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Biomedical subjects

J C Puffer

Publications and source records attributed to J C Puffer.

15 recordsLinked to original sources

Attitudes toward and experience in research among family medicine chairs.

BACKGROUND: Productive research environments are important for the development of academic family medicine, yet many of the current family medicine chairs have had little research training or experience and have rated research skills as a low priority for themselves. The younger chairs, however, representing the next generation of academic leadership, may have more traditional academic values, including the promotion of research. METHODS: The 106 active and interim chairs of family medicine academic units were surveyed by mail to determine their characteristics and attitudes toward their work responsibilities. We compared chairs 50 years of age or younger with those over 50 years of age. RESULTS: Before attaining their positions, younger chairs, in general, were more likely than older chairs to have received formal training in management, patient care, and academic skills, but they shared similar work experiences. Specifically, younger chairs were more likely to have had formal research training but did not have a great deal more research experience. Younger chairs were more likely to consider research skills to be essential in their present work activities and to identify faculty with formal training and extensive experience in research as potential chair replacements. CONCLUSIONS: Younger chairs appear to have a greater appreciation for the importance of research, having received more formal training and valuing research skills in themselves and potential replacements. With the impending large turnover in family medicine leadership, there will be an opportunity to recruit chair replacements with similar viewpoints toward research, thus improving the outlook for research in academic family medicine.

Age Factors

Depression and chronic fatigue in athletes.

For the most part, the competitive athlete is a well-adjusted individual who demonstrates considerable vigor and well-being, as well as less depression, anxiety, and fatigue than nonathletic counterparts. The well-trained athlete, however, may also have a personality that is somewhat rigid, strongly goal oriented, and perfectionist. It is not unrealistic to expect that when confronted with diminished performance or success, such an athlete may be compelled to drive himself or herself harder to succeed. Such behavior typically leads to the phenomenon of overtraining, which can express itself in the form of chronic fatigue and depression. There are a number of other organic causes of chronic fatigue and depression, however, which must be excluded by careful evaluation and appropriate diagnostic testing. Although the evaluation of the athlete who presents with chronic fatigue and depression can be somewhat complex, a diagnostic framework has been outlined here to assist the clinician in the assessment of an athlete who presents with such complaints.

Depression

A characterization of the imminent leadership transition in academic family medicine.

Of the 106 identified chairmen of academic departments, divisions, or sections of family medicine in the United States in 1990, 97 (92%) responded to a survey designed to characterize the current chairmen of family medicine and estimate requirements for future chairmen. Even though 43% had occupied the chair for less than five years, over half, not limited to older chairmen, intended to leave within five years. Reasons for leaving varied, including being required to leave, career choice, personal reasons, and especially dissatisfaction with the job. Only half of current chairmen identified one or more qualified applicants for chairmanship within their own departments. The formal training and experience of these potential chairmen strongly resembled the training and experience of current chairmen, especially the fact that they had little training or experience in research. In the 1990s, the demand for academic chairmen of family medicine is likely to be large, the competition for capable candidates keen, and the challenges great for new chairmen, who will probably be young, residency-trained family physicians with relatively limited academic experience.

Adult

Lifestyles and health risks of collegiate athletes.

BACKGROUND: No study has comprehensively assessed the health behaviors of intercollegiate athletes. To determine whether they may be at increased risk for unhealthy lifestyle behaviors, we compared the lifestyle and health risk behaviors of a group of college athletes with those of their nonathletic peers. METHODS: A confidential survey questionnaire addressing preventable lifestyle behaviors was given to 109 intercollegiate athletes and 110 nonathlete controls. RESULTS: Athletes had a significantly (P less than .05) higher proportion of "risky" lifestyle behavior patterns compared with the nonathletes in the following areas: quantity of alcohol consumed; driving while intoxicated with alcohol or other drugs; riding with an intoxicated driver; use of seatbelts; use of helmets when riding a motorcycle or moped; use of contraception; number of sexually transmitted diseases; and number of sexual partners. CONCLUSIONS: College athletes appear to be at higher risk for certain maladaptive lifestyle behaviors. Comprehensive lifestyle assessment and preventive health intervention deserve further study to determine whether they can facilitate the adoption of positive lifestyle behaviors in this high-risk group.

Adolescent

Depression and chronic fatigue in the college student-athlete.

