Healthcare and Trump"s travel ban: data shows success of doctors trained abroad

American patients treated by internationally educated doctors have slightly better outcomes than those treated by their American-educated counterparts, a new study has found, as Donald Trump’s ban on travel from seven Muslim-majority countries is expected to stop some immigrant physicians from coming to the United States.

But that is not because American medical schools are falling short, the authors of the report in the British Medical Journal said.

“We’re not saying medical school in the US is not doing a good job, it’s only about selection,” said Yusuke Tsugawa, a research associate at Harvard University’s TH Chan School of Public Health and lead author of the study. Self-selection, to be more specific.

“They are highly motivated,” Tsugawa said of doctors educated outside the US. “They are not random doctors from their home country, they are the best doctors.”

Trump’s executive order banned people from entering the US from seven countries – Iran, Iraq, Libya, Somalia, Sudan, Syria, and Yemen – for 120 days following the order. The order also stopped the Syrian refugee resettlement program indefinitely.

Researchers looked at 1.2m hospital admissions of patients on Medicare, the American public health insurance program for the elderly, who were treated by more than 44,000 physicians. The rate at which patients died or were readmitted was used to measure patient “outcomes”.

Despite the study’s findings that internationally educated doctors were slightly more likely to treat a sicker population – people with more chronic diseases, as well as more likely to be from racial minorities and more likely to be low-income – outcomes were slightly better than among their American-educated peers. That held when comparing doctors in the same hospitals. Patients treated by both international and US graduates were about the same age on average, approximately 80 years old.

“Our findings indicate that current standards of selecting international medical graduates for practice in the US are functioning well for at least one important dimension: inpatient outcomes,” researchers wrote.

By the numbers, researchers found that when patients were treated by internationally educated doctors, they died at a rate of 11.2%, versus 11.6% for US-educated physicians, in comparisons of doctors working in the same hospitals.

Readmissions showed the same trend. Patients returned to the hospital within 30 days at a rate of 15.4% for internationally educated doctors, and 15.5% for US educated doctors, when comparing doctors in the same hospital.

Tsugawa said he and his colleagues undertook the study because other research showed there “was a bias against foreign medical graduates, both from colleagues and patients, so they are thinking quality of care might be worse than US medical graduates.

“Given that 25% of the doctors in the US – or in the UK as well – are foreign medical graduates, we want to make sure they are providingquality medical care,” he said. Tsugawa said he expected to focus on the race of doctors in his next study.

“To do the residency program in the US, the bar is really high; only 50% of the candidates can get the slot in the residency program,” said Tsugawa. “There are multiple ways they are highly selected, and highly motivated, and that is the reason they have better outcomes.

“Those who come to the US are the brightest and the best,” he said.

About one quarter of physicians working in the US were educated abroad, multiple studies show. But many workforce experts believe that even if the immigration status of hundreds weren’t suddenly in question, there still would not be enough doctors coming to the US to make up shortages faced by ageing and rural Americans.

For example, the largely rural Alaska already needs an additional 60 doctors per year, the Atlantic reports. And a 2015 New England Journal of Medicine article argued that programs that brought 8,000 doctors to the US each year would fall far short of the primary care needs of the country’s ageing population.

Research from 2013 showed that 299 doctors from Iran, Iraq, Libya, Sudan, or Syria applied to train in the US as residents that year, with an acceptance rate of just 40%, a New England Journal of Medicine article reported.

Syria is also one of the top exporters of physicians to the US in another program that places doctors in high-need rural and inner-city areas, the J-1 visa program. In 2014, 165 Syrian doctors moved to the US under the program, according to the same article. If the ban continues beyond 120 days the number of doctors – and therefore patients – affected could escalate very quickly.

“Physicians with J-1 waivers are filling clinical jobs in areas of need,” the NEJM authors wrote. “An executive order that has not taken into account the widespread ramifications may lead to further shortages of physicians in areas that are already in dire need.”

Healthcare and Trump"s travel ban: data shows success of doctors trained abroad

Our children are paying a high price for society’s vision of success

Yet another report has been published showing frightening levels of mental illness among children and young people in England. The figure now stands at about a quarter of a million. I have written before, downplaying the phenomenon, usually along the lines of “children have never had it so good” and pointing to the increase in child-centrism, the boons of technology and the growth in living standards for most.

I can’t keep my head in the sand any longer. Something is going seriously wrong. Owen Jones, in an article in this newspaper, recited the usual suspects – overcrowded and poor housing, poor diet, lack of exercise, family conflict, the stresses of poverty and lack of state support. I am dubious about most of these explanations, largely because such matters have long been with us without an accompanying crisis of mental illness.

