Showing papers in "JAMA in 1989"
TL;DR: Higher levels of physical fitness appear to delay all-cause mortality primarily due to lowered rates of cardiovascular disease and cancer, and lower mortality rates in higher fitness categories also were seen for cardiovascular Disease and cancer of combined sites.
Abstract: We studied physical fitness and risk of all-cause and cause-specific mortality in 10 224 men and 3120 women who were given a preventive medical examination. Physical fitness was measured by a maximal treadmill exercise test. Average follow-up was slightly more than 8 years, for a total of 110 482 person-years of observation. There were 240 deaths in men and 43 deaths in women. Age-adjusted all-cause mortality rates declined across physical fitness quintiles from 64.0 per 10 000 person-years in the least-fit men to 18.6 per 10 000 person-years in the most-fit men (slope, —4.5). Corresponding values for women were 39.5 per 10 000 person-years to 8.5 per 10 000 person-years (slope, —5.5). These trends remained after statistical adjustment for age, smoking habit, cholesterol level, systolic blood pressure, fasting blood glucose level, parental history of coronary heart disease, and follow-up interval. Lower mortality rates in higher fitness categories also were seen for cardiovascular disease and cancer of combined sites. Attributable risk estimates for all-cause mortality indicated that low physical fitness was an important risk factor in both men and women. Higher levels of physical fitness appear to delay all-cause mortality primarily due to lowered rates of cardiovascular disease and cancer. ( JAMA . 1989;262:2395-2401)
3,957 citations
TL;DR: For example, patients with either current depressive disorder or depressive symptoms in the absence of disorder tended to have worse physical, social, and role functioning, worse perceived current health, and greater bodily pain than did patients with no chronic conditions.
Abstract: We describe the functioning and well-being of patients with depression, relative to patients with chronic medical conditions or no chronic conditions. Data are from 11 242 outpatients in three health care provision systems in three US sites. Patients with either current depressive disorder or depressive symptoms in the absence of disorder tended to have worse physical, social, and role functioning, worse perceived current health, and greater bodily pain than did patients with no chronic conditions. The poor functioning uniquely associated with depressive symptoms, with or without depressive disorder, was comparable with or worse than that uniquely associated with eight major chronic medical conditions. For example, the unique association of days in bed with depressive symptoms was significantly greater than the comparable association with hypertension, diabetes, and arthritis. Depression and chronic medical conditions had unique and additive effects on patient functioning. ( JAMA . 1989;262:914-919)
2,759 citations
TL;DR: As part of the National Institute of Mental Health Epidemiologic Catchment Area study, 7954 respondents were questioned at baseline and 1 year later about sleep complaints and psychiatric symptoms using the Diagnostic Interview Schedule.
Abstract: As part of the National Institute of Mental Health Epidemiologic Catchment Area study, 7954 respondents were questioned at baseline and 1 year later about sleep complaints and psychiatric symptoms using the Diagnostic Interview Schedule. Of this community sample, 10.2% and 3.2% noted insomnia and hypersomnia, respectively, at the first interview. Forty percent of those with insomnia and 46.5% of those with hypersomnia had a psychiatric disorder compared with 16.4% of those with no sleep complaints. The risk of developing new major depression was much higher in those who had insomnia at both interviews compared with those without insomnia (odds ratio, 39.8; 95% confidence interval, 19.8 to 80.0). The risk of developing new major depression was much less for those who had insomnia that had resolved by the second visit (odds ratio, 1.6; 95% confidence interval, 0.5 to 5.3). Further research is needed to determine if early recognition and treatment of sleep disturbances can prevent future psychiatric disorders.
2,658 citations
TL;DR: For eight of nine common chronic medical conditions, patients with the condition showed markedly worse physical, role, and social functioning; mental health; health perceptions; and/or bodily pain compared with patients with no chronic conditions.
