Deaf persons' english reading levels and associations with epidemiological, educational, and cultural factors.

One hundred six Michigan d/Deaf persons, part of a study evaluating how to improve d/Deaf persons' understanding of cancer prevention recommendations, had reading levels determined using the Test of Reading Comprehension, Syntactic Sentences. Respondents averaged 52 years old, 59% female, 84% Caucasian, 58% married, and 75% Deaf community members. The mean Test of Reading Comprehension, Syntactic Sentences score was 6.1 (women: 6.2, men: 6.0). Higher scores were associated with greater income (p = .02), employment (p = .01), education (high school p = .002, some college p < .001), English use (child at home, teacher in school, at home now: all p < .001), a hearing spouse (p = .003), hard of hearing/d/Deaf father (p = .02), losing hearing after age 20 years, believing smoking is bad (p < .001), speaking with and satisfaction with physicians and nurses (p < .001), good communication with (p = .01), and comfort discussing cancer with doctors (p < .001). Lower scores were associated with using American Sign Language with physicians and nurses (.019) and Deaf community membership (p = .02). In multivariate analysis, higher scores were associated with higher income, college degree, and teacher using English. Reading levels of a predominantly Deaf population were low. Higher income, college degree, and teacher using English were associated with higher reading levels.

Effectiveness of videos improving cancer prevention knowledge in people with profound hearing loss.

Deaf persons have a poorer understanding of cancer prevention, which is felt to be partly due to communication barriers. One hundred ninety-seven d/Deaf persons completed a survey and video on cancer prevention. Half viewed a spoken English program designed for hearing persons (control group); the other half viewed an amended program that had American Sign Language, captions, and printed English options added (experimental group). Knowledge was measured before and after the video, including 1 and 6 months later. Respondents were primarily Caucasian, had low incomes, lost hearing at young ages, and had d/Deaf spouses. Although overall knowledge improved after viewing the video, the presence of culture-specific communications (American Sign Language, captions) did not improve scores compared to the control group, either immediately after the intervention or over time. Moreover, percentage correct on all pretest, and almost all post-test, questions was <50% for both experimental and control groups. For all subjects, regardless of which group they were in, a hearing spouse (p < 0.001) and more healthcare information sources (p = 0.001) improved knowledge, while African-Americans showed a trend to lesser improvement (p = 0.06). Using culture-specific language did not improve cancer prevention knowledge in this d/Deaf population, and overall knowledge remained low. More study is needed to determine the best way to increase cancer prevention knowledge in this population.

Football (soccer) safety equipment use and parental attitudes toward safety equipment in a community youth sports program.

While a growing number of children are playing football (soccer), there are limited data on prevalence of injuries, actual use of football safety equipment (SE), and parental attitudes about football SE. We distributed a self-administered survey by mail to parents of all players enrolled in a community recreation youth football program. Parents of 865 children responded. Overall, 32 (3.7%) children were reported as having injuries requiring medical/dental evaluation. Upper/lower extremities were the most commonly injured sites. Shinguards (SGs) were the only equipment commonly used. While there was high parental support for SG use (97.4%) and moderate support for mouthguards (MGs; 53.8%), there was less support for other SE. Many parents were unfamiliar with available SE, but they were mostly willing to pay for it. In a community youth sports program, reports of football injuries were low as was the use of football SE other than SGs.

Cancer prevention knowledge of people with profound hearing loss.

