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Biomedical subjects

M B Mengel

Publications and source records attributed to M B Mengel.

18 recordsLinked to original sources
PubMed1992

Recurrent bacterial vaginosis: association with vaginal sponge use.

A hypothesis-generation study was conducted to examine risk factors for bacterial vaginosis recurrences among women participating in a randomized controlled trial of male sexual partner treatment. Of the 140 women enrolled in the trial, 72 had a normal vaginal gram-stained slide at the first follow-up visit and were included in this analysis. Nineteen of the 72 (26.2%) women developed a bacterial vaginosis recurrence documented by a vaginal gram-stained slide during the 6-week follow-up period. Of the 19 women, 4 of 6 sponge users (66%) developed a bacterial vaginosis recurrence (RR 2.93, 95% CI: 1.43-6.02). Logistic regression analysis supported the association between sponge use and bacterial vaginosis recurrences (adjusted RR 2.71, 95% CI: 1.06-6.99) but revealed that an apparent protective effect of diaphragm use was due to the confounding effect of sexual partner treatment. Our hypothesis is that bacterial vaginosis recurrences may be due to factors other than sexual transmission, such as sponge use. Further studies are needed to examine risk factors for bacterial vaginosis recurrences. In the interim, physicians might suggest another form of contraception to their sponge-using patient with frequent bacterial vaginosis infections.

Adolescent↗
PubMed1990

Individual and family factors impacting diabetic control in the adolescent: a preliminary study.

The focus of this preliminary study is the impact of family and individual factors on diabetes control for the adolescent. Adolescents between the age of 15 and 18 years and their parents participated in this study. Questionnaires completed by subjects included FACES III, FILE, Social Support Inventory, and the Kvebaek Family Sculptures. Diabetic control was determined by measuring glycosylated hemoglobin. Subjects were asked to identify how they perceived family cohesion, family dysfunction, relationship distance, and social support. Initial analysis, utilizing bivariate correlations because of the small sample size, revealed statistically significant correlations between the adolescent's perception of family cohesion and diabetes control. Moreover, the more dysfunctional the parents perceived the family system, the worse the diabetic control of the adolescent. Adolescents with better diabetic control had fathers who perceived a greater distance between the mother-father relationship as well as a greater distance between the ideal father-patient relationship. Patients who perceived their mothers as nonsupportive experienced worse diabetic control. Yet patients who perceived they had more social support experienced better control of their diabetes. The more disengaged the family system, the worse the diabetic control for the adolescent.

Adaptation, Psychological↗
PubMed1990

Physicians' role in managing emotionally distressed patients already in psychotherapy.

Much has been written on how physicians should manage patients in emotional distress, including recommendations for making successful referrals to mental health providers. Little has been written, however, on the management of distressed patients who are already in psychotherapy. This article, drawing on three cases, a review of the literature, and systems theory, presents recommendations for managing these patients. Physicians are encouraged to assess these patients for risk of suicide or homicide, substance abuse, and indications for psychotropic medication. They are advised to seek a patient's permission to speak to his or her therapist when the patient may be in immediate danger, when psychotropic medications, hospitalization, or psychiatric consultation is considered, and when the patient fails to respond to ongoing treatment. For patients whose therapists are not psychiatrists, psychiatric consultation is recommended when there are questions about psychotropic medications, when psychiatric and substance abuse disorders coexist, and when hospitalization is considered. Therapists skilled in applying systems theory should be consulted when the patient, psychotherapist, and physician agree that the patient is not making sufficient progress. In most cases, however, physicians should reassure patients about distressing symptoms, avoid expressing opinions about the therapist and psychosocial issues, and encourage patients to renew or to expand their commitment to their psychotherapy.

Adult↗
PubMed1989

The effectiveness of single-dose metronidazole therapy for patients and their partners with bacterial vaginosis.

