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Lesbians' sexual history with men: implications for taking a sexual history.

BACKGROUND: Health care providers may not solicit a comprehensive sexual history from lesbian patients because of provider assumptions that lesbians have not been sexually active with men. We performed this study to assess whether women who identify themselves as lesbians have a history of sexual activities with men that have implications for receipt of preventive health screening. OBJECTIVE: To convey the importance for health care providers to know their patients' sexual history when making appropriate recommendations for preventive health care. METHODS: A survey was printed in a national news magazine aimed at homosexual men, lesbians, and bisexual men and women. The sample included 6935 self-identified lesbians from all 50 US states. The outcomes we measured were respondents' number of lifetime male sexual partners and partners during the past year, their lifetime history of specific sexual activities (e.g., vaginal intercourse, anal intercourse), their lifetime condom use, and their lifetime history of sexually transmitted diseases. RESULTS: Of respondents, 77.3% had 1 or more lifetime male sexual partners, 70.5% had a lifetime history of vaginal intercourse, 17.2% had a lifetime history of anal intercourse, and 17.2% had a lifetime history of a sexually transmitted disease. Exactly 5.7% reported having had a male sexual partner during the past year. CONCLUSION: These findings reinforce the need for providers to know their patients' sexual history regardless of their reported sexual orientation, especially with regard to recommendations for Papanicolaou smears and screening for sexually transmitted diseases.

Adult↗

Can a Back Pain E-mail Discussion Group improve health status and lower health care costs?: A randomized study.

BACKGROUND: Given the high health care utilization, limited evidence for the effectiveness of back pain interventions, and the proliferation of e-mail health discussion groups, this study seeks to determine if the Internet can be used to improve health status and health care utilization for people with chronic back pain. METHODS: Randomized controlled trial. Participants included 580 people from 49 states with chronic back pain having at least 1 outpatient visit in the past year, no "red-flag" symptoms, and access to e-mail. Major exclusion criteria included continuous back pain for more than 90 days causing major activity intolerance and/or receiving disability payments. INTERVENTION: Closed, moderated, e-mail discussion group. Participants also received a book and videotape about back pain. Controls received a subscription to a non-health-related magazine of their choice. MAIN OUTCOME MEASURES: Pain, disability, role function, health distress, and health care utilization. RESULTS: At 1-year treatment, subjects compared with controls demonstrated improvements in pain (P =.045), disability (P =.02), role function (P =.007), and health distress (P =.001). Physician visits for the past 6 months declined by 1.5 visits for the treatment group and by 0.65 visits for the control group (P =.07). Mean hospital days declined nearly 0.20 days for the treated group vs and increased 0.04 days for the control group (P =.24). CONCLUSIONS: An e-mail discussion group can positively affect health status and possibly health care utilization. It may have a place in the treatment of chronic recurrent back pain.

Back Pain↗

Controversial approaches to treating learning disabilities and attention deficit disorder.

It is estimated that between 3% and 7% of children and adolescents in this country--up to 4 million--are learning disabled. Of this group, about 20% also have attention deficit disorder. Many professionals in multiple disciplines have proposed treatment approaches. When research has been done to support the approach, the reports and data may be published in journals not normally read by the practicing physician. When research data are not available, the information may be in a popular book, newspapers, or lay magazines or on television. Thus, parents may know of ideas and suggestions before the professional in clinical practice. These acceptable and controversial approaches to treatment are reviewed. It is understandable that a parent would seek out improved ways of helping his or her child. I reviewed the significant literature in an effort to assist the practicing physician in providing appropriate parental guidance and clinical interventions.

Adolescent↗

Do cigarette warning labels reduce smoking? Paradoxical effects among adolescents.

