A recent study published in the Maternal and Child Health Journal explored the association between pacifier use during sleep and SIDS. Pacifier Use and Sids: Evidence for a Consistently Reduced Risk examines "the association between pacifier use during sleep and SIDS in relation to other risk factors and to determine if pacifier use modifies the impact of these risk factors."

Citing studies which have shown that pacifier use during sleep decreases the incidence of SIDS, GWUMC faculty members Rachel Y. Moon, Diane Choi Yang, and Heather A. Young as well as Kawai O. Tanabe and Fern R. Hauck used data drawn from the Chicago Infant Mortality Study (CIMS) which include 260 SIDS deaths and 260 living controls to try identify additional factors which might increase or decrease the risk of SIDS.

You can read the entire article Himmelfarb Library's online journal collection, and also explore more articles on this topic by searching PubMed or MEDLINE.

Could posting to Facebook violate HIPAA? Are Flickr images going to derail your residency match?

A new article by GWUMC faculty in Academic Medicine examines student perspectives on online postings. Katherine C. Chretien, Ellen F. Goldman, Louis Beckman, and Terry Kind interviewed medical students from The George Washington University to compile data for this qualitative study.

To get more information, read the original article as well as related articles, all of which can be accessed as part of Himmelfarb Library's online collection :

• Chretien, K. C., Goldman, E. F., Beckman, L., & Kind, T. (2010). It's your own risk: Medical students' perspectives on online professionalism. Academic Medicine : Journal of the Association of American Medical Colleges, 85(10 Suppl), S68-71.
• Greysen, S. R., Kind, T., & Chretien, K. C. (2010). Online professionalism and the mirror of social media. Journal of General Internal Medicine, 25(11), 1227-1229.
• Kind, T., Genrich, G., Sodhi, A., & Chretien, K. C. (2010). Social media policies at US medical schools. Medical Education Online, 15, 10.3402/meo.v15i0.5324.

While multiple large, well-designed studies have show that vaccines do not cause autism, this idea persists for many parents as a possibility and as a factor in their decisions regarding their children's healthcare. The popular press continues to cover the controversy, as does the medical press as health care professionals try to determine how to best take care of those patients whose parents refuse vaccination.

Paul A. Offit, Chief of the Division of Infectious Diseases and the Director of the Vaccine Education Center at the Children's Hospital of Pennsylvania, has written Autism's False Prophets : Bad Science, Risky Medicine, and the Search for a Cure (Columbia University Press, 2008) which examines this issue. Dr. Offit's chapter on Science and Society examines why this idea persists and discusses how the general public's conception of knowledge can be at odds with the scientific method.

You can read more about the research surrounding vaccines and autism in Himmelfarb Library's collection:

• Plotkin, S. A., Orenstein, W. A., & Offit, P. A. (2008). Vaccines (5th ed.). Philadelphia, Pa. ; London: Saunders.
• Dyer, C. (2010). Lancet retracts wakefield's MMR paper. BMJ (Clinical Research Ed.), 340, c696.
• DeStefano, F. (2007). Vaccines and autism: Evidence does not support a causal association. Clinical Pharmacology and Therapeutics, 82(6), 756-759.
• Wilson, K., Mills, E., Ross, C., McGowan, J., & Jadad, A. (2003). Association of autistic spectrum disorder and the measles, mumps, and rubella vaccine: A systematic review of current epidemiological evidence. Archives of Pediatrics & Adolescent Medicine, 157(7), 628-634.
• Madsen, K. M., Hviid, A., Vestergaard, M., Schendel, D., Wohlfahrt, J., Thorsen, P., et al. (2002). A population-based study of measles, mumps, and rubella vaccination and autism. The New England Journal of Medicine, 347(19), 1477-1482.
• Taylor, B., Miller, E., Farrington, C. P., Petropoulos, M. C., Favot-Mayaud, I., Li, J., et al. (1999). Autism and measles, mumps, and rubella vaccine: No epidemiological evidence for a causal association. Lancet, 353(9169), 2026-2029.
• Peltola, H., Patja, A., Leinikki, P., Valle, M., Davidkin, I., & Paunio, M. (1998). No evidence for measles, mumps, and rubella vaccine-associated inflammatory bowel disease or autism in a 14-year prospective study. Lancet, 351(9112), 1327-1328.