A randomized, placebo-controlled, double-blind clinical trial was performed to test the hypothesis that a 2-g single dose of metronidazole for male partners of women with bacterial vaginosis was more effective than placebo in improving cure rate and decreasing recurrence rate. In addition, the effectiveness of a 2-g single dose of metronidazole was compared with a seven-day course of 500 mg of metronidazole twice a day in patients with bacterial vaginosis. Statistically significant benefits of partner treatment were noted in the initial cure rate by Gram-stained smear criteria (P less than .01) and in percentage of women with symptoms eight weeks after initiating therapy (P less than .05). The seven-day course of metronidazole was superior to the single-dose regimen in the percentage of patients with clue cells and the percentage of patients with a positive "sniff" test at the first follow-up visit; however, differences in the initial cure rate assessed by clinical criteria and Gram-stained smear criteria were not statistically significant between the two patient treatment regimens. Recurrence rates by Gram-stained smear criteria between patient and partner treatment groups at five and eight weeks after initiation of treatment were also not significantly different between the two patient regimens. Single-dose metronidazole treatment of the sexual partner of women with bacterial vaginosis improves initial bacterial vaginosis cure rates. The seven-day course of metronidazole was not found by statistical analysis to be significantly superior to single-dose therapy when considering initial cure rates by clinical or Gram-stained smear criteria or recurrence rates.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1988

Bacterial vaginosis.

Bacterial vaginosis (nonspecific vaginitis) is a polymicrobial, superficial vaginal infection caused by an increase in anaerobic organisms and a concomitant decrease in lactobacilli. Gardnerella vaginalis, once thought to be the sole etiologic agent, is probably one of several endogenous members of the vaginal flora that overgrow in women with bacterial vaginosis. Whether the growth of anaerobes or a primary decrease in lactobacilli is the initial pathogenic event remains unclear. Epidemiological studies have revealed that current or previous infections caused by Trichomonas organisms, increased sexual activity, and intrauterine device use are risk factors for this condition. Studies have indicated that bacterial vaginosis, previously thought to be a benign illness, is associated with some morbidity in pregnant women. Symptoms remain unreliable in the diagnosis of bacterial vaginosis. Diagnostic efficacy is best achieved by utilizing clinical signs. Assessment of cure is best accomplished by Gram stain, not clinical criteria. Metronidazole, 500 mg orally for seven days, remains the treatment of choice; however, a 2-g single dose of metronidazole represents a reasonable alternative if cost and compliance issues predominate in a clinical situation. Although a recent study supports the contention that treatment of the male sexual partner of women with bacterial vaginosis is effective, a general recommendation cannot be made with confidence on the issue of sexual partner treatment until other supporting work is done.

Bacterial Infections↗
PubMed1988

Functional assessment of families with a diabetic person.

Recent studies have revealed that family functioning affects diabetic control, compliance behavior, and treatment of obesity, all of which are issues important to the care of the NIDDM patient. By assessing a few important family dynamics and intervening where appropriate, primary care physicians cannot only improve family functioning, but the health of their patients as well. Family therapy may be necessary when families are resistant to practitioner interventions.

Diabetes Mellitus, Type 1↗
PubMed1987

The quality of obstetric care in family practice: are family physicians as safe as obstetricians?

A literature review on the quality of obstetric care in family practice was conducted to determine whether family physicians are as competent in providing obstetric care as obstetricians. Three types of studies were reviewed: case series, historical cohorts, and population-based studies. No conclusion on the quality of obstetric care in family practice can be drawn from the available studies because of research design limitations. Available evidence suggests, however, that family physicians are as safe as obstetricians when delivering babies, particularly when they concentrate their efforts on providing personal prenatal care, refer high-risk pregnant women appropriately, and practice less technologically oriented care on women who deliver normal-weight babies. In addition, no evidence emerged that family physicians provided significantly poorer obstetric care than obstetricians. In fact, the results from population-based studies suggest that family physicians may be safer than obstetricians in delivering normal-weight infants because of their hypothesized less use of technological interventions in that low-risk group of patients. Further studies, especially prospective randomized trials in which the outcomes are assessed in a blinded fashion and case mix is rigorously controlled, are needed to provide a definitive answer. As practical, ethical, and economic constraints are likely to preclude such studies, the case-control design may provide a reasonable alternative.