OBJECTIVE: To examine the association between adolescents knowledge of cigarette warning labels and actual smoking behavior. DESIGN: Cohort analytic study. SETTING: Four public high schools in northern California. SUBJECTS: Seventeen hundred forty-seven ninth graders (mean age, 14.9 years). Students from 2 of the schools (n = 803) were observed for approximately 3 months. MAIN OUTCOME MEASURES: Self-reported knowledge of warning labels was assessed at baseline. Self-reports of smoking behavior were completed at baseline and at follow-up. RESULTS: Greater knowledge of cigarette package warning labels was significantly associated with higher levels of smoking. Knowledge of warning labels on magazine and billboard advertisements did not differ significantly by level of smoking. In the longitudinal sample, greater knowledge of cigarette package warning labels was significantly associated with a subsequent increase in smoking, controlling for the baseline level of smoking, sex, ethnicity, and knowledge of warning labels on cigarette advertisements (odds ratio [OR], 1.22; 95% confidence interval [CI], 1.02-1.46). Knowledge of warning labels on cigarette advertisements was not associated with a significant change in smoking behavior (OR, 1.06; 95% CI, 0.82-1.35). CONCLUSIONS: Sizable proportions of adolescent smokers are not seeing, reading, or remembering cigarette warning labels. In addition, knowledge of warning labels on cigarette packages and advertisements is not associated with reduced smoking. The current warning labels are ineffective among adolescents.

Adolescent↗

Sexual excitement.

Sexual excitement depends on a scenario the person to be aroused has been writing since childhood. The story is an adventure, an autobiography disguised as fiction, in which the hero/heroine hides crucial intrapsychic conflicts, mysteries, screen memories of actual traumatic events and the resolution of these elements into a happy ending, best celebrated by orgasm. The function of the fantasy is to take these painful experiences and convert them to pleasure-triumph. In order to sharpen excitement-the vibration between the fear of original traumas repeating and the hope of a pleasurable conclusion this time-one introduces into the story elements of risk (approximations of the trauma) meant to prevent boredom and safety factors (sub-limnal signals to the storyteller that the risk are not truly dangerous). Sexual fantasy can be studied by means of a person's daydreams (including those chosen in magazines, books, plays, television, movies, and outright pornography), masturbatory behavior, object choice, foreplay, techniques of intercourse, or postcoital behavior.

Fantasy↗

Telepathology: a diagnostic tool for the millennium?

Many developments in science have their origins in science fiction and telepathology is no exception. The concept was first illustrated in 1924 in the magazine 'Radio News'. It was not until 1980, however, that the first working telepathology system was demonstrated. Although the system was shown to work, it required special hardware, dedicated software and special microwave transmission links to be installed. Little interest was shown worldwide because of the very high cost and the inability of many people to replicate such a system. Ten years later, the personal computer (PC) was able to provide more than adequate performance at low cost for both image display quality and speed, and the development of video technology had resulted in high quality images being produced by television cameras that were now easily affordable. Microscopes were also relatively cheaper. Thus, by 1993 or 1994, all the hardware necessary to produce a telepathology system was available at reasonable cost. Telepathology can now be used for remote primary diagnosis, remote referral to a specialist pathologist, remote teaching, remote presentation of post-mortem or microscopic findings, quality assurance image circulation and feedback, and consensus diagnosis for pathological review in clinical trials. There are two residual problems. The first concerns the speed of data transmission, commonly referred to as the bandwidth. The second is that the software provided by most of the manufacturers and suppliers of these systems is not entirely suitable to the task and the systems are not interoperable. It is clear that the approach of the manufacturers is at present unlikely to produce telepathology systems which pathologists feel comfortable in using. A somewhat different approach is illustrated by the accompanying article in this issue from the Berlin group, where a relatively simple Java-based applet and the Internet are used to allow single or multiple users to view slides on a robotic microscope. This could form the basis for a truly useful system, but still needs modification for some applications.

Clinical Trials as Topic↗

Breast cancer genetics and managed care. The Kaiser Permanente experience.

