RESUMO
The free-living infectious stages of macroparasites, specifically, the cercariae of trematodes (flatworms), are likely to be significant (albeit underappreciated) vectors of nutritionally important polyunsaturated fatty acids (PUFA) to consumers within aquatic food webs, and other macroparasites could serve similar roles. In the context of de novo omega-3 (n-3) PUFA biosynthesis, it was thought that most animals lack the fatty acid (FA) desaturase enzymes that convert stearic acid (18:0) into É-linolenic acid (ALA; 18:3n-3), the main FA precursor for n-3 long-chain PUFA. Recently, novel sequences of these enzymes were recovered from 80 species from six invertebrate phyla, with experimental confirmation of gene function in five phyla. Given this wide distribution, and the unusual attributes of flatworm genomes, we conducted an additional search for genes for de novo n-3 PUFA in the phylum Platyhelminthes. Searches with experimentally confirmed sequences from Rotifera recovered nine relevant FA desaturase sequences from eight species in four genera in the two exclusively endoparasite classes (Trematoda and Cestoda). These results could indicate adaptations of these particular parasite species, or may reflect the uneven taxonomic coverage of sequence databases. Although additional genomic data and, particularly, experimental study of gene functionality are important future validation steps, our results indicate endoparasitic platyhelminths may have enzymes for de novo n-3 PUFA biosynthesis, thereby contributing to global PUFA production, but also representing a potential target for clinical antihelmintic applications.
Assuntos
Ácidos Graxos Dessaturases/genética , Ácidos Graxos Ômega-3 , Proteínas de Helminto/genética , Platelmintos , Animais , Ácidos Graxos Ômega-3/biossíntese , Platelmintos/enzimologia , Platelmintos/genética , Estudos ProspectivosRESUMO
Observed changes in eating and drinking behaviors in economically developing countries are associated with increase of obesity and related chronic diseases. Researchers from field of public health (PH) have attributed this problem to food processing and have created new food classification systems to support their thesis. These classifications conceptually differ from processing level concepts in food science, and state to people that food processing is directly related to nutritional impact of food. Our work aims to compare the concept of food processing from the standpoint of food science and technology (FST) and public health and to discuss differences related to formulation or level of processing of products and their impact on nutritional quality. There is a misconception between food processing/unit operation/food technology and formulation or recipes. For the public health approach, classification is based on food products selection and the use of ingredients that results in higher consumption of sugar, sodium, fat, and additives, whereas in FST, processing level is based on the intensity and amount of unit operations to enhance shelf life, food safety, food quality, and availability of edible parts of raw materials. Nutritional quality of a product or preparation is associated with formulation/recipe and not with the level of processing, with few exceptions. The impact of these recommendations on the actual comprehension of food processing and quality must be considered by the population.
Assuntos
Manipulação de Alimentos , Tecnologia de Alimentos , Saúde Pública , Humanos , Valor Nutritivo , ObesidadeRESUMO
Currently, one of the acclaimed alternatives for increasing maize yield is accomplished through utilization of heterosis in hybrid cultivars. However, upon performing crosses between related pairs, there are losses due to inbreeding depression. Thus, the aim of this study was to estimate inbreeding depression and the contribution of loci in heterozygosity in different types of maize hybrids. Eight treatments were evaluated, considering the F1 and S0 generations of four commercial hybrids. A randomized block experimental design was used, with three replications, and plots consisting of two three-meter long rows at a spacing of 0.50 m. The traits evaluated were plant height, first ear height and husked ear weight. For ear weight trait, there was a significant difference, where the treatments could be classified into three distinct groups. In this case, the single-cross hybrids AG7088 and 30F90Y exhibited greater depression through inbreeding due to the greater contribution of loci in heterozygosity and consequent predominance of deviations due to dominance.
