RESUMEN
PURPOSE: The purpose of this investigation was to assess the weight loss practices of Michigan high school wrestlers at all levels of competition. METHODS: A two-page survey was designed to assess weight loss behaviors of high school wrestlers. It was mailed by the Michigan High School Athletic Association (MHSAA) midway through the wrestling season to all Michigan high schools participating in interscholastic wrestling. RESULTS: Completed surveys were received from 2532 wrestlers. Wrestlers lost an average of 6 pounds during the season. Over 50% of wrestlers lost more than 5 pounds; 27% of wrestlers lost at least 10 pounds; 72% of wrestlers engaged in at least one potentially harmful weight loss method each week of the wrestling season; 52% used at least two methods each week; 12% used at least five methods each week. Weekly use of laxatives, diet pill, or diuretics was reported by 2% of wrestlers. Vomiting to lose weight was done at least weekly by 2% of wrestlers. Wrestlers who engaged in at least one rapid weight loss method per week lost more weight, began wrestling at an earlier age, and reported more binge eating compared with wrestlers who did not report weekly rapid weight loss. CONCLUSION: The majority of Michigan high school wrestlers engaged in at least one potentially harmful weight loss method each week of the wrestling season. Fasting and various methods of dehydration were the primary methods of rapid weight loss. Wrestlers who lost weight each week were more likely to binge eat. Potentially harmful weight loss practices were found to be common at all grades and success levels.
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Dieta Reductora , Trastornos de Alimentación y de la Ingestión de Alimentos , Pérdida de Peso , Lucha , Adolescente , Conducta del Adolescente , Catárticos/uso terapéutico , Deshidratación , Diuréticos/uso terapéutico , Estado de Salud , Encuestas Epidemiológicas , Humanos , MasculinoRESUMEN
OBJECTIVE: To determine whether self-reported frequencies of food use were linked to self-reported preferences for the same foods. The hypothesis was that both food frequencies and food preferences can predict nutrient intakes. RESPONDENTS: Participants were adult women patients (n = 339), recruited through the University of Michigan Breast Care Center. The sample included both persons with breast cancer and persons who were cancer-free. DESIGN: All women completed a 98-item food frequency questionnaire and rated preferences for many of the same foods using a 9-point category scale. Percent energy from fat and saturated fat, and intakes of dietary fiber and vitamin C were estimated from analyses of 4-day food records. STATISTICAL ANALYSES: Pearson correlations coefficients were used for data analysis. RESULTS: Dislike was a strong predictor of nonuse. In contrast, the more preferred foods were also reported as more frequently consumed. Significant correlations between preference and frequency scores were obtained for virtually all item pairs. Median Pearson correlation coefficient was 0.30 (range 0.04 to 0.56). Correlations improved when foods were aggregated into the chief dietary sources of fat, saturated fat, and vitamin C. Food frequencies and food preferences showed the same strength of association with percent energy from fat and saturated fat (r = 0.20 to 0.25). Food frequencies showed a stronger association with vitamin C intakes than did preferences for vegetables and fruit. APPLICATIONS: Food preferences may provide a potential alternative to the food frequency approach.
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Neoplasias de la Mama/prevención & control , Dieta , Grasas de la Dieta/administración & dosificación , Ingestión de Alimentos , Conducta Alimentaria , Preferencias Alimentarias , Adulto , Anciano , Anciano de 80 o más Años , Ácido Ascórbico/administración & dosificación , Registros de Dieta , Grasas de la Dieta/efectos adversos , Fibras de la Dieta/administración & dosificación , Femenino , Humanos , Persona de Mediana Edad , Estadística como Asunto , Encuestas y CuestionariosRESUMEN
OBJECTIVE: To determine whether women with vulvodynia differ from women with chronic pelvic pain and normal controls in their psychological functioning, somatic preoccupation, pain experience and sexual functioning. STUDY DESIGN: Cross-sectional, self-report study of women presenting to University of Michigan specialty and general clinics for the treatment of vulvodynia or chronic pelvic pain or seeking a routine gynecologic examination. All subjects completed questionnaires assessing demographic characteristics, pain, depressive symptoms, general affective state, marital adjustment, functional activity, somatic complaints, exposures, and medical and sexual history. Univariate analyses, chi 2 tests, analyses of variance and logistic regression were used to assess associations between these variables and the diagnostic category. RESULTS: Women with vulvodynia (n = 31) were similar to asymptomatic control women (n = 23) in demographic characteristics, sexual relationship variables, sexual behaviors, current and past depression, somatic sensitivity, and history of sexual or physical abuse. Women with chronic pelvic pain (n = 18) were younger and less educated than the other two groups and were more likely to have a history of physical and sexual abuse, to report recent depression and to screen positive for current depression, to have more work absences and to have more somatic complaints. CONCLUSION: Women with vulvodynia are psychologically similar to control women but differ significantly from women with chronic pelvic pain. A primary psychological cause of vulvodynia is not supported.
