Search PubMed⌕ Search

Biomedical subjects

Arch G Mainous

Publications and source records attributed to Arch G Mainous.

At least 73 records · Page 4Linked to original sources
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↗
PubMed2003

Aspirin and ibuprofen: potential mediators of the cardiovascular risk due to smoking?

BACKGROUND AND OBJECTIVES: Smokers have elevated C-reactive protein (CRP), an indicator of systemic inflammation and a marker for increased risk for cardiovascular disease (CVD). This study investigated among smokers the relationship between CRP and use of the anti-inflammatories aspirin and ibuprofen. METHODS: Data from adults (>17 years) collected in the National Health and Nutrition Examination Survey (NHANES III) was analyzed (n = 8,850). Regression models were used to determine the independent relationship between aspirin and ibuprofen use and elevated CRP, controlling for demographics, body mass index, history of CVD, and health status. RESULTS: Frequency of use of aspirin and ibuprofen among "ever smokers," a population that includes current smokers and quitters, was associated with a decreased likelihood of having elevated CRP. Ever smokers with low frequency of use of either aspirin or ibuprofen had a lower likelihood of having elevated CRP similar to that for "never smokers." In adjusted relationships, aspirin use was not significantly related to elevated CRP, while low use of ibuprofen had decreased odds of having elevated CRP compared to no use. CONCLUSIONS: These preliminary findings from a nationally representative survey suggest that among patients refractory to smoking cessation interventions, use of ibuprofen may be useful to decrease CVD risk.

Adolescent↗
PubMed2003

Does having an outpatient visit after hospital discharge reduce the likelihood of readmission?

OBJECTIVE: To determine whether or not having an outpatient visit after hospital discharge is associated with a lower likelihood of readmission for a statewide Medicaid population. DESIGN AND SETTING: A case-control study in the Delaware Medicaid program over a two-year period (7/1/93-6/30/95). PARTICIPANTS: 3,846 continuously enrolled patients aged 0-64 years who were hospitalized and were readmitted within 90 days (cases = 641) or not readmitted within 90 days (controls = 3,205). Subgroups included those readmitted for the same diagnosis (N = 720), for ambulatory care sensitive conditions (N = 906), or both (N = 276). MAIN OUTCOME MEASURE: Likelihood of readmission within 90 days of discharge. RESULTS: Readmission was significantly more likely when an outpatient visit was made after hospital discharge, both before and after controlling for demographic variables and case mix (adjusted odds ratio = 1.47, 95% confidence interval = 1.20-1.80). When readmission for the same diagnosis was examined, having an outpatient visit was associated with an increased likelihood of readmission before but not after controlling for demographics and case mix (adjusted odds ratio = 1.11, 95% confidence interval = 0.67-1.86). The same was for those admitted for ambulatory care sensitive conditions (adjusted odds ratio = 1.16, 95% confidence interval = 0.74-1.85) and for those readmitted for the same ambulatory care sensitive condition (adjusted odds ratio = 1.53, 95% confidence interval = 0.54-4.29). CONCLUSIONS: This study fails to demonstrate that outpatient visits after hospital discharge are associated with fewer readmissions for nonelderly Medicaid patients. This suggests that it may not be appropriate to use hospital readmission rates as an indicator of the quality of outpatient care.

Adolescent↗
PubMed2003

Assessing students' communication and interpersonal skills across evaluation settings.

BACKGROUND AND OBJECTIVES: Medical students' interpersonal and communication skills are a fundamental dimension of their clinical competence and will be measured on the anticipated US Medical Licensure Examination (USMLE) standardized patient (SP) exam. We compared students' performance on measures of SP satisfaction on a third-year family medicine Objective Structured Clinical Examination (OSCE) with measures of SP satisfaction on a fourth-year Clinical Practice Examination (CPX). METHODS: A total of 127 students completed both the clerkship OSCE and a CPX. The CPX was a pilot of the National Board of Medical Examiners Standardized Patient Exam. To assess students' interpersonal skills, both exams used modified versions of the American Board of Internal Medicine Patient Satisfaction Questionnaire. Students' scores were standardized, and correlations were calculated. A logistic regression model examined the ability of the OSCE to predict poor performance on the CPX. RESULTS: The correlation between the OSCE and CPX patient satisfaction scores was.08. There was no significant predictive ability of the OSCE for poor performance on the CPX. CONCLUSIONS: Our study calls into question the ability of a routine end-of-clerkship OSCE to identify students' interpersonal skills abilities on fourth-year clinical performance exams and potentially that component of the anticipated USMLE SP exam.

Adult↗
PubMed2002

C-reactive protein, diabetes, and attendance at religious services.

