Literature and the arts in medical education.
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Attitude↗
Biomedical subjects
J Shapiro
Publications and source records attributed to J Shapiro.
DPCP for the treatment of alopecia areata.
Topical immunotherapy with diphencyprone (DPCP) for the treatment of severe alopecia areata has been used since 1983 and is felt to be the treatment of choice by many dermatologists. Although there have been no major side effects reported since its initial use, there remain some unknowns regarding its safety. Because DPCP has at least a 40% success rate for cosmetically acceptable regrowth in extensive alopecia areata, its availability is an important matter for patients with alopecia areata.
Administration, Topical↗
Practical management of hair loss.
OBJECTIVE: To describe an organized diagnostic approach for both nonscarring and scarring alopecias to help family physicians establish an accurate in-office diagnosis. To explain when ancillary laboratory workup is necessary to confirm the diagnosis. QUALITY OF EVIDENCE: Current diagnostic and therapeutic interventions for hair loss are based on randomized controlled studies, uncontrolled studies, and case series. MEDLINE was searched from January 1966 to December 1998 with the MeSH words alopecia, hair, and alopecia areata. Articles were selected on the basis of experimental design, with priority given to the most current large multicentre controlled studies. Overall global evidence for therapeutic intervention for hair loss is quite strong. MAIN MESSAGE: The most common forms of nonscarring alopecias are androgenic alopecia, telogen effluvium, and alopecia areata. Other disorders include trichotillomania, traction alopecia, tinea capitis, and hair shaft abnormalities. Scarring alopecia is caused by trauma, infections, discoid lupus erythematosus, or lichen planus. Key to establishing an accurate diagnosis is a detailed history, including medication use, systemic illnesses, endocrine dysfunction, hair-care practices, and family history. All hair-bearing sites should be examined. A 4-mm punch biopsy of the scalp is useful, particularly to diagnose scarring alopecias. Once a diagnosis has been established, specific therapy can be initiated. CONCLUSIONS: Diagnosis and management of hair loss is an interesting challenge for family physicians. An organized approach to recognizing characteristic differential features of hair loss disorders is key to diagnosis and management.
Adult↗
National evaluation of general practitioner commissioning pilots: lessons for primary care groups.
BACKGROUND: The national evaluation of general practitioner (GP) commissioning pilots was commissioned by the Department of Health in 1997 as part of its Policy Research Programme. It was conducted by the Health Services Management Centre at the University of Birmingham. AIM: To monitor the development of the 40 national pilot sites, identify the factors that inhibited or facilitated progress, and consider the implications for the implementation and development of primary care groups (PCGs). METHOD: Semi-structured face-to-face interviews with GPs, health authority (HA) managers, and pilot managers from each of the 40 pilot sites (141 interviews in total) and focus group discussions with nurses, social services officers, and community health council officers in the 40 sites. RESULTS: Stakeholders reported the key achievements of the pilots during their first six months as being improved collaboration between GPs, the establishment of organisational arrangements, and work towards managing the group prescribing budget. Obstacles for the groups included changes to government policy regarding primary care, the workload involved for clinical staff, the pilots' relationship with the local HA, and problems with information management and technology (IM&T). A more detailed analysis of the pilots' management arrangements, prescribing work, IM&T support, and stakeholder involvement points to a set of lessons for emerging PCGs. CONCLUSIONS: In their early stages of development, PCGs are likely to focus on issues of structure and process. Prescribing will be an area receiving particular attention, prefiguring some of the challenges of clinical governance in primary care. IM&T will prove to be more problematic than first assumed. The involvement of a wider range of stakeholders will be addressed by primary care groups, particularly in relation to GPs and nurses.
England↗
Primary care groups. Lending a hand.
High-quality, dedicated management support was crucial to the GP commissioning pilots. A fifth of the pilots reported difficult relationships with their health authority. There are concerns about bringing prescribing 'outliers' into line. Involving the public will be a considerable challenge for PCGs.
Community Health Planning↗
Alopecia areata investigational assessment guidelines. National Alopecia Areata Foundation.
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Alopecia Areata↗
Generational differences in psychosocial adaptation and predictors of psychological distress in a population of recent Vietnamese immigrants.