Abstract: Enhancing daily functioning and well-being is an increasingly advocated goal in the treatment of patients with chronic conditions. We evaluated the functioning and well-being of 9385 adults at the time of office visits to 362 physicians in three US cities, using brief surveys completed by both patients and physicians. For eight of nine common chronic medical conditions, patients with the condition showed markedly worse physical, role, and social functioning; mental health; health perceptions; and/or bodily pain compared with patients with no chronic conditions. Each condition had a unique profile among the various health components. Hypertension had the least overall impact; heart disease and patient-reported gastrointestinal disorders had the greatest impact. Patients with multiple conditions showed greater decrements in functioning and well-being than those with only one condition. Substantial variations in functioning and well-being within each chronic condition group remain to be explained. (JAMA. 1989;262:907-913)
2,174 citations
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TL;DR: The comprehensive nature of the work includes not only soft-tissue tumors, in the traditional sense, but also provides extensive analyses of lesions that are peripheral to the tumor designation, most strikingly in the sections on fibrous proliferations and fibromatoses.
Abstract: This is yet another example of the expert use of the extraordinary compass of one of the most remarkable institutions in the medical firmament, the Armed Forces Institute of Pathology (AFIP). In the great tradition of the publications from that institution that have established the diagnostic criteria for pathology for decades, Soft Tissue Tumors , in its second edition, achieves that goal and far exceeds previous work by incorporating clinical experience, therapeutic approaches, biologic behavior, and discussion of each entity. This method provides a comprehensive reference for clinicians as well as for pathologists in the complex field of disorders affecting soft tissues. The title of the volume is somewhat misleading. The comprehensive nature of the work includes not only soft-tissue tumors, in the traditional sense, but also provides extensive analyses of lesions that are peripheral to the tumor designation, most strikingly in the sections on fibrous proliferations and fibromatoses. The apposition
2,102 citations
TL;DR: Risk factors for having a single fall were few and relatively weak, but multiple falls were more predictable, and increased odds of two or more falls for persons who had difficulty standing up from a chair, difficulty performing a tandem walk, arthritis, Parkinson's disease, and a fall with injury during the previous year were found.
Abstract: Falls are a major threat to the health of older persons. We evaluated potential risk factors for falls in 325 community-dwelling persons aged 60 years or older who had fallen during the previous year, then followed up weekly for 1 year to ascertain nonsyncopal falls and their consequences. Risk factors for having a single fall were few and relatively weak, but multiple falls were more predictable. In multivariate analyses, we found increased odds of two or more falls for persons who had difficulty standing up from a chair, difficulty performing a tandem walk, arthritis, Parkinson's disease, three or more falls during the previous year, and a fall with injury during the previous year, and for whites. The proportion of subjects with two or more falls per year increased from 0.10 for those with none or one of these risk factors to 0.69 for those with four or more risk factors. Among older persons with a history of a recent fall, the risk of multiple nonsyncopal falls can be predicted from a few simple questions and examinations. ( JAMA . 1989;261:2663-2668)
1,818 citations
TL;DR: In this article, the authors assessed clinically diagnosed Alzheimer's disease and other dementing illnesses in a geographically defined US community and found that the prevalence rate was strongly associated with the age of individuals.
Abstract: Clinically diagnosed Alzheimer's disease and other dementing illnesses were assessed in a geographically defined US community. Of 3623 persons (80.8% of all community residents over 65 years of age) who had brief memory testing in their homes, a stratified sample of 467 persons underwent neurological, neuropsychological, and laboratory examination. Prevalence rates of Alzheimer's disease were calculated for the community population from the sample undergoing clinical evaluation. Of those over the age of 65 years, an estimated 10.3% (95% confidence limits, 8.1% and 12.5%) had probable Alzheimer's disease. This prevalence rate was strongly associated with age. Of those 65 to 74 years old, 3.0% (95% confidence limits, 0.8 and 5.2) had probable Alzheimer's disease, compared with 18.7% (95% confidence limits, 13.2 and 24.2) of those 75 to 84 years old and 47.2% (95% confidence limits, 37.0 and 63.2) of those over 85 years. Other dementing conditions were uncommon. Of community residents with moderate or severe cognitive impairment, 84.1% had clinically diagnosed Alzheimer's disease as the only probable diagnosis. These data suggest that clinically diagnosed Alzheimer's disease is a common condition and that its public health impact will continue to increase with increasing longevity of the population. (JAMA. 1989;262:2551-2556)
1,735 citations
TL;DR: The Medical Outcomes Study was designed to determine whether variations in patient outcomes are explained by differences in system of care, clinician specialty, and clinicians' technical and interpersonal styles and develop more practical tools for the routine monitoring of patient outcomes in medical practice.
