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PubMed1993

A comparison of university and community-based family practice physician educators.

BACKGROUND: Differences in satisfaction with training and perceived preparation for practice have been observed among residents trained in community and university family practice residency programs. Our study was undertaken to determine the degree to which faculty training, experience, or practice patterns may contribute to these different resident experiences. METHODS: Questionnaires addressing prior training, experience, current practice content, motivation for entering academic medicine, and satisfaction with current teaching position were sent to full-time physician faculty at 60 family practice residency programs. RESULTS: The 208 faculty responses showed no differences in faculty at various types of residency programs with respect to demographic factors, prior training, or past experience. Only small differences were found in the proportion of time devoted to most professional activities or in the content of clinical practice. CONCLUSIONS: Few differences were found between faculty at university- and community-based family practice residency programs. This implies that differences in residents' perceptions of training may be due to other factors, such as institutional philosophy or self-selection. However, qualitative differences in family practice faculty activities that were not measured in this research cannot be ruled out as factors influencing residents' perceptions of their training experiences.

Attitude of Health Personnel↗

PubMed1993

Wellness testing. Design and experience of an established program.

Consumers have responded to available information and generated a large demand for self-initiated testing. Carefully planned testing can provide significant benefits to these self-selected subjects. Most notable examples include using sensitive and specific tests for iron metabolism and thyroid dysfunction. Cholesterol and lipid concerns are also motivators for testing. Nutrition and laboratory professionals must get involved with self-initiated testing to assure proper design, proper methods, proper reporting, and proper follow-up. It is hoped that this article and accompanying references will aid the implementation of effective wellness testing.

Adult↗

PubMedDate not supplied

[The prevalence of caries in marginal rural and peripheral urban areas].

A descriptive study of caries prevalence in peripheral urban and rural underprivileged groups was undertaken in self-selected populations demanding basic dental therapy in seven states of Mexico. Dental therapy services were delivered as part of a mobile oral health care program in the Mexican countryside implemented by the Dental School of Universidad Nacional Autónoma de México, during 1990 and 1991. Partial examination of clinical histories of 2,596 patients (mean age 21.8 years) revealed a mean DMFT (the sum of decayed, missing and filled teeth) of 9.21. Only 6.3 per cent of patients had DMFT = 0 and 10.7 per cent were caries-free. The largest component of DMFT were decayed teeth and the smallest one filled teeth. In general, results suggested that caries prevalence was high within the study populations, highlighting the little restorative treatment previously undertaken. The convenience of implementing oral health care schemes to deal with caries morbidity is discussed from the perspective of both the traditional dental treatment approach and preventive public health policies, taking into account the background of complex treatment needs present in these population groups.

Adolescent↗

PubMed1993

Frequency and determinants of screening for breast cancer in primary care group practice.

BACKGROUND: Many studies reporting the frequency of breast cancer screening have been based only on physician and patient surveys or on data from quality assurance studies and do not assess the reliability of information obtained from these various sources. METHODS: To obtain more complete data we studied mammography performed in a 3-year period, 1988 through 1991, in 24 nonacademic primary care group practices by both auditing the medical records and obtaining questionnaire responses from 1819 women aged 53 to 62 years and from their 98 physicians in the nonmetropolitan Midwest. RESULTS: Medical record data indicated that mammography was performed in all 3 years in 16.7%, in at least two of 3 years in 49.8%, and in at least one of 3 years in 81.7% of women. While patient reports of a family history of breast cancer, health insurance coverage for mammography, and greater annual household income were each significant predictors, a patient report that a clinic staff member had discussed mammography was the strongest predictor of greater frequency of mammography. CONCLUSIONS: In this study of self-selected physicians and their patients, record-documented mammographic examinations were considerably more frequent than has been reported in some studies, but occurred at rates consistent with quality assurance data for the region. These data suggest that clinic staff initiatives with screening mammography have a large impact.

Breast Neoplasms↗

PubMed1977

Enrollment choice in a mutli-HMO setting:the roles of health risk, financial vulnerability, and access to care.