Asunto(s)
Dolor/psicología , Dolor Pélvico/psicología , Conducta Sexual , Enfermedades de la Vulva/psicología , Adolescente , Adulto , Análisis de Varianza , Distribución de Chi-Cuadrado , Enfermedad Crónica , Estudios Transversales , Depresión/complicaciones , Depresión/psicología , Femenino , Humanos , Matrimonio , Persona de Mediana Edad , Dolor/complicaciones , Dolor Pélvico/complicaciones , Análisis de Regresión , Delitos Sexuales/psicología , Trastornos Somatomorfos/psicología , Estrés Psicológico/complicaciones , Estrés Psicológico/psicología , Encuestas y Cuestionarios , Enfermedades de la Vulva/complicacionesRESUMEN
Sexual behaviors are associated with many genital infections, but the role of sexual variables as risk factors for Candida vulvovaginitis has not been clearly determined. To assess the association between sexual behaviors and other risk factors with the presence of Candida vulvovaginitis, we performed a case-control study comparing these potential risk factors in women with and without culture-documented Candida vulvovaginitis in two Midwestern community-based medical offices. Participants included 156 women with Candida vulvovaginitis and 92 controls, ages 18-60. Risk factors for Candida vulvovaginitis, including sexual and partnership behaviors, demographic data, past genital infections, exposures, and diet, were investigated using logistic regression. The presence of Candida vulvovaginitis was positively associated with recent cunnilingus (odds ratio [OR] = 2.22 for five times a month compared with no times, 95% confidence interval [CI] 1.36, 3.84), but was less likely in women who masturbated with saliva in the previous month (OR = 0.30 if masturbated five times vs. no times, 95% CI 0.09, 0.99). Other independent risk factors included knowing the sexual partner a shorter period of time (OR = 1.56 for 1 year vs. 5 years, 95% CI 1.16, 2.13) and lower milk ingestion (OR = 3.57 for no servings vs. two servings per day, 95% CI 2.00, 6.67). Increased number of sexual partners, early age at first intercourse, and increased frequency of intercourse are not related to risk.
Asunto(s)
Candidiasis Vulvovaginal/etiología , Conducta Sexual , Adolescente , Adulto , Factores de Edad , Animales , Estudios de Casos y Controles , Dieta , Femenino , Humanos , Persona de Mediana Edad , Leche , Análisis de Regresión , Factores de RiesgoRESUMEN
OBJECTIVE: To investigate the unique health care issues of deaf and hard-of-hearing (D&HH) persons by studying their attitudes, beliefs, and behaviors toward preventive medicine. DESIGN: A self-administered, cross-sectional survey, written in a format comprehensible to persons whose primary language is American Sign Language. POPULATION: One hundred forty D&HH persons recruited from southeastern Michigan, Chicago, Ill, and Rochester, NY, and 76 hearing subjects from southeastern Michigan and Rochester. RESULTS: No significant differences existed between D&HH or hearing persons from different states. However, numerous differences existed between D&HH and hearing persons. Deaf and hard-of-hearing persons were less likely to report receiving preventive information from physicians or the media, and more likely to report receiving it from a Deaf club. They rated the following physician-initiated procedures as less important than hearing persons: discussion of alcohol consumption, smoking, depression, and diet, plus screening for hypertension, hearing loss, and cancer. Deaf and hard-of-hearing persons often considered a preventive procedure important if it was reported performed at their last health maintenance examination. They were less likely to report being asked about alcohol consumption and smoking, or to having been examined for hypertension, cancer, height, and weight. They were more likely to report receiving a hearing examination, mammogram, and Papanicolaou smear. Deaf and hard-of-hearing persons were less likely to report believing that smoking less, exercising regularly, maintaining ideal weight, and regular physical examinations improve health. Differences existed within the D&HH cohort depending on the respondent's preferred language (oral English vs American Sign Language); our sample size was too small for a complete assessment of these differences. CONCLUSIONS: Deaf and hard-of-hearing persons appear to have unique knowledge, attitudes, and behaviors regarding preventive medicine, and their attitudes are influenced by their personal experiences with physicians. Preventive practices addressed during health visits may differ between D&HH and hearing patients. Further research is needed to clarify the reasons for these differences, including within D&HH subgroups, and to develop effective mechanisms to improve the health care of all D&HH persons.
