Index by author
The Issue in Brief
Vitamin D, Race, and Cardiovascular Mortality: Findings From a National US Sample
Kevin Fiscella , and colleagues
Background Low levels of vitamin D have been linked to cardiovascular disease. This study examines whether low vitamin D levels predict cardiovascular mortality among US adults and whether differences in vitamin D levels contribute to black-white differences in cardiovascular mortality after adjustments for age and sex.
What This Study Found Low levels of vitamin D are associated with increased cardiovascular mortality in a nationally representative US sample. Higher cardiovascular risk among blacks is partly related to lower vitamin D levels as a result of decreased sun exposure and absorption, higher dermal melanin, and lower vitamin D intake.
Implications
- The authors call for further research to determine whether vitamin D supplementation might improve cardiovascular outcomes and existing health disparities.
Incidence and Predictors of Hypertension Among Rural Chinese Adults: Results From Liaoning Province
Zhaoqing Sun , and colleagues
Background Cardiovascular disease, including both stroke and heart disease, is the leading cause of death among Chinese adults. Hypertension, or high blood pressure, is an important risk factor for these conditions. This study set out to determine the percentage of new cases of hypertension appearing in China each year, to help assess how quickly it is spreading, and to determine what steps might be needed to control the disease.
What This Study Found There is a high incidence of hypertension among rural Chinese adults. During a period of 28 months from 2004-2006 to 2008, more than 1in 4 adults developed hypertension. Most of these cases were untreated (80 percent) and uncontrolled (98 percent).
Implications
- The annual hypertension incidence of 11.4 percent is higher than that previously reported in China, Canada, or the United States.
- Increases in hypertension are probably related to rapid social changes in China and may apply to other areas of the developing world.
- The authors call for urgent public health measures to prevent and control hypertension.
Charles B. Eaton , and colleagues
Background Previous research suggests that there may be disparities by sex in the ways that doctors manage cardiovascular disease and its risk factors. This study looks at the role that the sex of the doctor and patient play in the management of cardiovascular disease risk factors.
What This Study Found This study finds that women doctors provide more preventive counseling for cardiovascular risk factors, including diet, weight loss, and physical activity. Women patients, regardless of the sex of their doctor, are less likely to receive drug therapy for diabetes management, including glucose-lowering medications, ACE inhibitor therapy and aspirin therapy. Quality of care (measured by whether patients meet treatment goals for cardiovascular disease risk factors), however, is similar regardless of the sex of the patient or physician.
Implications
- Future research is needed to explore whether stylistic differences in cardiovascular disease risk factor management have a long-term impact on clinical outcomes, such as heart attacks, strokes, heart failure, and death.
Suicide Inquiry in Primary Care: Creating Context, Inquiring, and Following Up
Steven D. Vannoy , and colleagues
Background Primary care visits offer an important opportunity for suicide prevention. Yet assessing a patient for potential suicide is difficult, since it is often an unstated concern. This study looks at how primary care doctors ask patients about suicide.
What This Study Found Most primary care doctors� suicide inquiries are sensitive and straightforward. Generally, physicians weave the topic of suicide into a discussion of psychosocial functioning. When patients deny suicidal thoughts, most doctors probe for more information or express support and concern for the patients' safety. In only a few instances do physicians use language that might prevent a patient from disclosing suicidal thoughts.
Implications
- Although primary care doctors inquire about suicide at low rates, most of their inquiries are sensitive, appropriate, and supportive.
- This study offers a descriptive framework that may be useful in developing educational programs to help doctors who are reluctant to ask patients about suicidal behavior.
Pia Bastholm Rahmner , and colleagues
Background Information about a patient�s current drug list is one of the keys to safe drug prescribing. The aim of this study is to explore general practitioners� perceptions of who is responsible for the patient�s drug list, so that drugs prescribed by different physicians don�t interact negatively or cause harm.
What This Study Found Interviews with 20 Swedish physicians reveal a variety of opinions about who is responsible for managing a patient�s drug list. The study finds 5 different strategies used by doctors to manage this responsibility: (1) imposed responsibility, (2) responsible for own prescriptions, (3) responsible for all drugs, (4) different but shared responsibility, and (5) patient responsible for transferring drug information.
Implications
- Technical solutions, like electronic health records, alone are unlikely to be sufficient for preventing drug errors.
- Doctors should be made aware of variations in understanding drug list responsibility so that health care quality can be improved.
