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Biomedical subjects

D W Gorenflo

Publications and source records attributed to D W Gorenflo.

At least 19 recordsLinked to original sources
PubMed2001

Weight loss methods of high school wrestlers.

PURPOSE: The purpose of this investigation was to assess the weight loss practices of Michigan high school wrestlers at all levels of competition. METHODS: A two-page survey was designed to assess weight loss behaviors of high school wrestlers. It was mailed by the Michigan High School Athletic Association (MHSAA) midway through the wrestling season to all Michigan high schools participating in interscholastic wrestling. RESULTS: Completed surveys were received from 2532 wrestlers. Wrestlers lost an average of 6 pounds during the season. Over 50% of wrestlers lost more than 5 pounds; 27% of wrestlers lost at least 10 pounds; 72% of wrestlers engaged in at least one potentially harmful weight loss method each week of the wrestling season; 52% used at least two methods each week; 12% used at least five methods each week. Weekly use of laxatives, diet pill, or diuretics was reported by 2% of wrestlers. Vomiting to lose weight was done at least weekly by 2% of wrestlers. Wrestlers who engaged in at least one rapid weight loss method per week lost more weight, began wrestling at an earlier age, and reported more binge eating compared with wrestlers who did not report weekly rapid weight loss. CONCLUSION: The majority of Michigan high school wrestlers engaged in at least one potentially harmful weight loss method each week of the wrestling season. Fasting and various methods of dehydration were the primary methods of rapid weight loss. Wrestlers who lost weight each week were more likely to binge eat. Potentially harmful weight loss practices were found to be common at all grades and success levels.

Adolescent↗
PubMed2000

Psychosocial and sexual functioning in women with vulvodynia and chronic pelvic pain. A comparative evaluation.

OBJECTIVE: To determine whether women with vulvodynia differ from women with chronic pelvic pain and normal controls in their psychological functioning, somatic preoccupation, pain experience and sexual functioning. STUDY DESIGN: Cross-sectional, self-report study of women presenting to University of Michigan specialty and general clinics for the treatment of vulvodynia or chronic pelvic pain or seeking a routine gynecologic examination. All subjects completed questionnaires assessing demographic characteristics, pain, depressive symptoms, general affective state, marital adjustment, functional activity, somatic complaints, exposures, and medical and sexual history. Univariate analyses, chi 2 tests, analyses of variance and logistic regression were used to assess associations between these variables and the diagnostic category. RESULTS: Women with vulvodynia (n = 31) were similar to asymptomatic control women (n = 23) in demographic characteristics, sexual relationship variables, sexual behaviors, current and past depression, somatic sensitivity, and history of sexual or physical abuse. Women with chronic pelvic pain (n = 18) were younger and less educated than the other two groups and were more likely to have a history of physical and sexual abuse, to report recent depression and to screen positive for current depression, to have more work absences and to have more somatic complaints. CONCLUSION: Women with vulvodynia are psychologically similar to control women but differ significantly from women with chronic pelvic pain. A primary psychological cause of vulvodynia is not supported.

Adolescent↗
PubMed1999

Childhood iron deficiency anemia, maternal nutritional knowledge, and maternal feeding practices in a high-risk population.

BACKGROUND: Despite the proven success of national efforts such as the Special Supplementary Food Program for Women, Infants, and Children (WIC) to curb childhood iron deficiency anemia (IDA) in the United States, aggregate programmatic data may not accurately represent the experience of particularly high risk groups, such as the children of adolescent mothers of low socio-economic status. METHODS: This study evaluated the prevalence and severity of childhood anemia and associated risk factors, at one urban teen health center serving primarily low-income adolescent mothers and their children. A total of 175 pediatric WIC charts were reviewed to abstract hemoglobin status and other data. Additionally, 81 mothers were interviewed with regard to their nutritional knowledge and feeding practices; these findings were compared with the measured hemoglobin (Hgb) of their children. RESULTS: A total of 34.9% of children in the study population were found to be anemic (Hgb </= 11. 2). Low childhood Hgb status was significantly correlated with racial identification, child age, maternal perception of feeding difficulty, and the presence of concurrent pediatric medical illness. Report of extensive nutritional discussion with a physician was correlated with normal Hgb levels. No differences in nutritional knowledge or feeding practices were detected between mothers of children with low iron status. CONCLUSIONS: We conclude that the risk of iron deficiency, even among children receiving WIC services, may be underestimated in certain "nutritionally very high risk" populations. Further study of interventions for IDA in children of young, low-income mothers is recommended.

