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Biomedical subjects

B Ewigman

Publications and source records attributed to B Ewigman.

14 recordsLinked to original sources
PubMed1999

Addressing spiritual concerns of patients: family physicians' attitudes and practices.

BACKGROUND: Our goals were to assess family physicians' spiritual well-being, identify their perceived barriers to discussing spiritual issues with patients, and determine how often they have these discussions. METHODS: We mailed a questionnaire to 231 Missouri family physicians (80 residents, 43 faculty, and 108 community physicians). The questionnaire included the Ellison Spiritual Well-being Scale (ESWS), as well as questions about physicians' attitudes toward spirituality and the barriers to and frequency of discussions of spiritual issues with patients. RESULTS: The response rate was 74%. The mean ESWS score indicated that the physician respondents had a high level of spiritual well-being. Nearly all respondents (96%) considered spiritual well-being an important health component, 86% supported referral of hospitalized patients with spiritual questions to chaplains, and 58% believed physicians should address patients' spiritual concerns. Fear of dying was the spiritual issue most commonly discussed, and less than 20% of physicians reported discussing other spiritual topics in more than 10% of patient encounters. Barriers to addressing spiritual issues included lack of time (71%), inadequate training for taking spiritual histories (59%), and difficulty identifying patients who want to discuss spiritual issues (56%). CONCLUSIONS: Family physicians in this survey had high spiritual well-being scores. Most believed spiritual well-being is an important factor in health. Despite this belief, however, most reported infrequent discussions of spiritual issues with patients and infrequent referrals of hospitalized patients to chaplains. Lack of time and training were key barriers to spiritual assessment.

Attitude of Health Personnel↗
PubMed1995

Is smoking an indication for prenatal ultrasonography? RADIUS Study Group.

OBJECTIVE: To evaluate whether ultrasound screening during pregnancy decreases the frequency of smoking in women who present with a history of smoking. DESIGN: The Routine Antenatal Diagnostic Imaging with Ultrasound Study was a multicenter, randomized clinical trial of ultrasound screening during pregnancy. We obtained information on smoking habits during pregnancy from birth certificate records for the subset of women who were delivered of a neonate in Missouri hospitals, and determined the effect of ultrasound screening on smoking habits during pregnancy. SETTING: The study was conducted in multiple practices in six states. PARTICIPANTS: Women who registered for prenatal care at participating practices. INTERVENTION: Women in the screened group were routinely scheduled for ultrasound screening at 16 to 22 weeks' gestation and at 31 to 35 weeks' gestation. Those in the control group received ultrasound screening only for medical indications, as determined by their physicians. MAIN OUTCOME MEASURE: Smoking habits were measured by the number of cigarettes smoked per day. RESULTS: There was no difference in the rates of smoking cessation between the screened group and the control group. For those who continued smoking, the mean number of cigarettes smoked per day, as reported at the time of delivery, was slightly higher in the screened group. CONCLUSION: Ultrasound screening does not reduce the frequency of smoking during pregnancy.

Female↗
PubMed1995

Epidemiologic predictors of cesarean section in nulliparous patients at low risk. RADIUS Study Group. Routine Antenatal Diagnostic Imaging with Ultrasound Study.

OBJECTIVES: We sought to determine whether certain maternal and fetal characteristics influenced the risk of maternal- and fetal-indicated cesarean sections in pregnant women at low risk for adverse perinatal outcomes. STUDY DESIGN: From a cohort of 6393 low-risk nulliparous patients maternal and fetal indicated cesarean section rates with 95% confidence intervals were calculated and stratified by demographic, anthropometric, and clinical tests and measurements. The strongest risk factors were modeled by means of multiple logistic regression. RESULTS: Few risk factors distinguished maternal from fetal characteristics preceding cesarean delivery. Maternal age was associated with increased cesarean section risk in the tallest group of women only, and cesarean section rates decreased with increasing height, increased with higher prepregnancy weights, and was highest in women carrying male fetuses. Higher first prenatal visit diastolic blood pressure, increasing numbers of nonstress tests, > or = 2+ prenatal urine protein, late sonograms, geographic region, and practice type were statistically significant risk factors as well. Interestingly, results of prenatal visit tests and measurements contributed less to the prevalence of cesarean section than did age, fetal sex, and anthropometric parameters. However, the generalizability of these results is limited to low-risk (predominantly white) populations. CONCLUSIONS: Of the risk factors we were able to assess, a large proportion of the incidence of cesarean section in this population of nulliparous patients at low risk was attributable to age, sex of fetus, and anthropometric patient profiles.

Adolescent↗
PubMed1993

Ultrasound during pregnancy: a discussion. Interview by Max Allen.

Prenatal screening by ultrasound is increasing in the United States. In 1990, 52 percent of mothers who had live births received ultrasound, compared with 48 percent in 1989 (Monthly Vital Stat Rep 1993; 42:2(S):6). A recent multicenter, randomized study of 15,151 low-risk pregnant women, conducted by the Routine Antenatal Diagnostic Imaging With Ultrasound (RADIUS) Study Group, reported no significant differences in pregnancy outcomes between women who received no ultrasound scan and women who received two scans during pregnancy (N Engl J Med 1993; 329:821-827). Ewigman et al concluded, "The adoption of routine ultrasound screening in the United States would add considerably to the cost of care in pregnancy, with no improvement in perinatal outcome."