Assuntos
Cruzamentos Genéticos , Hibridização Genética , Depressão por Endogamia/genética , Zea mays/genética , Loci Gênicos , Heterozigoto , Solo , Zea mays/anatomia & histologiaRESUMO
A rapid and sensitive method using liquid chromatography coupled with mass spectrometry triple quadrupole direct aqueous injection for analysis of atrazine and ametrine herbicides in surface waters was developed. According to the validation method, water samples from six different locations in the Piracicaba River were collected monthly from February 2011 to January 2012 and injected into a liquid chromatographer/dual mass spectrometer without the need for sample extraction. The method was validated and shown to be precise and accurate; limits of detection and quantification were 0.07 and 0.10 µg L(-1) for atrazine and 0.09 and 0.14 µg L(-1) for ametrine. During the sampling period, concentrations of atrazine ranged from 0.11 to 1.92 µg L(-1) and ametrine from 0.25 to 1.44 µg L(-1). After analysis of the herbicides, Danio rerio were exposed a range of concentrations found in the river water to check the induction of micronuclei and nuclear abnormalities (NAs) in erythrocytes. Concentrations of atrazine and ametrine >1.0 and 1.5 µg L(-1), respectively, induced MN formation in D. rerio. Ametrine was shown to be more genotoxic to D. rerio because a greater incidence of NAs was observed compared with atrazine. Therefore, environmentally relevant concentrations of atrazine and ametrine found in the Piracicaba River are dangerous to the aquatic biota.
Assuntos
Atrazina/toxicidade , Eritrócitos/efeitos dos fármacos , Herbicidas/toxicidade , Minerais/toxicidade , Mutagênicos/toxicidade , Poluentes Químicos da Água/toxicidade , Animais , Atrazina/análise , Brasil , Dano ao DNA , Monitoramento Ambiental , Herbicidas/análise , Micronúcleos com Defeito Cromossômico , Minerais/análise , Poluentes Químicos da Água/análise , Peixe-ZebraRESUMO
Immigration can improve economic status and access to education compared to the country of origin, but it challenges access to health and preventive care. Assess Brazilian immigrants' overall health conditions and dietary intake in New Jersey (US). This pilot study assessed health conditions and dietary intake. Brazilians immigrants were interviewed through their communities. Trained dietitians interviewed them using a questionnaire and three days of 24H recall. Dietary intake was analyzed using the Nutrition Data System for Research software. A sample of 118 individuals completed the protocol, majority female and overweight/obese, living in the US for 11.3 years with 21.1% declaring having Noncommunicable Diseases. The average number of daily meals was 2.20 ± 1.04. Energy intake does not correlate with time in the US. Obesity, dyslipidemia, and hypertension are the most prevalent Noncommunicable Diseases, demanding interventions that include managing saturated fat, cholesterol, and sodium intake.
Assuntos
Dieta , Emigrantes e Imigrantes , Nível de Saúde , Brasil/etnologia , Ingestão de Alimentos , Emigração e Imigração , Ingestão de Energia , Feminino , Humanos , Projetos Piloto , Estados Unidos/epidemiologiaRESUMO
Phagocytosis requires localized and transient remodeling of actin filaments. Phosphoinositide signaling is believed to play an important role in cytoskeletal organization, but it is unclear whether lipids, which can diffuse along the membrane, can mediate the focal actin assembly required for phagocytosis. We used imaging of fluorescent chimeras of pleckstrin homology and C1 domains in live macrophages to monitor the distribution of phosphatidylinositol-4,5-bisphosphate (4,5-PIP(2)) and diacylglycerol, respectively, during phagocytosis. Our results reveal a sequence of exquisitely localized, coordinated steps in phospholipid metabolism: a focal, rapid accumulation of 4,5-PIP(2) accompanied by recruitment of type Ialpha phosphatidylinositol phosphate kinase to the phagosomal cup, followed by disappearance of the phosphoinositide as the phagosome seals. Loss of 4,5-PIP(2) correlated with mobilization of phospholipase Cgamma (PLCgamma) and with the localized formation of diacylglycerol. The presence of 4, 5-PIP(2) and active PLCgamma at the phagosome was shown to be essential for effective particle ingestion. The temporal sequence of phosphoinositide metabolism suggests that accumulation of 4,5-PIP(2) is involved in the initial recruitment of actin to the phagocytic cup, while its degradation contributes to the subsequent cytoskeletal remodeling.
