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Biomedical subjects

R L Bauer

Publications and source records attributed to R L Bauer.

At least 19 recordsLinked to original sources
PubMed1992

Excess androgenicity only partially explains the relationship between obesity and bone density in premenopausal women.

Obese subjects have increased bone density relative to non-obese subjects yet this relationship is not fully understood. We examined whether alterations in sex hormones or binding proteins might explain the effect of obesity on osteoporosis in 83 premenopausal women from the San Antonio Heart Study, a population-based study of diabetes. We measured total testosterone, oestradiol, oestrone, sex hormone binding globulin (SHBG), and serum dehydroepiandrosterone sulphate (DHEA-SO4). Bone density was assessed by a Hologic dual photon absorptometer. Lumbar spine and femoral neck density were positively correlated with body mass index (BMI). In addition, femoral neck density was positively correlated with DHEA-SO4. BMI was negatively correlated with SHBG. After adjustment for sex hormones by multiple linear regression a positive association between bone density and obesity still exists suggesting that the association between obesity and bone density is at least partially independent of sex steroids in premenopausal women.

Adult↗
PubMed1990

Impact of legal liability, family wishes, and other "external factors" on physicians' life-support decisions.

PURPOSE: The purpose of this study was to determine the impact of external factors on physicians' life-support decisions. "External factors" are those factors that promote the interests of people other than the patient. Examples of external factors include physician legal liability and family wishes about patient care. SUBJECTS AND METHODS: A nationwide sample consisted of 300 randomly selected physician-members from the American Society of Law and Medicine (ASLM) and 300 from the Society for Critical Care Medicine (SCCM); 179 ASLM physicians (60%) and 165 SCCM physicians (55%) responded. A mailed questionnaire presented three cases, each requiring the physician to make a life-support decision. For each case, the physician chose one of several life-support options and rated the importance to his or her decision of specific "decision factors," including some external factors. We assumed the physician would choose the management option supported by the decision factors that the physician considered most important. For this reason, we used discriminant analysis to identify the factors whose importance ratings best predicted management choices. RESULTS: In the first case, 46% of ASLM respondents and 55% of SCCM respondents chose to stop the ventilator of a chronically comatose patient with unknown preferences about life support. Thirty-one percent of ASLM and 27% of SCCM respondents chose to continue the ventilator, and 21% of ASLM and 14% of SCCM respondents chose to apply for a judicial decision. Importance ratings for the external factor, physician legal liability, best predicted management choices. In the second case, 95% of ASLM and 94% of SCCM respondents chose to resuscitate a cancer patient at the patient's request; 3% of ASLM and 4% of SCCM respondents chose no resuscitation. Importance ratings for patient preferences best predicted management choices. In the third case, 38% of ASLM and 35% of SCCM respondents honored a stroke patient's previous refusal of tube feedings, but 59% of ASLM and 62% of SCCM respondents authorized tube feedings in order to secure nursing home placement. Importance ratings for patient preferences best predicted management choices in this case. External factors impacted management choices considerably in the first case and more modestly in the second and third cases. CONCLUSION: External factors impact the life-support decisions of physicians. Physician legal liability may have an especially great impact on these decisions when patients' preferences are not known.

Decision Making↗
PubMed1988

Ethnic differences in hip fracture: a reduced incidence in Mexican Americans.

To confirm a previous report of lower risks of hip fracture in Mexican Americans, we calculated the incidence of hip fractures among Hispanics, blacks, and non-Hispanic whites residing in Bexar County, Texas, during 1980. A total of 576 residents with hip fracture not due to severe trauma were identified. The 1980 census data were used to calculate ethnic-specific incidence rates which were age-adjusted using the entire 1980 US population as the standard. Hip fractures were more common among non-Hispanic white women (139 per 100,000; 95% confidence interval (CI) = 124-153) than among Mexican-American (67 per 100,000; 95% CI = 51-82) or black (55 per 100,000; 95% CI = 27-83) women. Thus, Mexican Americans and blacks are relatively protected from hip fractures, and they may benefit less than whites from prophylactic therapies for osteoporosis.

Adolescent↗
PubMed1987

Correlates of medication compliance in non-insulin-dependent diabetes mellitus.

Maintaining compliance with medications is important in the management of patients with non-insulin-dependent diabetes mellitus. We examined correlates of medication compliance in 77 patients followed up prospectively for 24 weeks. Of the demographic, socioeconomic, and clinical variables examined, only older age and greater education were related to compliance. While statistically significant, the differences observed were small and unlikely to be useful to clinicians. Factors reflecting the process of care, including frequency of appointments, minutes spent with the provider, and patient satisfaction were not related to compliance. Symptoms associated with poor glucose control and fasting glucose levels were also not significantly related. The patient's report of his own compliance, however, was strongly associated with our independent measures of medication taking. We conclude that rather than attempting to predict compliance from sociodemographic characteristics, symptoms, or glucose values, the physician should directly inquire about medication taking in a nonthreatening manner.

Age Factors↗
PubMed1987

Low risk of vertebral fracture in Mexican American women.

