis Model Mech. 2013 Feb 21;
van der Vaart M, van Soest JJ, Spaink HP, Meijer AH
Toll-like receptors (TLRs) are an important class of pattern recognition receptors (PRRs) that recognize microbial and danger signals. Their downstream signaling upon ligand binding is vital for initiation of the innate immune response. In human and mammalian models, myeloid differentiation factor 88 (MYD88) is known for its central role as an adaptor molecule in interleukin 1 receptor (IL-1R) and TLR signaling. The zebrafish is increasingly used as a complementary model system for disease research and drug screening. Here, we describe a zebrafish line with a truncated version of MyD88 as the first zebrafish mutant for a TLR signaling component. We show that this immune-compromised mutant has a lower survival rate under standard rearing conditions and is more susceptible to challenge with the acute bacterial pathogens Edwardsiella tarda and Salmonella typhimurium. Microarray and quantitative PCR analysis revealed that expression of genes for transcription factors central to innate immunity (including NF-?B and AP-1) and the pro-inflammatory cytokine Il1b, is dependent on MyD88 signaling during these bacterial infections. Nevertheless, expression of immune genes independent of MyD88 in the myd88 mutant line was sufficient to limit growth of an attenuated S. typhimurium strain. In the case of infection with the chronic bacterial pathogen Mycobacterium marinum, we show that MyD88 signaling has an important protective role during early pathogenesis. During mycobacterial infection, the myd88 mutant shows accelerated formation of granuloma-like aggregates and increased bacterial burden, with associated lower induction of genes central to innate immunity. This zebrafish myd88 mutant will be a valuable tool for further study of the role of IL1R and TLR signaling in the innate immunity processes underlying infectious diseases, inflammatory disorders and cancer. HubMed – drug