Australia↗
PubMed1993

Judgments regarding appropriate child supervision to prevent injury: the role of environmental risk and child age.

Parents, social service workers, and medical personnel failed to differ in the amount of time they estimated that children of 11 differing ages should be left without adult supervision within 5 different supervision domains. More hazardous circumstances dramatically reduced the amount of time respondents said children should be left unsupervised. Amount of unsupervised time increased with age, with clear developmental cutoffs that varied by level and type of risk. When the moderate center of the distribution was examined, 3 clear areas of consensus emerged. For most domains, constant supervision was recommended for preschool children. For early elementary school children, nearly constant (0-5 min without supervision) or close (0-15 min without supervision) supervision was recommended in safer locations, with constant supervision still recommended in high-risk situations. Only with older children was there an absence of consensus regarding supervision. The implications of these results for future injury prevention research are discussed.

Adult↗
PubMed1993

The Missouri child fatality study: underreporting of maltreatment fatalities among children younger than five years of age, 1983 through 1986.

Estimates of the incidence of child maltreatment fatalities vary widely; most experts believe they are underreported. To investigate the suspicion that fatal maltreatment was underreported in Missouri preschool children, a statewide, population-based study was conducted using nine data sources. The study cases included the 384 children younger than age 5 who died from 1983 through 1986 and whose death certificates were coded with an external cause (injury) or whose deaths were substantiated as abuse or neglect fatalities by the Missouri Division of Family Services. Each fatality was categorized as one of the following: definite maltreatment, probable maltreatment, possible maltreatment, non-maltreatment, or inadequate information. Of the 121 cases classified as definite maltreatment, only 47.9% had codes consistent with maltreatment on their death certificates. The Division of Family Services had substantiated 79.3% of definite maltreatment cases as abuse or neglect fatalities. The Federal Bureau of Investigation Uniform Crime Reports database reported only 38.8% of these cases as homicides. In 37.2% of the cases, there was at least one criminal conviction. Child maltreatment fatalities are drastically underreported as such in Missouri because of inadequate investigations, lack of information-sharing between investigators and agencies, and reporting systems that fail to capture the contribution of maltreatment as a cause of death. Missouri has created a statewide system of child fatality review panels and a child fatality surveillance system to address the problems documented in this study.

Abstracting and Indexing↗
PubMed1991

Cognitive factors influencing women to seek care during pregnancy.

To assess the relationship of cognitive factors to a pregnant woman's decision to seek prenatal care, a semi-structured interview instrument was administered to 30 women soon after they were seen for care. A content analysis of interview transcripts was performed to identify variables affecting the decision to seek care. Variables were coded numerically, and those correlated with number of weeks gestation at first visit for pregnancy care were entered into a stepwise linear multiple regression model. Three variables accounted for 74% of the variance in the week of gestation at which pregnancy care began. Women who desired the pregnancy, wished confirmation of the pregnancy, and experienced pregnancy-related symptoms tended to seek care earlier. Results were discussed in terms of the usefulness of this integration of quantitative and qualitative methods for the study of factors related to seeking pregnancy care and the need to consider cognitive factors when designing programs to improve the delivery of prenatal care.

Adolescent↗
PubMed1990

A randomized trial of routine prenatal ultrasound.

Nine hundred fifteen of 2171 pregnant patients had no indication for ultrasound at their first prenatal visit and were randomly assigned to receive either a single routine screening ultrasound or usual prenatal care. The estimated date of confinement was altered in 24.9% of routine-ultrasound patients and in 11.6% of usual-care patients through ultrasound examinations obtained for a subsequent clinical indication. Of these, 8.3% of routine-ultrasound and 5.2% of usual-care patients had gestational age errors of 2 weeks or more. There were no differences between the groups in inductions for post-dates pregnancy (7.0 versus 7.5%; P = .87), total inductions (22.6 versus 24.9%; P = .61), or adverse perinatal outcomes (6.7 versus 8.3%; P = .63). Both sets of twins were detected in the screened group. In the usual-care group, five of seven pairs of twins (71%) were diagnosed by 24 weeks' gestation. There was no benefit found from routine ultrasound as performed in this study.

Adult↗
PubMed1977

Effects of sonication on mature rat testes.

Exposure of rat testes to high-frequency sound waves temporarily interrupted the spermatogenic process. Rats treated with 1 watt/sq cm for 10 minutes exhibited a degeneration of advanced germinal cells and were incapable of impregnating females for 150 days. Forty-eight hours after sonication, spermatocytes and spermatids developed irregular membranes and released their contents into theinterstitium. Spermatogonia, Sertoli cells, and Leydig cells appeared normal, and no genetic anomalies could be detected in the progeny of treated animals. It was hypothesized that the reduction in sperm count was due to changes in membrane permeability which produced conditions unfavorable to maturation of testicular cells.

Animals↗
PubMedDate not supplied

A medical project in an African village.

The authors led a group of 15 students on a medical project to a remote traditional village in Sierra Leone, West Africa. The team lived in the village for one month. They staffed an outpatient clinic, performed a community health survey, and organized an immunization project and a health education program. This project offered a unique opportunity to teach many aspects of primary care, including clinical skills, use of health education, practice of preventive medicine, methods of community epidemiology, and the relationship of health to sociocultural factors. By living in the community, seeing the overwhelming health problems in the clinic, and working in the community to improve health, the students had a provocative and educational primary health care experience. Family medicine teachers are well suited for leading international medical projects.

Family Practice↗