Class struggles in the tubercular world: nurses, patients, and physicians, 1903-1915.
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Community Health Nursing↗
Biomedical subjects
J M Robbins
Publications and source records attributed to J M Robbins.
Patient referrals to a multispecialty asthma clinic. Asthma Care Center Clinical Consortium.
A total of 656 patients with asthma have been referred to a multispecialty pediatric asthma clinic for evaluation; 52 (7.9%): mild; 406 (61.9%): moderate; 177 (27%): severe; and 21 (3.2%): incomplete data. No significant differences in demographics or payer source were observed across disease severity levels. Only 25% of the patients with primary care providers were referred by these practitioners. Over 20% of the mild asthmatics were using inhaled bronchodilators regularly. Only 40% and 50% of the moderate and severe asthmatics, respectively, were using inhaled bronchodilators regularly, and only 19% and 36%, respectively, were on maintenance inhaled corticosteroids. Pressures to reduce subspecialty services may place some of these asthma patients at increased risk for complications from this chronic lung disease.
Administration, Inhalation↗
Social and economic consequences of rural alcohol use.
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Alcoholism↗
Long-term aftercare and prevention of further amputation.
This article discusses the recently instituted PACT (Prevention Amputation Care and Treatment) program now being used at the Cleveland Veterans Affairs Medical Center. This program is a multidisciplinary interventional prevention strategy that includes both physical and psychosocial components, addressing the long-term after-care for patients postamputation and preventive interventions for those at risk.
Aftercare↗
Patients who somatize in primary care: a longitudinal study of cognitive and social characteristics.
We examined the cognitive and sociodemographic characteristics of patients making somatic presentations of depression and anxiety in primary care. Only 15% of patients with depressive symptomatology on self-report, and only 21% of patients with current major depression or anxiety disorders on diagnostic interview, presented psychosocial symptoms to their GP. The remainder of patients with psychiatric distress presented exclusively somatic symptoms and were divided into three groups-initial, facultative and true somatizers-based on their willingness to offer or endorse a psychosocial cause for their symptoms. Somatizers did not differ markedly from psychologizers in sociodemographic characteristics except for a greater proportion of men among the true somatizers. Compared to psychologizers, somatizers reported lower levels of psychological distress, less introspectiveness and less worry about having an emotional problem. Somatizers were also less likely to attribute common somatic symptoms to psychological causes and more likely to endorse normalizing causes. In the 12 months following their initial visit, somatizers made less use of speciality mental health care and were less likely to present emotional problems to their GP. Somatizers were markedly less likely to talk about personal problems to their GP and reported themselves less likely to seek help for anxiety or sadness. Somatization represents a persistent pattern of illness behaviour in which mental health care is not sought despite easily elicited evidence of emotional distress. Somatization is not, however, associated with higher levels of medical health care utilization than that found among patients with frank depression or anxiety.
Adolescent↗
Transient and persistent hypochondriacal worry in primary care.
We present a 12-month prospective study of hypochondriacal worry in primary care. Data were obtained from 546 family medicine patients at the time of a physician visit for a new illness and again 1 year later. Patients were divided into four groups based on scores on the Illness Worry Scale: non-hypochondriacal (N = 460), transient hypochondriacal (N = 34); emerging hypochondriacal (N = 21); and persistent hypochondriacal (N = 31). Persistent patients had significantly more serious medical history but no more serious current illness than those low on illness worry. Patients with persistent illness worry were more likely than others to have a diagnosis of major depression or anxiety disorder, were more likely to believe that their most important significant other would pathologize new symptoms, yet were less likely to have been encouraged to see the doctor by them. Patients who became less worried over the year reported corresponding decreases in distress, attentiveness to bodily sensations, emotional vulnerability and pathological symptom attributions. We conclude that depressive or anxiety disorders, fears of emotional instability, pathological symptom attributional styles and interpersonal vulnerability provide the best prognostic evidence for enduring illness worry.
Adolescent↗
Both in vitro and in vivo irradiation are associated with induction of macrophage-derived fibroblast growth factors.