Results of an analysis of enrollment decisions in HMO-type plans are reported. Previous studies concern dual-choice situations; this paper deals with a quadruple-choice situation involving one open- and two closed-panel HMO-type plans as well as Blue Cross/Blue Shield (BC/BS). The risk-vulnerability hypothesis is disaggregated into its components and the results show that there is no adverse health risk self-selection in an employed population. The hypothesis of economic vulnerability is maintained when tested in terms of per capita income rather than the previously used measure of family income. It is shown that those who enroll in any HMO-type plan are younger and have younger and larger families and lower per capita income than those who do not. No meaningful differences in terms of health status, health concerns, or prior utilization are found. Of the few differences found between those who enroll in closed- and open-panel HMO-type plans, having a private physician as the usual source of care is the most significant: those with an established physician relationship who join any HMO-type plan tend to follow their physician into the open-panel plan. The results should not be generalized to situations involving premium differences since the premium cost to subscribers in any of the plans considered here was fully paid by the employer. The validity of the results in terms of nonfinancial factors, on the other hand, is enhanced by the removal of cost considerations.

Adolescent↗

PubMed1993

Gastrointestinal effects of sugarbeet fiber and wheat bran in healthy men.

Gastrointestinal effects of feeding 20 g total dietary fiber as wheat bran (WB) and sugarbeet fiber (SBF) were compared in 17 healthy men in a randomized cross-over design. The fibers were milled to similar particle sizes and consumed as supplements to the subjects' self-selected diets (SS). Transit times were similar among the diets. Fecal wet and dry weights were greater on the fiber diets compared to the SS diet (P < 0.05); wet weights were similar with WB and SBF; dry weights were greater with WB than SBF (P < 0.001); and moisture content was lower with WB than SBF (P < 0.01). Fecal pH was lower with WB than SBF (P < 0.025). WB and SBF provided similar fecal bulking effect; however, the contribution of fecal dry matter and fecal water content to increased bulk differed between fibers.

Adult↗

PubMedDate not supplied

Restrained patients: an important issue for critical care nursing.

OBJECTIVE: To determine practice and attitudes of acute-critical care nurses toward the use of physical restraints. DESIGN: Survey with a self-administered anonymous questionnaire. SUBJECTS: A self-selected sample of 235 acute-critical care nurses from 17 states who were enrolled in critical care review classes. MEASUREMENTS: Data were gathered by use of a questionnaire developed by the researchers. The questionnaire was designed to elicit information regarding demographic and professional characteristics, nursing practice, and attitudes toward the use of restraints. Nurses responded to the practice items on a three-point Likert Scale as to whether they "always," "sometimes," or "never" carried out the procedure. To obtain information on attitudes, nurses were asked to respond on a three-point Likert Scale as to whether they "agreed," were "undecided," or "disagreed" with the statement. RESULTS: Responses indicated 78% of the sample "always" try alternative nursing measures before restraining the patient. However, when units were believed to be understaffed there was more reliance on restraints. Thirty-eight percent of the sample would "always" rather sedate patients than physically restrain them. The overall score on the attitude component of the questionnaire reflected positive or acceptable attitudes toward the use of restraints. Most (62%) "agreed" that a patient suffers a loss of dignity when placed in restraints. Significant relationships did exist between select demographic and professional characteristics and practice and attitudes regarding the use of restraints. The longer the respondents had worked in critical care the more appropriate (positive) their attitudes toward the use of restraints (r = -.211, p < .01). CONCLUSIONS: In general, nursing practice and attitudes regarding the use of physical restraints indicated that respondents were using restraints in accordance with accepted practice. There is a need for additional research in this area, especially regarding the use of alternative measures to physical restraints.

Adult↗

PubMed1993

Sex preselection through albumin separation of sperm.

OBJECTIVE: To determine if passage of sperm through columns of liquid albumin before their use in artificial insemination could affect the sex ratio at birth. DESIGN: Sperm were isolated by layering over columns of liquid albumin. The isolated fractions were inseminated into the uterus on the presumptive day of ovulation. SETTING: Patients were treated in 65 clinical practices (Sperm Centers) located both in this country (57) and abroad (8). PATIENTS: Individuals were self-selected by their desire to have a child of a specified sex. MAIN OUTCOME MEASURE: The sex of offspring resulting from the insemination of isolated sperm. RESULTS: Insemination with sperm isolated to enhance male sex preselection produced 71% and 76% males depending on the technique. Use of isolated sperm in women who were taking clomiphene citrate was associated with a 69% birth of females. CONCLUSIONS: Separation of sperm on columns of liquid albumin can affect the sex ratio at birth.

