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Biomedical subjects

M E Wheat

Publications and source records attributed to M E Wheat.

9 recordsLinked to original sources
PubMed2000

Detection, evaluation, and treatment of eating disorders the role of the primary care physician.

OBJECTIVE: To describe how primary care clinicians can detect an eating disorder and identify and manage the associated medical complications. DESIGN: A review of literature from 1994 to 1999 identified by a MEDLINE search on epidemiology, diagnosis, and therapy of eating disorders, including anorexia nervosa and bulimia nervosa. MEASUREMENTS AND MAIN RESULTS: Detection requires awareness of risk factors for, and symptoms and signs of, anorexia nervosa (e.g., participation in activities valuing thinness, family history of an eating disorder, amenorrhea, lanugo hair) and bulimia nervosa (e.g., unsuccessful attempts at weight loss, history of childhood sexual abuse, family history of depression, erosion of tooth enamel from vomiting, partoid gland swelling, and gastroesophageal reflux). Providers must also remain alert for disordered eating in female athletes (the female athlete triad) and disordered eating in diabetics. Treatment requires a multidisciplinary team including a primary care practitioner, nutritionist, and mental health professional. The role of the primary care practitioner is to help determine the need for hospitalization and to manage medical complications (e.g., arrhythmias, refeeding syndrome, osteoporosis, and electrolyte abnormalities such as hypokalemia). CONCLUSION: Primary care providers have an important role in detecting and managing eating disorders.

Anorexia Nervosa↗
PubMed1992

Breast cancer screening for elderly women with and without comorbid conditions. A decision analysis model.

OBJECTIVE: To determine whether breast cancer screening extends life for women aged 65 years or more with and without comorbid medical conditions. SETTING: A provider-patient encounter. DESIGN: A decision analysis of the utility of screening for breast cancer. MEASUREMENTS: Clinical examination and mammography among four groups of women aged 65 to 85 or more years: average health, mild hypertension, congestive heart failure, and average-health black women. The effects of screening were estimated using the best quality data available. RESULTS: Screening saved life at all ages among patients studied. Savings were highest for black women and decreased with increasing age and comorbidity. Screening all average-health women aged 65 or more saved 67,912 years of life. For women who had cancer, screening extended life by 617 days for average-health women between 65 and 69 years of age and 178 days for those aged 85 years or more. Perioperative mortality and test characteristics had little effect on the results. The risks equaled the benefits of screening only when operative mortality was between 27% and 62%. The marginal costs of screening during a routine office visit were $138 and increased with advancing age and decreasing test specificity. Benefits persisted after adjustment for changes in long-term quality of life; however, for women aged 85 years and older (with and without comorbidities), the short-term morbidity of anxiety or discomfort associated with screening may have outweighed the benefits. CONCLUSION: No inherent reason exists to impose an upper-age limit for breast cancer screening; however, more data are needed on women's preferences for screening strategies.

Age Factors↗
PubMed1991

Hypertension in women: what is really known? The Women's Caucus, Working Group on Women's Health of the Society of General Internal Medicine.

PURPOSE: To determine whether there is sufficient information in the medical literature to guide appropriate treatment of hypertensive women. DATA IDENTIFICATION: Epidemiologic surveys of hypertension, clinical trials of antihypertensive therapy, and studies of selected adverse effects of antihypertensive agents were identified through a computerized search using MEDLINE and by identifying all studies cited in current medical textbooks as supporting evidence for the guidelines for the treatment of hypertensive individuals. All epidemiologic studies selected were cross-sectional or longitudinal, multicenter, population-based surveys. All clinical trials were large, randomized studies comparing one or more antihypertensive agents with a placebo or nonplacebo control group. Epidemiologic studies and clinical trials were reviewed to assess the quantity and quality of information available regarding important aspects of hypertension in women. Data pertaining to epidemiology, natural history, results of treatment, and two significant side effects of antihypertensive treatment were examined. RESULTS OF DATA ANALYSIS: The prevalence of hypertension is greater in black women than in black men and is about equal in white women and men. Because women outnumber men in the population, there are more hypertensive women than men. The attributable risk percent (the proportion of end points that could be eliminated by removing hypertension) for cardiovascular complications of hypertension is higher for women than men. Clinical trials show clear benefit of therapy for black women but no clear benefit for white women; some studies suggest that treatment of white women is harmful. Lipid profiles and their relation to ischemic heart disease differ for women and men; there is currently no information on the effects of antihypertensive agents on serum lipids in women. Few data have been published on the frequency of sexual dysfunction in treated hypertensive women. CONCLUSIONS: Hypertension in women and its related cardiovascular outcomes are a major public health problem. Clinical trials of antihypertensive therapy do not fully support current guidelines for the treatment of hypertensive women. Research concerning adverse effects of antihypertensive agents has largely excluded women from consideration; further studies are required to guide appropriate treatment.

Black or African American↗
PubMed1988

Recovery of function after hip fracture. The role of social supports.