While first-wave Vietnamese immigrants adapted well to life in the United States, subsequent immigrants have had greater adjustment difficulties, including more evidence of psychological distress. This study aimed to analyze psychosocial adaptation differences among three generations of recent Vietnamese immigrants, as well as to examine predictors of mental distress in the sample as a whole. A community sample of 184 recent Vietnamese immigrants, categorized as either elderly, middle-aged, or young adults, was assessed for levels of psychological distress, including depression, anxiety, and PTSD, as well as family conflict, dissatisfaction with life in the U.S., acculturation and biculturalism, social support, coping, and premigratory stressors. Young Vietnamese adults were most acculturated, most bicultural, and reported themselves as healthiest and least depressed. They were most often working, least often on welfare, and had the highest family income. However, they also reported most dissatisfaction with their current lives in the U.S. and most family conflict. Regression analysis explaining approximately one-quarter of the variance in mental distress implicated current dissatisfaction with and lack of adjustment of life in the United States, as well as greater acculturation and increased family conflict. Although young adults scored significantly higher than other generations on most of the risk factors for psychological distress, they appeared to be buffered against poorer mental health outcomes by factors of generation and perceived positive overall well-being. In terms of testing a predictive model of psychological distress, this study found current adjustment factors significantly more important in determining mental health outcomes than premigratory stressors such as war-related traumas.
Acculturation↗
Sexual behavior and AIDS-related knowledge among community college students in Orange County, California.
Whereas college students are not identified as a high-risk group for acquiring the HIV infection, they exhibit high-risk behaviors consistent with their age group, including multiple sexual partners and high rates of unprotected intercourse. This study was conducted to determine levels of HIV-related sexual behavior, along with knowledge and attitudes among students attending community colleges in a relatively affluent multiethnic community. This study used a random sample survey (N = 319) of students attending selected classes at four community colleges in Orange County, California, to assess HIV/AIDS knowledge, attitudes, and patterns of past and present sexual behavior. The level of student knowledge concerning HIV disease was found to be relatively high, and pronounced differences in knowledge and sexual permissiveness were identified as a function of ethnicity and religion, with Asians showing lower knowledge and lower concern about HIV, and religion/religiosity related to these variables and also to levels of sexual permissiveness. Respondents' comfort in asking a partner about his/her sexual history was positively associated with their level of self-esteem, and negatively related to peer pressure in this population. As in previous studies of college populations, HIV knowledge per se does not confer a protective effect against high-risk behavior. However, knowledge was found to be an enabling factor with regard to students' comfort levels in asking about their partner's sexual histories, and in requesting that partners take an AIDS test.
Acquired Immunodeficiency Syndrome↗
Alopecia areata-like hair loss in C3H/HeJ mice and DEBR rats can be reversed using topical diphencyprone.
This study demonstrates the ability to treat successfully alopecia areata-like hair loss in both mouse and rat models using topical immunotherapy with diphencyprone.
Administration, Topical↗
Alopecia areata: diagnosis and management.
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Alopecia Areata↗
The scalp biopsy: making it more efficient.
BACKGROUND: The scalp biopsy plays an important role in diagnosis and subsequent management of many scalp disorders. This simple diagnostic procedure can be time-consuming and frustrating for most dermatologists. OBJECTIVE: To outline an efficient technique for performing a scalp biopsy. METHODS: The technique of performing a scalp biopsy is reviewed and suggestions are made to make this time-consuming procedure more efficient. RESULTS: Sufficient specimen for histopathologic evaluation in a short perid of time is obtained. CONCLUSION: Attention to specific details in performing a scalp biopsy allows the physician to obtain a quick and histopathologically informative scalp biopsy.
Biopsy↗
Willingness to treat HIV-positive patients at different stages of medical education and experience.
The willingness of physicians to provide care to HIV-positive patients has been linked to a number of attitudinal factors, but little is known concerning the impact of premedical, medical, and residency training on these factors. The purpose of this study is to elicit responses to the same series of questions concerning HIV and its treatment from respondents at different stages of training, to detect trends in attitudes and to measure the impact of those attitudes on willingness to provide care for HIV/AIDS patients. Study data come from a cross-sectional survey (n = 249) of respondents across the training continuum, from premedical students to faculty physicians, using a self-administered questionnaire at a single medical school. The response rate was 59.6%. The study showed significant decreases in personal fear and misgivings concerning HIV, coupled with a substantial decrease in the perceived need for testing of non-high-risk individuals, as respondents gained additional education and training. Overall, the intent to treat HIV did not change significantly by training level, but multivariate analyses showed that while the initially strong influence of attitudes toward AIDS and its attendant risks diminishes, comfort relative to being around homosexuals per se continues to exert an impact on the intent to treat. Appropriate use of protective measures when providing care becomes far more common once individuals enter their clinical training years. The impact of medical education through its entire continuum therefore shows a positive impact on attitudes toward HIV, despite the absence of a significant trend in respondents' stated intent to treat. However, negative attitudes toward homosexuals continue to exert a negative influence on intent to treat that endures into the clinical training years.
Attitude of Health Personnel↗
Demographic and attitudinal variables related to high-risk behaviors in Asian males who have sex with other men.