BACKGROUND: Deaf persons, a documented minority population, have low reading levels and difficulty communicating with physicians. The effect of these on their knowledge of cancer prevention recommendations is unknown. METHODS: A cross-sectional study of 222 d/Deaf persons in Michigan, age 18 and older, chose one of four ways (voice, video of a certified American Sign Language interpreter, captions, or printed English) to complete a self-administered computer video questionnaire about demographics, hearing loss, language history, health-care utilization, and health-care information sources, as well as family and social variables. Twelve questions tested their knowledge of cancer prevention recommendations. The outcome measures were the percentage of correct answers to the questions and the association of multiple variables with these responses. RESULTS: Participants averaged 22.9% correct answers with no gender difference. Univariate analysis revealed that smoking history, types of medical problems, last physician visit, and women having previous cancer preventive tests did not affect scores. Improved scores occurred with computer use (p = 0.05), higher education (p < 0.01) and income (p = 0.01), hearing spouses (p < 0.01), speaking English in multiple situations (p < 0.001), and in men with previous prostate cancer testing (p = 0.04). Obtaining health information from books (p = 0.05), physicians (p = 0.008), nurses (p = 0.03) or the internet (p = 0.02), and believing that smoking is bad (p < 0.001) also improved scores. Multivariate analysis revealed that English use (p = 0.01) and believing that smoking was bad (p = 0.05) were associated with improved scores. CONCLUSION: Persons with profound hearing loss have poor knowledge of recommended cancer prevention interventions. English use in multiple settings was strongly associated with increased knowledge.

Vulvodynia incidence and remission rates among adult women: a 2-year follow-up study.

OBJECTIVE: To estimate the incidence and remission rates of vulvodynia over a 2-year period. METHODS: A 2-year follow-up survey was sent to the University of Michigan Women's Health Registry members who had participated in a previously reported, validated survey. Changes in clinical status, incidence, and remission rates for vulvodynia were estimated, as were factors associated with new onset or remission of symptoms, using univariable and multivariable analyses. RESULTS: Of 1,037 women enrolled in the initial study, 744 women (71.7%) completed an online or written follow-up survey between September 2006 and March 2007. Of the 372 asymptomatic women controls at initial enrollment, 13 (3.5%, 95% confidence interval 1.6-5.4%) had developed vulvodynia during the 2-year follow-up period; nine (2.2%) of these had ongoing symptoms. Of 45 women with vulvodynia at initial enrollment, 10 (22.2%, 95% confidence interval 10.1-34.4%) indicated their symptoms had resolved. Factors at enrollment that were associated with incidence of vulvodynia were younger age and history of pain after intercourse. Remission was more common in women who did not have pain after intercourse and in those who reported less severe pain at enrollment. CONCLUSION: Based on 2-year follow-up, each year approximately one in 50 women develop symptoms of vulvodynia, and one in 10 women with vulvodynia report remission of symptoms.

Depression and pain in retired professional football players.

PURPOSE: To assess the prevalence of depressive symptoms and difficulty with pain in retired professional football players, difficulties with the transition from active athletic competition to retirement, perceptions of barriers to receiving assistance for those difficulties, and recommended programs to provide such assistance. METHODS: Survey sent to 3377 retired members of the National Football League Players Association (NFLPA), with usable responses received from 1617 members (functional response rate, 48.6%). RESULTS: Respondents were categorized as experiencing no to mild depression (N=1366; 84.5%) or moderate to severe depression (N=237; 14.7%). Respondents were also categorized according to whether they reported difficulty with pain as not or somewhat common (N=837; 51.8%) versus quite or very common (N=769; 47.6%). Respondents most frequently reported trouble sleeping, financial difficulties, marital or relationship problems, and problems with fitness, exercise, and aging, all of which were strongly correlated with the presence of moderate to severe depression and with quite or very common difficulty with pain. The same difficulties were even more commonly experienced by respondents who reported both moderate to severe depression and quite or very common difficulty with pain, compared with those who reported low scores in both domains. CONCLUSION: Retired professional football players experience levels of depressive symptoms similar to those of the general population, but the impact of these symptoms is compounded by high levels of difficulty with pain. The combination of depression and pain is strongly predictive of significant difficulties with sleep, social relationships, financial difficulties, and problems with exercise and fitness. A hypothesis explaining this association is that significant musculoskeletal disability and chronic pain interferes with physical activity and fitness during retirement and increases the risk of depression.

Reliability and validity of self-reported symptoms for predicting vulvodynia.

