Assessment of Pediatric Residents' Attitudes toward Anticipatory Counseling on Gun Safety.

INTRODUCTION: Guns remain a major cause of injury and death among children. We determined pediatric residents' familiarity with gun safety campaigns and their gun safety counseling practices. We determined pediatric residents' comfort with the Asking Saves Kids (ASK) campaign, which recommends that parents ask about gun safety and storage where their children play. METHODS: Cross-sectional 27-item electronic survey was distributed to three pediatric residency programs in Baltimore, Maryland, USA. Residents were asked to respond to statements using a seven-point Likert scale on familiarity with three gun safety campaigns and their attitudes toward gun safety counseling. RESULTS: 82% of respondents were not familiar with gun safety programs. 23% reported not counseling. 87% believed it is a good idea to ask about guns in a home but only 64% were comfortable recommending their patients' parents to ask about guns. 59% were personally comfortable asking about guns in the home. 15% believed their patients' parents would be comfortable asking about guns in the homes of friends and families. CONCLUSIONS: The residents in this survey supported the idea of gun safety anticipatory guidance but discussing firearms can be problematic. Educational programs and strategies are needed to support physicians' counselling on gun safety.

The association of menopause status with physical function: the Study of Women's Health Across the Nation.

OBJECTIVE: The aim of this study was to determine whether postmenopause status is associated with self-reported limitations in physical function. METHODS: The Study of Women's Health Across the Nation is a multisite, multiethnic, longitudinal study of midlife women. Women aged 45 to 57 years (N = 2,566) completed the physical function scale of the Medical Outcomes Study Short-Form 36 on visit 4 (2000-2001). Scores created a three-category variable of physical function limitations: none (86-100), moderate (51-85), and substantial (0-50). In the Study of Women's Health Across the Nation, menopause status is a five-category list variable based on menstrual bleeding patterns and gynecological surgery. Premenopausal and perimenopausal women using hormones (n = 284) or missing physical function scores (n = 46) were excluded. Multinomial logistic regression was used to relate physical function and menopause status after adjustment for age, ethnicity, site, education, body mass index (BMI), and self-reported diabetes, hypertension, arthritis, depressive symptoms, smoking, and hormone use among postmenopausal women. RESULTS: Of 2,236 women, 8% were premenopausal, 51% were early perimenopausal, 12% were late perimenopausal, 24% were naturally postmenopausal, and 5% were surgically postmenopausal. In the full model, substantial limitations in physical function were higher in postmenopausal women, whether naturally postmenopausal (odds ratio, 3.82; 95% CI, 1.46-10.0) or surgically postmenopausal (odds ratio, 3.54; 95% CI, 1.15-10.84), than in premenopausal women. These associations were attenuated by higher BMI and depressive symptoms but remained significant. Moderate limitations in physical function were not significantly related to menopause status. CONCLUSIONS: Women experiencing surgical or naturally occurring postmenopause report greater limitations in physical function compared with premenopausal women, independent of age and only partly explained by higher BMI and depressive symptoms. This suggests that physiological changes in menopause could contribute directly to limitations in physical function.

The health of poor women under welfare reform.

OBJECTIVES: We compared the health of single mothers affected by welfare reform with the health of a nationally representative sample of women to document the prevalence of poor health as single mothers experience the effects of welfare reform. METHODS: We compared risk factors and measures of health among women randomly sampled from the welfare rolls with similar data from a nationally representative sample of women. RESULTS: Women in our welfare recipient sample had higher rates of elevated glycosylated hemoglobin (> or = 6%; prevalence ratio [PR]=4.87; 95% confidence interval [CI]=2.69, 7.04), hypertension (systole > or = 140 or diastole > or = 90; PR=2.36; 95% CI = 1.47, 3.24), high body mass index ( > or = 30; PR = 1.78; 95% CI = 1.49, 2.08), and high-density lipoprotein cholesterol (< or = 35 mg/dL; PR=1.91; 95% CI=1.17, 2.65); lower peak expiratory flow; and less physical functioning. Current smoking rates were higher (PR = 1.85; 95% CI = 1.50, 2.19) and smoking cessation rates were lower (PR=0.62; 95% CI=0.37, 0.86) than in the national sample. CONCLUSIONS: Current and former welfare recipients bear a substantial burden of illness. Further studies are necessary to interpret our findings of worsened health in the wake of welfare reform.

Material hardship alters the diurnal rhythm of salivary cortisol.

BACKGROUND: In the quest for biological mechanisms underlying socioeconomic differences in health outcomes, attention has turned to the role of the hypothalamic-pituitary-adrenocortical axis. As there is some evidence that both acute and chronic stress raise cortisol levels, and material hardship is a stressor, we examined the relationship of chronic material hardship with salivary cortisol levels over the day. METHODS: The data are from a survey of a sample of poor women aged 18-54. Up to four repeated measures of salivary cortisol levels were obtained from 188 women in this sample and modelled as a diurnal profile. Self-reports of a variety of sources of material hardship over the preceding year were combined into a single scale. Specific dimensions of the subjects' cortisol profiles were compared across levels of material hardship. RESULTS: Salivary cortisol varied over the day, and by level of reported material hardship. Upon awakening, salivary cortisol levels were comparable across hardship levels. But soon after waking, women at low levels of hardship experienced both a significantly sharper morning surge and subsequently a sharper decline in salivary cortisol (16.0 and 29.5 nmol/l/h) than women with high hardship levels (5.9 and 24.3 nmol/l/h). These differences in cortisol diurnal pattern tended to be related in a dose-response way to levels of material hardship. CONCLUSIONS: Material hardship among poor women is associated with changes in the diurnal rhythms of cortisol, particularly in the waking response, which is blunted in women with high levels of hardship.