Biomedical subjects
Publications and source records attributed to R L Blake.
A major objective of epidemiologic investigation is to determine whether or not an association between an exposure and a condition exists in a human population. The presence of such an association cna be explored using three distinct strategies, the cohort, the case-control, and the cross-sectional approaches. This paper describes each of these research designs and discusses their advantages and disadvantages.
The life space drawing was prospectively assessed as a predictor of 12-month morbidity in 27 white female participants of a clinical trial. Women who subsequently experienced a high rate of self-reported morbidity (greater than or equal to 3 restricted-activity days per month) had a higher proportion of interpersonal relationships characterized by poor communication than did women with less than or equal to 2 restricted activity days per month. The quality of the relationship with a spouse/significant other appeared to be a particularly strong predictor of morbidity in this small self-selected group of women.
Family physicians frequently encounter patients who have recently experienced stressful life changes and who have weak social supports. Since an accumulation of evidence indicates that these psychosocial profiles are associated with health impairment, further investigation of these factors is of importance to family medicine. This paper reviews conceptual and methodologic issues involved in the assessment of the health effects of stress and social support and identifies particular questions and directions appropriate for family medicine research. The ultimate goal of research inquiry in this area is to develop effective clinical and public health strategies that prevent or minimize adverse health consequences.
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BACKGROUND: A previous preterm delivery is a risk factor for preterm delivery in a subsequent pregnancy. We tested the hypothesis that evidence of inflammation on a Papanicolaou smear obtained during pregnancy is a risk factor for preterm delivery for women with a history of preterm delivery. METHODS: We studied women who had two singleton deliveries at a university hospital during an 8-year period. Women eligible for our study were those whose first delivery was preterm (< 37 weeks of gestation) and for whom a Papanicolaou smear was obtained during the second pregnancy. These smears were examined for evidence of inflammation by a cytopathologist. Information about the second pregnancy was obtained by chart review. RESULTS: The cytopathologist reviewed Papanicolaou smears from 92 study pregnancies and found evidence of cervical inflammation on 34 smears (37 percent). Preterm delivery ended 24 (26.1 percent) of the second pregnancies. The incidence of preterm delivery in women with inflammation on Papanicolaou smear was 41.2 percent compared with an incidence of 17.2 percent in women without inflammation (relative risk of 2.40 with a 95 percent confidence interval of 1.19 to 4.83). This association remained significant after controlling for potential confounding variables. A stratified analysis found that the association of cervical inflammation with preterm delivery was limited to women who had systemic exposure to an antibiotic during pregnancy. CONCLUSION: Among pregnant women with a history of preterm delivery, evidence of inflammation on Papanicolaou smear was associated with an increased risk of preterm delivery. If replicated in other studies, this finding might have implications for the management of pregnancies in women with a history of preterm delivery.
BACKGROUND: This study examined the frequency and nature of pregnancy-related dreams in pregnant women in a family practice center and assessed the extent such dreams were discussed with providers of prenatal care. METHODS: Pregnant women 18 years of age or older who were receiving prenatal care at the University of Missouri-Columbia Family Medical Care Center responded to a two-page self-administered questionnaire. The major variables measured were frequency of pregnancy-related dreams, frequency of frightening dreams, content of dreams, and discussion of dreams. Health professionals providing prenatal care to these women were also surveyed. RESULTS: Eighty-eight pregnant women, 41 family physicians, and 3 nurse practitioners participated in the study. Dreams about their pregnancy or baby were reported by 59 (67 percent) of 88 pregnant women, of whom 22 had experienced at least one frightening dream. Seventeen women reported being upset by a dream. The frequency of dreams increased with advancing gestational age. The content of the most common dream involved conflict with the father of the baby. Most women had talked to another person about their dreams, usually the baby's father. Only 2 women told their physicians about the pregnancy-related dream. One-half of the providers of prenatal care reported discussing pregnancy-related dreams with a pregnant patient at least once during their careers. CONCLUSION: Dreams about their pregnancy or baby occurred frequently in pregnant women and could be a neglected source of information about the psychological state of the patient.
BACKGROUND: Little is known about patients' awareness of and attitudes about gifts to physicians from pharmaceutical companies. METHODS: During a 7-week period in summer 1994, we surveyed adults (18 years of age and older) in the waiting rooms of two family practice centers in central Missouri. Four-hundred eighty-six adults (83 percent participation rate) responded to a self-administered questionnaire that assessed awareness of and attitudes about representative gifts. RESULTS: Rates of awareness of specific gifts were 87.0 percent for free drug samples, 55.3 percent for ballpoint pens, 34.6 percent for medical books, 28.6 percent for baby formula, 22.4 percent for dinner at a restaurant, and 13.8 percent for a coffee maker. Of the 486 respondents, the following percentages were reported that "it is not all right" for physicians to accept specific gifts: dinner at a restaurant, 48.4 percent; baby formula, 44.2 percent; coffee maker, 40.7 percent; ballpoint pens, 17.5 percent; medical books, 16.9 percent; drug samples, 7.6 percent. In addition, 32.5 percent did not approve of their physicians accepting payment by a pharmaceutical company of medical conference expenses and from 28.0 percent to 43.4 percent disapproved of their physicians attending specific social events sponsored by pharmaceutical companies at a medical conference. Seventy percent of the subjects believed that gifts sometimes or frequently influence a physician's prescribing of medication; 64.0 percent believed that gifts to physicians increase the cost of medication. Beliefs that gifts influence prescribing behavior and beliefs that gifts increase medication costs were strongly associated with disapproval of each gift except for drug samples. CONCLUSIONS: Respondents distinguished between particular gifts; approval rates were high for gifts generally considered to be trivial or that have potential value to patient care; disapproval rates were relatively high for gifts that have some monetary value but have little or no benefit for patients. Opinions about gifts were related to perceptions of their effects on prescribing behavior and costs.