My explanation is that our children are having their childhood stolen from them, and at some level they know it. They kick against this with rage and frustration. But it is important to note that this is a rise in mental illness, not unhappiness. They are different things. Mental illness is an unhappiness that is unsanctioned, denied essentially. It is unhappiness that does not know itself. It is unhappiness that arises from confusion and double standards. Why this confusion? Chiefly, it is down to the idea that achievement and competition are all important. There is nothing wrong with this as an ethos, but achievement of what? Competition for what? And when does it end?

In the world I grew up in, when mental illness among young people was largely unheard of, achievement, although desirable, was not considered particularly important. Many people from my very ordinary background didn’t pass any important exams. Few went to university. And it wasn’t thought a big deal, because it was recognised that not everyone could be outstanding or high achieving. It wasn’t a failure to get a job in a local shop or factory, find somewhere OK to live and have a couple of kids. It was normal and many people embraced it.

But things have changed in the world of societal expectation. The myth seems to have arisen that individual striving and effort will always get you what you want – money, status or a satisfying career. A few generations ago, we were more realistic. The class structure of society, and our own individual limitations – such things were acknowledged then – meant that few of us could hope to hit the heights. But it didn’t matter as long as we had a reasonable job, our community, our homes, our families. Expectations were in line with reality.

Now that middle-class aspirational values have seeped and bled everywhere, this is no longer the case. Not only are we told that we can do anything if we want to, but that we should. We must all become middle class, or count ourselves a failure. Competitive narcissism runs rampant.

It is bad enough for those who come from a background that invests in this – the ambitious middle class. To get sucked in from a culture that does not invest in it, or have much of a chance in the race – well, no wonder some children are either rejecting education, or experiencing mental illnesses.

Achievement is healthy, but we don’t all have to hit the heights to feel good about ourselves. Society is made up of mostly low- or medium-achievers, and to make us feel ashamed of who we are is a great burden. Success should be redefined as achieving what you feel capable of, and what lies within the realm of possibility – not what society tells you that you must achieve in order to conform to a fantasy that, for most, only exists in glossy magazines and university prospectuses.

@timlottwriter

Our children are paying a high price for society’s vision of success

NLP Tip: Optimism and Your Personal Success

It makes sense that optimism would be good for your personal goals, and even your well-being, but it’s shocking just how good optimism for your health.

An article titled Optimism and Your Health published by Harvard Health Publications says, “According to a series of studies, optimism helps people cope with disease and recover from surgery. Even more impressive is the impact of a positive outlook on overall health and longevity. Research tells us that an optimistic outlook early in life can predict better health and a lower rate of death during follow-up periods of 15 to 40 years.”

15-40 years!

Any efforts spent building a more optimistic outlook, therefore, are wise investments. One way is to begin to let go of our uncanny attachments to negativity.

Often times we unknowingly limit ourselves to past negative experiences by our use of language. For example, if you have a history of a particular behavior, such as being bad at certain skill, you will limit yourself by saying “Oh, I’m bad at that,” as if it were a fact that is present and unchanging.

What many of us don’t realize is that we are forcing this generalization into reality by using words in limiting ways..

If we simply change our wording, the door to a whole new world of possibility will be opened.

Instead of referring to a past experience as if it were a present fact, use words like “In the past…” or “At one point in time…”

Doing this will unleash more possibility, and open up your mind to the idea that you can get better at it, and that your previous experience is not one that must remain. Your bad experience is not being projected into future experiences, and you are closer to beginning with a clean slate.

If believe that you are bad at something, instead of utilizing and activating the negative feeling of being bad at something, say “I wasn’t very effective at the time”. Simply changing “bad” to “wasn’t very effective” opens up the positive end of the spectrum, and allows us to see that there is room for improvement.

References
Optimism and your health – Harvard Health. (n.d.). Retrieved from http://www.health.harvard.edu/heart-health/optimism-and-your-health

NLP Tip: Optimism and Your Personal Success

NLP Tips for Success: How to Get Yourself to Focus

There comes a time in everyone’s day that they are going to have to focus, pay attention to detail, and remember that information. It’s just a part of life.

But some people have a hard time getting themselves to focus when it’s important, and often they miss out on information that will be useful to remember in the future.

Whether you are a student, a parent, or someone in the workplace, there will be times that you have to learn, and retain information. If you feel that you are a person who has a hard time doing this, or that it is simply out of your control, there is a very simple way to hone in your focus and get the job done.

Try out this little method to get yourself to focus…

Physically look up at the ceiling, close your eyes and completely clear your mind, and focus on your breath for a few seconds. Don’t think about the task at hand, don’t think about your baby at home, just make your thoughts quiet.

Then, open your eyes while still looking up, and while maintaining a clear head slowly bring your eyes down to your task while strongly imagining that focus staying right in your peripheral vision as you carry out your job.

If you feel your focus heading in another direction and need to regroup, start over and repeat the process. It doesn’t take more than five minutes, and can make all the difference in completing tasks and learning new information.

