RESUMEN
BACKGROUND AND OBJECTIVES: Few studies address the impact of physician attire on ratings of personality characteristics in the presence of varied physician demographic characteristics (gender, racial/ethnic background). Even fewer have examined the boundaries of acceptable physician attire, given recent loosening of societal standards of dress. METHODS: Using an online survey methodology, adult participants (N=505; 45% medical professionals) were recruited. Participants rated target photos depicting a male and female individual from three ethnic/racial categories each dressed in business casual (with and without a white coat) or in professional attire (with and without a white coat) on a number of personality characteristics. General willingness to have physicians wear certain apparel items was also queried, as was the importance/acceptability of specific clothing items and appearance choices. Responses were analyzed by gender, age, ethnicity, and profession of respondent. RESULTS: Both business casual and professional attire were rated highly. A name tag had the highest ratings for importance of wear. The results for wearing a white coat were not as consistent as earlier studies as physicians were perceived as warmer and kinder when not wearing a lab coat, particularly with professional attire. However, female Caucasian physicians were rated most positively when wearing a lab coat. Consistent with previous studies, attire that was too casual (jeans, t-shirts) was rated negatively. CONCLUSIONS: The current study supports the notion that rules of attire are changing, even in the physician's office. Name tags were perceived to be crucial in medical settings, and casual clothing should be avoided. Despite often being considered a defining component of a physician's "uniform," the white lab coat may not be a universal positive and perhaps even a negative for some physicians.
Asunto(s)
Vestuario , Demografía , Prioridad del Paciente/psicología , Médicos Mujeres/psicología , Médicos/psicología , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Encuestas y CuestionariosRESUMEN
How effective are cognitive behavioral therapy, prescribed exercise, dietary supplements, and other nonpharmacologic options for alleviating depression? Here's what the evidence tells us.
Asunto(s)
Antidepresivos/uso terapéutico , Terapia Cognitivo-Conductual , Depresión/terapia , Medicina Familiar y Comunitaria , Ácidos Grasos Omega-3/uso terapéutico , HumanosRESUMEN
The practice of family medicine includes the care of many patients with mental health or behavior change needs. Patients in mild to moderate distress may benefit from brief interventions performed in the family physician's office. Patients in more extreme distress may be helped by referral to behavioral health clinicians for short-term or open-ended therapies. Electronic therapy programs and bibliotherapy are also useful resources. The transition to the patient-centered medical home model may allow for more widespread integration of behavioral health care clinicians into primary care, in person and through telemental health care. Integrated care holds the promise of improved access, greater effectiveness of behavioral health service provision, and enhanced efficiency of primary care for patients with behavioral health care needs.
Asunto(s)
Terapia Conductista/organización & administración , Conducta , Medicina Familiar y Comunitaria/organización & administración , Trastornos Mentales/terapia , Servicios de Salud Mental/organización & administración , Libros , Comunicación , Terapias Complementarias , Conducta Cooperativa , Conductas Relacionadas con la SaludRESUMEN
Family physicians play an important role in identifying and treating the behavioral etiologies of morbidity and mortality. Changing behavior is a challenging process that begins with identifying a patient's readiness to change. Interventions, such as motivational interviewing, are used to increase a patient's desire to change, and cognitive behavioral therapy can be initiated to increase a patient's likelihood of change, particularly if barriers are identified. After patients embark on change, family physicians are uniquely positioned to connect them to self-help programs, more intensive psychotherapy, and newer technology-based support programs, and to provide repeated, brief, positive reinforcement. Specific behavioral interventions that can be effective include computerized smoking cessation programs; electronic reminders and support delivered by family physicians or other clinicians for weight loss; linkage to community-based programs for seniors; increased length and demands of in-school programs to support exercise participation by children; and access reduction education to prevent firearm injury.