Cell Separation↗

PubMed1993

An examination of narcissistic personality traits as seen in a military population.

Various studies examining the prevalence of personality disorders in civilian inpatient and outpatient populations have consistently found narcissistic personality disorder to be one of the least common. In striking contrast to this, a recently published study showed narcissistic personality features to be among the most common personality features in a military outpatient clinic population. This paper examines several possible explanations for this finding. This surprisingly high relative incidence of narcissistic personality features may be related to a self-selection bias on the part of persons choosing a military career. Narcissistic personality traits may confer adaptive advantage in certain military professional roles. Kohut's theory of specific transference requirements in individuals with narcissistic character structure serves as a useful explanatory model for these findings.

Humans↗

PubMed1993

Curriculum focus: traditional dental education confronts the new biology and social responsibility.

The traditional dental education base does not suggest that graduates are prepared only for private general practice. It promises much, much more. It is the beginning of what any graduate may wish or want it to be. In fact it is necessary for new graduates contemplating private practice to seek more in the way of practice management if they plan to be successful in that model. Such is also the case for additional study if one wants to pursue a specialty; further training in the scientific method to undertake research; or further study in education for a teaching career. The predoctoral program promises to be just a beginning, but a sound and sensible beginning. The current foundation model of the predoctoral curriculum continues to serve society and the profession very well. It provides the necessary grounding in the fundamentals of basic medical sciences, clinical biological sciences, and behavioral sciences upon which any graduate can build and pursue a career beyond what is thought to be the traditional role model of the private practice of general dentistry. Faculty members and dental programs can choose, if they desire, to tailor mission statements to reflect a changing emphasis. This could help dental applicants become more thoughtful and self-selective in considering one of many different career options available. Given the emerging demographic profile and trends in needs, the curriculum emphasis could be altered to encourage a change in the balance or proportion of graduates who undertake career options in a postdoctoral experience, in public health, research, teaching, administration, the military, hospital, or specialty practice.(ABSTRACT TRUNCATED AT 250 WORDS)

Curriculum↗

PubMed1993

Sentinel surveillance for HIV-1 infection: how representative are blood donors, outpatients with fever, anaemia, or sexually transmitted diseases, and antenatal clinic attenders in Mwanza Region, Tanzania?

OBJECTIVE: To assess the validity of extrapolation from sentinel data by comparing the HIV-1 prevalence of various sentinel groups with that of the general population in Mwanza Region, Tanzania. METHODS: In a population survey, 4161 individuals were selected in a stratified random cluster sample. Sentinel groups (all in the age group 15-54 years) included blood donors (n = 1090); patients examined at district hospitals for the presence of malaria parasites (n = 1488), anaemia (n = 1339), or syphilis (n = 33); and antenatal clinic attenders (n = 1193). The HIV-1 serostatus of individuals selected from the population survey was tested using enzyme-linked immunosorbent assay (ELISA) and Western blot; 51% of the blood donors were tested using HIVCHEK, and all others using ELISA. HIV-1 prevalence was standardized for age, sex, and urban/non-urban location. RESULTS: HIV-1 prevalence (standardized by age, sex, and residence) in Mwanza Region was 4.0% (3.0% in non-urban areas and 11.3% in town). The standardized HIV-1 prevalences in the sentinel groups were: blood donors, 4.5%; patients with fever, 11.6%; patients with anaemia, 8.9%; urban sexually transmitted disease patients, 27.1%; urban antenatal clinic attenders, 11.8%. The crude prevalence in blood donors was 6.0%. CONCLUSION: Blood donors who are related to blood recipients appear to be a representative sentinel group in this region, provided that data are standardized for age, sex, and urban/non-urban location. Patients with fever and antenatal clinic attenders may reflect trends, but data from patients with fever markedly overestimate, and data from antenatal clinic attenders underestimate, population HIV-1 prevalence. Because self-selection of blood donors may become more pronounced, this comparison should be repeated later or elsewhere, should the opportunity arise.

Adolescent↗

PubMed1993

A comparison of physician-patient interaction at fee-for-service and HMO sites.

