Biomedical subjects

Daniel W Gorenflo

Publications and source records attributed to Daniel W Gorenflo.

11 recordsLinked to original sources

PubMed2005

Herb and vitamin supplementation use among a general ophthalmology practice population.

PURPOSE: To survey comprehensive ophthalmology patients about their use of vitamins and herbal supplements. DESIGN: Cross-sectional survey. METHODS: A survey instrument was developed and distributed to 397 patients presenting to a main campus university-based comprehensive ophthalmology clinic and to an off-site comprehensive ophthalmology clinic. Information gathered included demographics, use of prescription medications, use of vitamin and herbal supplements, the reasons for using these supplements, perceived benefits of these products, where the information regarding them was gathered, and with whom patients had discussed their use. RESULTS: Fifty-eight percent of patients reported nearly daily use of vitamins. Multivitamins were the most common vitamin and were used by 46% of the patients. Eight percent of patients used herbal products on a daily basis. Twenty-six percent learned about vitamins from their primary care physician (PCP), and just 2% from their ophthalmologists, while 35% discussed their actual use with a PCP, and 5% with their ophthalmologists. Just 2% of these patients learned of herbs from a PCP, and <1% from an ophthalmologist. Older patients used multivitamins and other vitamins most frequently, while gender and education were not predictive of vitamin or herbal use. Mean monthly spending on vitamins by users was 15.74 dollars, while herbal users spent a monthly mean of 15.35 dollars. CONCLUSIONS: Vitamins and herbs are used by a significant number of patients in a comprehensive ophthalmology setting. Given the prevalence of vitamin and herbal use, ophthalmologists should systematically inquire about their use.

Adolescent↗

PubMed2004

Interventions fail to increase cancer screening rates in community-based primary care practices.

BACKGROUND: Cancer screening in primary care offices is reaching only a modest percentage of adults 50 years and older. The objectives of this study were to determine if screening rates for breast, cervical, and colorectal cancer could be significantly increased by two simple office interventions in community-based primary care offices and then maintained over 3 years. METHODS: Twenty-two community-based primary care practices were divided randomly into four arms: control, practice-based intervention, patient-based intervention, and both interventions combined. At baseline and annually for 3 years, medical records from approximately 100 male and 100 female patients 50 years and older were randomly selected. The outcome measures were screening rates for mammogram, Pap smear, fecal occult blood test, and flexible sigmoidoscopy or other colonic imaging. RESULTS: Generally each study arm evidenced a significant 1-year increase in screening rates, followed by an overall decline to approximate baseline levels. The first year increases in screening were not related to either invention, alone or in combination. CONCLUSIONS: These interventions do not have a significant impact on cancer screening rates in adults over several years. A variety of possible variables may have affected the long-term outcomes.

Adult↗

PubMed2004

Deaf persons and computer use.

Deaf person's computer use was studied (N = 227). Respondents self-administered a survey in their preferred language (voice, American Sign Language, captions, or printed English). A small nonparticipant sample was also recruited. Demographics were consistent with those in other studies of deaf people: 63% of respondents reported computer use, mostly at home; 50% of nonparticipants reported computer use. Subjects with hearing loss due to meningitis were less likely to use computers (p = .0004). Computer use was associated with English usage at home (p = .008), with hearing persons (p = .002), and with physicians and nurses (p = .00001). It was also associated with the use of Signed English as a child to communicate (p = .02), teacher use of Signed English (p = .04), and teacher use of ASL (p = .03). Two thirds of respondents reported using computers, though nonresponder data suggested less use among all deaf persons. Computer use was associated with English use and inversely associated with hearing loss due to meningitis.

Age Factors↗

PubMed2004

Emergency contraception: knowledge and attitudes of family medicine providers.

BACKGROUND AND OBJECTIVES: Emergency contraception (EC) is an underutilized method of preventing unplanned pregnancy. This study assessed family physicians' and nurse providers' knowledge, attitudes, and beliefs about EC. METHODS: A cross-sectional survey was distributed to faculty, residents, and clinic nurses in a Midwestern department of family medicine. Data were analyzed using Statistical Package for the Social Sciences. Statistical significance was tested by chi-square test, Student's t test, and Mann-Whitney U test where appropriate. RESULTS: Seventy-eight providers participated (response rate 81%). Seventy-four percent of physicians have prescribed EC in the past, with an average of 3.2 (range 0-10) times in the last year. The majority of providers reported that they were familiar with indications (96%) and protocols (78%) for prescribing EC, yet knowledge inaccuracies were identified. Overall attitudes regarding EC were positive. CONCLUSIONS: Although the majority of participating providers were willing to prescribe EC and had generally favorable attitudes toward it, rates of providing this therapy were low. There was a discrepancy between providers' perceived and actual knowledge about EC. Interventions targeting misunderstandings might help reduce missed opportunities to provide EC.