Fibrosis in the lung directly underlying the field of irradiation is an almost universal long term sequelae of thoracic irradiation. It is assumed to represent the consequence of direct damage to local tissues and/or vascular endothelium by ionizing radiation. This view, however, is not in keeping with our current understanding of fibrotic processes, which suggest that growth factors for fibroblasts (including platelet-derived growth factor (PDGF), insulin-like growth factor I (IGF-I)) and cytokines stimulating collagen synthesis (notably transforming growth factor-beta) are largely responsible for this process. Since a major source of these factors is the macrophage, present in large numbers within the lung, it appeared possible that radiation-induced fibrosis might be mediated by similar mechanisms. Therefore, a study was designed to determine, first, whether in vitro irradiation of mononuclear phagocytes could induce the release of growth factors for fibroblasts. Second, we wished to ascertain whether these same growth factors might also be secreted by bronchoalveolar cells from humans who had undergone in vivo thoracic irradiation. The results of this study indicate that irradiation of a number of different types of mononuclear phagocytes resulted in the dose-dependent synthesis and release of several growth factors for fibroblasts, including PDGF, tumour factor-alpha (TNF-alpha) and IGF-I. Further, cells obtained by bronchoalveolar lavage from patients undergoing thoracic radiation spontaneously released PDGF following irradiation. These findings strongly support the contention that synthesis and release of macrophage-derived growth factors for fibroblasts (particularly PDGF and IGF-I) occur after thoracic irradiation and play a significant role in the pathogenesis of irradiation-induced pulmonary fibrosis in humans.
Breast Neoplasms↗
"Stand down for the homeless". Podiatric screening of a homeless population in Cleveland.
Health care for the homeless is a major public health concern. With the rise in antibiotic-resistant tuberculosis, the increase of human immunodeficiency virus (HIV) diseases, and other health risks, the medical community has begun to recognize the urgency of taking a proactive role in providing care for this population. Lower extremity pathology can result in limb-threatening and, in some cases, life-threatening sequelae for homeless populations. This patient group has limited access to regular hygiene, appropriate shoes, and podiatric medical care. Participation in the "Stand Down for the Homeless" projects provided an opportunity to evaluate the podiatric needs of a homeless population and to project a response to those needs. The authors define and compare this homeless population with the national homeless population, compare the podiatric needs of this homeless populations versus the general population, and respond to those needs.
Adolescent↗
Rewards of entering podiatric medicine and attitudes toward older adults.
This study examined the relationships between social and demographic characteristics (ie, gender, race, year in school, desired residency choice, and socioeconomic background), motivations for entering the profession of podiatric medicine (extrinsic and intrinsic rewards), and negative attitudes toward treating elderly patients. The study used ordinary least squares multiple regression models to analyze data from a random, national sample of 448 podiatric medical students. In particular, the ordinary least squares models were developed to determine the independent effect of intrinsic and extrinsic rewards on negative attitudes toward treating elderly patients. Consistent with the study hypotheses, after adjusting for social and demographic characteristics, the study found extrinsic rewards to have strong positive relationships with negative attitudes toward treating elderly patients, and intrinsic rewards to have strong negative relationships with negative attitudes toward treating elderly patients. The authors discussed the implications of the findings for podiatric physicians and educators training podiatric medical students.
Aged↗
Physicians' beliefs and behaviour during a randomized controlled trial of episiotomy: consequences for women in their care.
OBJECTIVE: To evaluate whether physicians' beliefs concerning episiotomy are related to their use of procedures and to differential outcomes in childbirth. DESIGN: Post-hoc cohort analysis of physicians and patients involved in a randomized controlled trial of episiotomy. SETTING: Two tertiary care hospitals and one community hospital in Montreal. PARTICIPANTS: Of the 703 women at low risk of medical or obstetric problems enrolled in the trial we studied 447 women (226 primiparous and 221 multiparous) attended by 43 physicians. Subjects attended by residents or nurses were excluded. MAIN OUTCOME MEASURES PATIENTS: intact perineum v. perineal trauma, length of labour, procedures used (instrumental delivery, oxytocin augmentation of labour, cesarean section and episiotomy), position for birth, rate of and reasons for not assigning women to a study arm, postpartum perineal pain and satisfaction with the birth experience, physicians: beliefs concerning episiotomy. RESULTS: Women attended by physicians who viewed episiotomy very unfavorably were more likely than women attended by the other physicians to have an intact perineum (23% v. 11% to 13%, p < 0.05) and to experience less perineal trauma. The first stage of labour was 2.3 to 3.5 hours shorter for women attended by physicians who viewed episiotomy favourably than for women attended by physicians who viewed episiotomy very unfavorably (p < 0.05 to < 0.01), and the former physicians were more likely to use oxytocin augmentation of labour. Physicians who viewed episiotomy more favourably failed more often than those who viewed the procedure very unfavourably to assign patients to a study arm late in labour (odds ratio [OR] 1.88, p < 0.05), both overall and because they felt that "fetal distress" or cesarean section necessitated exclusion of the subject. They used the lithotomy position for birth more often (OR 3.94 to 4.55, p < 0.001), had difficulty limiting episiotomy in the restricted-use arm of the trial and diagnosed fetal distress and perineal inadequacy more often than the comparison groups. The patients of physicians who viewed episiotomy very favourably experienced more perineal pain (p < 0.01), and of those who viewed episiotomy favourably and very favourably experienced less satisfaction with the birth experience (p < 0.01) than the patients of physicians who viewed the procedure very unfavourably. CONCLUSIONS: Physicians with favourably views of episiotomy were more likely to use techniques to expedite labour, and their patients were more likely to have perineal trauma and to be less satisfied with the birth experience. This evidence that physician beliefs can influence patient outcomes has both clinical and research implications.