In 1996, with evolution of the science of cancer genetics and the advent of commercially available BRCA1 and later BRCA2 testing, Kaiser Permanente began to apply these advances in clinical practice. Recommendations for referral to genetic counseling were developed in 1997 as the Clinical Practice Guidelines for Referral for Genetic Counseling for Inherited Susceptibility for Breast and Ovarian Cancer. Implementation of these guidelines with associated protocols in Kaiser Permanente's Northern California Region has occupied the ensuing years and includes dissemination of the high-risk guidelines for breast and ovarian cancer, dissemination of patient and physician educational materials on the breast cancer guidelines, monthly classes and taped healthphone messages for patients, interactive videoconferencing for physicians, a training seminar for medical geneticists who will counsel patients at risk, publication of articles on breast cancer and genetic risk in health plan member- and physician-directed magazines, identification and training of clinical specialists and supporting clinicians to care for patients before and after counseling, individual counseling and testing of patients and families, and development of a data registry. Implementing the guidelines helped us communicate the uncertainty surrounding breast cancer testing, and we were obliged to learn more about ethical, legal, societal, and insurance controversies surrounding genetic testing. Given the lack of effective prevention for breast or ovarian cancer and the difficulty of treatment, the appropriate use of genetics in patient care is essential. In the near future, we will see the need for cancer genetics to become an integral part of practice throughout the spectrum of health care. We at Kaiser Permanente feel that the breast cancer guideline project is the first step in this process.

BRCA1 Protein↗

Relationship of weight, body dissatisfaction, and self-esteem in African American and white female dieters.

OBJECTIVE: The present study examined the relationship among weight, body dissatisfaction, and self-esteem in a large group of African American and white female dieters who were generally overweight and of middle to high socioeconomic status. METHOD: Subjects were participants in a survey of dieting practices undertaken by Consumer Reports magazine. Major outcome measures included the Rosenberg Self-Esteem Scale and an assessment of shape and weight attitudes. RESULTS: No significant differences between African American and white women were found for body dissatisfaction, self-esteem, discrepancies between actual and ideal weight and shape, or the relationship between self-esteem and body dissatisfaction. Body mass index contributed less to body satisfaction scores in African American than in white women. DISCUSSION: This study provides a comparison of African American and white women in the upper social classes, and raises the possibility that previous findings of less body concern in African American women reflect class rather than race effects.

Adult↗

Eating disturbances in white and minority female dieters.

OBJECTIVE: This study examined disordered eating, attitudes about weight and appearance, self-esteem, weight loss, and reasons for weight regain in a sample of white, black, Asian, and Hispanic female dieters. METHOD: In this cross-sectional descriptive study, we scrutinized survey responses of a large number of households subscribing to Consumer Reports magazine. Females (N = 9,971) between 21 and 65 years old (M = 42.9, SD = 10.4) with a mean body mass index (BMI) of 27.2 (SD = 6.2) were selected for comparisons. RESULTS: Ethnic groups were different in terms of age, BMI, household income, and marital status. Therefore, these variables were used as covariates in the analyses. More black women were overweight and purged compared to the other groups. Asian women valued the beneficial role of exercise in weight control more, while black women were more inclined to attribute weight gain to cravings and slow metabolism. The groups did not differ in terms of binge eating, attitudes about weight and appearance, self-esteem, the number of attempts to lose weight, and the reasons for their failures. CONCLUSIONS: This study suggests that unhealthy eating attitudes and practices may be similar for women who diet, irrespective of ethnic background. However, the generalizability of these findings is limited by the inherent sampling bias.

Adult↗

The effects of the ideal of female beauty on mood and body satisfaction.

OBJECTIVE: The present study examined changes in women's mood states resulting from their viewing pictures in fashion magazines of models who represent a thin ideal. METHOD: Female university students completed the Profile of Mood States (POMS), the Body Parts Satisfaction Scale (BPSS), and the Eating Disorder Inventory (EDI). They were then exposed to 20 slides; the experimental group (N = 51) viewed images of female fashion models and a control group (N = 67) viewed slides containing no human figures. All subjects then completed the POMS and the BPSS again. RESULTS: Women were more depressed (R2 = 0.745, p < .05) and more angry (R2 = 0.73, p < .01) following exposure to slides of female fashion models. DISCUSSION: Viewing images of female fashion models had an immediate negative effect on women's mood. This study, therefore, supports the hypothesis that media images do play a role in disordered eating.

Adolescent↗

Knowledge of Down syndrome in pregnant women from different ethnic groups.