Adolescent↗
PubMed1999

The psychosexual impact of human papillomavirus cervical infections.

BACKGROUND: Occult human papillomavirus (HPV) infection, present in approximately 20% of women in the United States, is usually sexually transmitted, associated with substantial health risks, and unpredictable in its resolution. The potential for adverse psychosexual alterations due to HPV infection in women considered at low risk for bacterial sexually transmitted diseases is substantial, but data is lacking. METHODS: This cross-sectional study was conducted with sexually active women aged 18 to 60 years who had been enrolled at community-based offices in the University of Michigan Vaginitis Study. Women found to have occult HPV infection of the cervix were notified, received physician consultation, and were encouraged to have colposcopy performed to assess lesion status. Responses to a follow-up written questionnaire for differences in psychosexual functioning and attitudes following diagnosis were compared among these women and those without HPV infection. RESULTS: The women enrolled were primarily white and had a current sexual partner at the time of enrollment. They had few sexually transmitted infections and few risk factors, yet 20% had unsuspected HPV infection. Psychosexual characteristics at baseline and at follow-up, as well as perceived changes in these characteristics by the women, did not differ between women with HPV infection and those without. Stratification by potential confounders, including the presence of a vaginal infection at the time of study enrollment, household income level, ethnic background, age, marital status, and sexual history, did not alter these results. CONCLUSIONS: Women at low risk for sexually transmitted diseases, but who had a cervical HPV infection, were similar to those not infected in reported psychosexual characteristics and functioning. Adverse changes in these characteristics between the time of the diagnosis and subsequent follow-up were no more likely in those with the diagnosis than in those without.

Adolescent↗
PubMed1998

Knowledge and attitudes about AIDS among deaf and hard of hearing persons.

We investigated whether the public information being dispensed about Acquired Immunodeficiency Syndrome (AIDS) reaches Deaf and Hard of Hearing (D&HH) persons to the same extent as the rest of the American population. Using a self-administered written survey, modified so that D&HH persons whose primary language is American Sign Language (ASL) could understand the questions, we studied 40 D&HH and 37 hearing persons in southeast Michigan. There were no significant demographic differences between the two populations, but there were differences regarding attitudes towards and knowledge about AIDS. D&HH persons were less likely to associate sexual contact with drug users and number of sexual partners as high risk sexual behaviours, were more likely to believe that storing blood for future personal use lowers their chances of contracting AIDS, and believed that using public restrooms, kisses on the cheek and visiting an AIDS patients increased their chance of contracting AIDS. Furthermore, they were more likely to believe they did not need to change their sexual behaviour as a result of the AIDS epidemic. D&HH persons also reported different attitudes towards AIDS patients, such as they were not important to their community, dentists with AIDS should not be allowed to continue working, and landlords should be able to evict people with AIDS. Our findings suggest differences in receiving, trusting, and/or being exposed to current information about AIDS by the Deaf community, consistent with the fact that they are a minority population with distinct knowledge and cultural traditions.

Acquired Immunodeficiency Syndrome↗
PubMed1998

Low false-negative rate of PCR analysis for detecting human papillomavirus-related cervical lesions.