Assuntos
Macrófagos/citologia , Macrófagos/metabolismo , Fagocitose , Fosfatidilinositol 4,5-Difosfato/metabolismo , Actinas/metabolismo , Animais , Linhagem Celular , Diglicerídeos/metabolismo , Imunofluorescência , Genes Dominantes , Isoenzimas/antagonistas & inibidores , Isoenzimas/química , Isoenzimas/metabolismo , Macrófagos/enzimologia , Camundongos , Microscopia Eletrônica , Modelos Biológicos , Fagossomos/metabolismo , Fosfolipase C gama , Fosfotransferases (Aceptor do Grupo Álcool)/metabolismo , Estrutura Terciária de Proteína , Pseudópodes/metabolismo , Receptores de IgG/fisiologia , Proteínas Recombinantes de Fusão/metabolismo , Transdução de Sinais , Transfecção , Fosfolipases Tipo C/antagonistas & inibidores , Fosfolipases Tipo C/química , Fosfolipases Tipo C/metabolismoRESUMO
Phagosomes acquire their microbicidal properties by fusion with lysosomes. Products of phosphatidylinositol 3-kinase (PI 3-kinase) are required for phagosome formation, but their role in maturation is unknown. Using chimeric fluorescent proteins encoding tandem FYVE domains, we found that phosphatidylinositol 3-phosphate (PI[3]P) accumulates greatly but transiently on the phagosomal membrane. Unlike the 3'-phosphoinositides generated by class I PI 3-kinases which are evident in the nascent phagosomal cup, PI(3)P is only detectable after the phagosome has sealed. The class III PI 3-kinase VPS34 was found to be responsible for PI(3)P synthesis and essential for phagolysosome formation. In contrast, selective ablation of class I PI 3-kinase revealed that optimal phagocytosis, but not maturation, requires this type of enzyme. These results highlight the differential functional role of the two families of kinases, and raise the possibility that PI(3)P production by VPS34 may be targeted during the maturation arrest induced by some intracellular parasites.
Assuntos
Fagocitose/fisiologia , Fagossomos/metabolismo , Fosfatidilinositol 3-Quinases/metabolismo , Androstadienos/farmacologia , Animais , Células Cultivadas , Inibidores Enzimáticos/metabolismo , Fibroblastos/metabolismo , Genes Reporter , Humanos , Imunoglobulina G/metabolismo , Isoenzimas/genética , Isoenzimas/metabolismo , Lisossomos/metabolismo , Macrófagos/efeitos dos fármacos , Macrófagos/metabolismo , Camundongos , Camundongos Knockout , Microinjeções , Fagossomos/ultraestrutura , Fosfatidilinositol 3-Quinases/genética , Inibidores de Fosfoinositídeo-3 Quinase , Estrutura Terciária de Proteína , Proteínas Recombinantes de Fusão/genética , Proteínas Recombinantes de Fusão/metabolismo , WortmaninaRESUMO
BACKGROUND: Group B streptococcus (GBS) is the main bacteria that infects pregnant women and can cause abortion and chorioamnionitis. The impact of GBS effects on human trophoblast cells remains largely elusive, and actions toward anti-inflammatory strategies in pregnancy are needed. A potent anti-inflammatory molecule, uvaol is a triterpene from olive oil and its functions in trophoblasts are unknown. We aimed to analyze biomechanical and functional effects of inactivated GBS in trophoblast cells, with the addition of uvaol to test potential benefits. METHODS: HTR-8/SVneo cells were treated with uvaol and incubated with inactivated GBS. Cell viability and death were analyzed. Cellular elasticity and topography were accessed by atomic force microscopy. Nitrite production was evaluated by Griess reaction. Nuclear translocation of NFkB p65 was detected by immunofluorescence and Th1/Th2 cytokines by bead-based multiplex assay. RESULTS: GBS at 108â¯CFU increased cell death, which was partially prevented by uvaol. Cell stiffness, cytoskeleton organization and morphology were changed by GBS, and uvaol partially restored these alterations. Nuclear translocation of NFkB p65 began 15â¯min after GBS incubation and uvaol inhibited this process. GBS decreased IL-4 secretion and increased IL-1ß, IFN-γ and IL-2, whereas uvaol reverted this. CONCLUSIONS: The increased inflammation and cell death caused by GBS correlated with biomechanical and cytoskeleton changes found in trophoblast cells, while uvaol was effective its protective role. GENERAL SIGNIFICANCE: Uvaol is a natural anti-inflammatory product efficient against GBS-induced inflammation and it has potential to be acquired through diet in order to prevent GBS deleterious effects in pregnancy.