For the most part, the intercollegiate athlete is a well-adjusted individual who demonstrates considerable vigor and well-being and less depression, anxiety, and fatigue when compared with nonathletic counterparts. The well trained athlete also demonstrates a personality that may be somewhat rigid, is strongly goal oriented, and strives for excellence. It is not unrealistic to expect that when confronted with diminished performance or success, athletes may be compelled to drive themselves harder to succeed. Such behavior typically leads to the phenomenon of overtraining, which can express itself in the form of chronic fatigue and depression. A number of other organic causes of chronic fatigue and depression must be excluded by careful evaluation and appropriate diagnostic testing. Although the evaluation of the athlete who presents with chronic fatigue and depression can be somewhat complex, a diagnostic framework has been outlined that may assist the clinician in the assessment of the athlete who presents with such complaints.

Adult

An inquiry into the decision to practice obstetrics.

Little attention has been given to factors which affect the decision of a family physician to practice or not to practice obstetrics. A survey of 27 university-based and 32 community hospital-based residency graduates was undertaken. Respondents reported decreasing interest in performing obstetrics from the beginning of residency training (82%), at its completion (66%), and in their current practice (51%). This practice decision appears to have been unaffected by pre-residency attitudes, the nature of the training experience or by difficulty in obtaining hospital privileges. Further study is necessary to determine other critical variables which may play an important role in this decision-making process.

Family Practice

The use of drugs in swimming.

The use of drugs to enhance athletic performance poses tremendous potential risk to amateur sport. The aquatic sports are not immune from this risk. Although the exact incidence of drug usage among aquatic athletes is not known, empirical evidence would suggest that there are indeed athletes who are using substances in an effort to enhance performance. A number of the commonly used substances have been discussed and their risks and side effects reviewed. Future success in eradicating drug usage in sport will only result from increased efforts directed at enhancement of athlete education, development of strict policies dealing with those athletes who use banned substances, and refinement of drug testing procedures.

Alcohol Drinking

The diagnosis of ectopic pregnancy.

Recent developments in pregnancy testing, pelvic ultrasound, and diagnostic laparoscopy have enabled the physician to make an early and accurate diagnosis. Familiarity with these diagnostic aids is critical since prompt diagnosis will reduce the likelihood of life-threatening intraperitoneal hemorrhage and may allow more conservative surgery to be performed.

Blood Cell Count

Transient ischemic attacks.

Patients with transient cerebral ischemic attacks (TIAs) are generally felt to be at increased risk for stroke. A comprehensive clinical evaluation consisting of a thorough history and physical examination, as well as adjunctive laboratory and radiologic studies, is required to substantiate the diagnosis and to identify the underlying etiology. For patients with TIAs of atherothrombotic origin, the optimal course of management is still controversial. Although surgical therapy, antiplatelet therapy, and anticoagulant therapy have all shown promise in preventing stroke, their precise roles in the management of TIAs still await further elucidation.

Aged

Ectopic pregnancy.

Ectopic pregnancy continues to be a major clinical problem and is the leading cause of death in the first trimester of pregnancy. Diagnosis can be elusive. A thorough knowledge of the clinical spectrum of this disease, as well as the diagnostic tools available to the primary care clinician, provides the opportunity for making an early diagnosis. This is essential if the morbidity and mortality of ectopic pregnancy are to be reduced.

Adult

Three-dimensional cinematographic analysis of water polo throwing in elite performers.

Thirteen members of the United States Men's Water Polo Team were filmed using two synchronized cameras while shooting at a goal. Three-dimensional (3D) coordinates of the throwers' shoulder, elbow, wrist, and the ball were used to estimate elbow angle, elbow angular velocity, and ball velocity at release. Ball release velocities ranged from 14.5 to 25.8 m/sec, with peak elbow angular velocities averaging 1137 degrees/sec. Peak elbow angular velocity typically was reached just prior (x = 28 msec) to release as the elbow approached full extension. Results are significant in establishing the efficacy of 3D techniques in evaluating throwing mechanics and may prove useful in: identifying characteristics of superior performers, assessing differences in throwing technique between injured and non-injured populations, and providing a kinematic data base for further studies of throwing kinetics and potential injury mechanisms.

Adult

Success strategies for departments of family medicine.

Strong departments of family medicine in academic medical centers help assure the future scope and quality of family practice patient care, the ongoing evolution of family medicine as a scholarly discipline, and a continued flow of qualified medical school graduates into family practice residency programs and eventually into practice. This report presents key strategies of six successful departments of family medicine and describes the methods and skills considered important by the leaders of these departments. Common themes that emerge are (1) recruit and mentor the best faculty, (2) build a reputation for clinical excellence of faculty and residents, (3) become part of schoolwide curriculum activities, (4) establish a scholarly presence, and (5) develop networks of support.

Academic Medical Centers