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Actitud Frente a la Salud , Sordera/prevención & control , Conductas Relacionadas con la Salud , Pérdida Auditiva/prevención & control , Aceptación de la Atención de Salud/estadística & datos numéricos , Servicios Preventivos de Salud/estadística & datos numéricos , Adulto , Factores de Confusión Epidemiológicos , Estudios Transversales , Femenino , Conocimientos, Actitudes y Práctica en Salud , Humanos , Masculino , Persona de Mediana Edad , Examen Físico , Encuestas y Cuestionarios , Estados UnidosRESUMEN
BACKGROUND: As we enter the year 2000, it is worth looking at whether primary care practices are reaching the goals established in Healthy People 2000 for breast, cervical, colorectal, and prostatic cancer screening. The objectives of this study were (1) to determine the current rates of cancer screening; and (2) to determine which factors predict completion of a single screening test, of all tests for each cancer, and of all procedures for age and sex. METHODS: Medical records of 200 eligible patients (100 men and 100 women) from each of 24 community-based primary care practices were abstracted for cancer-screening events. RESULTS: We audited 5125 charts. A Papanicolaou smear was documented for 63.8% of women with an intact cervix within 3 years of the audit.. We found that 46.8% of women had documentation of ever having a discussion of breast self-examination. For breast cancer screening, 41.8% of the women had a clinical breast examination within 1 year, 48.2% aged 40 to 49 years had a mammogram within 2 years, and 38.5% aged 50 years and older had a mammogram within 1 year. Only 29% of women aged 40 to 49 years and 17% of women 50 years and older were current for all breast cancer-screening tests. Among patients 50 years and older, 33% of men and 38% of women had a digital rectal examination within 1 year, 26% of men and 28% of women had a fecal occult blood test within 1 year, and 22% of men and 16.8% of women had a flexible sigmoidoscopy within 5 years. Of all men 28.7% had a prostate-specific antigen test within 1 year. Completion of all tests relevant for age and sex were documented for 8.6% of women aged 40 to 49 years, 3% of women 50 years and older, and 5% of men 50 years and older. The single most significant predictor of documented cancer screening was a health maintenance visit. CONCLUSIONS: This sample of primary care clinicians has not reached the goals set in Healthy People 2000 for cancer screening. Interventions aimed at increasing the percentage of patients who schedule a health maintenance visit could serve to increase cancer screening and help us reach goals set for the year 2010.
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Tamizaje Masivo/estadística & datos numéricos , Neoplasias/prevención & control , Pautas de la Práctica en Medicina/estadística & datos numéricos , Atención Primaria de Salud/estadística & datos numéricos , Adulto , Neoplasias de la Mama/diagnóstico , Neoplasias Colorrectales/diagnóstico , Femenino , Humanos , Modelos Logísticos , Masculino , Mamografía/estadística & datos numéricos , Auditoría Médica , Michigan , Persona de Mediana Edad , Neoplasias/diagnóstico , Sangre Oculta , Prueba de Papanicolaou , Antígeno Prostático Específico/sangre , Neoplasias de la Próstata/diagnóstico , Sigmoidoscopía/estadística & datos numéricos , Frotis Vaginal/estadística & datos numéricosRESUMEN
BACKGROUND: Despite the proven success of national efforts such as the Special Supplementary Food Program for Women, Infants, and Children (WIC) to curb childhood iron deficiency anemia (IDA) in the United States, aggregate programmatic data may not accurately represent the experience of particularly high risk groups, such as the children of adolescent mothers of low socio-economic status. METHODS: This study evaluated the prevalence and severity of childhood anemia and associated risk factors, at one urban teen health center serving primarily low-income adolescent mothers and their children. A total of 175 pediatric WIC charts were reviewed to abstract hemoglobin status and other data. Additionally, 81 mothers were interviewed with regard to their nutritional knowledge and feeding practices; these findings were compared with the measured hemoglobin (Hgb) of their children. RESULTS: A total of 34.9% of children in the study population were found to be anemic (Hgb
Asunto(s)
Anemia Ferropénica/epidemiología , Ciencias de la Nutrición del Niño , Conocimientos, Actitudes y Práctica en Salud , Conducta Materna , Adolescente , Conducta del Adolescente , Adulto , Anemia Ferropénica/etnología , Distribución de Chi-Cuadrado , Niño , Ciencias de la Nutrición del Niño/educación , Femenino , Humanos , Lactante , Pobreza/estadística & datos numéricos , Prevalencia , Estudios Retrospectivos , Factores de Riesgo , Familia Monoparental/estadística & datos numéricos , Estados Unidos/epidemiología , Salud Urbana/estadística & datos numéricosRESUMEN
