Functional health literacy in adults in a rural community health center.

At a rural community health center, 183 adult patients were invited to participate in an unspecified study. In a closed-door session, interested invitees were told the study required taking the Test of Functional Health Literacy in Adults (TOFHLA). After the purpose of the study was privately disclosed, 70 patients agreed to enroll (38.25 percent acceptance rate). Approximately 15 percent demonstrated literacy/numeracy deficits, scoring in the Inadequate and Marginal Functional Health Literacy ranges. Student's t-test comparison of mean scores suggested patients with literacy/numeracy deficits tended to have higher mean ages and completed fewer mean years of school than those scoring in the Adequate range, p = 0.0007 and p = 0.0005, respectively. Pearson's Product Moment Correlations demonstrated a negative correlation between age and TOFHLA score, r = -0.52, a positive correlation between highest year of schooling and TOFHLA score, r = 0.51, and a negative correlation between age and highest grade of schooling, r = 0.39. Regression analysis suggested 27 percent of the variability in TOFHLA score was attributable to age, p = 0.0001, supporting the role of age in cognitive decline. Upon review of these patients' medical records, no information on their literacy/numeracy problems or deficits was identified.

Updated treatment for influenza A and B.

Influenza causes significant morbidity and mortality and is responsible for considerable medical expenditures. Vaccination is the most effective public health measure to combat this illness. Amantadine and rimantadine are older antiviral agents that have been important adjuncts in the prevention and treatment of influenza A outbreaks. Zanamivir and oseltamivir are newer agents indicated for the treatment of both influenza A and B. For antiviral agents to be effective, they must be used within 48 hours of the onset of influenza symptoms. Antiviral agents reduce the duration of fever and illness by one to two and one-half days and also reduce the severity of some symptoms. Use of amantadine or rimantadine is appropriate if influenza virus A is known to be the predominant agent in a particular year or location. Data need to be evaluated on the development of resistance and use of the newer antiviral agents in geriatric patients, high-risk patients and children. For optimal use of antiviral agents, patients with influenza symptoms must present early, and family physicians must accurately and rapidly diagnose the illness.

Implementing the guidelines for adolescent preventive services.

The Guidelines for Adolescent Preventive Services (GAPS) include recommendations developed and promoted by the American Medical Association's Department of Adolescent Health and are intended to organize, restructure and redefine health care delivery for 11- to 21-year-old patients. Data show that health risks in this age group are more social in origin than medical, and that these unhealthy behaviors can be recognized and interventions can be applied at an earlier age to reduce adolescent mortality and morbidity. In fact, evidence suggests that some interventions may result in a decrease in premature adult mortality. GAPS provides physicians with preventive service recommendations and a flow sheet that is useful for implementing and documenting these services during office visits. This system enables the busy physician to identify at-risk adolescent patients and provide them with information about changing unhealthy behaviors

Utilization of nicotine nasal spray in smoking cessation.

It is widely accepted that nicotine replacement therapy can help patients to quit smoking. Recent approval by the US Food and Drug Administration of a nicotine nasal spray gives clinicians greater flexibility in choosing the best replacement therapy for a particular patient. Four types of smoking cessation therapy are currently available (gum, patch, nasal spray, and bupropion). These differ with respect to their onset and duration of action, adverse effects, and cost. This article focuses on which patients may benefit most from the use of nicotine nasal spray. Instructions for proper administration and dosing of the nicotine nasal spray are discussed as well as how to taper it appropriately, and how to avoid--and manage--adverse effects. Additionally, the cost of the nicotine nasal spray is reviewed and compared with over-the-counter products and bupropion. Resources for behavioral support are provided as well.

Step treadmill exercise training and blood pressure reduction in women with mild hypertension.

Stepping as an exercise modality has gained increasing popularity. The step treadmill is an exercise machine which simulates actual stair-climbing. The purpose of this study was to determine the effectiveness of a 16-week supervised aerobic step treadmill exercise training protocol in reducing resting blood pressure in women with unmedicated mild hypertension. During the training protocol, subjects exercised during a self-selected appointment three times a week on the step treadmill, increasing from 20 minutes up to 60 minutes per session, at a target heart rate corresponding to 70-80% heart rate reserve for 16 weeks. Utilizing paired t-test analysis, mean resting systolic blood pressure decreased from 142.2 +/- 9.1 to 132.7 +/- 8.2 mm Hg (p < .01) and mean resting diastolic blood pressure decreased from 93 +/- 4.9 to 87.4 +/- 5.4 mm Hg (p < .01) during the 16-week protocol. Mean maximal oxygen uptake was significantly increased, whereas mean body weight did not change significantly over the 16-week period. Large scale trials are needed to further delineate the effectiveness of stepping as a health care intervention in adults with unmedicated mild hypertension, especially in women.

Medical coverage of recreational cycling events.

Our goal is to optimize the level of medical care delivered to riders on the tour in a comprehensive way. Participation of local EMS squads and advance planning is essential for providing acute, prompt medical care at the scene and to provide transport to local or distant hospitals to evaluate or treat more serious conditions. Fortunately the majority of injuries is minor, but when EMS personnel and physicians work closely together, riders and tour staff feel more comfortable with concerns about their health during the event. Based on our experience, we have made suggestions for preventing injuries and have provided a framework for the physician interested in effectively delivering medical care at any recreational cycling event.

Do tobacco companies avoid proper use of warnings in magazine ads?

By law, cigarette advertisements in magazines must contain one of four surgeon general's warnings and these warnings must be rotated quarterly. This study surveyed the top 13 magazines by paid subscription in the United States that accept cigarette advertising to determine if cigarette companies are compliant with this law. All issues of these magazines published during 1990 were surveyed yielding 1329 ads. Goodness of fit chi-square was used to compare observed distributions of each warning with the expected distribution. There were no significant differences in the number of times each warning appeared over the year or in each magazine. The tobacco industry as a whole appears to follow the guidelines of the Comprehensive Smoking Education Act, though 2 of 6 companies and 8 of 32 brands appear to advertise more heavily when using certain warnings and less heavily when other warnings are utilized.