OBJECTIVE: To evaluate the reliability and validity of self-reported symptoms to predict vulvodynia, compared with examination-based confirmation. METHODS: Between August 5, 2004, and December 13, 2004, 1,046 members of the University of Michigan Women's Health Registry were surveyed regarding the presence of symptoms suggestive of vulvodynia. Diagnoses of vulvodynia and of control status based on survey responses were made, and a subset of these respondents was evaluated in the office. RESULTS: One thousand forty-six of 1,447 (72.3%) eligible women, aged 19 to 92 years, completed the survey. Seventy-nine (7.6%) of the survey respondents who reported ongoing vulvar pain lasting more than 3 months were predicted to have vulvodynia, while women reporting no current pain with intercourse and no history of prolonged vulvar pain were predicted to be controls (N = 543). Agreement between the history taken at the office and that reported on the survey was very good (reliability: Cohen's kappa = 0.86, 95% confidence interval 0.73-0.99). Of the 28 women predicted to have vulvodynia who were examined in the office, 27 (96.4%) were confirmed to have vulvodynia, and 28 of the 34 (82.4%) asymptomatic women examined did not have increased vulvar sensitivity (Cohen's kappa = 0.78, 95% confidence interval 0.64-0.92). CONCLUSION: Excellent reliability and validity of survey responses for predicting vulvodynia were demonstrated. LEVEL OF EVIDENCE: II-2.

Physician experience with family presence during cardiopulmonary resuscitation in children.

OBJECTIVE: Family presence during cardiopulmonary resuscitation in children is an emerging practice. Although many hospitals allow this practice, there is scant research on physician attitudes and opinions and on physician views about training for resident physicians. DESIGN: Survey method. SETTING: University and community settings. PATIENTS: We randomly selected 1,200 pediatric critical care and emergency medicine providers from professional association mailing lists. INTERVENTION: The providers were mailed up to two written surveys and two reminder cards. The survey consisted of 40 multiple-choice and short-answer questions about demographics, past experiences, and opinions on pediatric family presence. MEASUREMENTS AND RESULTS: Of 1,200 surveys mailed, 521 were completed (43.4%) and 73 (6.1%) respondents returned the form declining to participate. More than 99% of respondents were physicians. Four hundred and thirty-three respondents (83%) reported participation in pediatric resuscitation with family members present, with a mean of 15 episodes ever and three episodes within the last year. Of those who had ever participated, more than half thought it was helpful for the family, and two thirds believed that parents wanted the option. Ninety-three percent would allow family presence in some situations. Seventy-four percent believed family presence would be stressful for a resident physician, but nearly 80% believed that residents working with children should be educated in this area. CONCLUSIONS: Family presence during cardiopulmonary resuscitation in children is not an uncommon experience for health care providers. Most respondents had resuscitated a child with family members present. The majority thought that presence was helpful to parents and that residents should be trained in this practice.

Residency education through the family medicine morbidity and mortality conference.

BACKGROUND AND OBJECTIVES: The value of the morbidity and mortality conference (M&MC) has received little examination in the primary care literature. We sought to understand the educational content of M&MCs by examining data from a family medicine training program. METHODS: Archived morbidity and mortality conference data (July 2001-July 2003) were retrieved from two University of Michigan family medicine adult inpatient services (one community based and one university based). We used chi-square and t test to compare demographic variables and adverse events between hospital sites. We qualitatively analyzed written comments about adverse events. RESULTS: Both family medicine services shared similar diagnoses, patient volume, length of stay, and gender distribution of patients, but the community hospital had an older average patient age (67.9 years versus 52.9 years) and a higher outpatient complication rate. Analysis of the qualitative data revealed patterns of adverse events, such as an association between avoidable admissions and inadequate pain control, that could be improved through educational intervention. CONCLUSIONS: Although family medicine residents' experiences in university and community hospitals were comparable, there were differences in patient populations and case complexity. Modifying the M&MC format could enhance its effectiveness as an educational tool about adverse events.

Herb and vitamin supplementation use among a general ophthalmology practice population.