Attitude of Health Personnel↗

PubMed2003

Sexual activities and attitudes of women with vulvar dysesthesia.

OBJECTIVE: To assess the relationship between sexual activities and attitudes of women with and without vulvar dysesthesia. METHODS: Women with vulvar dysesthesia, 18-60 years old, and ethnically matched women without this disorder were enrolled in this cross-sectional study, completed a 27-page questionnaire, and had a physical examination. We compared sexual activities and attitudes between patients and controls using univariate and multivariable analyses. RESULTS: Between January 21, 2001, and December 12, 2002, we enrolled 63 women with vulvar dysesthesia and 62 controls who reported having a current sexual partner. Women with vulvar dysesthesia were less likely than controls to have had, during the previous month, intercourse (66.7% versus 83.9%, P =.03) and orgasms (57.6% versus 78.7%, P =.02), although the association with intercourse was no longer statistically significant after controlling for age, education, and smoking status (P =.07). Of those having had intercourse in the past month, the frequency of this activity was less among patients (3.0 +/- 2.7 versus 6.2 +/- 4.5 episodes, P <.001). Frequencies of orgasms, fellatio, cunnilingus, and masturbation did not significantly differ between patients and controls. Patients rated sex less important and rated themselves more negatively as sexual people than did controls (P <.001). CONCLUSION: Women with vulvar dysesthesia are similar to those without in many sexual activities but are less likely to have had an orgasm in the past month or to have had intercourse at the same frequency as controls. Although some attitudes were similar, sexual interest and self-concept were decreased among those with this disorder.

Adult↗

PubMed2003

Depressive symptoms among women with vulvar dysesthesia.

OBJECTIVE: The purpose of this study was to determine whether vulvar dysesthesia is associated with elevated depressive symptoms. STUDY DESIGN: This was a cross-sectional case-control study of women who underwent treatment of vulvar dysesthesia (n=32) or who were seen for a routine gynecologic examination (n=32). Subjects completed measures of depressive symptoms and pain and a sexual and medical history. Multivariate and univariate analyses were conducted. RESULTS: Analyses that were adjusted for age, education, and medical conditions indicated that vulvar dysesthesia was associated positively with depressive symptoms (P=.002). However, this was attributable to the somatic (P=.002) rather than cognitive-affective symptoms (P=.16) of depression, partially related to the endorsement of sexual disinterest, and mediated by pain reports. CONCLUSION: Vulvar dysesthesia is associated with elevated depressive symptom severity, although not to the extent that indicates probable depressive disorder. In this condition, depressive symptoms are likely to be a measurement artifact, rather than a depressive process. Certain depressive symptoms (eg, sexual disinterest) directly inflate depression estimates in this patient group.

Adult↗

PubMed2003

Candida transmission and sexual behaviors as risks for a repeat episode of Candida vulvovaginitis.

OBJECTIVE: To assess associations between female and male factors and the risk of recurring Candida vulvovaginitis. METHODS: A prospective cohort study of 148 women with Candida vulvovaginitis and 78 of their male sexual partners was conducted at two primary care practices in the Ann Arbor, Michigan, area. RESULTS: Thirty-three of 148 women developed at least one further episode of Candida albicans vulvovaginitis within 1 year of follow-up. Cultures of Candida species from various sites of the woman (tongue, feces, vulva, and vagina) and from her partner (tongue, feces, urine, and semen) did not predict recurrences. Female factors associated with recurrence included recent masturbating with saliva (hazard ratio 2.66 [95% CI 1.17-6.06]) or cunnilingus (hazard ratio 2.94 [95% CI 1.12-7.68]) and ingestion of two or more servings of bread per day (p </= 0.05). Male factors associated with recurrences in the woman included history of the male masturbating with saliva in the previous month (hazard ratio 3.68 [95% CI 1.24-10.87]) and lower age at first intercourse (hazard ratio 0.83 [95% CI 0.71-0.96]). CONCLUSIONS: Sexual behaviors, rather than the presence of Candida species at various body locations of the male partner, are associated with recurrences of C. albicans vulvovaginitis.

Adult↗

PubMed2003

Generalized vulvar dysesthesia vs. vestibulodynia. Are they distinct diagnoses?