CONTEXT: Rapid repeat pregnancy (RRP) among adolescents, usually defined as pregnancy onset within 12-24 months of the previous pregnancy outcome, has frequently been the target of public health interventions, due to the exacerbation of negative consequences associated with recurrent adolescent pregnancy (and more specifically with childbearing). OBJECTIVE: To examine what, if any, relationship exists between RRP and the experience of interpersonal violence and abuse among low-income adolescents at one semi-urban health center. DESIGN: Case-control study using retrospective chart review. PARTICIPANTS AND SETTING: 100 women aged 13-21 who received prenatal care at one independent nonprofit health center that serves adolescents and their children from June 1994 through June 1996. MAIN OUTCOME MEASURES: Number and timing of pregnancies, occurrence of physical or sexual abuse; other psychosocial risk factors were evaluated. RESULTS: In this population, the experience of any form of physical or sexual violence during the study interval was associated with RRP within 12 months (p = 0.01, OR = 3.46) and 18 months (p = 0.013, OR = 4.29). Other previously reported predictors of RRP, including family stress, financial stress, and other environmental stressors did not reach statistical significance at either 12 months or 18 months in this sample. Of additional note, young women who experienced any form of abuse during the 12-month study interval were substantially more likely to miscarry than were their nonabused peers, and spontaneous abortion was also very strongly associated with RRP (p < 0.00001; OR = 22.6). CONCLUSIONS: The experience of interpersonal violence is correlated with rapid repeat pregnancy among low-income adolescents. This study strongly suggests a need for both extensive screening for partner and family violence among pregnant and postpartum adolescents, and follow-up safety planning support in combination with family planning interventions.
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Violencia Doméstica/estadística & datos numéricos , Número de Embarazos , Resultado del Embarazo , Embarazo en Adolescencia/estadística & datos numéricos , Adolescente , Adulto , Estudios de Casos y Controles , Femenino , Humanos , Incidencia , Relaciones Interpersonales , Oportunidad Relativa , Pobreza/estadística & datos numéricos , Embarazo , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Muestreo , Delitos Sexuales/estadística & datos numéricos , Factores de Tiempo , Estados Unidos/epidemiologíaRESUMEN
BACKGROUND: Occult human papillomavirus (HPV) infection, present in approximately 20% of women in the United States, is usually sexually transmitted, associated with substantial health risks, and unpredictable in its resolution. The potential for adverse psychosexual alterations due to HPV infection in women considered at low risk for bacterial sexually transmitted diseases is substantial, but data is lacking. METHODS: This cross-sectional study was conducted with sexually active women aged 18 to 60 years who had been enrolled at community-based offices in the University of Michigan Vaginitis Study. Women found to have occult HPV infection of the cervix were notified, received physician consultation, and were encouraged to have colposcopy performed to assess lesion status. Responses to a follow-up written questionnaire for differences in psychosexual functioning and attitudes following diagnosis were compared among these women and those without HPV infection. RESULTS: The women enrolled were primarily white and had a current sexual partner at the time of enrollment. They had few sexually transmitted infections and few risk factors, yet 20% had unsuspected HPV infection. Psychosexual characteristics at baseline and at follow-up, as well as perceived changes in these characteristics by the women, did not differ between women with HPV infection and those without. Stratification by potential confounders, including the presence of a vaginal infection at the time of study enrollment, household income level, ethnic background, age, marital status, and sexual history, did not alter these results. CONCLUSIONS: Women at low risk for sexually transmitted diseases, but who had a cervical HPV infection, were similar to those not infected in reported psychosexual characteristics and functioning. Adverse changes in these characteristics between the time of the diagnosis and subsequent follow-up were no more likely in those with the diagnosis than in those without.