PURPOSE: To survey comprehensive ophthalmology patients about their use of vitamins and herbal supplements. DESIGN: Cross-sectional survey. METHODS: A survey instrument was developed and distributed to 397 patients presenting to a main campus university-based comprehensive ophthalmology clinic and to an off-site comprehensive ophthalmology clinic. Information gathered included demographics, use of prescription medications, use of vitamin and herbal supplements, the reasons for using these supplements, perceived benefits of these products, where the information regarding them was gathered, and with whom patients had discussed their use. RESULTS: Fifty-eight percent of patients reported nearly daily use of vitamins. Multivitamins were the most common vitamin and were used by 46% of the patients. Eight percent of patients used herbal products on a daily basis. Twenty-six percent learned about vitamins from their primary care physician (PCP), and just 2% from their ophthalmologists, while 35% discussed their actual use with a PCP, and 5% with their ophthalmologists. Just 2% of these patients learned of herbs from a PCP, and <1% from an ophthalmologist. Older patients used multivitamins and other vitamins most frequently, while gender and education were not predictive of vitamin or herbal use. Mean monthly spending on vitamins by users was 15.74 dollars, while herbal users spent a monthly mean of 15.35 dollars. CONCLUSIONS: Vitamins and herbs are used by a significant number of patients in a comprehensive ophthalmology setting. Given the prevalence of vitamin and herbal use, ophthalmologists should systematically inquire about their use.

Sexual activities and attitudes of women with vulvar dysesthesia.

OBJECTIVE: To assess the relationship between sexual activities and attitudes of women with and without vulvar dysesthesia. METHODS: Women with vulvar dysesthesia, 18-60 years old, and ethnically matched women without this disorder were enrolled in this cross-sectional study, completed a 27-page questionnaire, and had a physical examination. We compared sexual activities and attitudes between patients and controls using univariate and multivariable analyses. RESULTS: Between January 21, 2001, and December 12, 2002, we enrolled 63 women with vulvar dysesthesia and 62 controls who reported having a current sexual partner. Women with vulvar dysesthesia were less likely than controls to have had, during the previous month, intercourse (66.7% versus 83.9%, P =.03) and orgasms (57.6% versus 78.7%, P =.02), although the association with intercourse was no longer statistically significant after controlling for age, education, and smoking status (P =.07). Of those having had intercourse in the past month, the frequency of this activity was less among patients (3.0 +/- 2.7 versus 6.2 +/- 4.5 episodes, P <.001). Frequencies of orgasms, fellatio, cunnilingus, and masturbation did not significantly differ between patients and controls. Patients rated sex less important and rated themselves more negatively as sexual people than did controls (P <.001). CONCLUSION: Women with vulvar dysesthesia are similar to those without in many sexual activities but are less likely to have had an orgasm in the past month or to have had intercourse at the same frequency as controls. Although some attitudes were similar, sexual interest and self-concept were decreased among those with this disorder.

Candida transmission and sexual behaviors as risks for a repeat episode of Candida vulvovaginitis.

OBJECTIVE: To assess associations between female and male factors and the risk of recurring Candida vulvovaginitis. METHODS: A prospective cohort study of 148 women with Candida vulvovaginitis and 78 of their male sexual partners was conducted at two primary care practices in the Ann Arbor, Michigan, area. RESULTS: Thirty-three of 148 women developed at least one further episode of Candida albicans vulvovaginitis within 1 year of follow-up. Cultures of Candida species from various sites of the woman (tongue, feces, vulva, and vagina) and from her partner (tongue, feces, urine, and semen) did not predict recurrences. Female factors associated with recurrence included recent masturbating with saliva (hazard ratio 2.66 [95% CI 1.17-6.06]) or cunnilingus (hazard ratio 2.94 [95% CI 1.12-7.68]) and ingestion of two or more servings of bread per day (p

Emergency contraception: knowledge and attitudes of family medicine providers.