Although PCR analysis is a sensitive test for detection of human papillomavirus (HPV) in the cervix, the proportion of cases of cervical dysplasia missed, or the false-negative rate, has been unknown. We determined the accuracy of PCR analysis for HPV DNA as a predictor of HPV-related cervical lesions in a cross-sectional study of sexually active women, aged 18 to 50 years, from the University of Michigan Family Medicine HPV study. Of 133 eligible participants, 41 underwent colposcopy because of a positive result for HPV of the cervix by the PCR method and 92 underwent screening colposcopy with biopsy prior to knowing the HPV PCR results. Twenty-four of those screened were subsequently found to also be HPV DNA positive. In those found to be HPV positive, histological studies revealed the presence of condyloma or cervical intraepithelial neoplasia in 16 women (24.6%) and changes suggestive of condyloma in 5 (7.6%). No HPV-negative woman had an abnormal biopsy or cytology report (P = 0. 000001). The false-negative rate (1 - sensitivity) for HPV PCR analysis for detection of the presence of a cervical HPV-related lesion was 0% (95% confidence interval, 0 to 0.047), and the specificity was 60.7%. In summary, PCR analysis for HPV DNA had a very low false-negative rate for predicting HPV-related lesions of the cervix in a community-based population. This supports the validity of using the absence of HPV at the cervix, as determined by PCR testing, as an inclusion criterion for patients in control groups in studies dealing with low-grade cervical lesions.

Adolescent↗
PubMed1998

Iron deficiency and maternal feeding practices among high-risk urban children.

This study evaluated the nutritional knowledge and feeding practices (via a verbal questionnaires) of the clients of one semiurban women, infants, and children (WIC) center, which serves exclusively younger women (aged 12-21) and their children, and compared these variables to the hemoglobin levels of their infants and children. No significant benefit from documented WIC education regarding iron was detectable. African American identification was associated with childhood anemia (p = 0.05); the presence of concurrent medical problems approached significance (p = 0.06). Other previously reported risk associations were not found to be significant. Children with low iron ate more meals outside the home per week (2.9 vs. 1.9, p = 0.10). Despite the proven value of the WIC program in reducing childhood iron deficiency, it appears that members of certain very high-risk populations may not experience the full benefit of this nutritional program and may require additional, targeted interventions.

Adolescent↗
PubMed1997

Racial group differences in plasma concentrations of antioxidant vitamins and carotenoids in hemodialysis patients.

Approximately 50% of the mortality in hemodialysis patients is due to cardiovascular disease. Antioxidant vitamins and carotenoids may be protective because oxidation of low-density lipoproteins appears to be a necessary prerequisite for the development of atherogenesis, and hemodialysis itself may stimulate the generation of oxygen reactive species. African Americans comprise a substantial proportion of dialysis patients because they have higher rates of hypertension, glomerulonephritis, and diabetic end-stage renal disease than do whites. The purpose of this cross-sectional study was to determine the plasma concentrations of antioxidant vitamins and carotenoids in hemodialysis patients and to investigate whether differences in these concentrations in the major racial or ethnic groups exist. Plasma concentrations of alpha- and gamma-tocopherol, carotenoids, and retinol were measured with HPLC and plasma vitamin C was measured with a spectrophotometric method in 109 white and African American hemodialysis patients. Dietary intakes of selected micronutrients were also compared by using data from a food-frequency questionnaire. Overall, plasma vitamin C and alpha-tocopherol concentrations were comparable but plasma carotenoid concentrations were lower than those reported for other populations. African American patients had significantly higher mean plasma concentrations of retinol (P < 0.04), lutein (P < 0.02), and total carotenoids minus lycopene (P < 0.04); whites had significantly higher mean plasma concentrations of alpha-tocopherol (P < 0.02), independent of age and plasma lipid concentrations. Diabetes comorbidity had an independent negative association with plasma beta-carotene concentration but was not associated with other measures.

Adult↗
PubMed1996

Teaching of human rights in US medical schools.

