A problem-based approach to teaching outcomes research in family medicine residency.

Objective: This study's objective was to introduce research concepts and skills in family medicine residency through a problem-based course.

Methods: Eight third-year residents per year in 3 academic years participated. Groups of two-three were presented with the task of developing, executing, and reporting on a small research project within the family medicine clinic.

Does binge eating disorder impact weight-related quality of life?

Objectives: To determine whether binge eating disorder (BED) impacts weight-related quality of life in obese individuals seeking weight loss treatment and to investigate the role of psychological symptoms, BMI, and demographic variables in the relationship between BED and weight-related quality of life.

Research Methods And Procedures: Three hundred seventeen women (BMI = 37.6) and 213 men (BMI = 41.

An integrated comprehensive occupational surveillance system for health care workers.

Background: Workers in the health care industry may be exposed to a variety of work-related stressors including infectious, chemical, and physical agents; ergonomic hazards; psychological hazards; and workplace violence. Many of these hazards lack surveillance systems to evaluate exposures and health outcomes. The development and implementation of a comprehensive surveillance system within the Duke University Health System (DUHS) that tracks occupational exposures and stressors as well as injuries and illnesses among a defined population of health care workers (HCWs) is presented.

Molecular characterization of a PDZ-LIM protein in Atlantic salmon (Salmo salar): a fish ortholog of the alpha-actinin-associated LIM-protein (ALP).

A protein containing both PDZ and LIM protein-protein interaction motifs has for the first time been identified in a lower vertebrate species. A full-length cDNA encoding the ortholog of the alpha-actinin-associated LIM protein (ALP) was isolated from white skeletal muscle of Atlantic salmon (Salmo salar). Whereas ALP is expressed as two muscle specific isoforms in mammals and chicken as the result of alternative splicing, a single ALP transcript was found in both muscle and non-muscular tissues of Atlantic salmon.

The effect of smoking on years of healthy life (YHL) lost among middle-aged and older Americans.

Objective: To estimate the effects of smoking on quality of life over time, using the Years of Healthy Life (YHL) construct.

Data Sources/study Setting: The Health and Retirement Study (HRS) survey (N=12,652) of persons 50 to 60 years old and the Asset and Health Dynamics Among the Oldest Old (AHEAD) survey (N=8,124) of persons > or =70 years old, plus spouses regardless of age, followed from 1992/1993 to 2000.

Study Design: Years of healthy life from baseline to death were estimated.

Screening mammography and Pap tests among older American women 1996-2000: results from the Health and Retirement Study (HRS) and Asset and Health Dynamics Among the Oldest Old (AHEAD).

Background: We wanted to determine the frequency of self-reported receipt of screening mammography and Papanicolaou (Pap) tests in older women and investigate important predictors of utilization, based on 2 national longitudinal surveys.

Methods: This cohort study includes participants from 4 waves (1994-2000) of the Health and Retirement Study (HRS)--5,942 women aged 50 to 61 years, and 4 waves (1993-2000) of the Asset and Health Dynamics Among the Oldest Old (AHEAD) survey--4,543 women aged 70 years and older. The self-reported receipt of screening mammograms and Pap smears in the most recent 2 years were reported in 1996 and 2000 for HRS, with predictors of receipt measured in 1994 and 1998.

Number of children associated with obesity in middle-aged women and men: results from the health and retirement study.

Objective: To study associations between number of children and obesity in middle-aged women and men.

Methods: In the Health and Retirement Study, a national survey of households, we tested the association between increasing number of children and obesity (body mass index [BMI] >or= 30) in 9046 middle-aged women and men (4523 couples).

Results: Women (n = 4523) who were obese were more frequently nonwhite, reported lower household income, were more frequently employed outside the home, were less frequently covered by health insurance, and were more frequently less educated compared with nonobese women.

Nutritional risk predicts quality of life in elderly community-living Canadians.

Background: Although nutrition parameters have been linked to quality of life (QOL), few studies have determined if nutritional risk predicts changes in QOL over time in older adults.