Assuntos
Streptococcus agalactiae/patogenicidade , Triterpenos/farmacologia , Trofoblastos/efeitos dos fármacos , Trofoblastos/microbiologia , Animais , Transporte Biológico , Fenômenos Biomecânicos , Morte Celular , Linhagem Celular , Núcleo Celular/metabolismo , Sobrevivência Celular , Chlorocebus aethiops , Citocinas/metabolismo , Feminino , Humanos , NF-kappa B/metabolismo , Nitritos/metabolismo , Gravidez , Células Th1/metabolismo , Trofoblastos/metabolismo , Células VeroRESUMO
SYCP3 localizes to the lateral elements of the synaptonemal complex and is essential for male meiosis. The genomic structure of SYCP3 consists of nine exons spanning approximately 14 kb. In mouse and rat, but not in hamster, the putative translation start of SYCP3 is present in the first exon. The putative promoter of SYCP3 was also cloned and shown to drive transcription of a reporter gene in somatic cells.
Assuntos
Proteínas Nucleares/genética , Complexo Sinaptonêmico/genética , Células 3T3 , Sequência de Aminoácidos , Animais , Sequência de Bases , Proteínas de Ciclo Celular , Proteínas de Ligação a DNA , Éxons , Íntrons , Meiose/genética , Camundongos , Dados de Sequência Molecular , Proteínas Nucleares/química , Regiões Promotoras Genéticas , Complexo Sinaptonêmico/química , TransfecçãoRESUMO
Cells of the innate immune system engulf invading microorganisms into plasma membrane-derived vacuoles called phagosomes. Newly formed phagosomes gradually acquire microbicidal properties by a maturation process which involves sequential and coordinated rounds of fusion with endomembranes and concomitant fission. Some pathogens interfere with this maturation sequence and thereby evade killing by the immune cells, managing to survive intracellularly as parasites. Phosphoinositides seem to be intimately involved in the processes of phagosome formation and maturation, and initial observations suggest that the ability of some microorganisms to survive intracellularly is associated with alterations in phosphoinositide metabolism. This chapter presents a brief overview of phosphoinositides in cells of the immune system, their metabolism in the context of phagocytosis and phagosome maturation and their possible derangements during infectious pathogenosis.
Assuntos
Fagocitose/fisiologia , Fagossomos/metabolismo , Fosfatidilinositóis/metabolismo , Animais , Humanos , Modelos Biológicos , Transdução de SinaisRESUMO
A quick and sensitive liquid chromatography-electrospray ionization tandem mass spectrometry method, using dynamic multiple reaction monitoring and a 1.8-µm particle size analytical column, was developed to determine 57 pesticides in tomato in a 13-min run. QuEChERS (quick, easy, cheap, effective, rugged, and safe) method for samples preparations and validations was carried out in compliance with EU SANCO guidelines. The method was applied to 58 tomato samples. More than 84% of the compounds investigated showed limits of detection equal to or lower than 5 mg kg(-1). A mild (<20%), medium (20-50%), and strong (>50%) matrix effect was observed for 72%, 25%, and 3% of the pesticides studied, respectively. Eighty-one percent of the pesticides showed recoveries ranging between 70% and 120%. Twelve pesticides were detected in 35 samples, all below the maximum residue levels permitted in the Brazilian legislation; 15 samples exceeded the maximum residue levels established by the EU legislation for methamidophos; and 10 exceeded limits for acephate and four for bromuconazole.
Assuntos
Cromatografia Líquida/métodos , Frutas/química , Resíduos de Praguicidas/análise , Praguicidas/análise , Solanum lycopersicum/química , Espectrometria de Massas por Ionização por Electrospray/métodosRESUMO
Florfenicol (FLC) and oxytetracycline (OTC) are the two most commonly used antibiotics for bacterial treatment in fish farming in Brazil, and because of their intensive use, the potential harmful effects on aquatic organisms are of great concern. This study evaluated the effects of environmental concentrations of FLC and OTC on the genetic material of juvenile tilapia (Oreochromis niloticus) erythrocytes by using the comet assay and the occurrence of micronuclei (MN) and other erythrocytic nuclear abnormalities (ENAs) after exposure to 96hour. The comet assay showed that fish erythrocytes exhibited significantly higher DNA damage after exposure to environmental concentrations of FLC and OTC. Although MN was not observed, ENAs were significantly higher after exposure to FLC, indicating that ENAs are a better biomarker for FLC than MN. The results showed that environmental concentrations of FLC and OTC were genotoxic to erythrocytes of O. niloticus; however, future studies on DNA damage recovery are needed.