Previous studies have found that social support may reduce mortality after myocardial infarction and reduce overall mortality among the elderly. To determine whether social support also influences the recovery of function among patients who have had hip fractures and to describe other potential predictors of recovery after hip fracture, 111 patients with hip fractures were interviewed and examined before discharge from the hospital. The functional status of surviving patients was assessed again 6 months later. Patients who had a greater number of social supports had more complete recovery of their prefracture level of function (r = .21; P = .04). This association was strongest for patients over 60 years old (r = .31; P = .006); among these patients, this association remained statistically significant after adjustment for other significant (P less than .05) predictors of recovery: arm strength, mental status, and serum albumin. Additional studies should be done to test whether interventions to increase social supports can improve the recovery of function among elderly patients with hip fractures and other illnesses. In the meantime, health professionals should counsel elderly patients about the potential rehabilitative and preventive benefits of social supports.

Activities of Daily Living↗
PubMed1988

Pap smear screening in women 65 and older.

Pap smear screening in women 65 years of age and older is controversial. To assess the need to offer screening in this group, we examined Pap results of women 65 and older whose charts were reviewed as part of a cancer screening study in two San Francisco hospitals. Two hundred thirty women (41%) were 65 years of age or older (mean age, 73). Compared with younger women, they were less likely to have had a Pap smear during the past 3 years (61% versus 72%), less likely to have seen a gynecologist (24% versus 34%), and were more likely to have refused Pap screening (11% versus 5%). Of the 140 women who had Paps, five showed atypia (class II). None exhibited dysplasia or carcinoma in situ. Those with atypia were all nonwhite. One had had a hysterectomy; two had a history of previously abnormal Paps. Overall, women with a history of abnormal Paps were far more likely to be screened (91% versus 58%). Those who had had a hysterectomy were significantly less likely to be screened (51% versus 68%). These results showed a low rate of cervical dysplasia/carcinoma in older, low-income women. Although our sample was small, the low rate of abnormals may reflect the relatively high rate of prior screening in this population. Because older women are not likely to see gynecologists, primary care physicians should continue Pap screening in older women (including those with a history of hysterectomy) until a history of repeated, technically adequate, normal Pap smears is documented.

Age Factors↗
PubMed1983

Aspects of medical care of Soviet Jewish Emigrés.

Soviet Jewish emigrés are a recently arrived refugee group in San Francisco and in other cities in the United States. They have frequently been perceived as a demanding and complaining population, particularly the elderly, often chronically ill members. These behaviors can also be seen as positive survival mechanisms that have evolved in response to the Soviet health care system and cultural background. An understanding of that background and system, together with time, greatly improves the interaction between Soviet Jewish patients and American physicians.

Aged↗
PubMedDate not supplied

Cancer screening in women: a study of house staff behavior.

To explore physician, patient, and provider factors associated with house staff performance of cancer screening in women, we reviewed 565 randomly selected charts of 58 medical residents in two San Francisco teaching hospitals, H1 and H2. We assessed performance of Pap smear, breast exam, mammography, rectal exam, and stool occult blood testing, and administered questionnaires to all residents to ascertain screening beliefs and attitudes and individual screening criteria. The main finding was a significant difference in screening between the two hospitals. Four of five tests (Pap smear, breast exam, mammography, rectal exam) were performed more frequently at H2. Neither provider nor patient factors could explain this. Organizational differences between the sites included more frequent flow sheet recommendations for mammography and rectal exams at H2. Increased gynecological referral at H2 was also associated with more frequent Pap smears, breast exams, and rectal exams. White women did receive more frequent rectal exams, and mammography was increased among those who agreed with American Cancer Society screening recommendations, but no other provider or patient characteristics were associated with difference in screening. Results of further study of the effect of the learning environment and referral strategies on cancer screening, including assessment of patient acceptability and cost, can be used to improve cancer screening behaviors of medical house staff.

Adult↗
PubMedDate not supplied

Preventing HIV transmission: behavior and attitudes of medical house staff in a high-prevalence area.

Our objective was to evaluate human immunodeficiency virus (HIV) risk-factor assessment and counseling behavior in 86 medical house staff and to ascertain the effect of question format (closed versus open) on reported physician behaviors. We designed a cross-sectional survey using a self-report questionnaire; we received 78 returns of 86 questionnaires (91% response) from one-year and three-year medical housestaff at two general medical clinics in a university-affiliated Bronx municipal hospital. House staff reported assessing sexual behavior (51%) and intravenous drug use (81%) in new patients significantly less often than they assessed smoking (95%) or alcohol use (94%). Counseling to reduce the risk of HIV transmission among all patients occurred even less frequently (41%, all P < .05). Question format (closed versus open) significantly affected response rate; respondents to closed-format questions reported far more behaviors performed. Intravenous drug users (IVDUs) received more frequent advice than general clinic patients about reducing HIV transmission (85% versus 41%), but house staff may ignore sexual risks in IVDUs. Resident confidence that IVDUs would change sexual or drug risk behavior was equally low, 1.5 on a 4-point scale. They reported greater discomfort discussing sexuality than drug use (2.4 versus 1.7; 4-point scale, P = .003). Discomfort discussing sexuality inversely associated with sexual history-taking in multi-variate analysis. Greater involvement with HIV positive patients and fewer perceived barriers to counseling were also associated with more assessment or counseling about risks for HIV transmission. These results suggest that enhancing house staff assessment and counseling efforts to reduce risks for HIV transmission requires interventions that foster involvement with HIV positive patients, emphasize the importance of sexual transmission in IVDUs, facilitate competence in discussing sexual behavior, and address provider belief that IVDUs will not change risk behaviors. Results also demonstrate a significant effect of question format on reported physician behavior.

Attitude of Health Personnel↗