OBJECTIVE: To determine the extent to which human rights issues are included in required bioethics curricula in US medical schools and to identify medical school characteristics associated with the extent of human rights issues covered. DESIGN: Cross-sectional survey. PARTICIPANTS: Bioethics course directors and bioethics section directors of 125 US medical schools. MAIN OUTCOME MEASURE: The extent of human rights teaching at each school was measured as the percentage of 16 human rights issues. RESULTS: Course directors at 113 (90%) of the 125 US medical schools responded to the survey. Medical schools included about half (45%; 95% confidence interval, 41%-49%) of 16 human rights issues in their required bioethics curricula. Domestic human rights issues, such as discrimination in the provision of health care to minorities (82% of medical schools), were covered much more frequently than international human rights issues, such as physician participation in torture (17% of schools). Public medical schools included substantially fewer human rights issues than private medical schools (F[1,112]=7.7; P<.01). CONCLUSIONS: Required courses in medical education do not adequately address the medical aspects of human rights issues, especially international issues.

Analysis of Variance↗
PubMed1996

Nutritional characteristics, eating pathology, and hormonal status in young women.

Ovulatory dysfunction is common in patients with eating disorders. However, many women engage in pathologic dieting behaviors without meeting the current diagnostic criteria for anorexia or bulimia nervosa. Clinical eating disorders are only the most extreme form of pathologic eating attitudes and behaviors that are present in many young women. Specific food choices and nutrient intakes may be associated with altered gonadal hormone status of these dieters. This cross-sectional study was conducted to describe the nutritional characteristics of college-aged women defined by their eating attitudes and behaviors with a previously described questionnaire. We evaluated dietary intake, body composition, and selected biochemical indicators in 76 undergraduate women. Serum concentrations of estradiol, progesterone, lipids, and carotenoids were measured on days 6, 21, and 28 of one menstrual cycle. Dietary assessment was based on food records at two 3-d intervals during the cycle. Ovulatory status was definitively determined on the basis of biochemical data for 46 of the women. Increased degree of pathologic dieting was associated with a significantly lower intake of dietary fat (P < 0.02), despite similar mean body mass index and body composition across the eating pathology groups. Serum concentration of alpha-carotene was significantly greater (P < 0.005) in association with a greater degree of eating pathology. With ovulation as a between-group factor, serum lutein concentration and dietary intake of energy and fat differed significantly between groups (P < 0.003). Nutritional characteristics associated with pathologic dieting behavior may also be associated with menstrual irregularities in young women.

Adolescent↗
PubMed1995

Attitudes and behaviors on physician-assisted death: a study of Michigan oncologists.

PURPOSE: To ascertain the attitudes of oncologists toward physician-assisted death, ie, physician-assisted suicide and active euthanasia, as well as their experiences with these activities and their opinions toward their legalization. METHODS: A survey was mailed to all practicing 250 oncologists in the state of Michigan, with subsequent development of psychometric scales and their correlation with self-reported behaviors in physician-assisted death. RESULTS: Analysis revealed five distinct, meaningful factors regarding approval or disapproval of physician-assisted death. These factors reflected global attitudes toward physician-assisted death, passive euthanasia, philosophical prohibitions toward physician-assisted death, concerns of legal consequences with physician-assisted death, and attitudes that physician-assisted death could be avoided with better end-of-life care (alpha = .94, .74, .76, .87, and .84, respectively). High levels of therapy withdrawal were reported (81%), with significant reservations toward assisted suicide and active euthanasia, although reported participation in such actions was noteworthy (18% and 4%, respectively). The scales reflecting global and philosophical attitudes correlated with several attitudes and behaviors toward physician-assisted death (P < .001). Legislation that would allow physician-assisted death was favored by 20.8% of respondents. CONCLUSION: Although they have reservations about physician-assisted death, significant numbers of oncologists are willing to consider such actions should they become legal. Given the substantial number of physicians who report that they have already participated in physician-assisted death, these findings may help better understand the attitudes that motivate physician behaviors toward assisted death.

Attitude of Health Personnel↗
PubMed1995

Disqualifying criteria in a preparticipation sports evaluation.