Assuntos
Antibacterianos/toxicidade , Ciclídeos/genética , Oxitetraciclina/toxicidade , Tianfenicol/análogos & derivados , Poluentes Químicos da Água/toxicidade , Animais , Ensaio Cometa , Dano ao DNA , Eritrócitos/efeitos dos fármacos , Testes para Micronúcleos , Tianfenicol/toxicidadeRESUMO
BACKGROUND AND OBJECTIVES: We conducted a survey of STFM members to: 1) measure perceived knowledge of and support for four health care reform proposals, 2) rate the members' priorities about specific legislative activities relevant to STFM, health care reform, and STFM general activities, and 3) assess interest in STFM developing a monograph on health care reform. METHODS: A self-administered questionnaire was mailed to a 15% random sample (n = 470) of STFM members. Researchers were blinded to the identity of respondents. RESULTS: Three hundred seven members returned completed surveys (response rate = 65%). Members were largely divided in their support between the pay or play and the single payer plans, with 39% (95% confidence interval (CI) 33%-44%) preferring the former and 34% (95% CI = 31%-37%) preferring the latter. Employer mandate and tax credit plans were rated less favorably. Overall, members rated their perceived knowledge about these plans as fair to good. In terms of rating their priorities about STFM activities, members gave the highest ratings to STFM legislative activities specific to the needs of academic family medicine (eg, faculty development, reimbursement for clinical and teaching activities, and research). These specific legislative activities were rated higher than all of the general categories of STFM activities. CONCLUSION: STFM members want STFM to advocate for specific legislation pertinent to the development of academic family medicine. Although most members support comprehensive health care reform, no single plan is preferred by a majority of members.
Assuntos
Medicina de Família e Comunidade/educação , Reforma dos Serviços de Saúde/legislação & jurisprudência , Papel do Médico , Sociedades Médicas , Ensino , Humanos , Inquéritos e Questionários , Estados UnidosRESUMO
Primary care physicians provide access and continuity of care to difficult patients and their families. Optimal medical management may be jeopardized by the emotional responses of physicians caring for such patients. These responses may pose moral dilemmas for the physician, who may be reluctant to treat these patients. Even though physicians have the right to dismiss such patients, the ethos of primary care engenders a sense of obligation to provide access to care. Traditional continuing medical education (CME) overemphasizes content and avoids emotional issues common in problematic physician-patient relationships. This CME demonstration project for community based physicians addressed this issue through a longitudinal course which was learner-centered and process-oriented. This article reports the successes and difficulties in organizing this innovative course.
Assuntos
Educação Médica Continuada , Medicina de Família e Comunidade/educação , Processos Grupais , Relações Profissional-Família , Currículo , Humanos , Projetos PilotoRESUMO
Using this model, clinicians can enhance skills for screening, assessing, and aiding at-risk and problem drinkers. The six-step model incorporates the transtheoretic model of behavior change and uses motivational interviewing strategies and the concept of brief, early interventions. Primary care physicians can apply this model for patients in their offices and in hospital settings where they provide continuity of care. Furthermore, physicians can also use this model to intervene successfully at both the secondary and tertiary levels of prevention. In essence, this model uses a variety of strategies to aid at-risk and problem drinkers. These strategies can help patients and families overcome their ignorance about the role that alcohol plays in their lives and to motivate them toward a healthier lifestyle. Physicians can select strategies that range from simple advice to motivational counseling. Depending on the presenting problems and the likelihood and severity of an alcohol problem, the physician can select strategies described in this model to develop an individualized approach to motivate at-risk and problem drinkers to move through the phases of behavioral change: precontemplation, contemplation, preparation, action, and maintenance. Such an approach can help patients take responsibility for changing their drinking habits.
Assuntos
Alcoolismo/reabilitação , Drogas Ilícitas , Psicotrópicos , Transtornos Relacionados ao Uso de Substâncias/reabilitação , Alcoolismo/prevenção & controle , Alcoolismo/psicologia , Medicina de Família e Comunidade , Humanos , Educação de Pacientes como Assunto , Transtornos Relacionados ao Uso de Substâncias/prevenção & controle , Transtornos Relacionados ao Uso de Substâncias/psicologiaRESUMO
Motivational approaches that build on the concepts of risk and harm reduction are new developments in the application of behavioral sciences to health promotion and disease prevention. This article develops a generic approach for helping practitioners motivate patients to change unhealthy behaviors.