The uptake of any screening test is influenced by knowledge of the condition being screened for. In the present study, the knowledge and the source of knowledge of women offered antenatal screening for Down syndrome (DS) was assessed by means of a self-administered questionnaire. The questionnaire was administered to 300 consecutive women booking for antenatal care, of the 245 (82%) women who completed and returned the questionnaire, 117 (48%) were Caucasian, 85 (35%) were Asian born outside the UK, 32 (13%) were Asian born in the UK and ten (4%) belonged to other categories. Only 30% of the cohort had a good understanding of the condition. Racial groups other than Caucasian had a poorer understanding of DS. The factors which affected knowledge of DS included quality of spoken English, knowing an affected child, parity and religion. The most significant factor affecting acceptance of screening was the woman's knowledge of DS. The source of information for the condition varied widely: 42% from a general practitioners (GP), 24% from the hospital and 16% from midwives. The proportion with good knowledge was similar in those women whose source of information was the GP (45%) and the midwife (41%). These proportions were, however, higher (though not significantly) when the source of information was from magazines and newspapers (67%) and from friends (53%). Uptake of the screening test was best in those with good knowledge (53%) compared to those with poor knowledge (23%) (p<0.02). Between 28% and 66% (depending on the ethnic group) of women had a screening blood test "allegedly" without knowing why it had been performed. In order to improve uptake of the screening test for DS there is need for better education and counselling of women attending for antenatal care.

Adolescent↗

Body size and shape characteristics of personal ("in search of") ads.

This study investigated sociocultural norms for height, weight, and body shape by analyzing 481 personal ads in a large metropolitan city magazine to determine self-report characteristics of males and females seeking companionship as well as the desired height, weight, and shape characteristics of the person being sought. Seventy percent of ads specified weight, shape, or height characteristics and of those ads most were heterosexual Caucasian males and females. Male searchers described themselves as tall, fit, and athletic, but of average weight. Female searchers described themselves as petite or tall and fit with body weight as significantly less (89.4%) than the ideal body weight. Male searchers sought females 5 years younger, thin, fit, petite or tall. Women seekers sought men 3 years older, tall, fit, and athletic. These ads confirmed the use of stereotyped and highly athletic body size and shape for self-descriptions and for characteristics of companions sought.

Adult↗

Effect of body image and self-image on women's sexual behaviors.

OBJECTIVES: To evaluate the relationship between women's body image, self-image, and sexual behaviors; to determine the effect of body image on personal and sex variables; and to identify factors that contribute to more frequent and greater comfort with sex. METHOD: A magazine survey that included items about body image, self-image, and sexual behaviors was completed by 3,627 women. RESULTS: Women more satisfied with body image reported more sexual activity, orgasm, and initiating sex, greater comfort undressing in front of their partner, having sex with the lights on, trying new sexual behaviors, and pleasing their partner sexually than those dissatisfied. Positive body image was inversely related to self-consciousness and importance of physical attractiveness, and positively related to relationships with others and overall satisfaction. Body image was predictive only of one's comfort undressing in front of partner and having sex with lights on. Overall satisfaction was predictive of frequency of sex, orgasm, and initiating sex, trying new sexual behaviors, and confidence in giving partner sexual pleasure. DISCUSSION: Results indicate that overall self-image and body image are significant predictors of sexual activity. Directions for future research are discussed.

Adolescent↗

The effects of Ginkgo biloba extract (LI 1370) supplementation on activities of daily living in free living older volunteers: a questionnaire survey.

This survey assessed the impact of four months supplementation with 120 mg/day of the standardized Ginkgo biloba special extract (LI 1370) on activities of daily living and various aspects of mood and sleep in a population of free living older volunteers using both observer- and self-rated scales. 5028 Participants (mean age 68.9 years) were recruited through a magazine editorial. One thousand received Ginkgo biloba extract (GBE) and the remainder were allocated to the Control group. The B-ADL (activities of daily living) Scale was completed at baseline and at the end of month 4 by an informant familiar with the participant, a Self-rating ADL scale and Line Analogue Ratings Scales of mood and sleep were completed by the participants at the end of months 1, 2, 3, and 4. There were significant differences between the GBE and Control groups on all scales at each time point. The GBE group felt better able to cope with their daily activities and showed positive changes in mood and sleep compared to the Control group. These results suggest that GBE supplementation has beneficial effects on areas of functioning that have implications for quality of life in an older population. Copyright 2000 John Wiley & Sons, Ltd.