Adult↗
Relationship of episiotomy to perineal trauma and morbidity, sexual dysfunction, and pelvic floor relaxation.
OBJECTIVE: Our purpose was to compare consequences for women of receiving versus not receiving median episiotomy early and 3 months post partum on the outcomes perineal pain, urinary and pelvic floor functioning by electromyography, and sexual functioning and to analyze the relationship between episiotomy and third- and fourth-degree tears. STUDY DESIGN: A secondary cohort analysis was performed of participants within a randomized clinical trial, analyzed by type of perineal trauma and pain, pelvic floor, and sexual consequences of such trauma, while controlling for trial arm. The study was conducted in three university or community hospitals; 356 primiparous and 341 multiparous women were studied. RESULTS: Early and 3-month-postpartum perineal pain was least for women who gave birth with an intact perineum. Spontaneous perineal tears were less painful than episiotomy. Sexual functioning was best for women with an intact perineum or perineal tears. Postpartum urinary and pelvic floor symptoms were similar in all perineal groups. At 3 months post partum those delivered with an intact perineum had the strongest pelvic floor musculature, those with episiotomy the weakest. Among primiparous women third- and fourth-degree tears were associated with median episiotomy (46/47). After forceps births were removed and 21 other variables potentially associated within such tears were controlled for, episiotomy was strongly associated with third- and fourth-degree tears (odds ratio +22.08, 95% confidence interval 2.84 to 171.53). Physicians using episiotomy at high rates also used other procedures, including cesarean section, more frequently. CONCLUSION: Perineal and pelvic floor morbidity was greatest among women receiving median episiotomy versus those remaining intact or sustaining spontaneous perineal tears. Median episiotomy was causally related to third- and fourth-degree tears. Those using episiotomy at the highest rates were more likely use other interventions as well. Episiotomy use should be restricted to specified fetal-maternal indications.
Adolescent↗
Somatoform disorders: personality and the social matrix of somatic distress.
Personality traits that may contribute to somatization are reviewed. Negative affectivity is associated with high levels of both somatic and emotional distress. Agreeableness and conscientiousness may influence interactions with health care providers that lead to the failure of medical reassurance to reduce distress. Absorption may make individuals more liable to focus attention on symptoms and more vulnerable to suggestions that induce illness anxiety. More proximate influences on the selective amplification of somatic symptoms include repressive style, somatic attributional style, and alexithymia; however, data in support of these factors are scant. Most research on somatoform disorders confounds mechanisms of symptom production with factors that influence help seeking. Longitudinal community studies are needed to explore the interactions of personality with illness experience and the stigmatization of medically unexplained symptoms.
Adaptation, Psychological↗
Physician characteristics and the recognition of depression and anxiety in primary care.
We examined physician characteristics associated with the recognition of depression and anxiety in primary care. Fifty-five physicians treating a total of 600 patients completed measures of psychosocial orientation, psychological mindedness, self-rating of sensitivity to hidden emotions, and a video test of sensitivity to nonverbal communication. Patients were classified as cases of psychiatric distress based on the CES-D scale and the Diagnostic Interview Schedule. Physician recognition was determined by notation of any psychosocial diagnosis in the medical charts over the ensuing 12 months. Of 192 patients scoring 16 or above on the CES-D, 44% (83) were recognized as psychiatrically distressed. Three findings were central to this study: 1) Physicians who are more sensitive to nonverbal expressions of emotion made more psychiatric or psychosocial assessment of their patients and appeared to be over-inclusive in their judgments of psychosocial problems; 2) Physicians who tended to blame depressed patients for causing, exaggerating, or prolonging their depression made fewer psychosocial assessments and were less accurate in detecting psychiatric distress; 3) False positive labeling of patients who had no evidence of psychiatric distress was rare. Surprisingly, more severe medical illness increased the likelihood of labeling and accurate recognition. Physician factors that increased recognition may indicate a greater willingness to formulate a psychiatric diagnosis and an ability notice nonverbal signs of distress.