OBJECTIVE: Previous studies have shown an association between attendance at religious services and health, particularly cardiovascular morbidity and mortality. People with diabetes have higher risk of cardiovascular mortality and higher C-reactive protein (CRP) levels than people without diabetes. The purpose of this study was to explore the relationship between religious attendance and CRP in people with diabetes. RESEARCH DESIGN AND METHODS: This study used cross-sectional survey and examination of a nationally representative sample of noninstitutionalized U.S. adults aged > or = 40 years, derived from the National Health and Nutrition Examination Survey III 1988-1994 (n = 10,059). There were 556 people with diabetes. The primary outcome measure was the presence of elevated CRP. RESULTS: There were no differences between people with diabetes compared with people without diabetes in the percentage of those who attended religious services (62.29 vs. 62.0%, P = 0.36). Religious service nonattenders with diabetes were more likely than attenders to have an elevated CRP (odds ratio [OR] 2.17 [95% CI 1.15-4.09]). In people without diabetes, the association between attendance and CRP was not significant (P > 0.05). Among people with diabetes, after adjusting for demographic variables, health status, smoking, social support, mobility, and BMI, the association between religious attendance and CRP remained significant for respondents with diabetes (1.90 [1.03-3.51]). CONCLUSIONS: These findings revealed that people with diabetes who have not attended religious services in the previous year are more likely to have elevated levels of CRP. Further research should be conducted to evaluate this association to improve our understanding of the psychological and religious factors that influence diabetes.

Adult↗
PubMed2002

Patient use of automatic blood pressure measures in retail stores: implications for diagnosis and treatment of hypertension.

This study examined the simple behavior on the part of hypertensive patients of having their blood pressure checked at a retail store. We found that hypertensive patients checked their blood pressure frequently using these automated machines, believe them to be accurate, and frequently make health care decisions based on the reading they obtain. The inaccuracy of these machines is apparently not widely known. It is therefore incumbent on physicians to be aware of technologies that are in use by their patients. Patients need to be educated about the appropriate use and potential or harm that results from misuse of these technologies. Physicians might encourage their patients to invest in a home blood pressure monitor that they can bring with them to their visit to calibrate against the physician's own machine.

Aged↗
PubMed2002

Does continuity between prenatal and well-child care improve childhood immunizations?

BACKGROUND AND OBJECTIVES: Continuity of care has been associated with positive health benefits, but the benefit of continuity for the maternal-child unit has not been studied. This study determined whether continuity from prenatal to pediatric care is associated with higher immunization rates for low-income children in Delaware. METHODS: This retrospective cohort study included 187 women who received prenatal care in one of four clinics (predominantly family practice) over a 2-year period. Each maternal-child pair was defined as having provider continuity (same provider for prenatal and pediatric care), clinic continuity (same clinic but different provider), or no continuity (different clinic). We measured the association between continuity and completion of immunizations by 7 months of age and by 12 months of age. RESULTS: Provider continuity was significantly associated with a higher immunization rate both at 7 and 12 months of age. After controlling for age, gender, ethnicity, insurance, birth order, and language, this association persisted at 7 months but lost statistical significance at 12 months. Those with clinic continuity were not significantly different than those with no continuity for any outcomes. CONCLUSIONS: For low-income persons in Delaware, provider continuity for the maternal-child unit is associated with higher completion rates for early childhood immunizations.

Adult↗
PubMed2002

The importance of interpersonal relationship factors in decisions regarding authorship.

BACKGROUND AND OBJECTIVES: Authorship on scientific articles is an important form of academic productivity. We examined the influence of personal and professional relationships on authorship decisions, particularly as they may conflict with stated criteria of the International Committee of Medical Journal Editors (ICMJE). METHODS: We conducted an anonymous e-mail survey of corresponding authors of original research articles in the Archives of Family Medicine, British Medical Journal, New England Journal of Medicine, and the American Journal of Psychiatry in 1999. Assessments were made of how often concerns about personal and professional relationships enter authorship decisions as well as factors affecting authorship if that person does not meet ICMJE criteria. RESULTS: Of 578 eligible individuals, 292 participated, for a response rate of 50.5%. Personal and professional relationship concerns enter into decisions about who should be named as an author Junior faculty and individuals whose job is dependent on publications were significantly more likely to feel obligated to consider adding an author who doesn't meet ICMJE criteria when that person has administrative power over them. Current strategies to improve the veracity of authorship were endorsed as moderately effective. CONCLUSIONS: Authors arefaced with the difficult task of negotiating interpersonal relationships while allocating authorship according to ICMJE criteria. Mechanisms should be explored to provide greater protection of junior faculty from pressure by senior faculty.