Journal Article↗

Breathing exercises for asthma.

BACKGROUND: There is much anecdotal evidence in Eastern and Western literature describing considerable benefits for patients with asthma when treated with breathing interventions. The term 'breathing exercise or training' has numerous interpretations depending on the nature of the therapy, therapist and cultural background. OBJECTIVES: The objective of this review was to assess the evidence for the effectiveness of breathing re-training in the treatment of patients with asthma. SEARCH STRATEGY: Trials were searched for in the Cochrane Airways Group trials register, Cochrane Complementary Medicine Field trials register, EMBASE: Physical Medicine & Rehabilitation Field, and Databases of the physiotherapy library of current research, World Congress of Physical Therapy Proceedings (1995) and AMED (Allied & Alternative Medicine). Hand searching of the Association of Chartered Physiotherapists in Respiratory Care Journals was undertaken. Chartered physiotherapists in the field of respiratory medicine were contacted and appeals made in the 'Physiotherapy' Journal and the Physiotherapy Respiratory Care magazine. SELECTION CRITERIA: Randomised or quasi randomised controlled trials of breathing re-training in patients of all ages with a diagnosis of asthma. Breathing re-training should be a major component of the treatment intervention. DATA COLLECTION AND ANALYSIS: Two reviewers (EH & FR) independently assessed trial quality and extracted data. Study authors were contacted for additional information. Information on adverse effects was collected from the included trials where possible. MAIN RESULTS: Abstracts were identified and 32 full text papers were obtained for assessment and possible inclusion of studies in the review. Twenty seven papers were excluded. A total of five papers were included in this review. Most were small. One large study (106 patients) showed an improvement in PEFR and reduction in rescue bronchodilator use. Otherwise benefit of breathing exercises was found in isolated outcome measures in single small studies. REVIEWER'S CONCLUSIONS: No reliable conclusions can be drawn concerning the use of breathing exercises for asthma in clinical practice.

Asthma↗

Breathing exercises for asthma.

BACKGROUND: There is much anecdotal evidence in Eastern and Western literature describing considerable benefits for patients with asthma when treated with breathing interventions. The term 'breathing exercise, training and retraining' has numerous interpretations depending on the nature of the therapy, therapist and cultural background. OBJECTIVES: To assess the evidence for the efficacy of breathing retraining in the treatment of patients with asthma. SEARCH STRATEGY: Trials were searched for in the Cochrane Airways Group trials register, Cochrane Complementary Medicine Field trials register, EMBASE: Physical Medicine & Rehabilitation Field, and Databases of the physiotherapy library of current research, World Congress of Physical Therapy Proceedings (1995) and AMED (Allied & Complementary Medicine Database 1985-2003/4). Hand searching of the Association of Chartered Physiotherapists in Respiratory Care Journals was undertaken. Chartered physiotherapists in the field of respiratory medicine were contacted and appeals made in the 'Physiotherapy' Journal and the Physiotherapy Respiratory Care magazine. Searches were undertaken of bibliographies from the included studies and other appropriate papers. Authors of included studies were contacted for information concerning other relevant trials. SELECTION CRITERIA: Randomised or quasi-randomised controlled trials of breathing retraining in patients of all ages with a diagnosis of asthma. Breathing retraining should be a major component of the treatment intervention. DATA COLLECTION AND ANALYSIS: Two reviewers (EH & FR) independently assessed trial quality and extracted data. Authors of included trials were contacted for additional data. Where possible adverse effects were noted. MAIN RESULTS: Abstracts were identified and 42 full text papers were obtained for assessment and possible inclusion. Thirty five studies were excluded. A total of five studies were included in the original review. Two further studies have been added to this update. Most studies were of small size. Two studies demonstrated significant reductions in rescue bronchodilator use and three studies showed reductions in acute exacerbations, although these were measured in different ways. Two single studies showed significant improvements in quality of life measures. Overall, benefits of breathing exercises were found in isolated outcome measures in single studies. Five studies compared breathing retraining with no active control and two with asthma education control groups. REVIEWER'S CONCLUSIONS: Comparisons and conclusions were difficult to evaluate as treatment interventions and outcome measurements from the seven trials varied considerably. At present therefore no reliable conclusions can be drawn concerning the use of breathing exercises for asthma in clinical practice. However trends for improvement, notably in quality of life measurements, are encouraging and further studies including full descriptions of treatment methods and outcome measurements are required.