For other NLP tips visit iNLP Center – or check out this post on manifesting your desires.

NLP Tips for Success: How to Get Yourself to Focus

Australia"s success in methadone treatment could guidebook Russia, says UN envoy

Australia could demonstrate crucial in convincing Russia to adjust laws avoiding heroin addicts from accessing opiate treatment method packages, the UN secretary general’s special envoy for Aids in eastern Europe and central Asia mentioned.

Michel Kazatchkine, who has been involved in the worldwide response to Aids for 3 decades, mentioned 20 individuals had died in Crimea by means of becoming unable to access methadone remedy, after Kremlin-backed forces seized handle of the area earlier this 12 months.

“There had been 800 men and women on methadone in Crimea, which we know is the most effective way of avoiding HIV spread in individuals who use medicines, in blend with needle exchange applications,” Kazatchkine said.

“Within days following the alter of authorities in Crimea, it was mentioned that opioid substitution therapy would be discontinued.”

Underneath Russian law, methadone is illegal. Until finally Kremlin forces gained management of Crimea, Ukraine had been creating considerable progress in implementing methadone remedy applications and expanding needle exchange packages.

“Now it has stopped and twenty individuals, at least, have died, and they are just the instances I have confirmed,” Kazatchkine mentioned. “What we know for positive is forcing the discontinuation of methadone therapy is unjustifiable by all human rights and scientific indicates, and that the consequences are hugely tragic.”

Opiate withdrawal was really unpleasant and a kind of torture, Kazatchkine mentioned, and had driven some people unable to access methadone to suicide. Other individuals had overdosed on heroin, returning to the drug since they could no longer accessibility the substitute.

Methadone is manufactured, and is employed as a substitute for individuals addicted to heroin and other opioids due to the fact its effects final longer than heroin. When in a therapy plan, folks are significantly less very likely to inject illegal drugs which expose them to threat of catching conditions and getting into the criminal method.

Kazatchkine stated he had spoken in front of the Russian wellness minister about the harmful predicament and the need for methadone plans to carry on in Crimea to aid curb the spread of HIV, but to no avail. A scheduled meeting with Russian authorities about the situation had been cancelled, he explained.

Russia favoured psychological treatment packages, believing methadone therapy packages utilised taxpayer funds to “entertain” drug use by substituting 1 kind of opiate with another, Kazatchkine said. He mentioned Australia ought to now stage in.

“The voice of Australia as 1 of the 1st countries to efficiently implement harm reduction applications like methadone to curb the HIV epidemic among individuals who use medicines, to me is very critical,” Kazatchkine told Guardian Australia at the Aids 2014 conference in Melbourne.

“Australia has science, it has evidence , and it is only on individuals grounds that we can open the debate with Russia – not on political or ideological ground.”

According to the National opioid pharmacotherapy statistics 2013 about 47,000 folks in Australia obtained pharmacotherapy treatment method for their opioid dependence in 2013.

“While Russia is not the only nation that does not believe in methadone as a harm reduction strategy, Russia is exactly where there is a massive HIV epidemic largely driven by drug use, and where indicates that we know can stop that epidemic are not becoming implemented, so the epidemic there is definitely acute,” Kazatchkine explained.

Former large court judge Michael Kirby used his plenary tackle at the Aids 2014 conference on Sunday night to get in touch with on Tony Abbott to set an instance to other countries in the fight against the HIV and Aids epidemic.

Kirby told conference delegates that the Australian prime minister could use his political conservatism to appeal to other conservative planet leaders who had been slow to consider action on HIV/Aids. On Tuesday, he echoed Kazatchkine’s feedback about the value of Australia in the worldwide HIV battle.

“Mr Abbott is the first prime minister of Australia ever to acknowledge that the war on medication is being misplaced,” Kirby stated. “The inference that could be drawn from that is new policies should be adopted and worldwide laws on the global war on medicines ought to be reformed.”

A Ukrainian living in Crimea and forced off methadone recorded a video for conference delegates, her face blacked out for concern of retribution.

“A minister from the Russian well being department met with us and promised us treatment method, but we did not get something,” she explained. “Now we are are dying, and many end users in Crimea have relapsed.

“Maybe for some individuals they will proceed to inject heroin if they can afford it, but for me, I just want it to be all above. It is so, so unpleasant. I do not want to even breathe.”

• If you are in distress and would like help, please contact Lifeline 13 eleven 14 BeyondBlue 1300 224 636 or Mensline 1300 789 978 for support and details.

Australia"s success in methadone treatment could guidebook Russia, says UN envoy

Peanut allergy treatment ‘a success’

Doctors say a possible treatment for peanut allergy has transformed the lives of children taking part in a large clinical trial.