Asunto(s)
Infecciones por Papillomavirus/psicología , Conducta Sexual , Infecciones Tumorales por Virus/psicología , Vaginitis/psicología , Adolescente , Adulto , Actitud Frente a la Salud , Femenino , Humanos , Masculino , Michigan , Persona de Mediana Edad , Papillomaviridae , Infecciones por Papillomavirus/diagnóstico , Reacción en Cadena de la Polimerasa , Factores de Riesgo , Infecciones Tumorales por Virus/diagnóstico , Vaginitis/virología , Salud de la MujerRESUMEN
We investigated whether the public information being dispensed about Acquired Immunodeficiency Syndrome (AIDS) reaches Deaf and Hard of Hearing (D&HH) persons to the same extent as the rest of the American population. Using a self-administered written survey, modified so that D&HH persons whose primary language is American Sign Language (ASL) could understand the questions, we studied 40 D&HH and 37 hearing persons in southeast Michigan. There were no significant demographic differences between the two populations, but there were differences regarding attitudes towards and knowledge about AIDS. D&HH persons were less likely to associate sexual contact with drug users and number of sexual partners as high risk sexual behaviours, were more likely to believe that storing blood for future personal use lowers their chances of contracting AIDS, and believed that using public restrooms, kisses on the cheek and visiting an AIDS patients increased their chance of contracting AIDS. Furthermore, they were more likely to believe they did not need to change their sexual behaviour as a result of the AIDS epidemic. D&HH persons also reported different attitudes towards AIDS patients, such as they were not important to their community, dentists with AIDS should not be allowed to continue working, and landlords should be able to evict people with AIDS. Our findings suggest differences in receiving, trusting, and/or being exposed to current information about AIDS by the Deaf community, consistent with the fact that they are a minority population with distinct knowledge and cultural traditions.
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Síndrome de Inmunodeficiencia Adquirida/psicología , Conocimientos, Actitudes y Práctica en Salud , Trastornos de la Audición/psicología , Adolescente , Adulto , Anciano , Actitud Frente a la Salud , Comunicación , Sordera/psicología , Promoción de la Salud , Encuestas Epidemiológicas , Humanos , Michigan , Persona de Mediana Edad , Conducta SexualRESUMEN
Although PCR analysis is a sensitive test for detection of human papillomavirus (HPV) in the cervix, the proportion of cases of cervical dysplasia missed, or the false-negative rate, has been unknown. We determined the accuracy of PCR analysis for HPV DNA as a predictor of HPV-related cervical lesions in a cross-sectional study of sexually active women, aged 18 to 50 years, from the University of Michigan Family Medicine HPV study. Of 133 eligible participants, 41 underwent colposcopy because of a positive result for HPV of the cervix by the PCR method and 92 underwent screening colposcopy with biopsy prior to knowing the HPV PCR results. Twenty-four of those screened were subsequently found to also be HPV DNA positive. In those found to be HPV positive, histological studies revealed the presence of condyloma or cervical intraepithelial neoplasia in 16 women (24.6%) and changes suggestive of condyloma in 5 (7.6%). No HPV-negative woman had an abnormal biopsy or cytology report (P = 0. 000001). The false-negative rate (1 - sensitivity) for HPV PCR analysis for detection of the presence of a cervical HPV-related lesion was 0% (95% confidence interval, 0 to 0.047), and the specificity was 60.7%. In summary, PCR analysis for HPV DNA had a very low false-negative rate for predicting HPV-related lesions of the cervix in a community-based population. This supports the validity of using the absence of HPV at the cervix, as determined by PCR testing, as an inclusion criterion for patients in control groups in studies dealing with low-grade cervical lesions.
Asunto(s)
Papillomaviridae/aislamiento & purificación , Infecciones por Papillomavirus/diagnóstico , Reacción en Cadena de la Polimerasa/métodos , Infecciones Tumorales por Virus/diagnóstico , Displasia del Cuello del Útero/virología , Adolescente , Adulto , Estudios de Casos y Controles , Colposcopía , Estudios Transversales , Demografía , Escolaridad , Reacciones Falso Negativas , Medicina Familiar y Comunitaria , Femenino , Humanos , Renta , Michigan , Persona de Mediana Edad , Papillomaviridae/clasificación , Papillomaviridae/genética , Infecciones por Papillomavirus/epidemiología , Reacción en Cadena de la Polimerasa/normas , Estudios Prospectivos , Factores de Riesgo , Sensibilidad y Especificidad , Conducta Sexual , Infecciones Tumorales por Virus/epidemiología , Displasia del Cuello del Útero/epidemiología , Vaginitis/virologíaRESUMEN
This study evaluated the nutritional knowledge and feeding practices (via a verbal questionnaires) of the clients of one semiurban women, infants, and children (WIC) center, which serves exclusively younger women (aged 12-21) and their children, and compared these variables to the hemoglobin levels of their infants and children. No significant benefit from documented WIC education regarding iron was detectable. African American identification was associated with childhood anemia (p = 0.05); the presence of concurrent medical problems approached significance (p = 0.06). Other previously reported risk associations were not found to be significant. Children with low iron ate more meals outside the home per week (2.9 vs. 1.9, p = 0.10). Despite the proven value of the WIC program in reducing childhood iron deficiency, it appears that members of certain very high-risk populations may not experience the full benefit of this nutritional program and may require additional, targeted interventions.
