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Biomedical subjects

Peter J Carek

Publications and source records attributed to Peter J Carek.

At least 19 recordsLinked to original sources
PubMed2006

Competing impact of excess weight versus cardiorespiratory fitness on cardiovascular risk.

Obesity is a risk factor for cardiovascular disease, whereas high cardiorespiratory fitness (CRF) is cardioprotective. This study evaluated the competing effect of weight and fitness on biomarkers of cardiovascular risk in a nationally representative sample of 2,112 adults (20 to 49 years of age; body mass index [BMI] > or =18.5 kg/m(2)) without previously diagnosed cardiovascular disease from the National Health and Nutrition Examination Survey 1999 to 2002. CRF levels were assigned using age- and gender-specific reference points of estimated maximal oxygen consumption calculated from submaximal graded exercise treadmill testing. CRF was also categorized by sample-specific tertiles of maximal oxygen consumption. Weight was categorized using BMI. Fasting insulin level >12.2 mU/L, C-reactive protein level > or =3.0 mg/L, and total cholesterol/high-density lipoprotein ratio (TC/HDL) >5 characterized increased cardiovascular risk. CRF and BMI were independently associated with increased fasting insulin and C-reactive protein (p <0.05). When patients with low, moderate, and high CRF were further stratified as normal, overweight, or obese, weight remained significantly associated with increased fasting insulin, C-reactive protein, and TC/HDL (p <0.001), but CRF did not. Logistic regressions evaluating increased fasting insulin, C-reactive protein, and TC/HDL demonstrated no significant differences in overweight/obese patients by CRF level after adjustment for other factors. Significant differences were present between normal-weight and overweight or obese patients regardless of fitness level. Analyses using tertiles of CRF yielded similar results. In conclusion, patients who are "fat but fit" require weight-loss interventions to improve their cardiovascular risk profiles. Future interventions should emphasize weight control, even for those with high CRF.

Adult↗
PubMed2006

How well are practice management curricula preparing family medicine residents?

BACKGROUND: While emphasis has been placed on practice management curricula in residency, studies indicate that residents are not adequately prepared. To assess the effectiveness of current practice management skills training in residency, we examined the confidence levels of family medicine residents and recent graduates in practice management skills. METHODS: A survey was sent to family medicine residency programs within South Carolina. Participants ranked their confidence level in 13 practice management skills on a 5-point Likert scale. Analysis of covariance compared confidence levels in their skills while controlling for program, gender, and age. Residency directors of these programs were also surveyed about the content of their practice management programs. RESULTS: Residents and graduates rated their confidence in all areas moderately high. Graduates rated themselves significantly more confident than residents did in seven practice management skills. CONCLUSIONS: Family medicine practice management curricula appear to be effective in establishing confidence regarding practice management skills in residents and recent graduates.

Adult↗
PubMed2005

Race and diet in the overweight: association with cardiovascular risk in a nationally representative sample.

OBJECTIVE: Because dietary differences may account for much of the racial and ethnic disparities in cardiovascular risk status, we evaluate the effect of race on cardiovascular risk after adjustment for dietary factors. METHODS: Prevalence of healthy diets in overweight U.S. adults (body mass index > or = 25 kg/m(2), age > or = 18 y) by race or ethnicity was determined by using 24-h dietary recalls from the National Health and Nutrition Examination Survey of 1999 to 2000. Dietary recalls included daily total calories, percentage of calories obtained from saturated fat, cholesterol, dietary fiber, and sodium and potassium intakes. Logistic regressions were used to evaluate the association between race/ethnicity, dietary factors, and cardiovascular risk markers (high levels of total cholesterol, C-reactive protein, systolic blood pressure, and diastolic blood pressure and low levels of high-density lipoprotein). RESULTS: The percentage of respondents who met healthy diet parameters ranged from 11.2 to 63.3. Non-Hispanic whites without diagnosed disease were less likely to have healthy diets than were African Americans or Hispanics, except with regard to cholesterol and fiber intake. After controlling for dietary factors, African American ethnicity was associated with a lower risk of hypercholesterolemia (odds ratio 0.587, 95% confidence interval 0.403 to 0.855), lower level of high-density lipoprotein (odds 0.440, 95% confidence interval 0.236 to 0.763), and a greater risk of high systolic blood pressure (odds ratio 2.383, 95% confidence interval 1.043 to 5.442) compared to whites. CONCLUSIONS: Differences in adherence to healthy diet parameters by race/ethnicity exist. However, after adjustment for diet and other modifiable factors, African Americans have a decreased risk of hypercholesterolemia and low level of high-density lipoprotein but an increased risk of systolic hypertension. Further research into the genetic basis for these differences is suggested.