Authorship↗
PubMed2002

Is an elevated serum transferrin saturation associated with the development of diabetes?

OBJECTIVES: Diabetes mellitus is a common comorbid condition of hemochromatosis and is often identified as a complication of untreated hemochromatosis. However, there are few primary data examining the development of diabetes secondary to hemochromatosis. Our objective was to determine the likelihood of developing diabetes in a nationally representative cohort of patients who have an elevated serum transferrin saturation rate but no current diagnosis of diabetes. STUDY DESIGN: This is a retrospective cohort study based on merging the National Health and Nutrition Examination Survey I (1971-1974; NHANES I) with the NHANES I Epidemiologic Followup Study (1992). POPULATION: Individuals aged 25 to 74 years at the time of the NHANES I without diabetes (n = 9274). OUTCOMES MEASURED: The outcome was development of diabetes according to patient report, proxy report, or death certificate by the time of the follow-up interview. RESULTS: The incidence of diagnosed diabetes in the cohort was 10.2%. Among individuals with serum transferrin saturation levels above 55%, 7.5% developed diagnosed diabetes compared with 10.2% with a serum transferrin saturation of no more than 45% (P =.38). The relation remained nonsignificant in models adjusted for risk factors of diabetes and in analyses that assumed 10% of patients had received treatment for hemochromatosis. CONCLUSIONS: In this nationally representative cohort of adults, elevated serum transferrin saturation was not significantly associated with the development of diabetes.

Adult↗
PubMed2002

The Cooper River Bridge Run Study of low back pain in runners and walkers.

Investigations dedicated to examining relationships between low back pain (LBP) and factors specific to running and walking are limited. Current literature suggests runners and walkers may have a lower relative risk for significant LBP. The purpose of this study was to investigate the incidence, prevalence, and possible risk factors for LBP among a group of runners and walkers. A survey was administered to participants who registered for either a 10-kilometer run or 4-mile recreational walk. A total of 539 responses were received. Previous history of LBP was reported by 74% of respondents overall. Prevalence of LBP at the time of survey completion was 13.6%. Low back pain was experienced more frequently by obese runners and by those who reported certain patterns of shoe wear. Regular participation in aerobics correlated with a reduced lifetime risk for LBP. We believe these findings warrant further investigation. This knowledge may benefit not only athletes in training, but other fitness enthusiasts, including casual runners and walkers and those who jog or walk to rehabilitate low back injuries.

Adolescent↗
PubMedDate not supplied

Should we screen for hemochromatosis? An examination of evidence of downstream effects on morbidity and mortality.

BACKGROUND: Population-based hemochromatosis screening has been suggested with the rationale that identification and treatment of subclinical disease would decrease morbidity and mortality due to hemochromatosis. OBJECTIVE: To examine the prevalence of elevated serum transferrin saturation levels and the burden of illness of hemochromatosis in terms of ambulatory visits, hospitalizations, and death in the United States. PARTICIPANTS AND METHODS: Four nationally representative data sets were used for the analysis of the prevalence of hemochromatosis as well as ambulatory care, hospitalizations, and deaths related to hemochromatosis. Participants included men and nonpregnant women aged 18 years and older in the Third National Health and Nutrition Examination Survey (1988-1994) and the 1996, 1997, and 1998 National Ambulatory Care Survey, National Hospital Discharge Survey, and Underlying Cause-of-Death Mortality Files. The data sets were based on single measurements of serum transferrin saturation levels, serum ferritin levels, and healthcare provider-recorded diagnoses according to the International Classification of Diseases, Ninth Revision, Clinical Modification, code for hemochromatosis. RESULTS: The prevalence of elevated serum transferrin saturation levels ranged from 1% to 6%. When an elevated serum transferrin saturation level of 55% is combined with an elevated serum ferritin level, the prevalence decreases from 1.9% to 0.65%. The proportion of diagnosed hemochromatosis utilization out of total ambulatory visits, hospitalizations, and deaths is stable across the measures and the 3 years of data ranging from 0.01% to 0.03%. When white men were examined separately, the relationships remained the same as those among the general population of adults. CONCLUSIONS: Although a substantial proportion of adults whose condition is not currently diagnosed would be identified in a population-based screening program for subclinical hemochromatosis, diagnosed morbidity or mortality owing to hemochromatosis is considerably lower than would be expected. Recommendations for screening programs may need to be revisited.

Adolescent↗
PubMedDate not supplied

Acculturation and diabetes among Hispanics: evidence from the 1999-2002 National Health and Nutrition Examination Survey.

