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OBJECTIVE: Obesity is a prevalent public health problem in the United States, especially for rural African American women, and causes increased morbidity and mortality. The purpose of this analysis was to determine whether the transtheoretical stages of change model was generalizable to weight loss intention among overweight and obese rural African American women and to identify important predictors of the stages of change. RESEARCH METHODS AND PROCEDURES: The study was conducted in two rural counties in central Virginia. A population-based sample of 200 women under the age of 40 completed questionnaires concerning weight loss behavior and beliefs about weight. Ordinal logistic regression was used to predict stage of change. RESULTS: A total of 142 of the 200 women (71%) were overweight or obese (body mass index of > or =25) and were classified into a stage of change. Overall, 30% of respondents were in the precontemplation stage, 15% in the contemplation stage, 48% in the preparation stage, 4% in the action stage, and 3% in the maintenance stage. Education, what friends think about weight, body mass index, and a scale of the positive aspects of weight loss were significant predictors of the stage of change (p < 0.05). CONCLUSIONS: Several predictors of stage were the same as those found in studies of other health behaviors, and this research provides support for applying a stages of change model for weight loss intention among rural African American women. Two predictors in particular, significance of what friends think about weight and a scale of the positive aspects of weight loss, have implications for health education initiatives and social support in weight loss interventions.

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OBJECTIVE: To increase understanding of body image among rural, African-American women through open-ended interviews. DESIGN: Individuals' perceptions of body image were investigated using open-ended, in-depth interviews that were tape-recorded, transcribed, and analyzed to identify common themes and to compare thematic data across three body mass index categories (obese, overweight, and normal). SETTING: University-affiliated rural community health center. PARTICIPANTS: Twenty-four African-American women, aged 21 to 47 years. MAIN RESULTS: Respondents reported the following common themes: dissatisfaction with current weight; fluctuating levels of dissatisfaction (including periods of satisfaction); family and social pressure to be self-accepting; and social and physical barriers to weight loss. The interviews revealed ambivalence and conflicts with regard to body image and weight. Among these women, there was strong cultural pressure to be self-accepting of their physical shape, to "be happy with what God gave you," and to make the most of their appearance. CONCLUSIONS: The pressure to be self-accepting often conflicted with these obese women's dissatisfaction with their own appearance and weight. Although the respondents believed they could lose weight "if [they] put [their] mind to it," those women wanting to lose weight found that they lacked the necessary social support and resources to do so. The conflicts stemming from social pressures and their own ambivalence may result in additional barriers to the prevention of obesity, and an understanding of these issues can help health care providers better address the needs of their patients.

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We sought to determine the effects of cigarette smoking on menstrual function using prospectively recorded menstrual data in a cohort study of women ages 37-39 years. Eighty-three current smokers and 275 nonsmokers provided menstrual data for analysis. Smoking was associated with decreased duration of bleeding, increased daily amount of bleeding (subjectively scored), and increased duration of dysmenorrhea. These effects were most pronounced in the heaviest smokers. Smoking was not associated with cycle length, but we found some evidence for increased variability of cycle length among heavier smokers. We conclude that cigarette smoking affects menstrual function, most importantly by increasing the duration of dysmenorrhea.

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PURPOSE: To assess the effect of knee magnetic resonance (MR) imaging on the diagnosis and management of acute knee injury. MATERIALS AND METHODS: Two orthopedic knee surgeons prospectively completed pre- and post-MR imaging questionnaires on 84 of 91 consecutive patients with acute knee injury. The pre- and post-MR imaging clinical diagnoses, certainty regarding these diagnoses, other diagnostic tests, and subjective impression of the usefulness of MR imaging were determined. RESULTS: Seven hundred thirty-one of 840 pre- and post-MR imaging diagnoses agreed. Agreement was lowest for medial meniscal injuries (54 of 84). Significantly fewer meniscal injuries were suspected after MR imaging (P < .05). In 60 patients, the orthopedist changed at least one of the 10 potential diagnoses after MR imaging. Clinical diagnostic certainty increased by a mean of 14% for all diagnoses. The increase in diagnostic certainty was greatest for medial meniscal injuries (30%), followed by lateral meniscal injuries (21%). The proposed management changed in 41 patients, resulting in significantly fewer arthroscopic procedures (P < .01). The post-MR imaging management plans included 37% (27 of 73) fewer arthroscopic procedures. CONCLUSION: MR imaging affects the diagnosis and management of acute knee injury by decreasing the number of arthroscopic procedures, improving clinician diagnostic certainty, and assisting in management decisions.