Idiopathic Superficial Thrombophlebitis and the Incidence of Cancer in Primary Care Patients
Frederiek F. van Doormaal , and colleagues
Background It is commonly believed that superficial venous thrombophlebitis (SVTP), or superficial blood clots, is associated with accompanying cancer. This study examines the incidence of cancer during a 2-year follow up period after a first episode of SVTP in a large general practice population.
What This Study Found Researchers found no increased incidence of cancer after a first episode of unprovoked SVTP. In this study, during the 2-year observation period after an episode of unprovoked SVTP, the rate of cancer was 2 percent, compared with 2 percent in a control group. Recurrent SVTP was not common in the study sample.
Implications
- A first episode of unprovoked SVTP diagnosed by a family physician is not associated with an increased risk of cancer in the next 2 years.
A Question of Balance: A Qualitative Study of Mothers� Interpretations of Dietary Recommendations
Fiona Wood , and colleagues
Background Poor nutrition is an increasing problem for economically deprived families, and mothers play a key role in establishing children�s diets. This study explores mothers� understanding of health promotion recommendations for healthy eating.
What This Study Found While basic public health slogans and messages about a healthy diet may reach the lay public, that awareness does not necessarily translate to understanding and application in daily life. In this study in a Welsh working class community, public health messages about healthy eating � like the importance of eating a balanced diet � were known by mothers and adopted into everyday language. The messages, however, were interpreted in a superficial way and appeared ineffective at achieving lasting change in health behaviors.
Implications
- Confused interpretations of public health messages may limit people�s ability to bring about lifestyle change.
- While generic slogans are useful starting points, clinicians must offer patients more personalized, detailed advice on how how lifestyle changes can be achieved and sustained.
Steroids as Adjuvant Therapy for Acute Pharyngitis in Ambulatory Patients: A Systematic Review
Jean-Francois Chenot , and colleagues
Background Antibiotics may shorten the duration of symptoms of a bacterial throat infection, but the benefits are considered moderate. Steroids, which are anti-inflammatory, might be effective in relieving symptoms. This study examines existing research to determine the effectiveness of steroids for treating sore throat.
What This Study Found Steroids are effective in relieving sore throat pain in adult and pediatric patients, with no serious adverse effects from the different steroids administered. The authors state that it is debatable whether earlier pain relief justifies the administration of steroids, particularly as there are safe and effective over-the-counter medications to relieve sore throat pain. In addition, the benefits of steroid use must be weighed against possible rare adverse drug effects.
Implications
- Further studies are needed to establish the safety of steroid use without antibiotic coverage and the added benefits of steroids when used with over-the-counter analgesic medications.
Safety and Efficacy of Nontherapeutic Male Circumcision: A Systematic Review
Guy J. Maddern , and colleagues
Background Male circumcision, a commonly performed surgical procedure, can be performed for therapeutic (medical) reasons or nontherapeutic (religious, cultural, or social) reasons. This study examines existing research to determine the safety and effectiveness of nontherapeutic male circumcision.
What This Study Found There is little evidence showing clinical benefit from nontherapeutic male circumcision. Although evidence does show that adult male circumcision is effective in preventing HIV/AIDS in sub-Saharan African men, these findings cannot necessarily be applied to men in other countries. Current evidence is unclear on the effectiveness of adult circumcision in preventing sexually transmitted infections, urinary tract infections, and penile cancer. Furthermore, there is no current evidence that circumcision in infants prevents HIV/AIDS, sexually transmitted infections, urinary tract infections, and penile cancer.
Implications
- Patients who request circumcision for clinical reasons should be informed of the lack of consensus surrounding the procedure, the lack of strong evidence regarding its benefits, and the potential medical and psychosocial harms of the procedure.
- The authors call for additional research to strengthen the evidence base and allow for more informed conclusions on nontherapeutic male circumcision.
Health Extension in New Mexico: An Academic Health Center and the Social Determinants of Disease
Arthur Kaufman , and colleagues
Background Researchers from the University of New Mexico describe a statewide program aimed at improving community health and local capacity in rural New Mexico by identifying community health priorities and linking them with resources from the University of New Mexico Health Services Center.
What This Study Found Modeled after the Agricultural Cooperative Extension Service, the Health Extension Rural Offices (HEROs) program enables health extension agents to attend to more than just immediate, strictly medical needs by addressing underlying social determinants of disease, such as school retention, food insecurity, and local economic development through community engagement.
Implications
- The HERO program has shown that, to help address community health needs, academic health center resources can be integrated and linked to resources in other parts of the community, such as education, food distribution, economic development, and policy.
- The authors suggest that programs similar to HEROs could be reproduced in other cities and towns.