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Anemia Ferropénica/epidemiología , Conducta Alimentaria , Educación en Salud , Adolescente , Adulto , Niño , Preescolar , Centros Comunitarios de Salud/organización & administración , Femenino , Servicios de Alimentación , Educación en Salud/métodos , Hemoglobinas , Humanos , Lactante , Masculino , Michigan/epidemiología , Pobreza , Prevalencia , Factores de Riesgo , Población UrbanaRESUMEN
OBJECTIVE: To compare the quality of prenatal care provided to patients with traditional fee-for-service, health maintenance organization, and Medicaid insurance using an evidence-based, community-derived prenatal care guideline. DESIGN: Retrospective cohort study. SETTING: Seven private and hospital-based prenatal care sites in a suburban county in southeast Michigan. PATIENTS: A stratified random sample of 267 patients (93 with Medicaid, 92 with health maintenance organization, and 82 with fee-for-service insurance) receiving prenatal care from community physicians (obstetricians-gynecologists and family practitioners) between January 1, 1991, and December 31, 1992. MAIN OUTCOME MEASURE: Adherence to explicit prenatal care criteria as measured by an evidence-based prenatal care guideline developed by a community panel. "Quality scores" were compared across groups in 4 areas: performance of prenatal screening procedures or tests, visit-based screening, substance use screening, and clinician management of abnormal clinical findings. RESULTS: Patients with Medicaid insurance presented for prenatal care significantly later in pregnancy (14.5 vs 10.5 weeks, P < .01). No significant differences were seen between groups in quality scores for screening tests, clinician management of abnormal clinical findings, visit-based screening, or substance use screening. The overall similarity in quality scores did obscure some significant differences in adherence to individual criteria, particularly in the area of screening tests. Significantly more patients with Medicaid were screened for genital infection (P < .001) and fewer for gestational diabetes (P < .001) or anemia (P < .001) than patients in the other 2 groups. CONCLUSIONS: Although patients with Medicaid presented for prenatal care later in pregnancy and received a different "package" of screening tests than the other 2 groups, there was no overall measurable difference in the quality of prenatal care provided to patients with Medicaid, health maintenance organization, and fee-for-service insurance. Clinicians may have altered screening protocols based on preexisting perceptions of patient risk. Although summary quality measures are a promising tool for comparative research, they provide an incomplete picture of the quality of the prenatal care process and must be interpreted with caution.
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Seguro de Salud , Atención Prenatal/economía , Calidad de la Atención de Salud , Planes de Aranceles por Servicios , Femenino , Sistemas Prepagos de Salud , Humanos , Medicaid , Michigan , Embarazo , Población Suburbana , Estados UnidosRESUMEN
Approximately 50% of the mortality in hemodialysis patients is due to cardiovascular disease. Antioxidant vitamins and carotenoids may be protective because oxidation of low-density lipoproteins appears to be a necessary prerequisite for the development of atherogenesis, and hemodialysis itself may stimulate the generation of oxygen reactive species. African Americans comprise a substantial proportion of dialysis patients because they have higher rates of hypertension, glomerulonephritis, and diabetic end-stage renal disease than do whites. The purpose of this cross-sectional study was to determine the plasma concentrations of antioxidant vitamins and carotenoids in hemodialysis patients and to investigate whether differences in these concentrations in the major racial or ethnic groups exist. Plasma concentrations of alpha- and gamma-tocopherol, carotenoids, and retinol were measured with HPLC and plasma vitamin C was measured with a spectrophotometric method in 109 white and African American hemodialysis patients. Dietary intakes of selected micronutrients were also compared by using data from a food-frequency questionnaire. Overall, plasma vitamin C and alpha-tocopherol concentrations were comparable but plasma carotenoid concentrations were lower than those reported for other populations. African American patients had significantly higher mean plasma concentrations of retinol (P < 0.04), lutein (P < 0.02), and total carotenoids minus lycopene (P < 0.04); whites had significantly higher mean plasma concentrations of alpha-tocopherol (P < 0.02), independent of age and plasma lipid concentrations. Diabetes comorbidity had an independent negative association with plasma beta-carotene concentration but was not associated with other measures.
