Quantum Sufficit

Just Enough



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Am Fam Physician. 1999 Sep 1;60(3):725-726.

▪ How did you do on your last report card? It may not matter. An increasing number of health plans and hospitals write “report cards,” or physician profiles, for the physicians they employ. A new study by the U.S. Agency for Health Care Policy and Research (AHCPR) questions the science behind such reporting tools. The study examined how doctors in different types of medical practices in various parts of the United States managed their patients with type 2 (non–insulin-dependent) diabetes. Results indicated that the report cards were unable to reliably detect differences in practices—and these differences in practice styles only contributed up to 4 percent in variance of patient management.

▪ They might be cheaper and “cooler,” but not healthier. Hand-rolled unfiltered cigarettes from India that cost much less than American cigarettes and closely resemble marijuana joints are smoking through the nation's high schools. Although young smokers think the “beedies,” as they're known, are OK, they actually have twice the nicotine and tar content of U.S. cigarettes, reports Family Practice News.

▪ What are the top eight fitness trends identified by the Fitness Products Council and the Sporting Goods Manufacturers Association? According to the report cited in American Demographics, they are (1) increased popularity of lifting free weights, (2) embrace of cardiovascular exercise machines, (3) skyrocketing popularity of treadmills, (4) broadening popularity of health clubs, (5) surge in the purchase of home exercise equipment, (6) continued commitment to fitness among baby boomers, (7) diversified forms of exercise, and (8) availability of personal trainers for the masses.

▪ Welfare reform has had one nasty side effect—it has left nearly half a million children without health insurance, according to a report by Families USA. Even more children were left standing outside the health care umbrella when caps on welfare benefits went into effect this summer. Additional caps go into effect in July 2002. Some of these children remain eligible for state children's health insurance programs, but outreach efforts are needed.

▪ You may be a piler or a filer—or you just may be a slob, according to USA Today. When office workers were asked to describe their organizational habits, almost one third of them described themselves as “neat freaks,” while 27 percent labeled themselves as pilers and 23 percent called themselves filers. Only 12 percent considered themselves to be pack rats, and a mere 2 percent admitted to being slobs.

▪ When a male patient walks in your door, one glance at his ivories might tell you a lot about his heart. In the Health Professionals Follow-Up Study, as reported in Family Practice News, 44,000 men were checked in 1986 and followed for eight years. The men with fewer than 25 teeth at baseline ended up with a 49 percent greater risk of having an ischemic stroke. It's not yet known if tooth loss marks a greater risk of cardiovascular disease or causes it.

▪ Got milk? In a two-year study of 54 women ages 18 to 31 years, researchers at Purdue University found that higher calcium intakes may reduce overall levels of body fat and slow weight gain for women in this age group. The women in the study, who consumed less than 1,900 calories daily and at least 780 mg of calcium, either had no body fat increase or lost body fat mass, compared with those who consumed less than 780 mg of calcium and gained body fat mass. Women whose calcium intake came from consumption of dairy products seemed to reap the most benefits.

▪ A new study to be funded by the Agency for Health Care Policy and Research (AHCPR) will investigate more effective ways of treating depression in teenagers. Five grants, totaling nearly $10 million in projected funding, have been awarded by AHCPR and other components of the U.S. Department of Health and Human Services in response to a solicitation for funding for child mental health research. By 1996, suicide was the fourth leading cause of death in children 10 to 14 years of age and the third leading cause of death among 15- to 24-year-olds. Depression can also cause loss of energy; problems with concentration, thinking and memory; and increases the risk of teenage pregnancy, school dropout and accidents.

▪ Good news for eggheads—eating one egg per day won't increase the risk of heart disease or stroke in an otherwise healthy person. Because eggs were long believed to cause heart disease as a result of their high cholesterol content, patients have been told to limit the number they eat. According to researchers at the Harvard School of Public Health, it's dietary fat, not dietary cholesterol, that affects blood cholesterol levels. However, people with high cholesterol or diabetes should still limit the number of eggs they eat, because they might not be able to handle the extra dietary cholesterol, according to the study published in JAMA.

▪ Gardening is becoming big business—in 1997, spending on gardening supplies and services totaled $26.6 billion. Why is this hobby so popular? When people were asked why they garden, 44 percent said they do so to be outdoors; 42 percent garden to be around beautiful things; 39 percent garden to relax and escape everyday stress; 35 percent garden to stay active and get exercise; 18 percent garden to produce food for their families; 14 percent garden to produce fresh flowers for their homes; and 14 percent think gardening is a perfect way to spend time with their families, according to a Roper Starch Worldwide survey cited in American Demographics.

▪ Among deaths in teenage boys, almost one in three are caused by gunshot wounds. Homicide is the second leading cause of death among children. Murder or suicide causes one third of deaths among older teens. In the past 20 years, the overall teen suicide rate has doubled, while the rate among black older teens has nearly tripled. Accidents in general cause almost half of deaths among young persons, according to a report released by the Public Health Policy Advisory Board.

▪ [corrected] Elderly persons do not consistently receive recommended health screening, reports the Dartmouth Atlas of Health Care. In addition, investigators found geographic differences in the preventive services that elderly patients receive. For example, pneumococcal vaccination should be given once to all elderly persons and revaccination offered after five years to those at highest risk of fatal pneumococcal infection. Keeping track of screening and preventive measures, and reminding patients to obtain these services, remains a challenge for many physicians.

▪ Do your patients have worries about cellulite? They're not alone. USA Today notes that up to 80 percent of women have the characteristic “cottage-cheese” appearance of adipose on the thighs, buttocks and hips. In addition, women are much more likely to have “cellulite” than men. Why? One theory is that the occurrence of cellulite is linked with estrogen and differences between men and women in the way that fat is stored. It's also likely that genetic factors play a role in the development of cellulite.



Copyright © 1999 by the American Academy of Family Physicians.
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