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Biomedical subjects

Peter J Carek

Publications and source records attributed to Peter J Carek.

17 recordsLinked to original sources
PubMed2004

The combined effect of transferrin saturation and low density lipoprotein on mortality.

BACKGROUND AND OBJECTIVES: Evidence suggests that cardiovascular disease (CVD) is accelerated by the oxidation of low-density lipoprotein (LDL) in the presence of iron. This study examined whether adults with elevated iron, as measured by transferrin saturation (TS), and elevated LDL are at an increased risk for mortality. METHODS: This is a cohort study of the adult US population using the National Health and Nutrition Examination Survey 1976-1980 (NHANES II) merged with the NHANES II Mortality Study in 1992. Multivariate Cox regression was performed to determine hazard ratios (HR) for CVD and all-cause mortality for high (>55%) or low (<55%) levels of TS and high (>160 mg/dl) or low (<160 mg/dl) levels of LDL. RESULTS: An elevated LDL alone did not significantly increase CVD mortality or all-cause mortality in the adjusted model. Individuals with elevated LDL and elevated TS had a statistically significant increase in both CVD mortality and all-cause mortality (HR=5.74 and 3.53, respectively) compared to the low LDL and low TS group. CONCLUSIONS: The results of this study indicate an increased risk associated with the combination of elevated LDL and elevated TS, which suggests that iron-mediated oxidation of LDL may be a significant factor in the progression of CVD.

Adult↗
PubMed2004

Ranking departments of family medicine: the eye of the beholder?

BACKGROUND AND OBJECTIVES: During each of the past several years, a nationally circulated periodical (US News & World Report) has provided a ranking of medical schools and their respective specialty departments. In contrast to the method used to rank medical schools, medical specialties, including family medicine, are ranked based solely on ratings by deans and senior faculty at peer schools. This study's purpose was to explore how closely this expert opinion-based process matches actual objective and quantifiable data about departmental performance. METHODS: Available quantifiable data in the following categories were obtained: administration, academic productivity, and medical student and resident education. Based on their ranking in a category, each department was awarded one to five stars depending on the quintile they achieved (except for the dichotomous variable pertaining to the presence of a postresidency fellowship). Five stars indicate a ranking in the highest quintile. RESULTS: In regards to success in administration, research, and residency education and production of family physicians, the departments, on average, were rated 3.4, 4.2, and 3.6 stars, respectively. Overall, half of the departments consistently ranked in the top quartile, as indicated by an average score of 4.0 to 5.0 stars. CONCLUSIONS: Many of the departments rated highly in the US News & World Report rankings of the departments of family medicine rated very high in the areas of administration, research, and education as determined by quantifiable information. In contrast, several highly ranked departments were not rated favorably in areas usually associated with excellence in academics.

Attitude of Health Personnel↗
PubMed2003

Evaluation and treatment of women with hirsutism.

Hirsutism is a common disorder, often resulting from conditions that are not life-threatening. It may signal more serious clinical pathology, and clinical evaluation should differentiate benign causes from tumors or other conditions such as polycystic ovary syndrome, late-onset adrenal hyperplasia, and Cushing's syndrome. Laboratory testing should be based on the patient's history and physical findings, but screening for levels of serum testosterone and 17alpha-hydroxyprogesterone is sufficient in most cases. Women with irregular menses and hirsutism should be screened for thyroid dysfunction and prolactin disorders. Pharmacologic and/or nonpharmacologic treatments may be used. Advances in laser hair removal methods and topical hair growth retardants offer new options. The use of insulin-sensitizing agents may be useful in women with polycystic ovary syndrome.

Algorithms↗
PubMed2003

Practice profiles, procedures, and personal rewards according to the sex of the physician.

BACKGROUND: The objective of this study was to explore physician and practice characteristics according to sex. METHOD: All graduates of a southeastern state's family practice residency programs were surveyed. RESULTS: Seven hundred fourteen (53.5%; 79.7% men, 20.3% women) surveys were returned and analyzed. Practice arrangements and practice settings did not differ significantly between the two study groups. Male graduates saw a significantly higher percentage of geriatric patients (28.9% versus 24.7%; P = 0.008) and made significantly more nursing home visits (50.6% versus 35.5%; P = 0.002) and home visits (49.0% versus 33.8%; P = 0.001) than female graduates. With the exception of skin biopsies, a greater percentage of male physicians performed procedures than female physicians. Female graduates and male graduates had the same initial salary but had a significantly different current salary range. No significant differences were seen in personal or career satisfaction. CONCLUSION: Practice patterns of male and female physicians were generally similar. However, significant differences were noted in geriatric care, procedures, and salary.

Adult↗
PubMed2003

A thorough yet efficient exam identifies most problems in school athletes.

A complete medical history, preferably from the student and a parent, will reveal approximately 75% of problems affecting initial athletic participation. For asymptomatic athletes with no previous injuries, a 90-second screening musculoskeletal test will detect 90% of significant musculoskeletal injuries. A routine screening need not include noninvasive cardiac testing or laboratory tests such as urinalysis, blood count, chemistry profile, lipid profile, ferritin level, or spirometry.

Death, Sudden, Cardiac↗
PubMed2002

Special olympics, special athletes, special needs?