Asthma↗

Impact of tobacco advertising and promotion on increasing adolescent smoking behaviours.

BACKGROUND: The tobacco industry denies that their marketing is targeted at young nonsmokers, but it seems more probable that tobacco advertising and promotion influences the attitudes of nonsmoking adolescents, and makes them more likely to try smoking. OBJECTIVES: To assess the effects of tobacco advertising and promotion on nonsmoking adolescents' future smoking behaviour. SEARCH STRATEGY: We searched the Cochrane Tobacco Group specialized register, the Cochrane Central Register of Controlled Trials, MEDLINE, the Cochrane Library, Sociological Abstracts, PsycLIT, ERIC, WorldCat, Dissertation Abstracts, ABI Inform and Current Contents to August 2002. SELECTION CRITERIA: We selected longitudinal studies that assessed individuals' smoking behaviour and exposure to advertising, receptivity or attitudes to tobacco advertising, or brand awareness at baseline, and assessed smoking behaviour at follow-ups. Participants were adolescents aged 18 or younger who were not regular smokers at baseline. DATA COLLECTION AND ANALYSIS: Studies were prescreened for relevance by one reviewer. Two reviewers independently assessed relevant studies for inclusion. Data were extracted by one reviewer and checked by a second. MAIN RESULTS: Nine longitudinal studies that followed up a total of over 12,000 baseline nonsmokers met inclusion criteria. The studies measured exposure or receptivity to advertising and promotion in a variety of ways, including having a favourite advertisement or an index of receptivity based on awareness of advertising and ownership of a promotional item. One study measured the number of tobacco advertisements in magazines read by participants. All studies assessed smoking behaviour change in participants who reported not smoking at baseline. In all studies the nonsmoking adolescents who were more aware of tobacco advertising or receptive to it, were more likely to have experimented with cigarettes or become smokers at follow-up. There was variation in the strength of association, and the degree to which potential confounders were controlled for. REVIEWER'S CONCLUSIONS: Longitudinal studies consistently suggest that exposure to tobacco advertising and promotion is associated with the likelihood that adolescents will start to smoke. Based on the strength of this association, the consistency of findings across numerous observational studies, temporality of exposure and smoking behaviours observed, as well as the theoretical plausibility regarding the impact of advertising, we conclude that tobacco advertising and promotion increases the likelihood that adolescents will start to smoke.

Adolescent↗

Disability as diversity in Fortune 100 companies.

To investigate the inclusion of people with disabilities in the diversity policies of the most successful businesses in the United States, we examined the publicly available workforce and supplier diversity policies of the top 100 companies on Fortune Magazine's 2003 list of the 500 most profitable companies in the nation. The majority of these companies have extensive information about their diversity policies and practices available on their corporate website. The information was used to categorize the policies into those that include people with disabilities, do not define diversity, and enumerate what is meant by diversity (e.g. in terms of race or gender) but do not expressly mention disability. In addition, we looked beyond the diversity policies to information available on corporate websites relating to a variety of diversity initiatives. Findings suggest that the majority of the companies that top the Fortune 500 list have developed and implemented diversity policies. Of these, 42% have diversity policies that include people with disabilities in the definition of a diverse workforce. Furthermore, 47% of companies with workplace diversity policies discuss diversity in a way that neither expressly includes nor excludes people with disabilities. Far fewer (15%) supplier diversity policies include disability in the definition of diversity, but a significant number of companies use criteria that allow a business owner with a disability to benefit from the company's supplier diversity program.

Cultural Diversity↗