2010 Historic 'Match Day' More Students Interested in Family-Medicine Residencies

This year's Match Day, organized by the National Resident Matching Program, proved to be historical. It was the largest Match Day , with 30,543 participants, and also showed an increase in American medical school students seeking residency programs in family medicine for the first time in a decade. The reasons for this increase may be related to the current debate over health-care and the new focus given to primary care.

The article In Reversal, 'Match Day' Sees Rise in Students Seeking Family-Medicine Residencies, in The Chronicle of Higher Education , discusses the 52% decline over the past ten years in American medical students entering family medicine. Experts suggest the high student loan debts, low reimbursement levels, and low salaries in primary care careers have contributed to the decline. They predict the shortage will only increase as primary-care doctors retire and baby boomers age. This year however, we are witnessing the numbers trend up from 1,071 in 2009 to this year's 1,169 American students entering in family medicine residencies.

The article suggests that a heightened awareness of preventive care in the health care debate was part of this turnaround. Congress is considering health care legislation that will increase reimbursement levels to primary care doctors. Congress is also discussing providing relief for student debt and forgiveness of student loans. According to Lori J. Heim, president of the American Academy of Family Physicians, "When I talk to students, they're very excited about the fact that primary care is being recognized and valued."

Congratulation to all graduating GW medical students! The Staff at Himmelfarb Library wishes you all much success in your future careers!

A recent study in JAMA by GWUMC faculty addresses the rise in popularity and use of social networking sites by medical students. Katherine C. Chretien, S. Ryan Greysen, Jean-Paul Chretien (Johns Hopkins School of Medicine), and Terry Kind examine the risk of posting unprofessional content which may be damaging to both the individual as well as the affiliated medical institution.

Online Posting of Unprofessional Content by Medical Students suggests that "Medical students may not be aware of how online posting can reflect negatively on the medical profession or might jeopardize their careers." The anonymous survey collected data from U.S. medical schools through deans of student affairs or their representatives. The survey asked questions related to Internet policy and any reported incidents of medical students posting unprofessional content. The study found 60% of the participating schools reported incidents of students posting unprofessional online content. The incidents varied from patient confidentiality issues to profanity. When asked if the schools had professionalism policies which specifically included Internet use such as blogs and social networking sites, 82% of the schools answered no and only 18% answered yes.

The article makes a case for medical schools to establish best practice guidelines and raise awareness of the potential harm online content can place on students' future careers. The article also suggests practical steps medical schools and students can take.

1. Create best practice guidelines and specifically include a "digital media component" including instruction on managing the "digital footprint."
2. Instruction on Health Insurance Portability and Accountability Act (HIPAA) and the Family Educational Rights and Privacy Act (FERPA, 20 U.S.C.) could incorporate Web 2.0 policy.
3. Elect privacy settings on social networking sites.
4. Perform periodic Web searches on your own name; this is important given that residency program directors, future employers, and patients may access this information.
5. Encourage faculty to be aware of the capabilities of Web 2.0.

This month's issue of Academic Medicine contains a collection of articles examining the state of medical education today. The issue was published on the 100th anniversary of the Abraham Flexner's landmark report Medical Education in the United States and Canada.

