Perceptions of obesity: Black and White differences.

To better understand similarities and differences in Black and White women's perceptions about obesity, we conducted race-matched focus groups with thirty physician-referred, obese women. Participants completed demographic questionnaires and body image assessments. Analysis yielded some common themes. Unique themes for Black women included disagreement with the thin ideal and their own and family members' satisfaction with their weight; dislike of physical activity because of perspiration and appearance; program access barriers; and difficulties with clothing. White women desired support during weight loss from other obese individuals. Results support education and intervention programs that respond to specific needs of each group.

Survey of student education in surgery.

BACKGROUND: Few data exist comparing medical student surgical education programs across the US and Canada. We conducted a 30-question, Web-based survey of 142 medical schools in the US and Canada about the administration of undergraduate surgical education programs at their institutions. STUDY DESIGN: From October 2005 to January 2006, 142 Association of American Medical Colleges (AAMC) medical schools in the US and Canada were asked to complete a 30-item, Web-based questionnaire. Descriptive statistics were compiled for all responses and data were analyzed using Student's t-test. RESULTS: One hundred two medical schools responded to the survey (90 of 125 US and 12 of 17 Canadian schools, overall response rate,=72%). The majority of surgical clerkships have between 16 and 30 students rotating at a time through 2 to 4 teaching sites. The most frequent overall clerkship duration was 8 weeks, divided most frequently between a 4- to 6-week general surgery rotation and a 4-week subspecialty rotation. There was no consensus about what services constitute general surgery rotations, although the most common subspecialty rotations were urology (68%) and orthopaedics (66%). American medical schools were more likely to use the National Board of Medical Examiners (NBME) subject examination for student assessment (90.9% US versus 50.0% Canadian, p < 0.05); Canadian medical schools were more likely to use an Objective Structured Clinical Examination (69.2% Canadian versus 37.7% US, p < 0.05) and other written examinations (69.2% Canadian versus 37.7% US, p < 0.05). CONCLUSIONS: There is wide variation in the structure and administration of medical student surgical education programs in the US and Canada. These findings underscore the need for a clerkship directors committee and a national dialog about a core student curriculum to ensure consistency in the quality of student education in surgery.

A collaborative approach to wellness: diet, exercise, and education to impact behavior change.

PURPOSE: The purpose of this study was to evaluate an interdisciplinary Wellness Program developed to help patients implement behavior changes necessary to begin weight reduction. DATA SOURCES: A 12-week program was developed to offer a choice of three diets, education, behavior change, and support groups that would allow participants to work through their concerns. A total of 109 participants provided feedback throughout the program and had varying degrees of change. Measures included education, food diaries, support, exercise, and anthropomorphic measurements. CONCLUSIONS: Participants who attended the exercise classes showed the most positive results with weight loss, and the greater the number of times attending the exercise classes, the more weight was lost. Readiness and willingness to change and the degree of involvement in the program also proved to be major factors in the program. IMPLICATIONS FOR PRACTICE: While obesity and overweight continue to be major healthcare issues in the United States, a real positive approach to helping patients with this problem has not been found. Continued study and support are needed to help patients deal with the impact of weight on overall health and well-being.

The prevalence of dysphagia in primary care patients: a HamesNet Research Network study.

PURPOSE: A number of disorders cause dysphagia, which is the perception of an obstruction during swallowing. The purpose of this study was to determine the prevalence of dysphagia in primary care patients. METHODS: Adults 18 years old and older were the subjects of an anonymous survey that was collected in the clinic waiting room before patients were seen by a physician. Twelve family medicine offices in HamesNet, a research network in Georgia, participated. RESULTS: Of the 947 study participants, 214 (22.6%) reported dysphagia occurring several times per month or more frequently. Those reporting dysphagia were more likely to be women (80.8% women vs 19.2% men, P = .002) and older (mean age of 48.1 in patients with dysphagia vs mean age of 45.7 in patients without dysphagia, P = .001). Sixty-four percent of patients with dysphagia indicated that they were concerned about their symptoms, but 46.3% had not spoken with their doctor about their symptoms. Logistic regression analyses showed that increased frequency [odds ratio (OR) = 2.15, 95% CI 1.41-3.30], duration (OR = 1.91, CI 1.24-2.94), and concern (OR = 2.64, CI 1.36-5.12) of swallowing problems as well as increased problems eating out (OR = 1.72, CI 1.19-2.49) were associated with increased odds of having talked to a physician. CONCLUSIONS: This is the first report of the prevalence of dysphagia in an unselected adult primary care population. Dysphagia occurs commonly in primary care patients but often is not discussed with a physician.

Students assigned to community practices for their pediatric clerkship perform as well or better on written examinations as students assigned to academic medical centers.

BACKGROUND: Medical schools are increasingly using community practice sites (CPS) for clerkship training. PURPOSES: We compared the test performance of all students assigned to CPS with all students trained at an academic medical center (AMC) for their pediatric clerkship for the past 5 years. METHODS: Baseline comparability of both groups was established by the group mean scores on 1st and 2nd year medical school grade point average (GPA) and the United States Medical Licensing Examination (USMLE) Step 1 and Step 2. Performance outcome was compared by group mean scores on a written clerkship exam and the National Board of Medical Examiners Pediatric Subject Examination. RESULTS: There was no statistical difference between the two groups with regard to GPA or USMLE scores. Standardized test performance results: [table: see text] CONCLUSION: The CPS-trained students performed as well or better on standardized written tests compared with AMC-trained students. Community pediatric practices can provide a quality clerkship experience for junior medical students.