Your dietary iron may put you at risk for cancer; it's likely there's a significant association among continuity of care, preventive care and lower hospitalization rates; and preferences for physicians of a given minority group may affect patients' satisfaction levels. These insights are among conclusions in articles in the March/April Annals of Family Medicine.
Dietary Iron Link to Cancer
If you already have higher than normal body iron stores -- indicated by high percentages of transferrin saturation -- and then eat plenty of iron-rich food, you set yourself up for increased cancer risk. That's the take-home message in "Transferrin Saturation, Dietary Iron Intake and Risk of Cancer," by Arch Mainous III, Ph.D., of Charleston, S.C., and his co-authors.
Earlier studies targeted transferrin saturation of more than 60 percent as a cancer risk factor. Mainous, professor in the family medicine department at the Medical University of South Carolina, Charleston, and his colleagues showed that a transferrin saturation level as low as 41 percent, plus iron intake of more than 18 mg a day, led to an increased cancer risk. By contrast, people with a normal iron intake (18 mg or less) did not have an increased cancer risk, even when their transferrin saturation level was high.
"Although severe iron deficiency causes serious adverse health effects," said the authors, "these data call into question the strategy of the addition of iron to food by manufacturers."
Continuity of Care
The medical literature has lots to say about continuity of care. FP John Saultz, M.D., of Portland, Ore., and his co-author ferreted out information on the impact of this cornerstone of family medicine. Their report, "Interpersonal Continuity of Care and Care Outcomes: A Critical Review," documents consistency among many studies, although the authors note persistent methodologic problems within the studies.
Forty studies on continuity of care and care outcomes yielded a total of 81 outcomes. Among them, 51 outcomes were significantly improved in association with interpersonal continuity; only two were significantly worsened. "In particular, interpersonal continuity seems to be associated with improved delivery of preventive services and with lower rates of hospitalization," the authors said.
They also found 22 articles reporting results of 20 studies on interpersonal continuity and cost. There was significantly lower cost or utilization for 35 of 41 cost variables in association with continuity of care.
The authors said there could be a cause-effect relationship between continuity of care and the outcomes of improved preventive care and reduced hospitalization. However, they noted, "It could be that increased interpersonal continuity is the effect of patients experiencing desired health outcomes rather than the cause of these outcomes" -- patients with good outcomes choose to maintain longer relationships with their clinicians than do patients with poorer outcomes.
Racial Preferences
African-Americans and Latinos who perceive racism in the health care system tend to prefer and be more satisfied with physicians from their own racial or ethnic groups. So said the article "Patients' Beliefs About Racism, Preferences for Physician Race and Satisfaction With Care."
The authors found that "the scores of the discriminatory belief scale (a scale reflecting patients' beliefs about racism) were strongly associated with patients' racial preferences for their physician."
Twenty-two percent of African-Americans and 34 percent of Latinos surveyed said they preferred personal physicians of their same race or ethnicity; most others in these two groups had no preference. Fifty-seven percent of African-Americans who preferred and had African-American physicians rated them as excellent, and only 20 percent who preferred but did not have African-American physicians rated them as excellent.
Solutions for racial and ethnic disparities in health need to go beyond increasing the number of minority physicians and teaching cultural competence, said the authors. They called for additional approaches that would take into account patients' beliefs and preferences, increase access to minority physicians and improve ways for patients to choose physicians.
Authors included staff members of AAFP's Robert Graham Center in Washington and FP and principal investigator Frederick Chen, M.D., M.P.H., acting assistant professor at the University of Washington, Seattle, a former intern at the center.