OBJECTIVE: Hispanic individuals in the United States have a greater prevalence of diabetes mellitus than non-Hispanic white individuals; however, it is unclear whether Hispanics' risk of diabetes differs based on their level of acculturation. The purpose of our research was to examine acculturation among Hispanic Americans with respect to prevalence and control of diabetes. METHODS: We conducted an analysis of the National Health and Nutrition Examination Survey (NHANES), 1999-2002, a nationally representative sample of the noninstitutionalized U.S. population. We evaluated data on Hispanic adults (> or = 18 years of age, unweighted n=2,696), analyzing diagnosed diabetes, glycemic blood pressure and lipid control, and diabetes complications according to acculturation as measured by language and birth outside the United States. RESULTS: Hispanics with low acculturation were more likely to be without a routine place for health care, have no health insurance, and have low levels of education. In adjusted analyses, individuals with low acculturation, measured by language, were more likely to have diabetes (odds ratio [OR] 1.90, 95% confidence interval [CI] 1.02, 3.54). Among individuals with diagnosed diabetes, no significant association was yielded between acculturation and diabetes control. However, individuals with low language acculturation were more likely to have the diabetes complication of peripheral neuropathy (OR 4.01, 95% CI 1.40, 11.48). CONCLUSIONS: Acculturation as measured through language is associated with diabetes and complications among Hispanics even after controlling for a variety of demographic characteristics including health insurance and education. The findings suggest that even within a "single" minority ethnic group, there are differences in disease prevalence and complications and access to health care.

Acculturation↗
PubMedDate not supplied

Race, rural residence, and control of diabetes and hypertension.

PURPOSE: African Americans are at increased risk for diabetes mellitus and hypertension, and rural residents have historically had decreased access to care. It is unclear whether living in a rural area and being African American confers added risks for diagnosis and control of diabetes and hypertension. The purpose of this study was to examine the prevalence of diagnosed diabetes and hypertension, as well as control of both conditions, among rural and urban African Americans and whites. METHODS: We conducted an analysis of the Third National Health and Nutrition Examination Survey (1988-1994). Non-Hispanic African Americans and non-Hispanic white adults 20 years and older were classified according to rural or urban residence (n = 11,755). Investigated outcomes were previously diagnosed diabetes mellitus and hypertension and control of diabetes and hypertension. RESULTS: The prevalence of diagnosed diabetes was 4.5% for urban whites, 6.5% for rural whites, 6.0% for urban African Americans, and 9.5% for rural African Americans. Among patients with diagnosed diabetes, 33% of rural whites, 43% of urban whites, 45% of urban African American, and 61% of rural African Americans had glycosylated hemoglobin (HbA(1c)) levels of 8% or higher (P < .01). Among patients with diagnosed hypertension, 11% of rural whites, 13% of urban whites, 20% of urban African Americans, and 23% of rural African Americans had diastolic blood pressure greater than 90 mmHg (P < .01). In regression models controlling for relevant variables, including body mass index, health status, access to care, education, income, and insurance, compared with rural African Americans, rural and urban whites were significantly more likely to have better glycemic control and diastolic blood pressure control. Urban African Americans also had better diabetes control than rural African Americans. CONCLUSIONS: In this nationally representative sample, rural African Americans are at increased risk for a lack of control of diabetes and hypertension.

Adult↗
PubMedDate not supplied

Physician-patient relationship and medication compliance: a primary care investigation.

PURPOSE: We assessed the relationship between 4 attributes of the physician-patient relationship and medication compliance. METHODS: We conducted a waiting room survey of patients consulting 22 general practitioners in 14 randomly selected practices in Auckland, New Zealand (81% response rate). A total of 370 consecutive patients (75% response rate) completed survey instruments about 4 attributes of the physician-patient relationship. Continuity of care (assessed from use of a usual physician, length of continuity, and perceived importance of continuity) and trust in the physician were ascertained before the consultation. After the consultation the Patient Enablement Index measured the physician's ability to enable patients in self-care, and concordance between the patient and physician was measured by a 6-item inventory of perceived agreement about the presenting problem and management, were ascertained immediately after the consultation. Compliance with prescribed medication therapy was ascertained by telephone follow-up 4 days after the consultation. RESULTS: Overall, 220 patients (61%) received a prescription, and 79% of these patients were taking the medication at follow-up. In a univariate analysis adjusted for clustering, only trust and physician-patient concordance were significantly related to compliance. In analysis further adjusted for health and demographic factors, physician-patient concordance was independently related to compliance (odds ratio = 1.34, 95% confidence interval, 1.04-1.72). CONCLUSIONS: Primary care consultations with higher levels of patient-reported physician-patient concordance were associated with one-third greater medication compliance. An emphasis on understanding and facilitating agreement between physician and patient may benefit outcomes in primary care.

Adult↗