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INTRODUCTION: Proof of effectiveness now exists for many health promotion and disease prevention practices, yet the importance of this knowledge is not widely appreciated, and a large percentage of the population does not receive this care. Universities with comprehensive academic medical centers are particularly appropriate places for providing health promotion programs. The University of Virginia began a health promotion and disease prevention program for employees in 1990. METHODS: Periodic health risk appraisal, with follow-up and selected interventions, is offered to approximately 14,000 employees as a cost-free fringe benefit. Health risks are assessed with a modification of the Carter Center Health Risk Appraisal. Results are given to participants in group sessions; referrals are made for clinical preventive services and interventions, as needed. RESULTS: During the first three years, 29% of the employee population participated in the program. Participants were more likely to be young, female and not African American. Nearly 96% had one or more risk factors, with an average of 3.6 risk factors overall. Participants on average had 1.8 risk factors for cardiovascular disease; 0.3 for cancer; 0.6 for injury; 0.1 for alcohol abuse; and 0.7 for mental health. Nonparticipants were not receiving similar comprehensive health risk appraisal elsewhere. CONCLUSIONS: University of Virginia employees have multiple health risks, not detected through their usual health care, for which effective interventions are available. This population probably reflects conditions throughout the state and nation. Academic medical centers should place high priority on establishing health promotion programs as part of their responsibilities to society.

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RATIONALE AND OBJECTIVES: We assessed the impact of ankle radiographs on referring physicians' diagnoses and treatment of acute ankle injuries. METHODS: Twenty emergency department physicians prospectively completed questionnaires before and after radiography on 101 patients with acute trauma receiving ankle radiographs. The questionnaires asked physicians to estimate the probability (0-100%) of their most likely diagnosis before and after receiving the radiographic information. We also asked their anticipated and final treatment plans. We calculated the mean gain in diagnostic confidence percentage and the proportion of patients with changed initial diagnoses or anticipated management. RESULTS: The mean gain in diagnostic certainty from ankle radiographs was 34% (95% confidence interval [CI] = 28-40%). Ankle radiographs changed physicians' initial diagnoses in 37% (95% CI = 28-47%) of the patients. Immediate clinical management changed in 30% (95% CI = 22-40%) of the patients. CONCLUSION: Plain ankle radiographs have considerable impact on referring physicians' diagnoses and treatment of acute ankle trauma.

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We interviewed 542 women whose mothers were in a randomized trial of diethylstilbestrol. Effects of diethylstilbestrol on the third generation were explored by ascertaining age at menarche for the women's daughters. A total of 123 daughters were > or = 10 years old (52 exposed and 71 unexposed). Age at menarche was unaffected by mother's prenatal diethylstilbestrol exposure.

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BACKGROUND: Prenatal exposure to diethylstilbestrol causes infertility in male mice and has been associated with malformations of the genital tract in men. However, little is known about the fertility of men who have been exposed prenatally to diethylstilbestrol. METHODS: In 1950 through 1952, 1646 pregnant women were enrolled in a randomized, placebo-controlled clinical trial of diethylstilbestrol at Chicago Lying-in Hospital. We interviewed men who were born to the women during that study about their fertility. RESULTS: Four decades after their birth, we were able to trace 548 of the surviving sons (68 percent). Ninety percent consented to be interviewed (253 who had been exposed to diethylstilbestrol in utero and 241 who had not been exposed). Congenital malformations of the genitalia were reported three times as often by the diethylstilbestrol-exposed men as by the sons of the women in the placebo group. Within the exposed group, malformations were reported twice as often among those exposed to diethylstilbestrol before the 11th week of gestation as among those exposed later (P = 0.05). Men with genital malformations were nonetheless as fertile as other men. The diethylstilbestrol-exposed men (with or without genital malformations) had no impairment of fertility by any measure, including whether they had ever impregnated a women, age at the birth of their first child, average number of children, medical diagnosis of a fertility problem, or length of time to conception in the most recent pregnancy of the female partner. Finally, diethylstilbestrol-exposed men had no impairment of sexual function, as indicated, for example, by the frequency of intercourse or reported episodes of decreased libido. CONCLUSIONS: High doses of diethylstilbestrol did not lead to impairment of fertility or sexual function in adult men who had been exposed to the drug in utero.

