Posted by on October 29, 2009 - 9:36am
Image: bodyandmore.auburnpub.com

Image: bodyandmore.auburnpub.com

Medscape Today recently wrote an article detailing the physician's dilemma regarding delivering test results, and how this may differ based whether the results are normal or identify a potentially dangerous problem. Much of the discussion uses PAP smear results as way to discuss the issue: it something women are supposed to do fairly regularly, and the results can be life-changing. In the article, doctors discuss whether a phone call is the best way to deliver results. If so, who should do the calling: the doctor or a nurse? The general conclusion seemed to be that a form letter or nurse's call is sufficient for normal test results, but that the doctor should do the notification for abnormal results. Interestly, the mode of doctor notification was disagreed upon: some doctors made phone-calls, others required appointments. I found some of the quotes on the topic annoying:

""Patients with multiple questions are offered an appointment," says an internist. "I am not going to provide unreimbursed care that includes lengthy phone calls." An ob/gyn agrees. "If I am going to spend more than 2 minutes talking to a patient, the reality of reimbursement is that it must be a billable visit. The patient needs to come in.""

I will say that other doctors disagreed and found this practice as gouging as I did. Either way, it's obvious that the issue is still up for debate. What do you all think? How would you prefer to receive test results? What do you think are your particular healthcare provider's motivations for delivering news as he or she does?

Posted by on August 26, 2009 - 11:07am

News related to obesity has recently been splattered all over the news, even more than usual in my opinion.  The latest headline is that obese or overweight patients had significantly less brain matter than those whose weights were considered normal.  The research article, "Brain Structure and Obesity," resulted from a collaboration between the University of Pittsburgh and the University of California, Los Angeles (UCLA) and was published online this month in the scientific journal Human Brain Mapping.  The senior author on the publication was quoted in the U. S. News & World Report as saying, "The brains of obese people looked 16 years older than their healthy counterparts while [those of] overweight people looked 8 years older."

An important thing to note about the research article is that their test subjects were an average age of 77 years old; therefore, these specific results are only applicable to the elderly population.  I looked through the research article itself and was happy to see that the genders were fairly represented in the test groups, with women comprising approximately 50% of the patients tested in normal, overweight, and obese groups.  As presented in the paper, authors did not find any striking differences correlated to gender; their results were equally applicable to both men and women.  It was acknowledged that there is some controversy among scientists regarding the association between brain volume and gender, and the authors cited additional published studies from other laboratories.  It was noted in their conclusion that gender effects are an important variable to pay attention to in future studies.  You can access a summary of the research article here.

Obesity is a sensitive issue for everyone, but a 2006 study suggested that it may affect the quality of life of women more than men.  A team led by Dr. Peter Muennig of Columbia University looked at existing data from a 2000 survey on health and quality of life.  More than 13,000 adults participated in this survey administered by the U. S. Department of Health and Human Services.  Dr. Muennig and colleagues also incorporated data from 1990-1995 on death rates in the U. S. into their study.  They concluded that health-related drops in quality of life scores were four times higher for overweight women than overweight men, and more than two times higher for obese women than obese men.  More strikingly, the authors found that there were about twice as many deaths among overweight and obese women than for men (when compared to their normal-weight counterparts) for the time represented in their study.  WebMD has a nice summary of the article here (including its caveats), or you can access the full article for free through PubMed Central.

You can help further these studies by participating in ventures such as the Illinois Women's Health Registry, or similar surveys administered in your state (or country, etc.)!  What do you think about these studies and their results?   Has obesity affected you or your loved ones in any way?

Posted by on August 18, 2009 - 12:53pm
skheart

Photo: Lamis Eli, Sarah Kiesewetter

A study was recently published online in the journal Circulation, the journal of the American Heart Association, showing that optimistic women are less likely to suffer from, or die of, heart disease. The study is actually really fascinating (the article abstract and the downloadable entire article can be found here.)

I think this particular study highlights some important points:

1. The study participants are very much like the group that we are trying to collect through the Illinois Women's Health Registry (if you’re an Illinois resident, go join!). They were women in the government-funded Women's Health Initiative, and the sheer number and racial diversity of participants allowed researchers to make new connections, simply by following the women’s health progress for a couple of years and administering very short questionnaires. It’s amazing what we can do when we all participate in these kind of registries!

2. I think the connection between mental well-being and physical health is really starting to become a key research topic and is likely changing the way patients are treated. As an admitted pessimistic cynic, I really do understand that those stress headaches and upset stomachs are taking their toll, and can be largely under my control. That’s pretty empowering, even for a pessimist.

3. It’s a great example of the benefits of studying several groups of people in scientific studies. The researchers found several statistical differences between the white and black women studied (the disparity in health outcomes between optimists and pessimists was much more striking in the black women studied, for example.) These differences would have been missed if men or white women were allowed to portray some standard of the everyperson.

So go read up! The questions used to classify a person as optimistic or hostile and cynical are particularly amusing, such as having to answer true or false to “ I have often had to take orders from someone who did not know as much as I did,” or “It is safer to trust nobody.”   I know I’ll be thinking twice about those negative thoughts about my higher-ups!

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