The 85 young children had to consume peanut protein every single day – initially in tiny doses, but ramped up for the duration of the research.

The findings, published in the Lancet, propose 84% of allergic youngsters could eat the equivalent of five peanuts a day after six months.

Specialists have warned that the treatment is not yet ready for widespread use.

Peanuts are the most common cause of fatal allergic reactions to food.

“The trial has been an encounter and adventure that has modified my life and I’ve had so much exciting, but I nonetheless hate peanuts”

Lena Barden Age eleven

There is no treatment so the only choice for patients is to avoid them totally, top to a lifetime of checking each and every meals label just before a meal.

Create up

The trial, at Addenbrooke’s Hospital in Cambridge, experimented with to train the children’s immune programs to tolerate peanut protein.

Every single day they were provided a peanut protein powder – starting up off on a dose equivalent to one 70th of a peanut.

The theory was that individuals started out at the very minimal dose, nicely beneath the threshold for an allergic response.

Once a fortnight the dose was improved although the kids were in hospital, in case there was any response, and then they continued taking the larger dose at property.

The bulk of individuals discovered to tolerate the peanut.

Claire Rooney describes the day-to-day anxieties of possessing a daughter with several food allergy symptoms.

Lena Barden, 11, from Histon in Cambridgeshire, explained: “It meant a journey to the hospital every two weeks.

“A year later on I could consume 5 complete peanuts with no reaction at all.

“The trial has been an encounter and adventure that has altered my lifestyle and I’ve had so a lot fun, but I nonetheless hate peanuts!”

‘Dramatic transformation’

One particular of the researchers, Dr Andrew Clark, informed the BBC: “It really transformed their lives drastically this really comes across throughout the trial.

“It’s a prospective treatment and the subsequent step is to make it available to sufferers, but there will be significant fees in offering the treatment method – in the specialist centres and personnel and producing the peanut to a sufficiently substantial common.”

Fellow researcher Dr Pamela Ewan extra: “This large study is the initial of its kind in the world to have had this kind of a constructive outcome, and is an crucial advance in peanut allergy research.”

But she stated more studies would be needed and that men and women should not attempt this on their personal as this “should only be completed by health care specialists in specialist settings”.

The investigation has been broadly welcomed by other researchers in the area, but some concerns about how any treatment could be introduced have been raised.

How to spot potentially existence-threatening allergic reactions and how to deal with them

Caution

Prof Gideon Lack, who is running a peanut allergy trial at the Evelina Children’s Hospital in London, advised the BBC: “This is a actually crucial research stage in making an attempt to increase our management of peanut allergy, but is not however prepared for use in clinical practice.

“We need a suitable danger evaluation needs to be completed to ensure we will not make life much more hazardous for these youngsters.

“This large research is the very first of its variety in the planet to have had this kind of a good end result, and is an essential advance in peanut allergy research”

Dr Pamela Ewan Cambridge University Hospitals

He warned that 60% of men and women with a peanut allergy had been also allergic to other nuts so a carefree lifestyle would rarely be an alternative.

Prof Barry Kay, from the division of allergy and clinical immunology at Imperial College London, said: “The real concerns that even now continue to be consist of how prolonged the final results will last, and no matter whether the optimistic effects might lead affected folks to have a false sense of protection.

“Another situation to deal with is no matter whether there will be prolonged phrase side-results of repeated peanut publicity even where complete allergic reaction does not arise, this kind of as irritation of the oesophagus.

“So, this research exhibits encouraging outcomes that add to the recent literature, but more research are required to pin down these concerns before the existing tips to peanut allergy sufferers, which is to stay away from consuming peanuts, is altered.”

Maureen Jenkins, director of clinical services at Allergy Uk, said: “The fantastic results of this research exceed expectation.

“Peanut allergy is a particularly frightening meals allergy, triggering consistent nervousness of a response from peanut traces.

“This is a major stage forward in the global quest to control it.”

Prof Simon Murch, an allergy expert at the Royal College of Paediatrics and Little one Overall health, explained: “This is plainly a promising paper but it definitely is not a remedy.

“Nevertheless this research does point towards a promising new route of therapy and as soon as further testing has been carried out, and methods refined, it could show to be a treatment with widespread use in hospitals in long term.”

But he added: ” This is not some thing that need to be undertaken at home, or indeed outside expert centres.”

Jordan Markuson is the Founder of Aqua Wellness Labs. He has been a nutritionist, author and entrepreneur for above 10 many years. He is an activist supporting consumption of raw, renewable, and organic meals. Jordan believes that based on all available scientific proof, as soon as meals is cooked it loses the vast majority of its important nutrients. He is extremely interested in marine-based mostly phytoplankton as a fish oil replacement due to the fact of the pure omega-three acids it generates.

Unique thanks to James Gallagher of BBC Information.

Peanut allergy treatment ‘a success’