Adult↗
PubMed2004

The combined effect of transferrin saturation and low density lipoprotein on mortality.

BACKGROUND AND OBJECTIVES: Evidence suggests that cardiovascular disease (CVD) is accelerated by the oxidation of low-density lipoprotein (LDL) in the presence of iron. This study examined whether adults with elevated iron, as measured by transferrin saturation (TS), and elevated LDL are at an increased risk for mortality. METHODS: This is a cohort study of the adult US population using the National Health and Nutrition Examination Survey 1976-1980 (NHANES II) merged with the NHANES II Mortality Study in 1992. Multivariate Cox regression was performed to determine hazard ratios (HR) for CVD and all-cause mortality for high (>55%) or low (<55%) levels of TS and high (>160 mg/dl) or low (<160 mg/dl) levels of LDL. RESULTS: An elevated LDL alone did not significantly increase CVD mortality or all-cause mortality in the adjusted model. Individuals with elevated LDL and elevated TS had a statistically significant increase in both CVD mortality and all-cause mortality (HR=5.74 and 3.53, respectively) compared to the low LDL and low TS group. CONCLUSIONS: The results of this study indicate an increased risk associated with the combination of elevated LDL and elevated TS, which suggests that iron-mediated oxidation of LDL may be a significant factor in the progression of CVD.

Adult↗
PubMed2004

Ranking departments of family medicine: the eye of the beholder?

BACKGROUND AND OBJECTIVES: During each of the past several years, a nationally circulated periodical (US News & World Report) has provided a ranking of medical schools and their respective specialty departments. In contrast to the method used to rank medical schools, medical specialties, including family medicine, are ranked based solely on ratings by deans and senior faculty at peer schools. This study's purpose was to explore how closely this expert opinion-based process matches actual objective and quantifiable data about departmental performance. METHODS: Available quantifiable data in the following categories were obtained: administration, academic productivity, and medical student and resident education. Based on their ranking in a category, each department was awarded one to five stars depending on the quintile they achieved (except for the dichotomous variable pertaining to the presence of a postresidency fellowship). Five stars indicate a ranking in the highest quintile. RESULTS: In regards to success in administration, research, and residency education and production of family physicians, the departments, on average, were rated 3.4, 4.2, and 3.6 stars, respectively. Overall, half of the departments consistently ranked in the top quartile, as indicated by an average score of 4.0 to 5.0 stars. CONCLUSIONS: Many of the departments rated highly in the US News & World Report rankings of the departments of family medicine rated very high in the areas of administration, research, and education as determined by quantifiable information. In contrast, several highly ranked departments were not rated favorably in areas usually associated with excellence in academics.

Attitude of Health Personnel↗
PubMed2003

Evaluation and treatment of women with hirsutism.

Hirsutism is a common disorder, often resulting from conditions that are not life-threatening. It may signal more serious clinical pathology, and clinical evaluation should differentiate benign causes from tumors or other conditions such as polycystic ovary syndrome, late-onset adrenal hyperplasia, and Cushing's syndrome. Laboratory testing should be based on the patient's history and physical findings, but screening for levels of serum testosterone and 17alpha-hydroxyprogesterone is sufficient in most cases. Women with irregular menses and hirsutism should be screened for thyroid dysfunction and prolactin disorders. Pharmacologic and/or nonpharmacologic treatments may be used. Advances in laser hair removal methods and topical hair growth retardants offer new options. The use of insulin-sensitizing agents may be useful in women with polycystic ovary syndrome.

Algorithms↗
PubMed2003

Practice profiles, procedures, and personal rewards according to the sex of the physician.

BACKGROUND: The objective of this study was to explore physician and practice characteristics according to sex. METHOD: All graduates of a southeastern state's family practice residency programs were surveyed. RESULTS: Seven hundred fourteen (53.5%; 79.7% men, 20.3% women) surveys were returned and analyzed. Practice arrangements and practice settings did not differ significantly between the two study groups. Male graduates saw a significantly higher percentage of geriatric patients (28.9% versus 24.7%; P = 0.008) and made significantly more nursing home visits (50.6% versus 35.5%; P = 0.002) and home visits (49.0% versus 33.8%; P = 0.001) than female graduates. With the exception of skin biopsies, a greater percentage of male physicians performed procedures than female physicians. Female graduates and male graduates had the same initial salary but had a significantly different current salary range. No significant differences were seen in personal or career satisfaction. CONCLUSION: Practice patterns of male and female physicians were generally similar. However, significant differences were noted in geriatric care, procedures, and salary.