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OBJECTIVES: As part of a larger health survey, we sought to determine whether prenatal exposure to diethylstilbestrol is associated with onset of early menopause or menopausal symptoms. STUDY DESIGN: Diagnosis of premature ovarian failure and symptoms of menopause were determined in a telephone interview with 542 women whose mothers participated in a randomized clinical trial of the use of diethylstilbestrol in pregnancy in the early 1950s. These women were aged 37 to 39 at the time of the interview. Medical records were obtained to confirm diagnosis of premature ovarian failure. RESULTS: The prevalence of menopausal symptoms (specifically hot flashes and night sweats) did not differ for exposed and unexposed women. One exposed woman and no unexposed women had a medically confirmed diagnosis of premature ovarian failure. CONCLUSIONS: Prenatal diethylstilbestrol exposure was not related to diagnosis or symptoms of menopause in this study. Further follow-up will be necessary to determine if a difference in age at menopause emerges as these women become older.

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OBJECTIVES: The purpose of this study was to determine the effects of in utero exposure to diethylstilbestrol on the menstrual cycle. STUDY DESIGN: This was a prospective cohort study of 198 diethylstilbestrol-exposed women and 162 unexposed controls, recruited from women whose mothers participated in a randomized trial of diethylstilbestrol in pregnancy at the Chicago Lying-In Hospital from 1950 to 1952. Women with severe menstrual abnormality were excluded from the study. RESULTS: Diethylstilbestrol exposure was associated with a statistically significantly decreased duration of menstrual bleeding of approximately one half day and a lower average daily bleeding score (self-reported). We found no evidence for effects of diethylstilbestrol exposure on cycle length or variability of cycle length. Exposure was not related to symptoms of dysmenorrhea. CONCLUSIONS: The decreased duration and amount of menstrual bleeding among diethylstilbestrol-exposed women could be due to direct effects on the uterus. The lack of an effect on cycle length and variability appears to indicate that endocrine function is not grossly disturbed in those women studied.

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A total of 91 women provided reproductive histories, including usual frequency of coitus, at their enrollment into prospective studies conducted by the National Institute of Environmental Health Sciences in Research Triangle Park, North Carolina, in 1984-1986. Those data were compared with coital data recorded during study participation. Overall, women reported a significantly higher frequency of coitus on the interviewer-administered questionnaire than they recorded daily, by an average of 0.8 episodes per week. The size of this difference did not vary significantly for subgroups of women defined by demographic and other covariates. Excluding days of menses from the prospective records reduced the difference by 25%. The authors attribute the overestimate on the questionnaire to a tendency to report a coital frequency that might exist in the absence of travel, illness, and other transient factors that are likely to decrease frequency. This nondifferential information bias is unlikely to produce misleading comparisons or erroneous associations in epidemiologic studies of reproduction.

PIP: Researchers interviewed 91 women of reproductive age who were married or living with a partner when they enrolled in a prospective study to compare the frequency of coitus on the questionnaire with the frequency on prospective daily record cards (mean, 70 days of records). 89% of the women reported a higher frequency of intercourse on the questionnaire than on the prospective records. The mean frequency of intercourse on the questionnaire was 2.5 times/week while the daily record cards indicated a mean of 1.7 times/week--a statistically significant mean difference of .8 times/week (p.0001). .4 times/week was the mean lowest value for all women and 3.3 times/week was the mean highest frequency. In addition, 75% of the women reported no intercourse for a least 1 week. The researchers guessed that the most likely explanation for the overestimate may be that the frequency reported on the questionnaire doe not take into account menstruation, illness, travel, or other conditions that might reduce the frequency of intercourse. When they calculated a frequency of coitus on all days, excluding menses, however, the mean difference was reduced only slightly to .6 times/week. Therefore the researchers could not explain the bulk of the difference. The myriad of potential reasons stated in the article for differences in the 2 sources of intercourse data suggest possible improvements in questionnaire design are needed, such as asking about factors that affect their usual intercourse. In addition, despite the fact that the differences constitutes an information bias, the bias occurs in the same direction and magnitude in all the various subgroups and thus is nondifferential.

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