Cultural competence education for practicing physicians: lessons in cultural humility, nonjudgmental behaviors, and health beliefs elicitation.

Introduction: Although numerous studies have examined cultural competence training, debate still exists about efficacious approaches to this training. Furthermore, little focus has been placed on training and evaluating practicing physicians.

Methods: A skills-based course on culturally competent diabetes care was developed and subsequently tested in a controlled trial of primary physicians caring for patients enrolled in one state's Medicaid program.

Assessing culturally competent diabetes care with unannounced standardized patients.

Background And Objectives: More effective diabetes care is desperately needed, especially for ethnic minority populations. Provider cultural competence promises to be an important means for reducing disparities in outcomes for patients with diabetes. The objectives of this study were to understand the role of cultural competence in the diabetes office visit.

How best to manage treatment-resistant depression?

Should you augment the treatment regimen with lithium, thyroxin, or an atypical antipsychotic? This review will help you decide.

Concurrent and longitudinal predictors of self-esteem in elementary and middle school girls.

Background: The purpose of this study was to analyze the effects of factors related to self-esteem, both cross-sectionally and longitudinally, among 2 cohorts of girls over a period of 4 years, from elementary through middle school.

Methods: A multiethnic sample of 656 elementary school girls recruited from 13 schools in Hayward, CA, and Tucson, AZ, was evaluated annually over a 4-year period. The McKnight Risk Factor Survey IV was administered, which consists of 103 questions that assess self-esteem, appearance appraisal, effect of body changes, depressed mood, teasing, school performance, and other factors.

Does dieting lead to weight gain? A four-year longitudinal study of middle school girls.

Objective: A majority of the published longitudinal research on children has reported that dieting is related to weight gain at a later point in time. The purpose of this study was to look at weight control behaviors and patterns of weight gain and loss, specifically whether dieting is related to weight gain.

Research Methods And Procedures: Baseline data were collected from 1358 female students in grades 6 to 9 from schools in Hayward, CA, and Tucson, AZ.

Ethnic differences in dieting, binge eating, and purging behaviors among American females: a review.

The research literature related to ethnic differences in dieting, binge eating, and purging behaviors among American females was reviewed. Relevant publications were located by means of computer searches utilizing MedLine and PsycInfo databases. The majority of the dieting studies that have been published thus far indicate that this behavior is more prevalent among White females while most studies of binge eating and purging behaviors indicate that these behaviors are as common among minority females as among White females.

Eating and weight control behaviors among middle school girls in relationship to body weight and ethnicity.

This study examined the links among body mass index (BMI), weight control practices, binge eating, and eating disorders in 1164 middle school girls. Both the prevalence and frequency of weight control behaviors increased as BMI increased, but binge eating was reported approximately equally by girls across the BMI spectrum.

Gender differences in academic advancement: patterns, causes, and potential solutions in one US College of Medicine.

Purpose: The influx of women into academic medicine has not been accompanied by equality for male and female faculty. Women earn less than men in comparable positions, progress more slowly through academic ranks, and have not attained important leadership roles. This study tested hypotheses about why gender disparities exist in salary, rank, track, leadership, and perceptions of campus climate at one academic center, the University of Arizona College of Medicine, Tucson.

The reflecting team: an innovative approach for teaching clinical skills to family practice residents.

Background And Objectives: This paper provides a description and evaluation of the reflecting team approach as a teaching method for family practice residents. We have used the reflecting team approach in our longitudinal behavioral health program for 6 years. Our purpose in using this approach is to 1) teach listening and interviewing skills, 2) teach systems-oriented psychosocial interventions, and 3) provide behavioral health consultations for patients.

The association of energy intake bias with psychological scores of women.

Objective: Assess the association between reporting bias of dietary energy intake and the behavioral and psychological profiles in women.

Design: At baseline a series of questionnaires were administered to 37 women, (the Marlowe-Crowne Social Desirability Scale, Weinberger Adjustment Inventory (WAI), the Eating Disorder Inventory (EDI), the Restraint Scale and Sorensen-Stunkard's silhouettes). Subjects received training on how to record dietary records.

Development and evaluation of the McKnight Risk Factor Survey for assessing potential risk and protective factors for disordered eating in preadolescent and adolescent girls.

Objective: To describe the development, test-retest reliability, internal consistency, and convergent validity of the McKnight Risk Factor Survey-III (MRFS-III). The MRFS-III was designed to assess a number of potential risk and protective factors for the development of disordered eating in preadolescent and adolescent girls.

Method: Several versions of the MRFS were pilot tested before the MRFS-III was administered to a sample of 651 4th through 12th- grade girls to establish its psychometric properties.

Factors associated with weight concerns in adolescent girls.

Objective: This study examined the association of weight concerns with potential risk factors for the development of eating disorders.

Method: A self-report survey was given to 103 elementary (Grades 4 and 5) and 420 middle (Grades 6-8) school students in Arizona and California. Of these, 78 elementary and 333 middle school students provided complete data and were used in the analyses.

Potential risk factors associated with weight control behaviors in elementary and middle school girls.