Assuntos
Comportamentos Relacionados com a Saúde , Promoção da Saúde/métodos , Motivação , Relações Médico-Paciente , Humanos , Controle Interno-Externo , Negociação , Cooperação do Paciente , Teoria PsicológicaRESUMO
How can physicians motivate patients with alcohol problems when they resist advice to change? A framework for understanding patient resistance is described to help physicians use this motivational approach more effectively with patients.
Assuntos
Alcoolismo/prevenção & controle , Alcoolismo/psicologia , Atitude Frente a Saúde , Medicina de Família e Comunidade/métodos , Conhecimentos, Atitudes e Prática em Saúde , Motivação , Atenção Primária à Saúde/métodos , Alcoolismo/diagnóstico , Tomada de Decisões , Comportamentos Relacionados com a Saúde , Humanos , Modelos Psicológicos , Educação de Pacientes como Assunto , Papel do Médico , Relações Médico-PacienteRESUMO
Psychoactive drug use by teens is a common occurrence. This article examines the influences that promote and deter experimentation with and hazardous use of psychoactive substances. Clinical guidance is offered on how to assess and intervene with teens and their parents at various developmental phases and levels of involvement with drugs. Understanding how youth make decisions to change their behavior can assist a clinician in helping a teenager avoid these problems.
Assuntos
Transtornos Relacionados ao Uso de Substâncias/prevenção & controle , Adolescente , Comorbidade , Feminino , Desenvolvimento Humano , Humanos , Masculino , Transtornos Mentais/epidemiologia , Atenção Primária à Saúde , Psicoterapia/métodos , Fatores de Risco , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/etiologia , Transtornos Relacionados ao Uso de Substâncias/psicologiaRESUMO
BACKGROUND: Drug nonadherence to long-term medication is a common and poorly understood problem in the elderly. A study was conducted to assess whether elderly patients would accept a research assistant conducting pill counts in their homes, and to examine how nonadherence was associated with patient variables. METHODS: A letter and a telephone follow-up call were used to identify eligible patients (aged 65 years and over, with two or more chronic diseases). RESULTS: A total of 98 eligible patients were identified. Fifty-nine agreed to participate in the study. Of the 59 participants, 54.7% were nonadherent to their medication regimen. Nonadherence was defined as an overall mean level of compliance of less than 80%. Drug regimen nonadherence was associated with the inability to read medication labels (P less than .01), but not with impaired visual acuity, the number of prescribed medications, the type of medication container lid, depression, cognitive impairment, perceived health status, or the cost of medications. Frequency of drug administration affected patient adherence to the medication regimen. Mean adherence of patients to prescriptions for drugs to be taken once or twice daily was 72%, whereas drugs to be taken three or four times daily had a mean adherence rate of 54% (P less than .01). CONCLUSIONS: Using the simple pill count method on home visits, rates of nonadherence to long-term medication were comparable to those found in studies using electronic pill-counting devices. Larger studies are needed to clarify how other variables, in addition to patient inability to read medication labels, are associated with noncompliance with medication regimens for chronic diseases in elderly patients.
Assuntos
Idoso , Doença Crônica , Prescrições de Medicamentos , Cooperação do Paciente , Preparações Farmacêuticas/administração & dosagem , Doença Crônica/psicologia , Embalagem de Medicamentos , Humanos , Projetos de Pesquisa , Pesquisadores , Autoadministração/psicologia , Recusa do Paciente ao Tratamento , Acuidade VisualRESUMO
BACKGROUND: The purpose of this study was to assess the behavior and preferences of patients regarding family involvement in their routine health care visits. METHODS: A self-administered questionnaire was given to a convenience sample of patients visiting a family medicine center for an appointment. RESULTS: Thirty-nine percent of patients came to the physician's office with a family member or friend. Married patients and those with higher emotional involvement scores were significantly more likely to come to the office with someone. Two thirds of accompanied patients reported that this person came into the examination room with them. One third of the accompanied patients, however, thought that their physician was unaware that someone had accompanied them to the office. The majority (55%) of patients indicated that they would prefer to have a friend or family member in the examination room with them for some of their visits. No patient indicated that they never wanted a family member or friend to come into the examination room. CONCLUSIONS: Patients prefer direct family involvement in their health care more often than what occurs in practice. Physicians can easily address this discrepancy by asking patients whether and in what way they would like others to be involved in their health care.