Asunto(s)
Terapia Conductista/organización & administración , Medicina Familiar y Comunitaria/organización & administración , Conductas Relacionadas con la Salud , Conducta , Comunicación , Conducta Cooperativa , MotivaciónRESUMEN
Depressive disorders commonly are diagnosed and managed in primary care settings, and many patients prefer a nonpharmacologic approach. Traditionally, symptom reduction through pharmacotherapy has been the primary focus of management, but there is a growing acknowledgment of the need to develop modalities that prevent subsequent relapse and recurrences. Psychotherapy, including cognitive behavioral and interpersonal therapies, can have enduring effects that reduce subsequent risk in ways that drugs cannot. Although most family physicians do not provide formal psychosocial interventions for depression, brief interventions and behavioral intervention technologies, such as those that deliver care via the Internet or mobile device, are key means of increasing access to psychotherapy. For children and adolescents with mild, uncomplicated depression, physician-provided social support, encouragement, and reinforcement of adaptive behavior patterns can be as effective as cognitive behavioral therapy. In addition, a primary care physician's involvement in parent education and safety planning for suicide prevention holds promise for risk reduction. Evidence also supports the use of problem-solving therapy and components of cognitive behavioral therapy and interpersonal psychotherapy provided by primary care physicians for patients with depression.
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Terapia Conductista/organización & administración , Conducta , Trastorno Depresivo/terapia , Medicina Familiar y Comunitaria/organización & administración , Servicios de Salud Mental/organización & administración , Comunicación , Conducta Cooperativa , Conductas Relacionadas con la Salud , Factores de Riesgo , Suicidio/psicologíaRESUMEN
Numerous behavioral therapies have been investigated in the management of anxiety- and stress-related disorders. There is strong evidence to support cognitive behavioral therapy (CBT) in the management of generalized anxiety disorder (GAD), posttraumatic stress disorder, obsessive-compulsive disorder, panic disorder, and social phobias. Adjunctive behavioral sleep intervention may enhance results for GAD, and initiation of a selective serotonin reuptake inhibitor for GAD before CBT also may enhance response. Several randomized clinical trials showed benefit of Internet-based CBT for GAD, but additional studies are needed before conclusions can be drawn regarding its effectiveness for posttraumatic stress disorder. Although outcome data are limited, family physicians can offer patients screening for anxiety disorders, psychological first aid (ie, listening to and comforting patients, teaching about emotional and physiologic responses to traumatic incidents, and encouraging engagement with social supports and coping) after trauma, education about anxiety disorders, and referral to evidence-based self-help resources. Family physicians also can ensure linkage with behavioral health care physicians and encourage adherence to self-help protocols.
Asunto(s)
Trastornos de Ansiedad/terapia , Terapia Conductista/organización & administración , Medicina Familiar y Comunitaria/organización & administración , Estrés Psicológico/terapia , Comunicación , Conducta Cooperativa , Conductas Relacionadas con la SaludRESUMEN
Cigarette smoking causes significant morbidity and mortality in the United States. Physicians can use the five A's framework (ask, advise, assess, assist, arrange) to promote smoking cessation. All patients should be asked about tobacco use and assessed for motivation to quit at every clinical encounter. Physicians should strongly advise patients to quit smoking, and use motivational interviewing techniques for patients who are not yet willing to stop smoking. Clinical contacts with unmotivated patients should emphasize the rewards and relevance of quitting, as well as the risks of smoking and anticipated barriers to abstinence. These messages should be repeated at every opportunity. Appropriate patients should be offered pharmacologic assistance in quitting, such as nicotine replacement therapies, bupropion, and varenicline. Use of pharmacologic support during smoking cessation can double the rate of successful abstinence. Using more than one type of nicotine replacement therapy ("patch plus" method) and combining these therapies with bupropion provide additional benefit. However, special populations pose unique challenges in pharmacotherapy for smoking cessation. Nicotine replacement therapies increase the risk of birth defects and should not be used during pregnancy. They are usually safe in patients with cardiovascular conditions, except for those with unstable angina or within two weeks of a coronary event. Varenicline may increase the risk of coronary events. Nicotine replacement therapies are safe for use in adolescents; however, they are less effective than in adults. Physicians also should arrange to have repeated contact with smokers around their quit date to reinforce cessation messages.