BACKGROUND AND OBJECTIVES: Emergency contraception (EC) is an underutilized method of preventing unplanned pregnancy. This study assessed family physicians' and nurse providers' knowledge, attitudes, and beliefs about EC. METHODS: A cross-sectional survey was distributed to faculty, residents, and clinic nurses in a Midwestern department of family medicine. Data were analyzed using Statistical Package for the Social Sciences. Statistical significance was tested by chi-square test, Student's t test, and Mann-Whitney U test where appropriate. RESULTS: Seventy-eight providers participated (response rate 81%). Seventy-four percent of physicians have prescribed EC in the past, with an average of 3.2 (range 0-10) times in the last year. The majority of providers reported that they were familiar with indications (96%) and protocols (78%) for prescribing EC, yet knowledge inaccuracies were identified. Overall attitudes regarding EC were positive. CONCLUSIONS: Although the majority of participating providers were willing to prescribe EC and had generally favorable attitudes toward it, rates of providing this therapy were low. There was a discrepancy between providers' perceived and actual knowledge about EC. Interventions targeting misunderstandings might help reduce missed opportunities to provide EC.

Generalized vulvar dysesthesia vs. vestibulodynia. Are they distinct diagnoses?

OBJECTIVE: To evaluate prospectively whether generalized vulvar dysesthesia and vestibulodynia possess unique characteristics that support the theory of differing etiologies. STUDY DESIGN: Women with vulvar dysesthesia for a minimum of 3 months were enrolled at the University of Michigan in 2 clinics specializing in vulvar disorders. Informed consent was obtained. Participants completed a 27-page questionnaire and had a physical examination. Differentiation of generalized vulvar dysesthesia and vestibulodynia was based on tenderness to light pressure isolated to the introitus vs. pain beyond the introitus, respectively. We compared women with the 2 diagnoses to each other on demographic characteristics, exposures, pain characteristics and physical findings using t test, Mann-Whitney U and chi 2 analysis. RESULTS: Between January 26, 2001, and August 28, 2002, we enrolled 39 women, aged 18-60 years, with tenderness localized to the vestibule (vestibulodynia) and 17 with generalized vulvar dysesthesia. Women in each diagnostic group were similar in demographic and exposure characteristics. The pain characteristics were similar between the 2 groups except that recent pain was rated as worse by those with generalized vulvar dysesthesia. Activities that aggravated or relieved the pain were similar. However, women with generalized vulvar dysesthesia were more likely to state that their pain was aggravated by sitting and by washing the area. Similar results were found when using "continuous" pain rather than vulvar pain location as the outcome variable. CONCLUSION: The characteristics of women with generalized vulvar dysesthesia are similar to those with localized pain, supporting the theory that the 2 disorders may exhibit 2 presentations on a continuum of severity seen in vulvar dysesthesia rather than 2 distinct entities.

Validating an instrument for selecting interventions to change physician practice patterns: a Michigan Consortium for Family Practice Research study.

OBJECTIVES: The goal of this study was to develop a psychometric instrument that classified physiciansamprsquo response styles to new information as seekers, receptives, traditionalists, or pragmatists. This classification was based on specific combinations of 3 scales: (a) belief in evidence vs experience as the basis of knowledge, (b) willingness to diverge from common or previous practice, and (c) sensitivity to pragmatic concerns of practice. The instrument will help focus efforts to change practice more accurately. STUDY DESIGN: This was a cross-sectional study of physician responses to a psychometric instrument. Paper-and-pencil survey forms were distributed to 3 waves of physicians, with revision for improved internal consistency at each iteration. POPULATION: Participants were 1393 primary care physicians at continuing education events in the Midwest or at primary care clinic sites in the Veteransamprsquo Health Administration system. OUTCOMES MEASURED: Internal consistency was measured by factor analysis with orthogonal rotation and Cronbachamprsquos alpha. RESULTS: A total of 1287 usable instruments were returned (106, 1120, and 61 in the 3 iterations, respectively), representing approximately three fourths of distributed forms. Final scale internal consistencies were a = 0.79, b = 0.74, and c = 0.68. The patterns of scores on the 3 scales were consistent with the predictions of the theoretical scheme of physician types. The "seeker" type was the rarest, at fewer than 3%. CONCLUSIONS: It is possible to reliably classify physicians into categories that a theoretical framework predicts will respond differently to different interventions for implementing guidelines and translating research findings into practice. The next step is to demonstrate that the classification predicts physician practice behavior.