Abstract: The Medical Outcomes Study was designed to (1) determine whether variations in patient outcomes are explained by differences in system of care, clinician specialty, and clinicians' technical and interpersonal styles and (2) develop more practical tools for the routine monitoring of patient outcomes in medical practice. Outcomes included clinical end points; physical, social, and role functioning in everyday living; patients' perceptions of their general health and well-being; and satisfaction with treatment. Populations of clinicians (n = 523) were randomly sampled from different health care settings in Boston, Mass; Chicago, Ill; and Los Angeles, Calif. In the cross-sectional study, adult patients (n = 22 462) evaluated their health status and treatment. A sample of these patients (n = 2349) with diabetes, hypertension, coronary heart disease, and/or depression were selected for the longitudinal study. Their hospitalizations and other treatments were monitored and they periodically reported outcomes of care. At the beginning and end of the longitudinal study, Medical Outcomes Study staff performed physical examinations and laboratory tests. Results will be reported serially, primarily inThe Journal. (JAMA. 1989;262:925-930)
1,139 citations
TL;DR: Using a new method with epilepsy as a model, compliance with long-term medications among newly treated and long- term patients is assessed using standard pill bottles with micro-processors in the cap to record every bottle opening as a presumptive dose.
Abstract: The evaluation of the efficacy of medication is confounded when patients do not adhere to prescribed regimens. Overdosing, underdosing, and erratic dosing intervals can diminish drug action or cause adverse effects. Using a new method with epilepsy as a model, we assessed compliance with long-term medications among newly treated and long-term patients. Medication Event Monitor Systems (Aprex Corporation, Fremont, Calif) are standard pill bottles with microprocessors in the cap to record every bottle opening as a presumptive dose. Compliance rates averaged 76% during 3428 days observed: 87% of the once daily, 81% of the twice daily, 77% of the three times a day, and 39% of the four times a day dosages were taken as prescribed. Coefficients of variation of drug serum concentrations had no significant relationship to compliance rates. Pill counts overestimated compliance increasingly as compliance with the prescribed regimen declined. Neither drug serum concentrations nor pill counts would have identified the frequency of missed doses that were revealed with continuous dose observations. (JAMA. 1989;261:3273-3277)
1,025 citations
TL;DR: The cardiovascular physical examination is used commonly as a basis for diagnosis and therapy in chronic heart failure, although the relationship between physical signs, increased ventricular filling pressure, and decreased cardiac output has not been established for this population.
Abstract: The cardiovascular physical examination is used commonly as a basis for diagnosis and therapy in chronic heart failure, although the relationship between physical signs, increased ventricular filling pressure, and decreased cardiac output has not been established for this population. We prospectively compared physical signs with hemodynamic measurements in 50 patients with known chronic heart failure (ejection fraction,.18±.06). Rales, edema, and elevated mean jugular venous pressure were absent in 18 of 43 patients with pulmonary capillary wedge pressures greater than or equal to 22 mm Hg, for which the combination of these signs had 58% sensitivity and 100% specificity. Proportional pulse pressure correlated well with cardiac index (r=.82), and when less than 25% pulse pressure had 91% sensitivity and 83% specificity for a cardiac index less than 2.2 L/min/m2. In chronic heart failure, reliance on physical signs for elevated ventricular filling pressure might result in inadequate therapy. Conversely, the adequacy of cardiac output is assessed reliably by pulse pressure. Our results facilitate decisions regarding treatment in chronic heart failure. (JAMA1989;261:884-888)
929 citations
TL;DR: It is demonstrated that CMV infection in cardiac transplant recipients is associated with more frequent rejection, graft atherosclerosis, and death.