BACKGROUND: This study was undertaken to demonstrate the relative frequency of disqualifying criteria in a complete history and physical sports examination. METHODS: A review was conducted of 2574 preparticipation physical evaluations (PPEs) performed on 11- to 18-year-old student athletes to determine which factors are associated with denial of unrestricted sports participation. RESULTS: Eighty-five percent of the student athletes passed the screening. Of those who did not, the denial decision was based on the medical history alone in 58% of cases (P < .05). A logistic regression analysis identified seven items associated with denial: dizziness with exercise, history of asthma, body mass index, systolic blood pressure, visual acuity, heart murmur, and musculoskeletal examination. CONCLUSIONS: Although physicians often take a complete history and perform physical examinations, relatively few variables appear related to denial of eligibility for participation in organized sports. The history is one of the most important aspects of the PPE. A directed PPE may be more efficient, thereby allowing more time to address other important issues.

Adolescent↗
PubMed1994

Patients' interpretation of qualitative probability statements.

BACKGROUND: Physicians often use qualitative probability statements to compare treatment options or describe risks of treatment, especially if exact numerical information is not readily available. OBJECTIVES: To determine (1) the effect of context, experience, age, gender, race, occupation, and education on patients' numerical interpretation of probability terms and (2) patient preferences for information about side effects (qualitative or numerical). DESIGN: Cross-sectional survey. SETTING: A university-based family practice in Ann Arbor, Mich. PARTICIPANTS: Patients 18 years of age and older and parents of patients younger than 18 years of age seen during January and February 1993 for any reason except complete physical examination. METHODS: A questionnaire presented scenarios of minor and major complications related to four different medical conditions. Participants were asked to estimate how many people of 100 would have a complication if their physician described the risk for the complication in each scenario as unlikely. Participants were then asked whether they preferred receiving information from their physician about the risk for complications in words or numbers. RESULTS: Of 345 questionnaires distributed, 307 patients (89%) completed them. The rates assigned to the minor complications were significantly higher than the rates assigned to the major complications (P = .0001). Participants who had experienced the described complication reported significantly higher rates for the minor complications of vaccination and surgery (P = .0001 and P = .0235, respectively). Education had a significant effect only on the rates assigned to vaccination complications (P = .0069). Occupation had a significant effect only on the rates assigned to antibiotic side effects (P = .0090). CONCLUSIONS: When a physician uses qualitative probability statements, he or she must be sensitive to the patient's previous experience with that procedure or medication. Also, if one wants to convey the same potential rate of occurrence for major and minor side effects, then one needs to use different words for each.

Adult↗
PubMed1994

Effects of synthetic voice output on attitudes toward the augmented communicator.

This study investigated the effects of four different voice synthesizers on attitudes of nondisabled individuals toward an augmented communicator. Subjects (N = 284) viewed one of four videotapes depicting an adult VOCA (voice output communication aid) user having a conversation with a normal-speaking individual. The voice synthesizers used in the respective videotapes were ArticR65B male voice, Smoothtalker 3.0 male voice, RealVoice female, and DECtalk "Beautiful Betty." The Attitudes Toward Nonspeaking Persons Scale (ATNP) was used as the primary dependent variable. Results showed that attitudes toward the augmented communicator are more favorable in terms of evaluation and potential interaction when the synthetic voice is "easier to listen to." Gender-appropriate voice did not produce more favorable attitudes than gender-inappropriate voice. Implications of these findings for technological development of augmentative devices are discussed.

Attitude↗
PubMed1994

A multivariate model for specialty preference by medical students.