Although AIDS is spreading rapidly in minority communities, little is known about attitudes, knowledge, and behavior related to AIDS and HIV in the Asian community. The purpose of this study was to examine these variables in a sample of gay Asian males, as well as to investigate the relationship between knowledge, sources of information, culturally influenced attitudes and high-risk behaviors in this population. Results from a sample of 60 young Asian men who self-identified as "having sex with other men" indicated they were generally knowledgeable about methods of transmission and prevention, and appeared linked to a large information network that included informal sources such as peers and formal sources. However, significant percentages held culturally biased views of AIDS, such as believing race of partner or one's own gender role in the sexual encounter determined level of risk; and one third of the sample did not use condoms regularly. Having been tested for HIV was associated with holding less traditional cultural beliefs and a higher sexual activity level. Open communication about safer sexual practices was associated with monogamous as opposed to multiple relationships and with decreased tendency to engage in alcohol-related unprotected sex. Variance in overall risk was predicted by demographic variables such as education, age, and level of sexual activity, rather than by the attitudinal factors measured. Limitations of this exploratory study include a time-limited subject recruitment period and consequent small sample size, a homogeneous sample weighted toward young, well-educated, and middle-class respondents, and the exclusion of non-English speaking individuals. Nevertheless, study findings suggest that educational outreach targeting Asians who have sex with other men needs to address inaccurate cultural beliefs about HIV/AIDS, emphasize consistent condom use, and encourage models of open communication with partners about safer sexual practices.
Adolescent↗
Correlates of family-oriented physician communications.
BACKGROUND: Family orientation in patient care has long been one of the primary tenets of the practice of family medicine. Yet we know surprisingly little about how frequently family-oriented transactions occur in actual doctor-patient encounters, or about what other aspects of physician communication patterns might be associated with increased family orientation. The purpose of this study was to investigate both frequency and correlates of family orientation in a residency-based practice. METHODS: Sixty videotapes representing 38 second and third-year residents interviewing a range of multiethnic patients over a 2-year period at a community clinic were analysed for evidence of family-oriented communications, as well as other interaction behaviours such as information exchange and partnership building. Inter-rater agreement was 78%. RESULTS: Asking for medical information, clarifying patient information, and giving medical information and explanations were the most common types of resident actions. Family orientation was much less common, but was more frequently observed than the eliciting of a patient-centered agenda or suggestion of a psychosocial intervention or referral. Family orientation was associated with longer interviews, non-interpreted interviews, more physician questions and clarifying behaviours, and greater tendency to elicit the patient's agenda. CONCLUSIONS: Findings of this investigation suggest that family orientation in the medical interview is enhanced by having more time and a shared language, as well as a generally probing, clarifying, patient-centered style on the part of the physician.
Adult↗
Benchmarking radiation protection programs.
Results are presented of a modest benchmarking project with eight institutions as part of a program review. Four of the institutions had programs with both research and clinical components. Metrics were derived from the data acquired. They included Registered Users per total Technical Staff (mean 284, SD 42%); Principal Investigators per Senior IP staff (mean 68.7, SD 49.6%); and Principal Investigators per HP staff (mean 44.7, SD 34.4%). Reasons for the differences among institutions were identified. The benchmarking exercise was an effective tool in providing guidance in setting staffing levels.
Benchmarking↗
Testosterone and other anabolic steroids as cardiovascular drugs.
There has been much interest in the effect of sex hormones on cardiovascular risk factors and as a therapeutic modality in both men and women. In this article, testosterone is considered as a possible therapy for cardiovascular disease. It has been shown that the level of serum testosterone decreases in men as they age. Healthy men with low testosterone levels have increased cardiovascular risk factors, including high fasting and 2-hour plasma glucose, serum triglycerides, total cholesterol and low-density lipoprotein (LDL) cholesterol, and apo A-I lipoprotein. Injections of testosterone to raise the levels to midnormal range have been shown to decrease total cholesterol and LDL cholesterol, while increasing high-density lipoprotein (HDL) cholesterol. Testosterone affects the clotting system by increasing thromboxane A (2) receptor activity and platelet aggregability. Testosterone has also been shown to augment the fibrinolytic system and antithrombin III activity. In men, testosterone has been shown to have antianginal effects, and endogenous levels have an inverse relationship to systolic blood pressure. Testosterone can be given in oral, injectable, pellet, and transdermal patch forms. There may be a role in administering testosterone to return men to normal physiologic range who have low serum levels. This treatment increases the risk of prostatic cancer, benign prostatism, erythrocytosis, and edema. No long-term studies of the effects of long-term testosterone replacement have been undertaken, so it is difficult to recommend this treatment as yet, but it is being considered as a therapy for augmenting skeletal muscle strength in patients with congestive heart failure.
Anabolic Agents↗
Practical management of alopecia areata and outlook for the future.
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Alopecia↗