A survey on the impact of being depressed on the professional status and mental health care of physicians.

CONTEXT: Recent studies have addressed the need to better understand the nature and risk of depression and suicide in physicians. OBJECTIVE: To assess the prevalence of depressive symptoms in a sample of practicing physicians, their perceptions of the impact of depression on their work lives, and their perceptions of the impact of being a physician on their pursuit of mental health care. DESIGN: An anonymous survey was mailed in April 2005 that included the Patient Health Questionnaire depression module (PHQ-9) and other Likert-style questions. PARTICIPANTS: Five thousand randomly selected practicing physicians in Michigan, from whom 1154 usable responses were received (23% response rate). MAIN OUTCOME MEASURES: The prevalence of depressive symptoms and the perceptions by respondents of the impact of depression on work roles and on their approach to seeking mental health care. RESULTS: Moderate to severe depression scores were reported by 130 physicians (11.3%). Roughly one quarter of respondents reported knowing a physician whose professional standing had been compromised by being depressed. Physicians reporting moderate to severe depression were 2 to 3 times more likely to report substantial impact on their work roles compared to physicians with minimal to mild depression scores, including a decrease in work productivity (57.7% vs. 18.5%; p < .001) and a decrease in work satisfaction (90.8% vs. 36.2%; p < .001). The same physicians were 2 to 3 times more likely to report a wide range of dysfunctional and worrisome approaches to seeking mental health care compared to physicians with minimal to mild depression scores, including a higher likelihood that they would self-prescribe antidepressants (30.0% vs. 9.9%; p < .001) and a higher likelihood that they would avoid seeking treatment due to concerns about confidentiality (50.7% vs. 17.3%; p < .001). CONCLUSIONS: Moderate to severe depression scores are reported by a substantial portion of practicing physicians in Michigan, with important influences on physician work roles and potential negative impact on licensing and medical staff status. The risk of being stigmatized may cause depressed physicians to alter their approach to seeking mental health care, including seeking care outside their medical community and self-prescribing antidepressants. Destigmatization of depression in physicians and interventions to improve the mental health care of physicians in ways that do not compromise their professional standing should receive more attention.

Assessment of depressive symptoms in deaf persons.

BACKGROUND: Evidence suggests that Deaf people may have a greater prevalence of depressive symptoms. However, it is unclear whether commonly used written screening instruments are accurate with this population because of their unique cultural and linguistic factors. SETTING: Deaf persons (n = 71) residing in southeastern Michigan. METHODS: Subjects completed the Zung Self-Rated Depression Scale in both the written (ZSDS-W) and American Sign Language (ZSDS-S) formats and the Hamilton Depression Scale (HAM-D) in American Sign Language in counterbalanced order, followed by a Test Of Reading Comprehension (TORC). They also provided extensive data on demographic, hearing loss, language use, social and health care use variables. RESULTS: Mean subject age was 52 years, 63% of subjects were women, 95% were Caucasian, and 47% were married (87% to another deaf/hard of hearing person). Thirty percent had a college degree and 20% had less than a 10th grade education. The ZSDS-W and ZSDS-S scores were highly correlated (r = +0.79), although the mean ZSDS-W score was 2.8 points higher (P = .001). The ZSDS-S correlated more highly (r = 0.80) with the HAM-D than the ZSDS-W (r = 0.71). There was a significant interaction effect (P < .001) such that the ZSDS-W and HAM-D were significantly associated among higher literacy subjects (beta = 0.80, P < .001) but not lower literacy subjects (beta = 0.20, P = .183). There were no other significant associations between depression scores and numerous demographic, educational, hearing loss, social or language variables. CONCLUSIONS: Compared with the conventional ZSDS-W, the ZSDS-S more accurately assesses depression severity among deaf persons with lower English literacy. However, given the greater sensitivity of the ZSDS-W and the practical barriers to ZSDS-S in physician practices, further research should determine which modality is best for routine depression screening.