Adult↗
Symptom attribution in cultural perspective.
The explanatory model perspective of medical anthropology emphasizes the cultural shaping of individuals' efforts to make sense of their symptoms and suffering. Causal attribution is a pivotal cognitive process in this personal and social construction of meaning. Cultural variations in symptom attribution affect the pathogenesis, course, clinical presentation and outcome of psychiatric disorders. Research suggests that styles of attribution for common somatic symptoms may influence patients' tendency to somatize or psychologize psychiatric disorders in primary care. At the same time, symptom attributions are used to negotiate the sociomoral implications of illness. Recent work in social psychology and medical anthropology emphasizes the roots of attributional processes in bodily and social processes that are highly context-dependent, and hence, must be understood as part of the construction of a local world of meaning. Symptom attributions then may be understood as forms of positioning with both cognitive and social consequences relevant to psychiatric assessment and intervention.
Anthropology, Cultural↗
Podiatric medical considerations in dealing with elder abuse.
The geriatric population is expanding at a rapid rate. With greater numbers of elderly patient visits to the podiatric medical office, the likelihood of difficult psychosocial problems increases. Elder abuse is potentially a serious health risk and the need for the podiatric physician to identify and report elder abuse is a professional and, in many cases, a legal responsibility. The authors identify the signs and symptoms of elder abuse and methods to address this difficult and perplexing problem.
Aged↗
Podiatric medical students' views toward geriatrics and elderly patients. A preliminary study.
This study examines podiatric medical students' perceptions toward podiatric medicine, their impressions of their geriatric training, and their attitudes toward treating elderly patients. A questionnaire was distributed to a random sample of 240 podiatric medical students at the Ohio College of Podiatric Medicine. The survey response rate was 57.1%. In general, the podiatric medical students were satisfied with their geriatric training; however, they believed that more geriatric training is needed. Podiatric medical students who entered podiatric medicine for intrinsic reasons, who visited their grandparents frequently, and who had close relationships with them while growing up, had favorable impressions toward geriatric patients. Furthermore, those who have had good geriatric instruction are more likely to have favorable impressions of geriatric patients.
Aged↗
Somatization and the recognition of depression and anxiety in primary care.
OBJECTIVE: The authors examined the effect of patients' style of clinical presentation on primary care physicians' recognition of depression and anxiety. METHOD: The subjects were 685 patients attending family medicine clinics on self-initiated visits. They completed structured interviews assessing presenting complaints, self-report measures of symptoms and hypochondriacal worry, the Diagnostic Interview Schedule (DIS), and the Center for Epidemiologic Studies Depression Scale (CES-D). Physician recognition was determined by notation of any psychiatric condition in the medical chart over the ensuing 12 months. RESULTS: The authors identified three progressively more persistent forms of somatic presentations, labeled "initial," "facultative," and "true" somatization. Of 215 patients with CES-D scores of 16 or higher, 80% made somatized presentations; of 75 patients with DIS-diagnosed major depression or anxiety disorder, 76% made somatic presentations. Among patients with DIS major depression or anxiety disorder, somatization reduced physician recognition from 77%, for psychosocial presenters, to 22%, for true somatizers. The same pattern was found for patients with high CES-D scores. In logistic regression models education, seriousness of concurrent medical illness, hypochondriacal worry, and number of lifetime medically unexplained symptoms each increased the likelihood of recognition, while somatized presentations decreased the rate of recognition. CONCLUSIONS: While physician recognition of psychiatric distress in primary care varied widely with different criteria for recognition, the same pattern of reduction of recognition with increasing level of somatization was found for all criteria. In contrast, hypochondriacal worry and medically unexplained somatic symptoms increased the rate of recognition.
Adolescent↗
[Does episiotomy prevent perineal trauma and pelvic floor relaxation?].
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Adult↗