Research has begun to identify elements in the practice environment that influence practice styles and health outcomes. One key element known to influence physician-patient interaction is the type of treatment environment: fee-for-service or health maintenance organization. Observers using the Davis Observation Code coded 82 physician-patient encounters in private practice settings and 72 encounters in a health maintenance organization. Populations were similar on all demographic measures except age, with health maintenance organization patients being older. Fee-for-service visits were shorter but included more coded behaviors per observation interval, resulting in equivalent total numbers of coded behaviors in each type of visit. Health maintenance organization visits included significantly more patient questions, preventive services, disease prevention, treatment planning, and discussion of substance use. Results may have reflected physician gender differences across sites or patient self-selection to sites rather than site differences. These results have implications for developing further research to explore treatment environment, process, and outcome.

Adult↗

PubMed1995

The effect of minimal exercise on fitness in elderly women after hip surgery.

To determine the effect of minimal exercise on functional fitness following total hip replacement in elderly women, 20 women (13 exercisers, 7 controls) who had undergone unilateral or bilateral hip replacement surgery for primary osteoarthritis were studied. An exercise treadmill test with respiratory gas and blood lactate analyses, and a field test of walking speed on a measured course, were administered before and after a twice weekly exercise programme of three months' duration. Markers of cardiorespiratory fitness, including peak achieved oxygen uptake (VO2) and ventilatory and lactate thresholds were measured. Maximum self-selected walking speed was also measured over a flat course. Peak VO2 increased in the exercise group when compared to baseline (P < 0.05) but did not differ from the control group. The exercise group significantly improved their walking speed by 10.1% compared with non-exercising controls (1.41 vs 1.20 m/sec, P < 0.05), and increased VO2 at lactate threshold. The improvements occurred despite the twice weekly exercise sessions being below the recommended frequency of exercise for improving cardiorespiratory fitness. Minimal exercise in elderly women after hip surgery can substantially improve submaximal exercise capacity, as well as walking speed.

Aged↗

PubMed1995

A comparison of the range of walking speeds between normal and hemiplegic subjects.

It is known that people who have suffered stroke walk slower than normal. However, their ability to deviate from a preferred speed of walking has not been reported. This study investigated the range of walking speeds of 20 hemiplegic subjects and compared the results with those of 20 normal age- and gender-matched controls. All subjects traversed a computerized grid walkway which measured selected temporal and spatial gait parameters. Subjects walked at five self-selected speeds: "normal"; "slower than normal"; "slowest"; "faster than normal"; and "fastest". Comparisons were made between velocity, range of velocity, stride time and stride length. The hemiplegic group walked significantly slower at all speeds, were less capable of adapting the speed of their gait, possessed a markedly reduced range of walking speed, and walked more cautiously than the controls. These deficiencies are likely to limit the stroke person's ability to respond to environmental demands.

Adult↗

PubMed1996

Energy expenditure with indoor exercise machines.

OBJECTIVE: To compare the rates of energy expenditure at given rating of perceived exertion (RPE) levels among 6 different indoor exercise machines. DESIGN: Repeated measures design. PARTICIPANTS: Healthy young-adult volunteers, including 8 men and 5 women. INTERVENTIONS: Subjects underwent a 4-week habituation period to become familiar with the RPE scale and exercise on an Airdyne, a cross-country skiing simulator, a cycle ergometer, a rowing ergometer, a stair stepper, and a treadmill. Following habituation, each subject completed an exercise test with each exercise machine. The exercise test comprised 3 stages of 5 minutes at self-selected work rates corresponding to RPE values of 11 (fairly light), 13 (somewhat hard), and 15 (hard). Oxygen consumption, from which the rate of energy expenditure was calculated, was measured during the last minute of each 5-minute exercise stage. Heart rate was measured during the last minute of each stage of the exercise test, and blood lactate levels were obtained immediately after each exercise stage. MAIN OUTCOME MEASURE: Rate of energy expenditure at specified RPE values. RESULTS: Rates of energy expenditure at a given RPE varied by 1093 kJ/h (261 kcal/h) for the exercise machines. The treadmill induced higher (P < .05) rates of energy expenditure for fixed RPE values than all other exercise machines. The cross-country skiing simulator, rowing ergometer, and stair stepper induced higher (P < .05) rates of energy expenditure than the Airdyne and cycle ergometer. Heart rate varied significantly (P < .01) among exercise machines, with the highest values associated with the treadmill and the stair stepper. Lactate concentration varied significantly (P = .004), with highest values associated with use of the stair stepper and the rowing ergometer. CONCLUSIONS: Under the conditions of the study, the treadmill is the optimal indoor exercise machine for enhancing energy expenditure when perceived exertion is used to establish exercise intensity.