Treatment of vulvodynia with tricyclic antidepressants: efficacy and associated factors.

OBJECTIVE: To determine the efficacy of tricyclic antidepressants (TCAs) as treatment for vulvodynia, and to identify demographic factors and pain characteristics associated with improvement. MATERIALS AND METHODS: Between January 2001 and April 2004, women diagnosed with vulvodynia were offered TCA therapy. The patients rated their worst recent pain on a 10-point scale at baseline and at follow-up; improvement was classified as at least 50% reduction in reported pain from baseline. RESULTS: Of 271 women diagnosed with vulvodynia, 209 (77.1%) were treated initially with a TCA (amitriptyline [n = 183], desipramine [n = 23], and other tricyclic medications [n = 3]). One hundred sixty-two (59.8%) of the women were followed up at a median period of 3.2 months after their initial visit, including 122 women who had started on a TCA. Of 83 women taking a TCA at the first follow-up, 49 (59.3%) improved by more than 50%, compared with 30 of 79 women not taking TCA at follow-up (improvement rate = 38.0%; p =.007; odds ratio = 2.35; 95% CI = 1.23-4.42). Multivariate analysis indicated that age, severity of pain, diagnosis (localized vs generalized vulvar pain), length of time with pain before treatment, age at menarche, use of oral contraceptives, and the number of previous pregnancies were not associated with the outcome; however, taking a TCA at the time of the first follow-up was strongly associated with improvement (p <.001; odds ratio = 4.23; 95% CI = 1.98-9.01). Repeated analysis including only those women prescribed with amitriptyline rather than any tricyclic revealed similar results. CONCLUSIONS: Women with vulvodynia who were prescribed a TCA in general (or amitriptyline, specifically) were more likely to have pain improvement compared with those women not taking these medications at follow-up. Randomized, controlled studies of TCAs versus other treatments are needed to clarify the overall effectiveness of these drugs.

Interventions fail to increase cancer screening rates in community-based primary care practices.

BACKGROUND: Cancer screening in primary care offices is reaching only a modest percentage of adults 50 years and older. The objectives of this study were to determine if screening rates for breast, cervical, and colorectal cancer could be significantly increased by two simple office interventions in community-based primary care offices and then maintained over 3 years. METHODS: Twenty-two community-based primary care practices were divided randomly into four arms: control, practice-based intervention, patient-based intervention, and both interventions combined. At baseline and annually for 3 years, medical records from approximately 100 male and 100 female patients 50 years and older were randomly selected. The outcome measures were screening rates for mammogram, Pap smear, fecal occult blood test, and flexible sigmoidoscopy or other colonic imaging. RESULTS: Generally each study arm evidenced a significant 1-year increase in screening rates, followed by an overall decline to approximate baseline levels. The first year increases in screening were not related to either invention, alone or in combination. CONCLUSIONS: These interventions do not have a significant impact on cancer screening rates in adults over several years. A variety of possible variables may have affected the long-term outcomes.

Primary care physician attitudes and values toward end-of-life care and physician-assisted death.

This study explores how primary care physician attitudes toward physician-assisted death (PAD) are related to their personal values toward end-of-life care and PAD. A group of 810 Michigan family physicians, internists, and general practitioners, divided into 4 typology groups by their intention toward participating in PAD, rated their attitudes toward PAD, along with their values and preferences for their own end-of-life care. Respondents who most objected to PAD were less likely to have executed an advance directive and more likely to have values promoting continued life-sustaining treatment in their own terminal care. Furthermore, a significant number of physicians, who had strong values against their own withdrawal of treatment in terminal care, were opposed to the withdrawing or withholding of life-sustaining treatment in patient care. Considerations of personal physician values are relevant in the discussion of PAD and the withdrawal of treatment in terminal care.