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Promoción de la Salud/métodos , Cese del Hábito de Fumar , Prevención del Hábito de Fumar , Adolescente , Adulto , Antidepresivos de Segunda Generación/administración & dosificación , Antidepresivos de Segunda Generación/efectos adversos , Benzazepinas/administración & dosificación , Benzazepinas/efectos adversos , Bupropión/administración & dosificación , Bupropión/efectos adversos , Terapias Complementarias , Medicina Familiar y Comunitaria , Femenino , Humanos , Masculino , Motivación , Agonistas Nicotínicos/administración & dosificación , Agonistas Nicotínicos/efectos adversos , Embarazo , Quinoxalinas/administración & dosificación , Quinoxalinas/efectos adversos , Fumar/psicología , Cese del Hábito de Fumar/psicología , Dispositivos para Dejar de Fumar Tabaco/efectos adversos , Estados Unidos , VareniclinaRESUMEN
Many psychosocial factors have been associated with successful aging. The impact of social relationships, personality factors, self-perceptions,and religiosity/spirituality is reviewed in this article and recommendations for enhancing psychological aging are provided.
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Envejecimiento/psicología , Actitud , Personalidad/fisiología , Humanos , AutoimagenRESUMEN
Evidence on the use of complementary and alternative medicine (CAM) modalities in the treatment of depression, anxiety, sleep disorders, and attention-deficit/hyperactivity disorder (ADHD) is reviewed. There is strong evidence to support the use of St. John's wort (SJW) in depression, and growing support for the use of omega-3 fatty acids and S-adenosyl-l-methionine as potential adjuncts to conventional therapies. Evidence is insufficient to support the antidepressant benefit of dehydroepiandrosterone, inositol, folate, and saffron. Only kava has high-quality evidence for use in the treatment of anxiety disorders, and its use is discouraged because of safety concerns. There is preliminary supportive evidence for valerian and inositol treatment of anxiety, but SJW and passionflower have achieved little research support. Melatonin is likely to be useful in treating delayed sleep phase, jet lag, or shift work, but there is little evidence for the benefit of valerian compared with placebo. There are currently no evidence-supported CAM treatments for ADHD (zinc and omega-3 fatty acids are reviewed).
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Terapias Complementarias , Trastornos Mentales/terapia , Ansiedad/terapia , Trastorno por Déficit de Atención con Hiperactividad/terapia , Depresión/terapia , Humanos , Fitoterapia , Trastornos del Sueño-Vigilia/terapiaRESUMEN
The impact of stress on physical functioning (endocrine, gastrointestinal, immune, and cardiovascular systems) is reviewed. The effect of stress on psychiatric functioning and health behaviors also is discussed. The importance of stress screening in primary care is emphasized, and several methods of stress reduction (including exercise, cognitive-behavioral therapy, and mindfulness-based stress reduction) appropriate to primary care settings are described.
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Estado de Salud , Salud Mental , Estrés Psicológico/complicaciones , Estrés Psicológico/terapia , Terapia Conductista , Enfermedades Cardiovasculares/etiología , Enfermedades del Sistema Digestivo/etiología , Emociones , Enfermedades del Sistema Endocrino/etiología , Ejercicio Físico , Conductas Relacionadas con la Salud , Humanos , Enfermedades del Sistema Inmune/etiología , Tamizaje Masivo , Terapia por Relajación , Apoyo Social , Estrés Psicológico/diagnósticoRESUMEN
This study investigates the prevalence of asthma and asthma-related symptoms in New Orleans inner-city schoolchildren. A cross-sectional survey of 1535 elementary, middle, and high school children (aged 5-18) was conducted by using the International Study of Asthma and Allergies in Childhood (ISAAC) written questionnaire. Lifetime prevalence of wheezing was 39.4%, and lifetime prevalence of asthma was 24.4%. Wheezing during the previous 12 months was reported by 25.7% of the sample. Twenty-one percent of respondents reported having one or more attacks of wheezing per year, with 5.6% reporting four or more attacks per year. Many participants reported sleep disturbance (15.4%), with 6.2% reporting sleep disturbance more than once a week. The 12-month rate of speech limitation due to asthma exacerbation was 6.6%. Exercise-induced asthma was reported by 16.9% of the students, and nocturnal cough (not associated with cold) was reported by 27.3%. Overall, boys reported higher rates of symptoms than girls, and younger children (aged 6-7) reported greater symptoms than older children (aged 13-14). These findings show that prevalence of asthma in this population is elevated, and the ISAAC written questionnaire successfully identified inner-city children at risk for asthma in New Orleans.