Clinical Competence↗
PubMed1982

Mega cisterna magna: diagnosis using metrizamide computed tomographic cisternography.

The mega cisterna magna is one cause of a midline, extra-axial, posterior fossa cyst. The computed tomographic features and differential diagnosis of midline posterior fossa cystic structures are reviewed, and the clinical features of the mega cisterna magna are discussed. We describe a method of metrizamide cisternography and report a case of mega cisterna magna that was diagnosed by this technique.

Adult↗
PubMedDate not supplied

The relationship of family dynamics/social support to patient functioning in IDDM patients on intensive insulin therapy.

A 6 month pilot study was conducted to examine the relationship between family dynamics/social support and patient functioning in diabetic patients on intensive insulin therapy. Intensified therapy was associated with improvements in the DUHP symptom score, MHI psychological well-being score, and in the DUHP social functioning score. In diabetic patients, regardless of therapy, extreme family dynamics were correlated with higher DUHP symptom scores and lower MHI psychological well-being scores at the initial measurement time. However, over the 6 month study period, extreme family dynamics were predictive of improvements in the DUHP symptoms score and in the quality of friendships in diabetic patients on intensive insuline therapy. In diabetic patients, regardless of therapy, higher levels of social support correlated with higher levels of psychological and social functioning at the initial measurement time, and with improvements in quality of family life over the 6 month measurement time. Higher social support was also associated with improvements in quantity of friends and the DUHP social functioning score in diabetic patients on intensive insulin therapy. The study also generated empiric support for co-evolutionary models of disease states/family dynamics/treatment systems by showing that 6 month changes in family dynamics were predicted by the initial FACES adaptability measure and the initial mean monthly glucose value. Intensified therapy predicted lower family cohesion and more family rigidity over the 6 month study period. These findings also suggest, when combined with the result that diabetic patients from more cohesive families experienced a rise in monthly mean glucose values, that some diabetic patients may become trapped in a vicious cycle which perpetuates poor glucose control and extreme family dynamics.

Adaptation, Psychological↗
PubMedDate not supplied

Generalist courses in US medical schools and their relationship to career choice.

We conducted a survey of required first-year generalist courses offered by US medical schools during 1980, 1985, and 1990 to see if significant growth had occurred in this curricular area and to determine if the presence of these courses was associated with an increase in the percent of graduates selecting family practice as a career option. During the 1980s, only two types of generalist courses were offered by more than 50% of US medical schools, clinical experience and human behavior/psychiatry courses, with significant growth occurring in only two types of generalist courses, ethics and medical humanities courses. The presence of a required clinical experience course in 1985 was associated with a 2% increase in the number of graduates selecting family practice as a career option in 1988.

Career Choice↗
PubMedDate not supplied

Infectious vaginitis.

Explore the source record for details and available documents.

Bacterial Infections↗
PubMedDate not supplied

Disarming the family ghost: a family of origin experience.

A training method based on family of origin theory was designed to improve health care providers' interactions with difficult patients. The training is divided into five phases. First, leaders introduce participants to basic family of origin issues and the goals and format of the process. Second, participants discuss a difficult case, and, third, construct a family of origin genogram. Fourth, participants analyze the similarities between the two emotional systems. Leaders conclude with a discussion of the symptoms of fusion and develop strategies to avoid fusion during the therapeutic process. Within each phase, leaders present case examples and the participants in dyads proceed through the same process. By going through this process, participants will be better able to understand how family of origin dynamics affect the care they provide patients and why certain patients often prove to be difficult cases.

Family↗