The current status of scoliosis screening in North America, 1986. Results of a survey by mailed questionnaire.

In May, 1986, 374 questionnaires on the multiple aspects of school screening for scoliosis were mailed to health care professionals throughout North America. An overall response rate of 73% provided objective information about screening efforts. Results showed that although there is great variability among the programs, at least some screening is done in each of the 50 United States and the District of Columbia. Previously widespread in Canada, only two Provinces currently are officially engaged in screening, Alberta (research projects only) and Prince Edward Island. The most common target population seems to be grades five through nine for both boys and girls. Lack of funding appears to be the largest factor hampering data collection. Although many varied comments and suggestions were received, most called for: 1) new recommendations for screening boys and girls at different grade levels; 2) quantitative referral criteria; 3) improved data gathering: 4) statewide uniformity within programs; and 5) improved understanding within the medical community about indications for referral and the principles of scoliosis treatment.

Neurology residency training programs in the United States.

A survey of 127 neurology residency training programs (124 approved by the Accreditation Council for Graduate Medical Education; 3 by the American Osteopathic Association) in the United States indicated that 80% were sponsored by medical schools. Of the 2,700 MD neurology faculty in 1982, 3/5 were full-time. As of 1982, there were 1,300 neurology trainees, including 334 fourth-year postgraduates (PG4s); 21% were women, and 3% held DO degrees. From 1960 through 1983, about 5,000 PG4s were produced, and for 1984 through 1990 the program directors estimated that this number will be about 3,000; our own projection, however, was only 2,400.

Neurologists in the United States--past, present, and future.

Neurologists in the United States were enumerated for each year from 1935 to 1984 on two bases: board certification (including Child Neurology and Psychiatry and Neurology) and completion of PG4 neurology residency training. The annual incidence of new neurologists was calculated at less than 200 until 1970; then it rose steadily to 380 in 1980, and plateaued thereafter at 385. The estimated number of neurologists present at one time (prevalence) was 1,500 in 1950, 2,400 in 1970, 4,600 in 1980, 8,100 in 1990, and 11,000 in 2000. These numbers for total neurologists will plateau at 12,200 by about 2010, at which time the number of certified neurologists will also plateau at 9,900. Both numbers are notably less than our prior estimate of needs: 16,500 neurologists by 1990, 19,100 in 2010.

On national needs for neurologists in the United States.

Estimates of the number of neurologists needed in the United States have been widely divergent. For direct patient care needs alone in a US population of 243.5 million, the Joint Commission on Neurology (ANA-AAN) estimate was 14,000 neurologist, the Delphi Panel median (Battelle/GMENAC) 11,200, and the Advisory Panel (Battelle/GMENAC) 6,200; our review suggests a need for 12,600. Total needs for clinical neurologists including faculty were 8,400 (Advisory Panel), 14,500 (Delphi Panel), and 16,500 (ours) for respective rates of 3.44, 5.96, and 6.76 neurologists per 100,000 population.

Epidemiological findings in a brain-tumor cluster in western Missouri.

A cluster of seven primary brain neoplasms was identified in a town of 3000 population during the 10-year period from 1973 to 1982. With six deaths, this represents an age-adjusted mortality rate 4.1 times greater than expected. No other neoplasms were found to be in excess of the anticipated incidence in this town. When brain-tumor mortality rates in 36 other towns of approximately the same population were calculated, only one other town was found to have an excessive rate. All seven tumors in this study were histologically verified: six were diagnosed as glioblastoma multiforme. Interviews were conducted with patients or next-of-kin to obtain the exposure histories of the patients. A number of respondents reported occupational or residential exposure either to a shoe factory or to one of the several chicken hatcheries in the town. Many of the patients ate fish from local ponds that had previously been used as coal mining strip pits. Two patients were siblings. None of the patients had a history of significant head trauma. This unique situation may provide an opportunity to learn more about environmental risk factors for brain neoplasia. Further epidemiological studies are planned.

Neurologists' knowledge of medication costs.

Using mailed questionnaires, neurologists were asked for (1) estimates of retail prices for 39 common drugs, (2) attitudes about drug costs, and (3) implications for clinical practice. Among these practitioners, (1) more product prices were overestimated than underestimated, (2) old products were as unfamiliar as new products, and (3) community practitioners were more aware of prices than academic neurologists and trainees, but still made errors. Future studies should also consider physician prescribing behavior in terms of adherence to recommended laboratory tests and patient inconvenience factors. Neurologists should be aware of alternative prescription outlets for patients.

Survey of neurology chairmen in U.S. and Canadian medical schools about neuroepidemiology.

Using a mailed questionnaire, 185 U.S. and Canadian directors of medical school departments and residency programs were surveyed about the role of neuroepidemiology in clinical neurology. Data were obtained about current neuroepidemiologic staff; consultation patterns; current and future needs for neuroepidemiologists, including duties and level of training; funding of neuroepidemiologists; and training of residents and fellows. We recommend more centralized teaching of the epidemilogy of neurologic disease with participation by practicing neurologists, courses in neuroepidemiology in schools without special training programs, and improved training of residents and fellows, with more active participation by medical school epidemiologists.