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Ácido Ascórbico/sangre , Población Negra , Carotenoides/sangre , Diálisis Renal , Vitamina E/sangre , Población Blanca , Adulto , Anciano , Anciano de 80 o más Años , Cromatografía Líquida de Alta Presión , Estudios Transversales , Dieta , Femenino , Humanos , Lípidos/sangre , Masculino , Micronutrientes/análisis , Persona de Mediana EdadRESUMEN
OBJECTIVE: To determine the extent to which human rights issues are included in required bioethics curricula in US medical schools and to identify medical school characteristics associated with the extent of human rights issues covered. DESIGN: Cross-sectional survey. PARTICIPANTS: Bioethics course directors and bioethics section directors of 125 US medical schools. MAIN OUTCOME MEASURE: The extent of human rights teaching at each school was measured as the percentage of 16 human rights issues. RESULTS: Course directors at 113 (90%) of the 125 US medical schools responded to the survey. Medical schools included about half (45%; 95% confidence interval, 41%-49%) of 16 human rights issues in their required bioethics curricula. Domestic human rights issues, such as discrimination in the provision of health care to minorities (82% of medical schools), were covered much more frequently than international human rights issues, such as physician participation in torture (17% of schools). Public medical schools included substantially fewer human rights issues than private medical schools (F[1,112]=7.7; P<.01). CONCLUSIONS: Required courses in medical education do not adequately address the medical aspects of human rights issues, especially international issues.
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Discusiones Bioéticas , Bioética , Curriculum , Derechos Humanos , Mala Conducta Profesional , Facultades de Medicina , Análisis de Varianza , Estudios Transversales , Disentimientos y Disputas , Educación Médica , Procesos de Grupo , Internacionalidad , Análisis de Regresión , Estados UnidosRESUMEN
Ovulatory dysfunction is common in patients with eating disorders. However, many women engage in pathologic dieting behaviors without meeting the current diagnostic criteria for anorexia or bulimia nervosa. Clinical eating disorders are only the most extreme form of pathologic eating attitudes and behaviors that are present in many young women. Specific food choices and nutrient intakes may be associated with altered gonadal hormone status of these dieters. This cross-sectional study was conducted to describe the nutritional characteristics of college-aged women defined by their eating attitudes and behaviors with a previously described questionnaire. We evaluated dietary intake, body composition, and selected biochemical indicators in 76 undergraduate women. Serum concentrations of estradiol, progesterone, lipids, and carotenoids were measured on days 6, 21, and 28 of one menstrual cycle. Dietary assessment was based on food records at two 3-d intervals during the cycle. Ovulatory status was definitively determined on the basis of biochemical data for 46 of the women. Increased degree of pathologic dieting was associated with a significantly lower intake of dietary fat (P < 0.02), despite similar mean body mass index and body composition across the eating pathology groups. Serum concentration of alpha-carotene was significantly greater (P < 0.005) in association with a greater degree of eating pathology. With ovulation as a between-group factor, serum lutein concentration and dietary intake of energy and fat differed significantly between groups (P < 0.003). Nutritional characteristics associated with pathologic dieting behavior may also be associated with menstrual irregularities in young women.