Asunto(s)
Asma/epidemiología , Salud Urbana , Adolescente , Niño , Preescolar , Estudios Transversales , Femenino , Humanos , Louisiana/epidemiología , Masculino , Prevalencia , Ruidos Respiratorios , Instituciones AcadémicasRESUMEN
Continuing Medical Education (CME) has been at the cornerstone of life-long learning for physicians for almost four decades. Constraints on physician services and reimbursement during the same period of time have increased the physicians' and CME providers' dependency on financial support from the medical industrial complex for CME activities. In a related arena, the competitive nature of the medical industrial complex has resulted in a frenzy of "enticements," amenities, or gifts for physicians. The busy practitioner is vulnerable to many unethical practices currently being reported and identified by the public, often unjustly presenting a tarnished image of the entire medical profession. The Louisiana State Medical Society Continuing Medical Education Accreditation Committee (LSMS CMEAC) recommended a review article on the current practices, attitudes, and guidelines relating to gifts to physicians from industry and industry's appropriate financial support for CME activities. Dr. Roger Zoorob, a member of the LSMS CMEAC, along with Michele Larzelere, PhD, responded to the committee's request. The LSMS CMEAC is grateful for their contribution. (LSUS CMEAC Chair: Albert Barrocas, MD, Chair of the CMEAC. LSMS CMEAC members and staff: Donnie Batie, MD; William Daly, Jr., MD; Barbara L. Deming, MD; Ricky Hendrix, MD; Benedict E. Idowu, DO; Harold L. Ishler, Jr., MD; Russell C. Klein, MD; Sharda Kumar, MD; Elma I. LeDoux, MD; I. Ricardo Martinez, MD, PhD; Pamela A. Parra, MD, Vice-Chair; William G. Rhea, Jr., MD; Rajasekharan Warrier, MD; Roger Zoorob, MD; Jeanette Harmon, MBA, Director of Administration; and JoAnna Cline, Medical Education Coordinator.)
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Conflicto de Intereses , Industria Farmacéutica/ética , Educación Médica Continua/economía , Equipos y Suministros/ética , Ética Médica , Donaciones/ética , Guías como Asunto , American Medical Association , Actitud Frente a la Salud , Humanos , Estados UnidosRESUMEN
Evidence for alternative treatments for depression, anxiety, and insomnia are reviewed in this article. Treatment of depression with St. John's wort, L-tryptophan, 5-hydroxytryptophan, S-adenosylmethionine, dehydroepiandosterone, folate, exercise, acupuncture, and meditation are examined. Evidence for the efficacy of kava kava, exercise, relaxation therapies, and acupuncture in treatment anxiety is reviewed. The use of valerian, melatonin, chamomile, passionflower, exercise, acupuncture, and behavioral therapies (i.e., sleep restriction, stimulus control, relaxation, and sleep hygiene) for insomnia is discussed.
Asunto(s)
Ansiedad/terapia , Terapias Complementarias/métodos , Depresión/terapia , Trastornos del Inicio y del Mantenimiento del Sueño/terapia , Acupuntura , Ansiedad/prevención & control , Depresión/prevención & control , Ejercicio Físico , Humanos , Estilo de Vida , Meditación , Fitoterapia/métodos , Trastornos del Inicio y del Mantenimiento del Sueño/prevención & control , Estados UnidosRESUMEN
BACKGROUND: This study examines the practice patterns of Louisiana family physicians in managing asthma with attention to National Asthma Education Program (NAEP) guidelines. METHODS: A confidential two-page, multiple choice, 24-question survey was faxed to the 550 active members of the Louisiana Academy of Family Practitioners. It included questions related to the use of peak flow meters and pulse oximetry, nedocromil, theophylline, beta 2 agonists, suppressive antibiotics, inhaled steroids, as well as knowledge of published guidelines for classifying and treating asthma. RESULTS: Most of those who participated have an appropriate knowledge of asthma classification, but a sharp drop in the knowledge of the correct management of step 4 asthma was seen. A minority of respondents claimed knowledge of the NIH guidelines, but their management patterns for adult step 1, 2, and 3 asthma were largely in agreement with the guidelines. CONCLUSIONS: Unlike previous studies in the literature, this one shows good knowledge and reported practice compliance with the NAEP guidelines by Louisiana family physicians.