Adult↗

PubMed1996

Athletic performance in relation to training load.

Athletic performance generally is thought to improve with increases in training load. However, few data exist showing the quantitative relationship between training load and performance. We followed 56 athletes (16 runners; 40 cyclists/speed skaters) during 12 weeks of training. We recorded index performances (3.2 km time trial or 5 or 10 km bicycle ergometry) after 6 weeks of baseline training and 6 weeks of a self-selected training increases. Training load was quantitated as the product of intensity (global rating of perceived exertion (RPE)) and the duration (time) of each training session. Load was expressed as the weekly average over the 6 weeks preceding each index performance. We also recorded the duration of high intensity training (RPE>5, hard) (inten). From 6 to 12 weeks, performance improved 12.95 +/- 3.83 to 12.66 +/- 3.00 min (p < .01). Training time (345 +/- 282 to 355 +/- 273 min/wk) and inten (61 +/- 88 to 71 +/- 91 min/wk) did not change significantly, although RPE (3.8 +/- 0.7 to 4.0 +/- 0.8) and load (1242 +/- 957 to 1386 +/- 978) increased significantly. No strong correlations existed between changes in performance and changes in any training measure (TIME, r = -0.031, RPE, r = -0.039, LOAD, r = 0.29, INTEN, r = 0.025.) Data suggest that improved performance in events of 7-20 minutes duration in response to intensified training is primarily dependent upon increases in total load and overall RPE during training and; that a 10-fold increase in training load may be associated with an approximately 10% improvement in performance. These data suggest the possibility of understanding the training responses of athletes on a quantitative basis.

Adult↗

PubMed1995

[Characteristics of corneal topography in candidates for surgery for myopia].

INTRODUCTION: Videokeratography analyses the corneal anterior topography. It is necessary in refractive surgery to estimate the anatomical effect of the surgery and to eliminate early Keratoconus. METHODOLOGY: Corneal anterior topography was studied on 70 consecutive patients (140 eyes) candidates for low myopia surgery (-1 to -6); 87 eyes were wearing regularly contact lenses. With the topographic analysis machine of EYESYS compagny, keratometry (Km) at 3 mm, astigmatism (delta K) at 3 mm, I-S value at 3 mm and 5 mm according to Rabinowitz method were measured in each eye. RESULTS: The average keratometry was 43.50 +/- 1.87 D. The average astigmatism was 0.909 +/- 0.75 D. 51 eyes presented an asymmetric corneal and among them 32 ware contact lenses regularly; 8 eyes out of 140 (6%) presented the association of an high central Keratometry value (> or = 47 D) and corneal asymmetry (I-S > 0.5 value). COMMENTS: The incidence of Keratoconus is higher in a candidate population for refractive surgery by self-selection. Its frequency is difficult to evaluate accurately because of the present limits for the diagnostic measures. In this population, it seems to represent about 6%. CONCLUSION: The videokeratography before refractive surgery is necessary to reveal corneal anterior topography abnormalities and to eliminate early Keratoconus.

Astigmatism↗

PubMed1995

The effect of five prosthetic feet on the gait and loading of the sound limb in dysvascular below-knee amputees.

The purpose of this study was to determine the effects of prosthetic foot design on the vertical ground reaction forces experienced by the sound and amputated limbs in a group of persons with dysvascular below-knee amputations. Stride characteristics, joint motion, and ground reaction forces were recorded simultaneously during a self-selected free walking velocity in seven subjects wearing five different prosthetic feet (SACH, Flex-Foot, Carbon Copy II, Seattle, Quantum). Subjects used each foot for one month prior to testing. Results indicated that the sound limb was exposed to higher vertical ground reaction forces than normal despite a reduced walking velocity. Use of the Flex-Foot resulted in the lowest sound limb vertical forces, which appears to be related to its large arc of dorsiflexion motion. In addition, there was increased loading response knee flexion of the sound limb indicating an attempt by these subjects to modulate floor impact. These results suggest that the intact lower extremity is susceptible to excessive floor impact, and that prosthetic foot design can have an effect on the magnitude of the vertical forces experienced by the limb.

Aged↗