Executive function and medical non-adherence: a different perspective.

Medical non-adherence is multifactorial: cost, convenience, side effect profile, and cognitive impairment are all implicated in medical nonadherence. We explore impaired executive function (EF) as a cause for medical non-adherence when other causes can be ruled out. EF describes the coordination and manipulation of higher-order cognitive processes involved in problem-solving, planning, and decision-making. EF has three components: working memory, mental flexibility, and inhibitory control. The latter, inhibitory control, when impaired will affect an individual's ability to make choices to produce long-term benefits, in favor of short-term gratification. When applied to adults with chronic diseases, like diabetes, that require lifestyle modification and, at times, complicated medical regimens to forestall long term complications, an intact EF has a role in adherence. EF development is protracted with behavioral corollaries observable from early childhood. Thus, teachers, family physicians, and pediatricians will be the professionals to first encounter and manage such individuals. We suggest screening tests for children in the doctor's office to detect impaired EF, and postulate a cognitive behavioral therapeutic approach for adults with uncontrolled DM and impaired EF.

How does pre-admission community service compare with community service during medical school?

BACKGROUND: Little research has examined the link between premedical community service and subsequent community service undertaken in medical school. PURPOSE: This study examined the relationship between applicants' community service history with reported community service experiences during medical school. METHODS: Admission files were retrospectively reviewed and community service hours during medical school were totaled for 2003 graduates at the study institution. Data were analyzed using descriptive statistics, chi-square tests, and logistic regressions. RESULTS: Applicants who were women, had volunteered with multiple types of organizations, and volunteered more than 2 years were all significantly more likely, chi2 p < .05, to have provided greater community service hours during medical school than others. CONCLUSIONS: Aspects of applicants' community service histories, particularly the number of different types of organizations served and length of service, appear related to their subsequent community service involvement in medical school. Admissions committees may wish to provide additional consideration to such applicants.

Views of family medicine department Chairs about mentoring junior faculty.

Mentoring can be a key component contributing to the success of faculty. We investigated the attitudes of family medicine department Chairs toward mentoring, with emphasis on mentoring female and minority faculty. This qualitative inquiry used semi-structured interviews with 13 Chairs of US departments of family medicine. Although most Chairs felt that mentoring had value, a minority of our sample had formal mentoring programs. Multiple mentors were suggested for female and minority faculty to meet both their personal career and content needs. Availability of senior faculty is a key resource. Until more senior women and minority faculty are available, cross-gender and cross-ethnicity mentoring will need to be utilized.

Nocturnal enuresis.

Nocturnal enuresis is a common problem that can be troubling for children and their families. Recent studies indicate that nocturnal enuresis is best regarded as a group of conditions with different etiologies. A genetic component is likely in many affected children. Research also indicates the possibility of two subtypes of patients with nocturnal enuresis: those with a functional bladder disorder and those with a maturational delay in nocturnal arginine vasopressin secretion. The evaluation of nocturnal enuresis requires a thorough history, a complete physical examination, and urinalysis. Treatment options include nonpharmacologic and pharmacologic measures. Continence training should be incorporated into the treatment regimen. Use of a bed-wetting alarm has the highest cure rate and the lowest relapse rate; however, some families may have difficulty with this treatment approach. Desmopressin and imipramine are the primary medications used to treat nocturnal enuresis, but both are associated with relatively high relapse rates.

Alopecia in women.

Alopecia can be divided into disorders in which the hair follicle is normal but the cycling of hair growth is abnormal and disorders in which the hair follicle is damaged. Androgenetic alopecia is the most common cause of hair loss in women. Other disorders include alopecia areata, telogen effluvium, cicatricial alopecia, and traumatic alopecias. The diagnosis is usually based on a thorough history and a focused physical examination. In some patients, selected laboratory tests or punch biopsy may be necessary. Topically administered minoxidil is labeled for the treatment of androgenetic alopecia in women. Corticosteroids and other agents are typically used in women with alopecia areata. Telogen effluvium is often a self-limited disorder. Because alopecia can be devastating to women, management should include an assessment for psychologic effects.

Patient use of automatic blood pressure measures in retail stores: implications for diagnosis and treatment of hypertension.

This study examined the simple behavior on the part of hypertensive patients of having their blood pressure checked at a retail store. We found that hypertensive patients checked their blood pressure frequently using these automated machines, believe them to be accurate, and frequently make health care decisions based on the reading they obtain. The inaccuracy of these machines is apparently not widely known. It is therefore incumbent on physicians to be aware of technologies that are in use by their patients. Patients need to be educated about the appropriate use and potential or harm that results from misuse of these technologies. Physicians might encourage their patients to invest in a home blood pressure monitor that they can bring with them to their visit to calibrate against the physician's own machine.