Abstract: We studied the effects of cytomegalovirus (CMV) infection on 301 cardiac transplant recipients who were treated during the cyclosporine era of immunosuppression (1980 to the present). These patients received varying combinations of cyclosporine, azathioprine, prednisone, rabbit antithymocyte globulin, and OKT3 as their immunosuppressive therapy. Two hundred ten patients were free of CMV infection (non-CMV group). During the same period CMV infection developed in 91 patients, as manifested by a fourfold IgG serologic titer rise, demonstration of CMV inclusion bodies in tissue, or positive cultures for the virus (CMV group). The rate of graft rejection was significantly higher in the CMV group. Graft atherosclerosis was significantly more severe in the CMV group as judged by angiographic criteria or by pathologic study. Patient survival rates were significantly lower in the CMV group. Death caused by graft atherosclerosis was significantly more common among patients in the CMV group. Finally, the graft loss rate (from either death or retransplantation for atherosclerosis) was significantly greater in the CMV group. These data demonstrate that CMV infection in cardiac transplant recipients is associated with more frequent rejection, graft atherosclerosis, and death. ( JAMA . 1989;261:3561-3566)
Journal Article•
TL;DR: Trends in cohort changes are evident in the United States, Sweden, Germany, Canada, and New Zealand, but not in comparable studies conducted in Korea and Puerto Rico and of Mexican-Americans living in theUnited States.
Abstract: Several recent, large epidemiologic and family studies suggest important temporal changes in the rates of major depression: an increase in the rates in the cohorts born after World War II; a decrease in the age of onset with an increase in the late teenaged and early adult years; an increase between 1960 and 1975 in the rates of depression for all ages; a persistent gender effect, with the risk of depression consistently two to three times higher among women than men across all adult ages; a persistent family effect, with the risk about two to three times higher in first-degree relatives as compared with controls; and the suggestion of a narrowing of the differential risk to men and women due to a greater increase in risk of depression among young men These trends, drawn from studies using comparable methods and modern diagnostic criteria, are evident in the United States, Sweden, Germany, Canada, and New Zealand, but not in comparable studies conducted in Korea and Puerto Rico and of MexicanAmericans living in the United States These cohort changes cannot be fully attributed to artifacts of reporting, recall, mortality, or labeling and have implications for understanding the etiology of depression and for clinical practice (JAMA 1989;261:2229-2235)
TL;DR: By understanding economic analysis, physicians will be able to act as patient advocates and fulfill their responsibilities to society to manage resources prudently, Eisenberg believes.
Abstract: PUBLIC and professional concern about the cost of medical care has evoked a variety of proposed remedies. Professional societies have promulgated guidelines to help physicians provide the most appropriate services. 1,2 Government has begun to recognize the need for more research into clinical strategies in hopes of exploring the variations in medical practice and reducing federal health care outlays. 3 Insurance companies and businesses have desperately sought (and bought) consultants who promise to control beneficiaries' and employees' utilization of medical services. Underlying these cost-cutting solutions is a faith that medical care can be made cost-effective, that more value can be obtained for the money spent. The application of economics to medical practice does not necessarily mean that less should or can be spent, but rather that the use of resources might be more efficient. 4-21 To achieve more cost-effective medical practice, the attention of experts in health policy ultimately must
TL;DR: Although this cancer detection system has been effective in reducing the rate of morbidity and mortality from invasive cervical cancer in appropriately screened populations, there is no evidence that the Papanicolaou test has succeeded anywhere in complete eradication of this theoretically preventable disease.