Methods: 367 frail older adults were recruited from 23 service agencies in the community. Baseline interview included nutritional risk as measured by SCREEN (Seniors in the Community: Risk Evaluation for Eating and Nutrition), as well as a wide variety of covariates.

Racial differences in influenza vaccination among older Americans 1996-2000: longitudinal analysis of the Health and Retirement Study (HRS) and the Asset and Health Dynamics Among the Oldest Old (AHEAD) survey.

Background: Influenza is a common and serious public health problem among the elderly. The influenza vaccine is safe and effective.

Methods: The purpose of the study was to determine whether frequencies of receipt vary by race, age group, gender, and time (progress from 1995/1996 to 2000), and whether any racial differences remain in age groups covered by Medicare.

Beyond memory impairment: cognitive changes in Alzheimer's disease.

In addition to memory impairment, deficits in other cognitive processes are common in the advanced stages of Alzheimer's disease (AD). The diagnosis of AD does not consider the relative prevalence of deficits in cognitive areas other than memory. We report on the prevalence of aphasia, apraxia, and other cognitive changes in individuals from a large representative sample of elderly Canadians.

Nutritional risk and time to death; predictive validity of SCREEN (Seniors in the Community Risk Evaluation for Eating and Nutrition).

Background: Undernutrition in community-living seniors is common and has the potential to adversely influence health outcomes. Nutritional risk screening tools can help identify seniors at risk, but few have predicted health outcomes.

Methods: Seniors were recruited from 23 community service providers.

Evaluation of an infrared/radiofrequency equipment-tracking system in a tertiary care hospital.

Optimal management of assets in large hospitals is important to both cost control and patient care. A prospective controlled evaluation was conducted to determine whether an asset-tracking system using combined radiofrequency and infrared signals could increase equipment utilization, increase appropriate charge capture, and decrease personnel time spent looking for equipment. Two wards at Duke University Medical Center were randomly assigned as intervention and control.

Interest in healthy diet and physical activity interventions peripartum among female partners of active duty military.

Overweight and obesity among soldiers and their dependents have increased over the last decade, mirroring rates in the general population. In general, few programs that result in sustained weight loss have been evaluated, although effective interventions could have clear health and cost benefits for the military. For women, the postpartum period represents a "teachable moment" to promote healthy diet and exercise behaviors related to weight loss, but the attitudes and preferences for weight-loss interventions in this population are unknown.

Patient satisfaction and quality of care in walk-in clinics, family practices and emergency departments: the Ontario Walk-In Clinic Study.

Background: Although walk-in clinics are an increasingly common feature of Ontario's health care system, the quality of care they provide is the subject of continuing debate. In this study we examined differences in patient satisfaction and quality of care for common acute conditions in walk-in clinics, family practices and emergency departments.

Methods: For this prospective cohort study, we recruited 12 walk-in clinics, 16 family practices and 13 emergency departments from 11 geographic areas in greater Toronto, Hamilton-Burlington and London, Ont.

Primary care: is there enough time for prevention?

Objectives: We sought to determine the amount of time required for a primary care physician to provide recommended preventive services to an average patient panel.

Methods: We used published and estimated times per service to determine the physician time required to provide all services recommended by the US Preventive Services Task Force (USPSTF), at the recommended frequency, to a patient panel of 2500 with an age and sex distribution similar to that of the US population.

Results: To fully satisfy the USPSTF recommendations, 1773 hours of a physician's annual time, or 7.

Prescription of QT-prolonging drugs in a cohort of about 5 million outpatients.

Many drugs prolong the QT interval and increase the risk of torsade de pointes. Concurrent use of two or more of these drugs can further increase the risk, but the prevalence of concurrent prescription of QT-prolonging drugs is not known. Using the administrative claims database of a national pharmaceutical benefit manager, we conducted a retrospective cohort study in 4,825,345 subjects aged 18 years or older.

Comparing the characteristics and attitudes of physicians in different primary care settings: The Ontario Walk-in Clinic Study.

Background: In Canada, walk-in clinics (WICs) are a focus for debate about access to and the costs and quality of primary care. While WICs may offer patients easier access through longer hours and shorter waits, it has been argued that they may also lead to unnecessary utilization, duplication of services, lack of continuity of care, decreased quality and increased costs.

