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In rural America, pediatricians and family doctors are in short supply, according to a study by DMS pediatrician Scott Shipman, M.D., et al. Between 1996 and 2006, the number of pediatric and family physicians increased 51% and 35%, respectively, but rural children's access to care remained poor. In 2006, 15 million children lived in areas with more than 4,400 children for each pediatric or family physician. Worse still, almost one million children lived in areas where there were no such physicians at all. Better workforce policies "aimed at reducing disparities in geographic access to primary-care physicians for children" is what's needed, wrote the researchers in Pediatrics.

Overexposure
Cigarette ads may be almost as harmful as cigarettes themselves, suggests a recent study conducted in Germany with help from DMS pediatrician James Sargent, M.D. The study, published in Pediatrics, links teens' exposure to cigarette ads to the initiation of smoking. "Our results . . . underline the specificity of the relationship between tobacco marketing and teen smoking" wrote the study's authors. In fact, teens in the highest exposure group were almost 50% more likely to begin smoking during the study than those in the lowest-exposure group.

A paper from the lab of Dartmouth microbiologist George O'Toole, Ph.D., plus one from a Cornell lab with which O'Toole collaborates, were highlighted as "Editors' Picks" in the journal PLoS Biology.

Additive effect
Hormone replacement therapy, a once-common treatment for the symptoms of menopause, has now been linked to early-stage breast cancer—in addition to invasive breast cancer. That's according to a new analysis by researchers from Dartmouth, San Francisco, and Seattle. The study, published in the Journal of Clinical Oncology, examined data from over 2 million mammograms of 700,000 women. "The effect of hormone therapy on breast cancer risk is reversed soon after discontinuation," noted DMS epidemiologist Tracy Onega, Ph.D., and her coauthors. Still, they say such therapy "should be limited to the shortest duration possible."

Detection projection
Colonoscopies could provide patients with a false sense of security, found a study by DMS's Heiko Pohl, M.D., and Douglas Robertson, M.D. "A significant number of patients undergoing a screening colonoscopy that did not detect cancer actually have a malignant lesion or adenoma that could progress in a short [time]," they wrote in Clinical Gastroenterology and Hepatology. The researchers estimate that almost 1 in 500 people who pass a standard screening will develop colorectal cancer within five years—a number that could be lowered by improving adenoma detection, they argue.

An issue of the American Journal of Reproductive Immunology has been devoted entirely to the proceedings of a symposium held at DMS on the sexual transmission of AIDS. See http://bit.ly/gJz7cU.

Quality, not quantity
Simply training more physicians might not improve access to health care, found a recent study by DMS's David Goodman, M.D. "Patients living in areas with more physicians per capita had perceptions of their health care that were similar to those of patients in regions with fewer physicians," Goodman et al. wrote in Health Affairs. They found no significant differences in the number of visits patients had with their personal physician or in their access to tests or specialists. Instead of focusing on increasing the number of physicians, they wrote that "focusing health policy on improving the quality and organization of care may be more beneficial."

Appendectomy blues
Appendicitis, though highly treatable, may be more deadly for patients in rural areas, found a recent study led by Dartmouth surgeon Samuel Finlayson, M.D. In 36% of rural patients with appendicitis, the organ had perforated by the time they got medical help, compared to 31% of urban patients, wrote Finlayson and his coauthors in Annals of Surgery. Perforations are "associated with increased morbidity, length of hospital stay, and overall health-care costs," they noted. The urbanrural gap, they concluded, "suggest[s] disparities in timely access to surgical care."

The Dartmouth Atlas of Health Care has gone global. The British National Health Service just published a compendium of variations in its use and distribution of health-care resources.


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