• The contribution of obesity to cardiovascular risk has not been adequately appreciated because of a failure to recognize the involvement of upper-body predominance of body weight with hypertension, diabetes, and hypertriglyceridemia even in the absence of significant overall obesity. This article examines the evidence that upper-body obesity, as usually induced by caloric excess in the presence of androgens, mediates these problems by way of hyperinsulinemia. Because of these interrelationships, there is a need to identify and prevent upper-body obesity or, failing that, to provide therapies that will control the associated problems without aggravating hyperinsulinemia. ( Arch Intern Med . 1989;149:1514-1520)

The Deadly Quartet: Upper-Body Obesity, Glucose Intolerance, Hypertriglyceridemia, and Hypertension

Targeted tuberculin testing and treatment of latent tuberculosis infection - Supplement - American Thoracic Society Centers for Disease Control and Prevention

The effect of patient race and socio-economic status on physicians' perceptions of patients.

BACKGROUND: The Institute of Medicine calls for physicians to engage patients in making clinical decisions, but not every patient may want the same level of participation. OBJECTIVES: 1) To assess public preferences for participation in decision making in a representative sample of the U.S. population. 2) To understand how demographic variables and health status influence people’s preferences for participation in decision making. DESIGN AND PARTICIPANTS: A population-based survey of a fully representative sample of English-speaking adults was conducted in concert with the 2002 General Social Survey (N=2,765). Respondents expressed preferences ranging from patient-directed to physician-directed styles on each of 3 aspects of decision making (seeking information, discussing options, making the final decision). Logistic regression was used to assess the relationships of demographic variables and health status to preferences. MAIN RESULTS: Nearly all respondents (96%) preferred to be offered choices and to be asked their opinions. In contrast, half of the respondents (52%) preferred to leave final decisions to their physicians and 44% preferred to rely on physicians for medical knowledge rather than seeking out information themselves. Women, more educated, and healthier people were more likely to prefer an active role in decision making. African-American and Hispanic respondents were more likely to prefer that physicians make the decisions. Preferences for an active role increased with age up to 45 years, but then declined. CONCLUSION: This population-based study demonstrates that people vary substantially in their preferences for participation in decision making. Physicians and health care organizations should not assume that patients wish to participate in clinical decision making, but must assess individual patient preferences and tailor care accordingly.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1525-1497.2005.04101.x

Not all patients want to participate in decision making. A national study of public preferences.

Background: Quantitative information about risks and benefits may be meaningful only to patients who have some facility with basic probability and numerical concepts, a construct called numeracy. O...

The Role of Numeracy in Understanding the Benefit of Screening Mammography

Absolutely relative: how research results are summarized can affect treatment decisions.

There has been a recent focus on explicit competencies to make the educational process in residency training more effective.1 With the implementation of reduced work hours—making training safer for patients and more humane for residents2,3—experts and panels have recommended strengthening mentoring programs to improve the experience and outcome of residency training.4–9 Clearly, an important goal of residency training remains the preparation of young physicians for their future careers in medicine, through a system that enables them to reach their personal and professional goals in service to society. Despite the obvious appeal of better mentoring for residents, few data are available to characterize residents' views of mentors, or to identify characteristics associated with effective mentoring experiences.

Recent studies describe stress10 and burnout11 during residency training. Discontent expressed by role models and teachers in academic medical centers10 may further affect quality of care and teaching, as well as residents' career choices. Little is known about ways to reduce this stress and to encourage personal and professional growth. Mentoring during the early stages of an individual's career has been associated with a higher level of career satisfaction and a higher rate of promotion, both in medical and non-medical fields,12 and may encourage personal growth. Mentoring during residency training may also foster the development of professionalism, a core competency as identified by the Accreditation Council for Graduate Medical Education (ACGME),13 and has been advocated as a means of enriching contact between residents and faculty physicians.14

Successful mentoring relationships may enable faculty to provide career and psychosocial support to trainees, while guiding their development of professional expertise.15–17 In a previous study, we found that junior faculty value mentors who maintain close contact while providing counsel on professional decisions and aiding in building professional networks.18 However, little is known about mentoring relationships during residency training. Although mentoring relationships between faculty and trainees have been encouraged in order to improve satisfaction with the training experience, and trainee perception of their preparation for their future careers,19,20 few data examine the effectiveness of such relationships during residency training. In this context, our aim was to describe mentoring relationships among internal medicine residents, and to examine the relationship between mentoring and perceived career preparation.

/pdf/mentoring-matters-mentoring-and-career-preparation-in-2ypa69hb2x.pdf

Mentoring matters. Mentoring and career preparation in internal medicine residency training.

In deciding whether to undertake a dietary program to reduce serum cholesterol levels, a person must consider how much benefit to expect. We developed a model that assumes cholesterol reduction is effective and safe in reducing the risk for death from ischemic heart disease. In the model, we considered asymptomatic adults with total serum cholesterol levels between 180 and 300 mg/dL. We defined risk status on the basis of blood pressure, smoking habit, and high-density-lipoprotein cholesterol level. For persons aged 20 to 60 years who are at low risk, we calculate a gain in life expectancy of 3 days to 3 months from a lifelong program of cholesterol reduction. For persons who are at high risk, the calculated gain ranges from 18 days to 12 months. Knowledge of the magnitude of the calculated benefits in increased life expectancy afforded by cholesterol reduction can assist persons in making decisions about dietary change.

Cholesterol reduction and life expectancy. A model incorporating multiple risk factors.

We used decision analysis to determine the benefits and risks of preventive therapy with isoniazid for young adults whose only risk factor for the development of active tuberculosis was a ...

Should Young Adults with a Positive Tuberculin Test Take Isoniazid

We developed a required, longitudinal course for first-year medical students that addressed the patient-doctor relationship. Our course linked understanding patients' experiences and perspectives o...

William C. Taylor

Papers

Absolutely relative: how research results are summarized can affect treatment decisions.

Mentoring matters. Mentoring and career preparation in internal medicine residency training.

Cholesterol reduction and life expectancy. A model incorporating multiple risk factors.

Should Young Adults with a Positive Tuberculin Test Take Isoniazid

Teaching medicine as a human experience: a patient-doctor relationship course for faculty and first-year medical students.