Objectives: The main objectives were to analyse the characteristics and attitudes of physicians working in different family practice types including WICs.

Does the label "fibromyalgia" alter health status, function, and health service utilization? A prospective, within-group comparison in a community cohort of adults with chronic widespread pain.

Objective: To determine if assigning the label of fibromyalgia (FM) to individuals with chronic widespread pain has a significant effect on long-term health status, function, and health service utilization.

Methods: In the London Fibromyalgia Epidemiology Study, 100 individuals with FM were identified by screening 3,395 non-institutionalized adults. Only 28 of the 100 had been previously diagnosed with FM; for 72, the diagnostic label was new.

Patient-reported frequency of taking aspirin in a population with coronary artery disease.

Despite the established benefits of antiplatelet agents in coronary artery disease (CAD), many appropriate patients are not receiving them. We investigated the prevalence of and factors associated with aspirin use and nonuse within a large referral population with CAD. The goal was to identify an approach to increase the use of antiplatelet agents by such patients.

The role of smoking and other modifiable lifestyle risk factors in maintaining and restoring lower body mobility in middle-aged and older Americans: results from the HRS and AHEAD. Health and Retirement Study. Asset and Health Dynamics Among the Oldest Old.

Objectives: To analyze the effect of smoking, smoking cessation, and other modifiable risk factors on mobility in middle-aged and older Americans.

Design: Panel study; secondary data analysis.

Setting: United States (national sample).

Walk-in clinics in Ontario. An atmosphere of tension.

Objective: To explore family practice (FP), emergency department (ED), and walk-in clinic (WIC) physicians' perceptions and experiences regarding the effect of walk-in clinics on Ontario's health care system.

Design: Qualitative method of focus groups.

Setting: Hamilton, London, and Toronto, Ont.

Chronic widespread musculoskeletal pain with or without fibromyalgia: psychological distress in a representative community adult sample.

Objective: To estimate the severity of depression, anxiety, and other symptoms of psychological distress in a representative general population sample of fibromyalgia (FM) cases (FC) compared to pain controls (PC), and to identify strong correlates of depression and anxiety.

Methods: We compared the severity of depression, anxiety, and other symptoms of psychological distress between 2 representative community samples: (1) 74 confirmed FC, and (2) 48 adults with chronic widespread pain (PC) who did not meet the 1990 ACR criteria for FM. Psychological distress was measured using the Centre for Epidemiological Studies Depression (CES-D) Scale, the State-Trait Anxiety Inventory (STAI), and other measures of psychological distress from the literature.

Walk-in clinics: patient expectations and family physician availability.

Background: For over two decades, there has been controversy over the role and impact of walk-in clinics on primary health care. This study evaluates the providers' perspective on this topic.

Objective: The purpose of this qualitative study was to explore the perceptions and experiences of family physicians, emergency physicians and walk-in clinic physicians regarding the impact of walk-in clinics on Ontario's health care system.

A longitudinal study of the effects of tobacco smoking and other modifiable risk factors on ill health in middle-aged and old Americans: results from the Health and Retirement Study and Asset and Health Dynamics among the Oldest Old survey.

Background: While the effects of smoking and other modifiable risk factors on mortality and specific diseases are well established, their effects on ill health more generally are less known. Using two national, longitudinal surveys, the objective of this study was to analyze the effect of smoking and other modifiable risk factors on ill health, defined in a multidimensional fashion (i.e.

Underuse of aspirin in a referral population with documented coronary artery disease.

Despite substantial evidence that antiplatelet therapy saves lives and reduces adverse events in patients with coronary artery disease (CAD), use of the most widely available and lowest cost antiplatelet agent, aspirin, continues to be disappointingly low. In a large database of patients with known CAD, we (1) explored trends in the use of aspirin over time, (2) characterized patients most likely to take aspirin regularly, and (3) estimated the effectiveness of aspirin use by examining long-term outcomes. Using patients entered in the Duke Databank for Cardiovascular Diseases, we explored the use of aspirin from 1969 to 1999.