Based upon the current study, the review of the literature, and our experience, the preparticipation physical examination for Special Olympics is an opportunity for physicians of all specialties to assist and encourage a group of athletes with special physical and emotional characteristics not found in other athletes. The physician should review the medical condition of the athlete (including prescribed medications and their potential side effects), the physical demands of the proposed activity, and the presence of volunteers to assist the athlete when necessary. Full or limited participation should be recommended in most cases. "No participation" should only apply to unstable medical conditions or situations that would place the athlete at risk for injury despite activity modification and close supervision.

Adolescent↗
PubMed2002

Does community- or university-based residency sponsorship affect future practice profiles?

BACKGROUND AND OBJECTIVES: The educational sponsor of a residency program (ie, community based versus university based, opposed versus unopposed) is one of the most influential factors in medical students' choice of a training program. This study examined the practice profiles of South Carolina family practice residency graduates to determine whether there were significant differences based on program sponsorship. METHODS: A survey was mailed to the 1,335 graduates of South Carolina Area Health Education Consortium (SC AHEC)-affiliated residency programs. Data were summarized and analyzed using the Epi-Info statistical program. Significance was preset at the P < .01 level. RESULTS: A total of 720 (56.0%) surveys were returned. Community-based program graduates were more likely to practice in the state, in a rural area, and closer to their residency site. University-based program graduates were more likely to practice in academic settings (18.9% versus 6.3%). Several minor differences in procedures performed were noted, with some procedures performed more commonly by physicians trained in university-based programs and others by physicians trained in community programs. No differences in salaries orpersonal or professional satisfaction between groups was found. CONCLUSIONS: The current study found some differences in location of practice but found few differences in procedures performed, salaries, or satisfaction based on sponsorship of residency.

Adult↗
PubMed2002

Nortriptyline effective for smoking cessation.

Nortriptyline (Pamelor), in combination with weekly behavioral therapy, is effective in helping highly motivated smokers to quit. The medication may be an alternative for patients who cannot tolerate or do not benefit from bupropion. Given the high motivation of the group and the extensive behavioral therapy they also received, results are not likely to be as good in typical practice.

Comment↗
PubMedDate not supplied

Elevated serum transferrin saturation and mortality.

BACKGROUND: A large proportion of US adults have elevated transferrin saturation, an indicator of a predisposition for iron overload. The purpose of this study was to evaluate the relationship between elevated serum transferrin saturation and mortality. METHODS: This cohort study was conducted using data from the First Health and Nutrition Examination Survey 1 (1971-1974) (NHANES I) merged with the NHANES I Epidemiologic Followup Study (1992) (N = 10,714). We used SUDAAN and appropriate weights to make population estimates for the adult US population (aged 25 to 74 years at baseline). All-cause mortality was evaluated in relation to serum transferrin saturation of greater than 45%, greater than 50%, greater than 55%, and greater than 60% using Cox proportional hazards regression. RESULTS: In a Cox proportional hazards model controlling for potential confounders, including comorbid diseases, smoking, and cholesterol, all-cause mortality is significantly greater for persons with a serum transferrin saturation of more than 55%, compared with those with saturations below this cutoff (hazards ratio [HR] = 1.60, 95% confidence interval [CI], 1.17-2.21). No one who died had hemochromatosis as any of the 20 listed causes of death. Many of the underlying causes of death for persons with serum transferrin saturation levels of more than 55% are common causes of death in the general population, although these persons were more likely to have died of cirrhosis and diabetes, a finding consistent with iron overload. CONCLUSIONS: In this nationally representative cohort of adults, those with elevated serum transferrin saturation, more than 2% of the adult US population, were at increased risk for all-cause mortality.

Adult↗
PubMedDate not supplied

The mortality risk of elevated serum transferrin saturation and consumption of dietary iron.

BACKGROUND: Recent data shows an increased mortality risk associated with elevated transferrin saturation. Because ingestion of dietary iron may contribute to iron overload in persons with elevated transferrin saturation, we investigated the relationship between elevated transferrin saturation, ingestion of dietary iron and red meat, and mortality. METHODS: This 12-year cohort study used data from the second National Health and Nutrition Examination Survey 1976-1980 (NHANES II) and the NHANES II Mortality Study 1992. Population estimates were based on 9,229 persons aged 35 to 70 years at baseline. A Cox proportional hazards analysis was performed based on levels of transferrin saturation, intake of dietary iron, and intake of red meat. The analysis was conducted while controlling for demographics, severity of illness, body mass index, and smoking status. RESULTS: Unadjusted analyses indicated that those who had a high transferrin saturation and reported high dietary iron or red meat consumption had an increased mortality risk. The adjusted survival analysis indicated that persons with elevated transferrin saturation who reported high dietary iron intake had a hazard ratio for death of 2.90 (95% confidence interval [CI], 1.39-6.04) compared with those with normal transferrin saturation levels and reported low dietary iron intake. Persons who had a high transferrin saturation and reported high red meat consumption also had an increased hazard ratio for death (2.26; 95% CI, 1.45-3.52) compared with those who had normal transferrin saturation and reported low red meat consumption. CONCLUSIONS: Ingestion of large quantities of dietary iron and red meat in persons with high transferrin saturation is associated with an increase in mortality. Simple dietary restrictions may reduce the mortality risk associated with high transferrin saturation.

Adult↗