Ethnicity is important in assessing risk for osteoporotic fractures, and should be considered in decision-making about the use of prophylactic treatments. Few data are available, however, on fracture risks among Hispanic patients. To assess the risk of vertebral fracture in Mexican Americans, we determined the prevalence of vertebral fracture among 822 patients, aged 15 to 86 years, who underwent spinal roentgenography in a study of low-back pain. After adjusting for age, use of steroids, drug or alcohol abuse, and recent trauma, the odds ratio for Mexican American women compared with non-Hispanic whites was 0.55 (95% confidence interval, 0.32 to 0.95), indicating a substantially lower risk. These results are concordant with earlier data documenting a reduced risk of hip fracture among Mexican American women. Thus, recommendations for prophylactic treatments for osteoporosis may be different for Mexican Americans than for non-Hispanic whites.

Adult↗
PubMed1986

Area variation in mortality from diseases amenable to medical intervention: the contribution of differences in morbidity.

Several conditions, whose timely and appropriate therapy should decrease case fatality, have been proposed as indicators of medical care quality for the National Health Service. Mortality rates for these diseases vary widely within the UK. To evaluate the contribution of varying incidence rates to these mortality differences, routinely collected morbidity and mortality data for 1974-1978 were analysed for 98 Area Health Authorities (AHAs) in England and Wales. Although differences in morbidity (as measured by hospital discharge and disease registration rates) and socioeconomic factors account for some of the area variation in mortality, significant heterogeneity persists after these factors are taken into account. This finding suggests that morbidity and socioeconomic factors are not the only determinants of mortality variation among areas for these particular diseases. Variation in quality of medical care may account for this result, although regional diagnostic and reporting differences and variation in disease severity among areas must also be considered.

Analysis of Variance↗
PubMed1986

Private physicians in ambulatory care training in U.S. medical schools.

The contribution of private physicians to medical student education in ambulatory care was determined by a questionnaire directed to departments of family practice, internal medicine, and pediatrics in 124 U.S. medical schools and their branch campuses. The response rate was 84 percent. Of the responding departments, 82 percent offered an ambulatory care course in curricular years three and/or four, and 56 percent utilized private physicians in their courses. Departments of internal medicine were least likely to offer such a course, and their courses less frequently included teaching by private physicians (p less than 0.0001). When offered, internal medicine courses in ambulatory care were least likely to be required for graduation and involved the fewer students. Departments of family practice were most likely to offer ambulatory care courses and were most likely to utilize private physicians in their courses.

Ambulatory Care↗
PubMed1986

Risk of postmenopausal hip fracture in Mexican American women.

To assess the risk of hip fracture in Mexican Americans, the ethnicity of 80 women aged 50 years and over admitted with hip fractures to a Texas hospital was compared with that of age-matched women hospitalized for other reasons. The risk of fracture for Mexican Americans was only 35 per cent that of Whites (95% CI = 19 per cent, 65 per cent). This finding was confirmed in a chart survey performed in a second hospital population. These results suggest that Mexican American women may receive less potential benefit from preventive measures for hip fracture than Whites.

Aged↗
PubMed1986

Office techniques to maintain the health of aging patients.

The fecal occult blood test is safe and inexpensive; however, diet, medications, desiccation of the sample, and delay in developing the specimen may affect results. If the test is used, six separate samples, two from each of three consecutive bowel movements, should be examined to obtain optimum results. Serum cholesterol need not be assessed routinely in geriatric patients. Dietary restriction of fats is a necessity only in the context of a weight reduction diet.

Accident Prevention↗
PubMed1985

Combined behavioral and pharmacological treatment of essential hypertension.

Fifty-two pharmacologically treated hypertensive patients were randomized to one of four treatment groups: (1) diastolic blood pressure biofeedback, (2) progressive deep muscle relaxation training, (3) self-directed relaxation training, or (4) medication alone. Data collection occurred during baseline, treatment, and 1-year follow-up phases in a laboratory, a medical clinic, and the patient's own home. Patients from all four groups combined showed mean blood pressure reductions of -10.2/-5.5 mm Hg on clinic recordings and -2.4/-.7 mm Hg on home recordings, which were maintained throughout the follow-up period. There were no significant differences among the four groups in terms of blood pressure reduction. Patients given adjunctive behavioral treatment showed significantly larger reductions in medication usage compared to patients treated with medication alone, but there were no significant differences among the three behaviorally treated groups. Patients who showed medication reductions did not show subsequent blood pressure elevation. The results suggest that combined behavioral and pharmacological therapy may be superior to pharmacological therapy alone in the treatment of essential hypertension.

Adult↗
PubMed1985

United Kingdom Heart Disease Prevention Project: 12-year follow-up of risk factors.

Ten of the original 24 factories from the United Kingdom Heart Disease Prevention Project were resurveyed in 1983 to assess the long-term (12-year) effects of an education program on diet, smoking, and exercise. These 10 factories had previously been grouped into five pairs matched for size, location, and nature of industry, with one of each pair randomly chosen for intervention. Men in intervention factories were given advice on reduction of cholesterol in diet, stopping smoking, weight reduction, and regular exercise. High-risk workers (13%) received personal counseling in addition to the factory-wide education program. A total of 1,204 workers randomly selected from those still employed in 1978 were surveyed. There were significant differences observed in cigarette consumption, butter use, and several other dietary behaviors; however, the differences were small and insignificant for the proportion smoking and leisure-time exercise. The largest effects were in the high-risk group who had received personal counseling. This education program appears to have some lasting effects on behavior associated with coronary disease risk factors. Similarly designed programs may serve as models for community-wide coronary disease prevention programs.

Adult↗
PubMed1978

Jalaproctitis.

Explore the source record for details and available documents.

Adult↗