Effects of weight status on the recommendations of and adherence to lifestyle modifications among hypertensive adults.

Overweight and obese hypertensive patients can greatly benefit from high adherence rates for lifestyle modifications. The objectives of this paper were to investigate how patients' weight status affected physicians' recommendations of lifestyle modifications and patients' adherence after they received the recommendations. The patients were adults (18+ years of age) with hypertension (prehypertension, Stage I and Stage II hypertension). The National Health and Nutrition Examination Survey (NHANES) 1999-2000 was used. Weight status was categorized as normal/underweight, overweight and obese. Physicians' recommendations of and patients' adherence to lifestyle modifications (weight control, exercise, sodium intake reduction, alcohol intake reduction) were examined using descriptive and multivariate analyses, controlling for weight status, hypertension stage, comorbidities and demographic characteristics. About 57.0% of the US adult population in 1999-2000 had prehypertension, Stages I or II hypertension. Among the hypertensive adults, 30.3% were normal/underweight, 32.6% were overweight and 37.2% were obese. We found that physicians were more aggressive in recommending lifestyle modification for obese patients. In contrast, obese hypertensive patients were not found to be more likely than normal/underweight patients to adhere to lifestyle modification recommendations. In addition, adherence rates for sodium and alcohol consumption reduction were higher than that for either exercise or weight control. In conclusion, more aggressive approaches should be taken by physicians to educate obese patients about the benefits of lifestyle modifications and to improve adherence to enhance the effects of antihypertensive medications.

Canine ovariohysterectomy and orchiectomy increases the prevalence of ACL injury.

To determine whether canine ovariohysterectomy or orchiectomy affects the prevalence of anterior cruciate ligament injury, we compared injury rates of anterior cruciate ligaments of animals that had gonadectomy and animals that were sexually intact as a function of gender, breed, or size. Records of 3218 dogs treated in one orthopaedic veterinary practice during a 2-year period were retrospectively reviewed. Anterior cruciate ligament injury, diagnosed by a history of acute hind limb lameness and by positive anterior drawer test, was confirmed at the time of surgery. The prevalence of anterior cruciate ligament rupture in all dogs was 3.48%. Females that had ovariohysterectomy and males that had orchiectomy had a significantly higher prevalence of anterior cruciate ligament rupture than the sexually intact dogs. Larger dogs had an increased prevalence of anterior cruciate ligament injury compared with smaller or medium-sized dogs, with the increased rupture rates for sterilized animals holding across breeds and sizes. Sterilization of either gender increased the prevalence of anterior cruciate ligament injury, suggesting a potential effect of gonadal gender on prevalence of injury of this ligament.

Prevalence and correlates of paediatric asthma and wheezing in a largely rural USA population.

OBJECTIVE: The prevalence of asthma among children has been increasing in the United States and it is estimated that there are approximately 5 million children with asthma. This cross-sectional survey sought to estimate the prevalence of asthma and asthma symptoms and potential risk factors among children aged 16 and younger, in a largely rural population in the USA. METHODS: This study was a telephone survey of 1500 households in the South Plains/Panhandle region of Texas. Parents of children were interviewed with a response rate of 64%. Having been diagnosed with asthma by a physician and a report of wheezing in the last 12 months were used as dependent variables in multivariate logistic regressions with several sociodemographic and environmental factors as potential confounders. RESULTS: The age-adjusted prevalence of asthma and wheezing among children were approximately 15 and 18%, respectively. The prevalence of asthma was highest (20%) among children aged 11-16 (P < 0.001). Living in urban areas was associated significantly with asthma and wheezing. Non-Hispanic blacks reported significantly increased odds of asthma in their children (adjusted odds ratio (OR) = 2.04, 95%CI 1.02-4.08), whereas Mexican-Americans reported significantly reduced odds of asthma (adjusted OR = 0.48, 95%CI 0.29-0.78) and wheezing (adjusted OR = 0.58, 95%CI 0.37-0.89) in their children. The odds of asthma (adjusted OR = 1.78, 95%CI 1.09-2.92) and wheezing (adjusted OR = 2.45, 95%CI 1.52-3.95) was highest among children in the highest body mass index quartile. No significant association with pet ownership and exposure to second-hand smoke with asthma and wheezing was observed in this study. CONCLUSION: Urban residence, non-Hispanic black and Mexican-American race/ethnicity, and being overweight were significantly associated with the increased risk of asthma and/or wheezing.

Duration of heart disease visits by elderly patients: productivity versus quality.

A balance should be reached between physician productivity and clinical quality, since the first comes at the expense of the second. The study described here used the National Ambulatory Medical Care Survey (NAMCS) to demonstrate that visit length for elderly heart disease patients is related to both appropriate (i.e. clinical) patient differences and to less justifiable factors. Both demand management and managerial control strategies should be considered.