Abstract: The complex detection system leading to the discovery and treatment of precancerous lesions and early cancer of the uterine cervix is described in detail and discussed By far the most difficult and underestimated component of this system is the screening and interpretation of cervical (Papanicolaou) smears Cytologic case finding may fail because of inadequate samples, insufficient time devoted to screening, or human fatigue Other weak points of the system, such as an inadequate clinical component, inadequate patient compliance, poor reproducibility of diagnoses, and ineffective aftercare, are also described For example, obtaining a second smear to confirm or refute a diagnosis of cellular atypia is often a misleading practice Although this cancer detection system has been shown to be effective in reducing the rate of morbidity and mortality from invasive cervical cancer in appropriately screened populations, there is no evidence that the Papanicolaou test has succeeded anywhere in complete eradication of this theoretically preventable disease It is important to inform the public about the potential failures of the system and the reasons for them (JAMA1989;261:737-743)
TL;DR: The relation of multivitamin intake in general, and folic acid in particular, to the risk of neural tube defects in a cohort of 23,491 women undergoing maternal serum alpha-fetoprotein screening or amniocentesis around 16 weeks of gestation was examined.
Abstract: We examined the relation of multivitamin intake in general, and folic acid in particular, to the risk of neural tube defects in a cohort of 23 491 women undergoing maternal serum α-fetoprotein screening or amniocentesis around 16 weeks of gestation. Complete questionnaires and subsequent pregnancy outcome information was obtained in 22 776 pregnancies, 49 of which ended in a neural tube defect. The prevalence of neural tube defect was 3.5 per 1000 among women who never used multivitamins before or after conception or who used multivitamins before conception only. The prevalence of neural tube defects for women who used folic acid-containing multivitamins during the first 6 weeks of pregnancy was substantially lower—0.9 per 1000 (prevalence ratio, 0.27; 95% confidence interval, 0.12 to 0.59 compared with never users). For women who used multivitamins without folic acid during the first 6 weeks of pregnancy and women who used multivitamins containing folic acid beginning after 7 or more weeks of pregnancy, the prevalences were similar to that of the nonusers and the prevalence ratios were close to 1.0. ( JAMA . 1989;262:2847-2852)
TL;DR: Analyses of 42 schools indicate that the prevalence rates of use for all three drugs are significantly lower at 1-year follow-up in the intervention condition relative to the delayed intervention condition, and the net increase in drug use prevalence among intervention schools is half that of delayed intervention schools.
Abstract: The entire early adolescent population of the 15 communities that constitute the Kansas City (Kansas and Missouri) metropolitan area has participated in a community-based program for prevention of drug abuse since September 1984. The Kansas City area is the first of two major metropolitan sites being evaluated in the Midwestern Prevention Project, a longitudinal trial for primary prevention of cigarette, alcohol, and marijuana use in adolescents. The project includes mass media programming, a school-based educational program for youths, parent education and organization, community organization, and health policy components that are introduced sequentially into communities during a 6-year period. Effects of the program are determined through annual assessments of adolescent drug use in schools that are assigned to immediate intervention or delayed intervention control conditions. In the first 2 years of the project, 22 500 sixth- and seventh-grade adolescents received the school-based educational program component, with parental involvement in homework and mass media coverage. Analyses of 42 schools indicate that the prevalence rates of use for all three drugs are significantly lower at 1-year follow-up in the intervention condition relative to the delayed intervention condition, with or without controlling for race, grade, socioeconomic status, and urbanicity (17% vs 24% for cigarette smoking, 11% vs 16% for alcohol use, and 7% vs 10% for marijuana use in the last month), and the net increase in drug use prevalence among intervention schools is half that of delayed intervention schools. (JAMA. 1989;261:3259-3266)
TL;DR: By multivariate analysis, black race, daily cocaine injection by blacks and Hispanics, all other cocaine injection, heavy use prior to entry into methadone treatment by blacks, and use of drugs in shooting galleries were independent predictors of HIV infection.