Adult↗
PubMed2003

A thorough yet efficient exam identifies most problems in school athletes.

A complete medical history, preferably from the student and a parent, will reveal approximately 75% of problems affecting initial athletic participation. For asymptomatic athletes with no previous injuries, a 90-second screening musculoskeletal test will detect 90% of significant musculoskeletal injuries. A routine screening need not include noninvasive cardiac testing or laboratory tests such as urinalysis, blood count, chemistry profile, lipid profile, ferritin level, or spirometry.

Death, Sudden, Cardiac↗
PubMed2002

Special olympics, special athletes, special needs?

Based upon the current study, the review of the literature, and our experience, the preparticipation physical examination for Special Olympics is an opportunity for physicians of all specialties to assist and encourage a group of athletes with special physical and emotional characteristics not found in other athletes. The physician should review the medical condition of the athlete (including prescribed medications and their potential side effects), the physical demands of the proposed activity, and the presence of volunteers to assist the athlete when necessary. Full or limited participation should be recommended in most cases. "No participation" should only apply to unstable medical conditions or situations that would place the athlete at risk for injury despite activity modification and close supervision.

Adolescent↗
PubMed2002

Does community- or university-based residency sponsorship affect future practice profiles?

BACKGROUND AND OBJECTIVES: The educational sponsor of a residency program (ie, community based versus university based, opposed versus unopposed) is one of the most influential factors in medical students' choice of a training program. This study examined the practice profiles of South Carolina family practice residency graduates to determine whether there were significant differences based on program sponsorship. METHODS: A survey was mailed to the 1,335 graduates of South Carolina Area Health Education Consortium (SC AHEC)-affiliated residency programs. Data were summarized and analyzed using the Epi-Info statistical program. Significance was preset at the P < .01 level. RESULTS: A total of 720 (56.0%) surveys were returned. Community-based program graduates were more likely to practice in the state, in a rural area, and closer to their residency site. University-based program graduates were more likely to practice in academic settings (18.9% versus 6.3%). Several minor differences in procedures performed were noted, with some procedures performed more commonly by physicians trained in university-based programs and others by physicians trained in community programs. No differences in salaries orpersonal or professional satisfaction between groups was found. CONCLUSIONS: The current study found some differences in location of practice but found few differences in procedures performed, salaries, or satisfaction based on sponsorship of residency.

Adult↗
PubMed2002

Nortriptyline effective for smoking cessation.

Nortriptyline (Pamelor), in combination with weekly behavioral therapy, is effective in helping highly motivated smokers to quit. The medication may be an alternative for patients who cannot tolerate or do not benefit from bupropion. Given the high motivation of the group and the extensive behavioral therapy they also received, results are not likely to be as good in typical practice.

Comment↗
PubMedDate not supplied

Elevated serum transferrin saturation and mortality.

BACKGROUND: A large proportion of US adults have elevated transferrin saturation, an indicator of a predisposition for iron overload. The purpose of this study was to evaluate the relationship between elevated serum transferrin saturation and mortality. METHODS: This cohort study was conducted using data from the First Health and Nutrition Examination Survey 1 (1971-1974) (NHANES I) merged with the NHANES I Epidemiologic Followup Study (1992) (N = 10,714). We used SUDAAN and appropriate weights to make population estimates for the adult US population (aged 25 to 74 years at baseline). All-cause mortality was evaluated in relation to serum transferrin saturation of greater than 45%, greater than 50%, greater than 55%, and greater than 60% using Cox proportional hazards regression. RESULTS: In a Cox proportional hazards model controlling for potential confounders, including comorbid diseases, smoking, and cholesterol, all-cause mortality is significantly greater for persons with a serum transferrin saturation of more than 55%, compared with those with saturations below this cutoff (hazards ratio [HR] = 1.60, 95% confidence interval [CI], 1.17-2.21). No one who died had hemochromatosis as any of the 20 listed causes of death. Many of the underlying causes of death for persons with serum transferrin saturation levels of more than 55% are common causes of death in the general population, although these persons were more likely to have died of cirrhosis and diabetes, a finding consistent with iron overload. CONCLUSIONS: In this nationally representative cohort of adults, those with elevated serum transferrin saturation, more than 2% of the adult US population, were at increased risk for all-cause mortality.

Adult↗