Asunto(s)
Dieta/efectos adversos , Estradiol/sangre , Trastornos de Alimentación y de la Ingestión de Alimentos/metabolismo , Progesterona/sangre , Adolescente , Adulto , Carotenoides/sangre , Estudios Transversales , Ingestión de Energía , Ensayo de Inmunoadsorción Enzimática , Trastornos de Alimentación y de la Ingestión de Alimentos/sangre , Trastornos de Alimentación y de la Ingestión de Alimentos/complicaciones , Femenino , Humanos , Lípidos/sangre , Trastornos de la Menstruación/sangre , Trastornos de la Menstruación/etiología , Trastornos de la Menstruación/metabolismo , Encuestas y CuestionariosRESUMEN
BACKGROUND: We wanted to validate reports that deaf persons have difficulty obtaining medical care by comparing physicians' attitudes towards these patients with physicians' attitudes toward their patients in general. METHODS: Two questionnaires were randomly distributed to physicians attending continuing medical education conferences at the University of Michigan during a 3-month period. The questionnaires were identical except that one asked about deaf patients and the other about patients in general. The questions assessed the respondent's perceptions of communication with patients, attitudes toward their patients, knowledge of current information about deaf people, and demographics. RESULTS: One hundred sixty-five physicians responded, 94 to the general questionnaire and 71 to the deaf questionnaire. The two physician groups were similar demographically, but 165 differed significantly in communication and attitude variables. Physicians receiving the questionnaire focusing on deaf patients reported greater difficulties in understanding (P < 0.001) and maintaining free-flowing conversations (P < 0.001), and that these patients had more difficulty understanding them (P < 0.001), trusted them less (P < 0.001), asked them to repeat statements more often (P < 0.001) and were less likely to understand the diagnosis and recommended treatments (P < 0.001). Physicians also reported feeling less comfortable with deaf patients (P < 0.001) and that they asked fewer questions (P < 0.001). Physicians were more likely to say that deaf patients rely on interpreters (P = 0.040), get frustrated easily (P < 0.001), and are harder to communicate with (P < 0.001). There were no significant differences between the two groups in knowledge about deaf people. All physicians, however, displayed ignorance about their legal obligations under the Americans with Disabilities Act to provide interpreters for their deaf patients. CONCLUSIONS: Physicians surveyed about deaf patients reported significantly greater difficulties communicating with and different attitudes toward these patients than physicians surveyed about their patients in general. All physicians were unaware of their obligations under the Americans with Disabilities Act to provide interpreters for deaf patients. Research is needed to determine whether physician attitudes and beliefs affect the actual quality of care they deliver to deaf patients.
Asunto(s)
Actitud del Personal de Salud , Comunicación , Sordera/psicología , Relaciones Médico-Paciente , Adulto , Personas con Discapacidad/legislación & jurisprudencia , Educación Médica Continua , Medicina Familiar y Comunitaria/educación , Femenino , Accesibilidad a los Servicios de Salud/legislación & jurisprudencia , Humanos , Masculino , Persona de Mediana Edad , Defensa del Paciente/legislación & jurisprudencia , ConfianzaRESUMEN
BACKGROUND: This study was undertaken to demonstrate the relative frequency of disqualifying criteria in a complete history and physical sports examination. METHODS: A review was conducted of 2574 preparticipation physical evaluations (PPEs) performed on 11- to 18-year-old student athletes to determine which factors are associated with denial of unrestricted sports participation. RESULTS: Eighty-five percent of the student athletes passed the screening. Of those who did not, the denial decision was based on the medical history alone in 58% of cases (P < .05). A logistic regression analysis identified seven items associated with denial: dizziness with exercise, history of asthma, body mass index, systolic blood pressure, visual acuity, heart murmur, and musculoskeletal examination. CONCLUSIONS: Although physicians often take a complete history and perform physical examinations, relatively few variables appear related to denial of eligibility for participation in organized sports. The history is one of the most important aspects of the PPE. A directed PPE may be more efficient, thereby allowing more time to address other important issues.
Asunto(s)
Traumatismos en Atletas/prevención & control , Estado de Salud , Anamnesis , Examen Físico , Deportes , Adolescente , Niño , Femenino , Control de Formularios y Registros , Humanos , Masculino , Estudios Retrospectivos , Factores de Riesgo , Estados UnidosRESUMEN
PURPOSE: To ascertain the attitudes of oncologists toward physician-assisted death, ie, physician-assisted suicide and active euthanasia, as well as their experiences with these activities and their opinions toward their legalization. METHODS: A survey was mailed to all practicing 250 oncologists in the state of Michigan, with subsequent development of psychometric scales and their correlation with self-reported behaviors in physician-assisted death. RESULTS: Analysis revealed five distinct, meaningful factors regarding approval or disapproval of physician-assisted death. These factors reflected global attitudes toward physician-assisted death, passive euthanasia, philosophical prohibitions toward physician-assisted death, concerns of legal consequences with physician-assisted death, and attitudes that physician-assisted death could be avoided with better end-of-life care (alpha = .94, .74, .76, .87, and .84, respectively). High levels of therapy withdrawal were reported (81%), with significant reservations toward assisted suicide and active euthanasia, although reported participation in such actions was noteworthy (18% and 4%, respectively). The scales reflecting global and philosophical attitudes correlated with several attitudes and behaviors toward physician-assisted death (P < .001). Legislation that would allow physician-assisted death was favored by 20.8% of respondents. CONCLUSION: Although they have reservations about physician-assisted death, significant numbers of oncologists are willing to consider such actions should they become legal. Given the substantial number of physicians who report that they have already participated in physician-assisted death, these findings may help better understand the attitudes that motivate physician behaviors toward assisted death.