Abstract: We assessed risk factors for human immunodeficiency virus (HIV) infection in 633 heterosexual intravenous drug users The HIV seroprevalence was 26% in blacks, 10% in Hispanics, and 6% in whites Intravenous cocaine use significantly increased the risk of HIV infection, with a seroprevalence of 35% in daily cocaine users (odds ratio, 64; 95% confidence interval, 30 to 133) Black subjects were more likely to use cocaine regularly Drug use in shooting galleries and sharing of drug injection equipment were also associated with HIV infection and were more common in cocaine users By multivariate analysis, black race, daily cocaine injection by blacks and Hispanics, all other cocaine injection, heavy use prior to entry into methadone treatment by blacks, and use of drugs in shooting galleries were independent predictors of HIV infection Methadone therapy was associated with substantial reductions in heroin use and some reduction in cocaine use, but 24% of cocaine users receiving methadone began or increased cocaine injection after entry into treatment ( JAMA 1989;261:561-565)
TL;DR: Medical record review for a sample of 189 cases suggested that this finding was not due to confounding by dementia, ambulatory status, functional status, or body mass, and it was not altered by sex, age, calendar year, nursing home residence, or history of hospitalization.
Abstract: To determine if the risk of hip fracture differed between persons receiving benzodiazepines with long (≥24 hours) or short ( (JAMA. 1989;262:3303-3307)
TL;DR: The results indicate that the likelihood of unanticipated admission is related more to the type of anesthesia and surgical procedure rather than to the patient's clinical characteristics.
Abstract: We conducted a case-control study to identify clinical and demographic risk factors for admission to the hospital following ambulatory surgery. Of 9616 adult patients who underwent ambulatory surgery at a university-affiliated hospital between 1984 and 1986, one hundred were admitted. The most common reasons for admission were pain (18), excessive bleeding (18), and intractable vomiting (17). The mean age (±SD) of patients who were admitted was 37±13 years, and 96% had American Society of Anesthesiologists' physical status scores of 1 or 2. Factors that were independently associated with an increased likelihood of admission were general anesthesia (odds ratio, 5.2), postoperative emesis (odds ratio, 3.0), lower abdominal and urologic surgery (odds ratio, 2.9), time in the operating room greater than 1 hour (odds ratio, 2.7), and age (odds ratio, 2.6). Our results indicate that the likelihood of unanticipated admission is related more to the type of anesthesia and surgical procedure rather than to the patient's clinical characteristics. ( JAMA . 1989;262:3008-3010)
TL;DR: An improved measure of physician volume is used to test the combined relationship of hospital and physician volume with in-hospital mortality rates and to explore the existence of threshold volumes that optimally discriminate high- and low-volume providers.
Abstract: Recent studies have demonstrated that the number of times a hospital or surgeon performs certain procedures annually has an inverse relationship with in-hospital mortality rates for patients undergoing the procedures. This study uses an improved measure of physician volume to test the combined relationship of hospital and physician volume with in-hospital mortality rates and to explore the existence of threshold volumes that optimally discriminate high- and low-volume providers. Five procedure groups have significant volume-mortality relationships. For total cholecystectomies, hospital volume is the more significant volume measure, but physician volume is marginally related to mortality rate. For coronary artery bypass surgeries, resection of abdominal aortic aneurysms, partial gastrectomies, and colectomies, physician volume is more significant than hospital volume, but hospital volume is marginally significant. Annual hospital volume thresholds for these data appear to exist at approximately 5 procedures for partial gastrectomies, 40 procedures for colectomies, and 170 procedures for total cholecystectomies. (JAMA. 1989;262:503-510)
TL;DR: Health care organizations may well make important advances in the quality of care and service through the application of principles and techniques developed in modern industrial quality science.
Abstract: In an effort to provide health care of optimal quality, providers traditionally assess or measure performance and then assure that it conforms to standards. In cases where performance fails to conform, providers attempt to modify or improve physician behavior. The analytic scope of this traditional paradigm may not be broad enough to allow modern health care organizations to provide optimal care. At a theoretical and practical level, many conceptual limitations inherent in the traditional approach are addressed in modern industrial quality science. A fundamental principle of industrial quality control is the recognition, analysis, and elimination of variation. Based on rigorous analysis of variation in outcomes and processes, industrial quality experts have developed principles and techniques for quality improvement. Health care organizations may well make important advances in the quality of care and service through the application of these principles and techniques. ( JAMA . 1989;262:2869-2873)
TL;DR: The extent to which the physicians intervened while the patient was hospitalized correlated with the patient's reported change in alcohol use after discharge, and recommendations based on these data are being incorporated into the medical education curriculum.