The purpose of this study was to examine the relationship between weight control behaviors and potential risk factors for disordered eating in a sample of young girls. The McKnight Risk Factor Survey was administered to 523 elementary and middle school girls. In the sample of elementary school girls, results from the multiple regression analyses indicated that frequency/severity of weight control behaviors was associated with body mass index (BMI), self-confidence, peers' weight-related pressures, ethnicity, and the interaction between having divorced/separated parents and BMI.

Attachment style and weight concerns in preadolescent and adolescent girls.

Objective: The purpose of this study was to assess the association between attachment style and weight concerns, a major risk factor for eating disorders, in preadolescent and adolescent girls.

Method: Three hundred and five female elementary and middle school students completed measures of attachment style and weight concerns.

Results: Insecurely attached subjects reported higher weight concerns than did securely attached subjects.

Eating disturbances among American minority groups: a review.

Objective: The purpose of this paper was to review the research literature related to eating behaviors and disturbances among American minority groups.

Method: A computer-based literature search was conducted to locate articles pertaining to this topic.

Results: This review indicates that, compared to Caucasian females, eating disturbances are equally common among Hispanic females, more frequent among Native Americans, and less frequent among Black and Asian American females.

The spectrum of eating disturbances.

Objective: The purpose of this paper was to review and summarize the research literature on the spectrum of eating disturbances.

Method: Literature was searched using a computer data base to identify recent articles related to the prevalence and occurrence of disturbed eating patterns as well as full and partial syndrome eating disorders (EDs).

Results: This review indicates that the prevalence of partial syndrome EDs in nonclinical populations is at least twice that of full syndrome EDs, and that there is a progression in some individuals from less to more severe disturbances in eating behavior.

Eating attitudes and weight preoccupation among female high school students in Japan.

Eating disorder tendencies in 197 eleventh grade Japanese girls were examined to ascertain whether or not the reported correlates of eating disorder tendencies in North America would be replicated in Japan. The 26-item Eating Attitudes Test was administered along with a set of supplementary questions. As hypothesized, higher levels of eating disturbances were found in the students who: (1) perceived themselves as being overweight, (2) had been encouraged to diet, (3) reported engaging in frequent conversations with their mother about food and dieting.

Is puberty a risk factor for eating disorders?

Objective: To examine the association between stage of sexual maturation and eating disorder symptoms in a community-based sample of adolescent girls.

Participants: All sixth- and seventh-grade girls (N = 971) enrolled in four northern California middle schools.

Main Variables Examined: Pubertal development measured using self-reported Tanner stage and body mass index (kg/m2).

Comparing obligatory to nonobligatory runners.

This study compares "obligatory" runners (runners who continue to run despite clear physical injury or contraindications) to nonobligatory runners. Both groups scored within the normal range on most psychological test indices. The two groups had more similarities than differences.

Clinical features of eating disorders and individual psychological functioning.

Relationships between the clinical features of eating disorders and individual psychological functioning were investigated in a population of 114 eating-disordered females, which consisted of 63 bulimics, 9 anorexics, 7 bulimic anorexics, 23 with eating disorders not otherwise specified, and 12 with indications of an eating disorder, but without sufficient data for further differential diagnosis. No significant differences in psychological functioning were found when diagnosis was used to classify the subjects into groups, but significant differences did emerge when subjects were classified by specific clinical features. Among the clinical features associated with greater psychopathology were: low body weight, frequent weight fluctuations, amenorrhea of longer duration, purging via laxatives, frequent exercising, and more frequent binges of longer duration.

Coexistence of bulimia nervosa and mania: a literature review and case report.

A literature review of the relationship between bulimia and affective disorder showed that the evidence from empirical research and case report studies suggests that a sizeable subgroup of bulimics suffer from bipolar disorder as well as bulimia and may benefit from antimanic medications such as lithium. A case report is presented of a bulimic patient with manic symptoms who was successfully treated with lithium. However, the use of lithium should be avoided with any patient who is purging, since it may exacerbate the loss of intracellular potassium, thereby increasing the risk of cardiac toxicity.

Prevention of eating disorders among adolescents.

Abstract Since eating disorders frequently begin during adolescence, high school students represent a high risk population for the development of these disorders. For this reason, a pilot project for the prevention of eating disorders was instituted at the high school level. The primary goal of this pilot project was to educate students, faculty, and staff at the school about the incidence, symptoms, and consequences of eating disorders.

Body weight and bulimia as discriminators of psychological characteristics among anorexic, bulimic, and obese women.

Bulimic women from underweight (n = 20), normal-weight (n = 31), and overweight (n = 22) categories were compared with restrictor anorexics (n = 20), normal controls (n = 31), and obese subjects (n = 22). Each subject was administered the Minnesota Multiphasic Personality Inventory, the Internal-External Locus of Control Scale, the Rosenberg Self-Esteem Scale, and the Semantic Differential Potency Scale. Bulimic women in all 3 weight categories exhibited greater psychopathology, more external locus of control, lower self-esteem, and lower sense of personal effectiveness than nonbulimic women at similar weight levels.