OBJECTIVE: To evaluate prospectively whether generalized vulvar dysesthesia and vestibulodynia possess unique characteristics that support the theory of differing etiologies. STUDY DESIGN: Women with vulvar dysesthesia for a minimum of 3 months were enrolled at the University of Michigan in 2 clinics specializing in vulvar disorders. Informed consent was obtained. Participants completed a 27-page questionnaire and had a physical examination. Differentiation of generalized vulvar dysesthesia and vestibulodynia was based on tenderness to light pressure isolated to the introitus vs. pain beyond the introitus, respectively. We compared women with the 2 diagnoses to each other on demographic characteristics, exposures, pain characteristics and physical findings using t test, Mann-Whitney U and chi 2 analysis. RESULTS: Between January 26, 2001, and August 28, 2002, we enrolled 39 women, aged 18-60 years, with tenderness localized to the vestibule (vestibulodynia) and 17 with generalized vulvar dysesthesia. Women in each diagnostic group were similar in demographic and exposure characteristics. The pain characteristics were similar between the 2 groups except that recent pain was rated as worse by those with generalized vulvar dysesthesia. Activities that aggravated or relieved the pain were similar. However, women with generalized vulvar dysesthesia were more likely to state that their pain was aggravated by sitting and by washing the area. Similar results were found when using "continuous" pain rather than vulvar pain location as the outcome variable. CONCLUSION: The characteristics of women with generalized vulvar dysesthesia are similar to those with localized pain, supporting the theory that the 2 disorders may exhibit 2 presentations on a continuum of severity seen in vulvar dysesthesia rather than 2 distinct entities.

Adult↗

PubMed2002

Validating an instrument for selecting interventions to change physician practice patterns: a Michigan Consortium for Family Practice Research study.

OBJECTIVES: The goal of this study was to develop a psychometric instrument that classified physiciansamprsquo response styles to new information as seekers, receptives, traditionalists, or pragmatists. This classification was based on specific combinations of 3 scales: (a) belief in evidence vs experience as the basis of knowledge, (b) willingness to diverge from common or previous practice, and (c) sensitivity to pragmatic concerns of practice. The instrument will help focus efforts to change practice more accurately. STUDY DESIGN: This was a cross-sectional study of physician responses to a psychometric instrument. Paper-and-pencil survey forms were distributed to 3 waves of physicians, with revision for improved internal consistency at each iteration. POPULATION: Participants were 1393 primary care physicians at continuing education events in the Midwest or at primary care clinic sites in the Veteransamprsquo Health Administration system. OUTCOMES MEASURED: Internal consistency was measured by factor analysis with orthogonal rotation and Cronbachamprsquos alpha. RESULTS: A total of 1287 usable instruments were returned (106, 1120, and 61 in the 3 iterations, respectively), representing approximately three fourths of distributed forms. Final scale internal consistencies were a = 0.79, b = 0.74, and c = 0.68. The patterns of scores on the 3 scales were consistent with the predictions of the theoretical scheme of physician types. The "seeker" type was the rarest, at fewer than 3%. CONCLUSIONS: It is possible to reliably classify physicians into categories that a theoretical framework predicts will respond differently to different interventions for implementing guidelines and translating research findings into practice. The next step is to demonstrate that the classification predicts physician practice behavior.

Adult↗

PubMed1999

Primary care physician attitudes and values toward end-of-life care and physician-assisted death.

This study explores how primary care physician attitudes toward physician-assisted death (PAD) are related to their personal values toward end-of-life care and PAD. A group of 810 Michigan family physicians, internists, and general practitioners, divided into 4 typology groups by their intention toward participating in PAD, rated their attitudes toward PAD, along with their values and preferences for their own end-of-life care. Respondents who most objected to PAD were less likely to have executed an advance directive and more likely to have values promoting continued life-sustaining treatment in their own terminal care. Furthermore, a significant number of physicians, who had strong values against their own withdrawal of treatment in terminal care, were opposed to the withdrawing or withholding of life-sustaining treatment in patient care. Considerations of personal physician values are relevant in the discussion of PAD and the withdrawal of treatment in terminal care.

Advance Directives↗

PubMed1992

A multigenerational study on the correlation of values and advance directives.

The development of the Values History instrument for use in advance directive decision making has raised the question of the importance of values in eliciting advance directives. This pilot study examines the relationship between the domains of values and advance directives drawn from the Values History in three generation intrafamily triads. Significant correlations between values and advance directives were found primarily within the youngest generation. Results reveal a relatively high familiarity by the participants of the various established forms of advance directives. Also, a significant percentage of parents and grandparents was found to have signed some form of advance directive.

Advance Directives↗