Articles in this issue explore the state of medical education one hundred years ago, how Flexner's recommendations have shaped medical education since, and how medical education can continue to evolve in the coming years. Key articles in this issue include:

• Medical Education for a Healthier Population: Reflections on the Flexner Report From a Public Health Perspective
• Progress for Whose Future? The Impact of the Flexner Report on Medical Education for Racial and Ethnic Minority Physicians in the United States
• Team Training of Medical Students in the 21st Century: Would Flexner Approve?
• The Increasing Complexities of Professionalism
• The Role of Social and Community Service in Medical Education: The Next 100 Years
• Reforming Medical Education in Ethics and Humanities by Finding Common Ground With Abraham Flexner
• Flexner Revisited: The Role and Value of the Basic Sciences in Medical Education
• Standardizing and Personalizing Science in Medical Education
• For-Profit Undergraduate Medical Education: Back to the Future?
• Early Bedside Care During Preclinical Medical Education: Can Technology-Enhanced Patient Simulation Advance the Flexnerian Ideal?

Health Care Fraud, a new analysis published by The George Washington University School of Public Health and Health Services, Department of Health Policy, in collaboration with the National Academy for State Health Policy, finds that health care fraud poses a major challenge in both the private and public insurance sectors and recommends policies aimed at assuring uniform and transparent measurement and reporting of fraud across all forms of coverage.

"A critical problem under current policy is the absence of ongoing and reliable fraud estimates similar to those available in the case of public health insurers," said lead author Sara Rosenbaum, Harold and Jane Hirsh Professor of Health Law and Policy and Chair of the Department. "As a result, it is difficult to fashion consistent policies to address fraud, a critical component of health reform."

The report also finds that fraud information related to public programs is frequently confused with payment error data. "While payment errors represent a major area for program improvement," Rosenbaum notes, "it is essential to separate such errors from actual instances of fraud, since the two problems call for distinct corrective strategies."

This report is issued as Congress considers steps to strengthen the tools and resources available to law enforcement to investigate and prosecute fraud, and as states focus increased attention on this problem.

In reviewing extensive data on health care fraud, the analysis points to evidence that fraud can emanate from the insurance industry itself. This finding is underscored by recent court decisions as well as by New York State's recent prosecution of multiple insurers for fraud in connection with provider claims payments as part of their administration of private insurance products and employee health benefit plans.

This report was funded with a Grant from the Robert Wood Johnson Foundation.

Resources

• Health Care Fraud
• Health Insurance Fraud: An Overview

Are you interested in health policy? Do you want to stay abreast of health policy reform legislation?

George Washington University's Hirsh Health Law and Policy Program at the School of Public Health and Health Services have created the National Health Reform Law and Policy Project. This project provides comparative analyses and summaries of the major pieces of health reform legislation in the 111th Congress.

The Project will track health policy reform legislation from legislation through and into implementation. Before preparing the analyses, GWUMC faculty and staff worked with experts in health care policy and management to determine which questions should be asked when considering health care policy and legislation. The Project uses these questions to frame their analyses.

The National Health Reform Law and Policy Project includes:

• A user's guide to navigating project contents
• A taxonomy that identifies the major themes guiding the comparative legislative analysis
• Comparative legislative tables showing provisions in each analyzed proposal and viewable independently or comparatively (side by side)
• Comprehensive summaries of each proposal and links to the actual legislation

"People in the bottom billion are the poorest in the world; they are often subsistence farmers, who essentially live on no money and are stuck in a poverty trap of disease, conflict, and no education. One of the most potent reinforcements of the poverty trap is the neglected tropical diseases. Almost everyone in the bottom billion has at least one of these diseases."

Hotez, P. J., Fenwick, A., Savioli, L., & Molyneux, D. H. (2009). Rescuing the bottom billion through control of neglected tropical diseases. Lancet, 373(9674), 1570-1575.

GWUMC's Peter Hotez is the first author on an article published in the May 2 issue of The Lancet. "Rescuing the bottom billion through control of neglected tropical diseases" outlines low-cost methods of controlling neglected tropical disease. The article describes:

• How neglected tropical diseases reinforce a cycle of poverty.
• Specific diseases and the geographic regions where they occur.
• Current availability of the drugs required to treat these diseases.

Image: Central Intelligence Agency (No Date). Political Map of the World. [Online image]. Retrieved May 7, 2009 from https://www.cia.gov/library/publications/the-world-factbook/reference_maps/political_world.html.