Abstract: As part of an institution-wide program to enhance the education of physicians in diagnosing and treating alcohol dependence and abuse, a comprehensive survey was conducted in which all new admissions to the adult inpatient services of The Johns Hopkins Hospital were screened for alcoholism. The prevalence of screen-positive alcoholism, by department, was as follows: medicine (25%), psychiatry (30%), neurology (19%), obstetrics-gynecology (12.5%), and surgery (23%). Detection rates by the house staff and faculty physicians caring for those patients who screened positively were less than 25% in surgery and obstetrics-gynecology, between 25% and 50% in neurology and medicine, and greater than 50% in psychiatry. However, physicians were less likely to identify as alcoholic those patients with higher incomes, higher education, or private medical insurance; women; and those who denied heavy alcohol intake. Physician-instituted treatment rates for those patients diagnosed by the physician as having nonrecovered alcoholism were less than 50% in surgery and obstetrics-gynecology, between 50% and 75% in medicine and neurology, and 100% in psychiatry. The extent to which the physicians intervened while the patient was hospitalized correlated with the patient's reported change in alcohol use after discharge. Recommendations based on these data are being incorporated into the medical education curriculum.
TL;DR: Author Padden and Humphries have undertaken the task of clarifying the cultural "uniqueness" of the deaf, but their approach is less rigorous than traditional approaches by cultural anthropologists or linguists, and this in some ways detracts from the structured scholarship that such credentials afford.
Abstract: Historically, medical schools have seldom prepared an emerging physician to deal with problems so fundamental as nutrition, much less such complex political and ethical issues as the subcultures of poverty, minorities, or the "handicapped." Authors Padden and Humphries have undertaken the task of clarifying the cultural "uniqueness" of the deaf. Being deaf was regarded as a separate but very undesirable culture as early as medieval times, when "the position of the deaf was especially difficult because they were thought to be 'possessed by the devil' or, at least, morally deficient. The deaf could not obtain 'the true faith' since in the Holy Scriptures is written fides ex auditu (faith comes from hearing)." 1 Although Padden and Humphries write with compassion and understanding, their approach is less rigorous than traditional approaches by cultural anthropologists or linguists, and this in some ways detracts from the structured scholarship that such credentials afford. The
TL;DR: Examination of admissions for circulatory diseases or chest pain to Massachusetts hospitals in 1985 suggests that substantial racial inequalities exist in the use of procedures for patients hospitalized with coronary heart disease.
Abstract: To examine interracial differences in the utilization of coronary angiography, coronary artery bypass grafting, and coronary angioplasty for white and black patients, we examined all admissions for circulatory diseases or chest pain to Massachusetts hospitals in 1985. After controlling for age, sex, payer, income, primary diagnoses, and the number of secondary diagnoses, whites underwent significantly more angiography and coronary artery bypass grafting procedures. Whites also underwent more angioplasty procedures, but the difference was not statistically significant. Although utilization differences may reflect patient preference or different levels of disease severity and socioeconomic status not adequately accounted for, this study suggests that substantial racial inequalities exist in the use of procedures for patients hospitalized with coronary heart disease. ( JAMA 1989;261:253-257)
TL;DR: Black Americans compared with whites are less likely to be satisfied with the qualitative ways their physicians treat them when they are ill, more dissatisfied with the care they receive when hospitalized, and more likely to believe that the duration of their hospitalizations is too short.
Abstract: A 1986 national survey of use of health services shows a significant deficit in access to health care among black compared with white Americans. This gap was experienced by all income levels of black Americans. In addition, the study points to significant underuse by blacks of needed medical care. Moreover, blacks compared with whites are less likely to be satisfied with the qualitative ways their physicians treat them when they are ill, more dissatisfied with the care they receive when hospitalized, and more likely to believe that the duration of their hospitalizations is too short.
TL;DR: Both groups of cocaine-exposed infants demonstrated significant impairment of orientation, motor, and state regulation behaviors on the Neonatal Behavioral Assessment Scale.