BACKGROUND: Numerous studies have demonstrated differences among students regarding their preference of a medical specialty. The goal of the present research was to develop a model for the selection of a primary care specialty (ie, family practice, general internal medicine, medicine/pediatrics, and general pediatrics). METHODS: A self-administered questionnaire was mailed to 822 first-year through fourth-year medical students at the University of Michigan Medical School in Ann Arbor. Students listed their first preference for medical specialty, anticipated income and work hours, and the influence of attitudinal and social factors on their preference. A total of 645 (78.5%) students responded. Average age was 25; 58% were male, and 77% resided in Michigan. RESULTS: Overall, 34.3% of the medical students who responded to the questionnaire expressed a preference for a surgical specialty; 27.3%, primary care; 19.9%, a hospital-based practice; and 18.5%, nonprimary care and non-hospital based practice. A multiple logistic regression model developed on preference for a primary care specialty achieved a classification accuracy of 82%. The most important factors influencing specialty preference were sex, expected income, attitudes about general medicine issues, attitudes about surgery, and the influence of other people. CONCLUSIONS: No single factor dominates a student's preference for primary care. Students preferring primary care were most strongly influenced by their perceptions of practice variations. Students preferring nonprimary care specialties were more interested in income, prestige, and hospital-based practice. Medical school faculty had no significant impact on the preferences of either group of students.

Adult↗
PubMed1994

Episodes of care for chest pain: a preliminary report from MIRNET. Michigan Research Network.

BACKGROUND: Although intensively studied in hospital and emergency settings, chest pain has remained largely unstudied in primary care, where it is associated with considerable diagnostic uncertainty and high utilization of medical resources. METHODS: We employed an established primary care research network to prospectively collect detailed information on episodes of care for chest pain. Over a 12-month period, Michigan Research Network (MIRNET) clinicians prospectively collected demographic, clinical, and clinician decision-making information for all patients seen in their offices with the complaint of chest pain. RESULTS: Three hundred ninety-nine complete episodes were collected and used for analysis. Episodes were well distributed among urban, rural, academic, and private sites. The average episode length was 1.53 visits. Musculoskeletal chest pain accounted for 20.4% of all diagnoses, followed by reflux esophagitis (13.4%) and costochondritis (13.1%). Stable angina pectoris was the primary diagnosis in only 10.3% of episodes, unstable angina or possible myocardial infarction in 1.5%. Most of the ancillary services used were directed toward finding or excluding cardiac disease. CONCLUSION: A practice-based network can be used to study episodes of care. Resource use during episodes of chest pain in primary care are directed toward exclusion of cardiac disease, despite the surprisingly low frequency of cardiac diagnoses.

Adult↗
PubMed1993

Factors associated with human papillomavirus infection in women encountered in community-based offices.

OBJECTIVE: To assess risk factors for cervical human papillomavirus (HPV) infection in women presenting to community-based offices because of vaginal symptoms or for preventive screening. DESIGN: Cross-sectional analysis of history, physical examination, and microbiological infection variables. SETTING: Two community-based family practice offices in southeastern Michigan. PATIENTS: Two hundred seventy-three women, 18 to 50 years of age, presenting to the study sites because of vaginal symptoms or for a pelvic examination for preventive screening. MAIN OUTCOME MEASURE: Human papillomavirus infection of the uterine cervix as determined by polymerase chain reaction testing. RESULTS: Human papillomavirus infection was detected in 21.2% of the women (24.9% and 13.1% of women with and without vaginal symptoms, respectively); 34% of these infections were HPV types 16 or 18. Fifty-four percent of the women with HPV infection who underwent colposcopy had condyloma or cervical intraepithelial neoplasia verified on biopsy. Independent associations were found between HPV infection and the following female risk factors: the presence of vaginal itching, odor, or swelling; knowing the current sexual partner less than 24 months; age less than 40 years; household income of $14,000 or less; and ever having had six or more sexual partners. CONCLUSIONS: In addition to three previously described risk factors for genital HPV infection, two previously unrecognized risk factors were identified in this lower-risk population. These risk factors included the presence of vaginal symptoms of itching, odor, or swelling and having known the current sexual partner less than 24 months. Nevertheless, using risk factors alone, two thirds of the women infected with HPV in this population were not identified as being at high risk of infection. No subset of sexually active women was identified who were at no risk of HPV infection.

Adolescent↗