Abstract: Seventy-five cocaine-using women enrolled in a comprehensive perinatal care program were divided into two groups: those who used cocaine in only the first trimester of pregnancy (group 1 [N = 23]) and those who used cocaine throughout pregnancy (group 2 [N = 52]). Perinatal outcomes of these pregnancies were compared with perinatal outcomes of a matched group of obstetric patients with no history or evidence of substance abuse (group 3 [N = 40]). Group 2 women had an increased rate of preterm delivery and low-birth-weight infants as well as an increased rate of intrauterine growth retardation. Group 1 women had rates of these complications similar to the drug-free group. Mean birth weight, length, and head circumference for term infants were reduced in only the group 2 infants. However, both groups of cocaine-exposed infants demonstrated significant impairment of orientation, motor, and state regulation behaviors on the Neonatal Behavioral Assessment Scale. ( JAMA 1989;261:1741-1744)
TL;DR: A continuous population-based registry of cases of squamous cell skin cancer within a single prepaid health plan is used to describe basic epidemiologic features of this malignancy and compare it with the more widely studied melanoma, finding that both malignancies are considerably more common in this population than expected.
Abstract: Squamous cell skin cancer, though common, remains largely unreported and unstudied, with little known about its incidence and time trends. We have used a unique resource—a continuous population-based registry of cases of squamous cell skin cancer within a single prepaid health plan—to describe basic epidemiologic features of this malignancy and compare it with the more widely studied melanoma. Both malignancies are considerably more common in this population than we expected based on previous reports from the general population. From the 1960s to the 1980s, the incidence of squamous cell skin cancer increased 2.6 times in men and 3.1 times in women, while incidence of melanoma rose 3.5-fold and 4.6-fold in men and women, respectively. Skin cancers of both types involving the head and neck or the extremities increased essentially in parallel over these 27 years. Melanomas of the trunk, however, appeared to increase at a faster rate in both sexes. These observations are consistent with the impression that the rising incidence of both malignancies may be attributable to increased voluntary exposure to the sun over an extended period. ( JAMA . 1989;262:2097-2100)
TL;DR: This is the first study to suggest that heterosexual transmission may play an important role in the spread of NANB hepatitis.
Abstract: To identify previously unrecognized sources for acquiring acute hepatitis B and non-A, non-B (NANB) hepatitis, we interviewed patients with these types of hepatitis who were reported to two county health departments in the United States and matched control subjects for known and potential risk factors for acquiring hepatitis. Of 218 patients with hepatitis B and 140 patients with NANB hepatitis, 46% and 53%, respectively, had no commonly recognized source for infection. When these patients were compared with control subjects, significantly more patients with hepatitis B had multiple heterosexual partners, accounting for 14% of all hepatitis B infections; more patients with NANB hepatitis either had sexual or household contact with a person who had hepatitis in the past or had multiple heterosexual partners, accounting for 11% of all NANB infections. This is the first study to suggest that heterosexual transmission may play an important role in the spread of NANB hepatitis. ( JAMA . 1989;262:1201-1205)
TL;DR: An association between hearing impairment and dementia is demonstrated and support is lent to the hypothesis that hearing impairment contributes to cognitive dysfunction in older adults.
Abstract: We conducted a case-control study in 100 cases who had Alzheimer's-type dementia and 100 age-, sex-, and education-matched, nondemented controls to evaluate the hypothesis that hearing impairment contributes to cognitive dysfunction in older adults. The prevalence of a hearing loss of 30 dB or greater was significantly higher in cases than in controls (odds ratio, 2.0; 95% confidence interval, 1.2 to 3.4), even when adjusted for potentially confounding variables. In addition, we observed a dose-response relationship in which greater hearing loss was associated with a higher adjusted relative odds of having dementia. Hearing loss was also significantly and independently correlated with the severity of cognitive dysfunction, as measured by the Mini-Mental State Examination, in nondemented as well as demented patients. These results demonstrate an association between hearing impairment and dementia and lend support to the hypothesis that hearing impairment contributes to cognitive dysfunction in older adults.