Family violence curricula in U.S. medical schools.

INTRODUCTION: Family violence (adult domestic violence, child abuse/neglect, and elder abuse) is endemic. Victims of family violence are seen in every venue of health care, yet physicians do not routinely inquire about abuse, even when patients present with obvious clinical characteristics. Although a comprehensive health care response is key to a coordinated community-wide approach to family violence, most practicing physicians have never received education in any aspect of family violence, including child abuse. This paper reports the results of a survey of family violence instruction in medical schools. METHODS: A written survey of medical school deans and student representatives of all 126 U.S. medical schools was conducted to (1) determine curriculum content in family violence, (2) assess differences between deans' and students' perceptions of curricular offerings, and (3) compare the results of the current survey with those of an earlier curriculum survey conducted in 1987. RESULTS: The majority of deans reported existing curriculum in all three topic areas of family violence. Compared to the 1987 survey, more deans reported existing curriculum in family violence. However, neither total instructional time nor curriculum during clinical training increased. Moreover, student and dean responses were discrepant regarding awareness of curriculum in domestic violence and elder abuse. CONCLUSION: Despite an increase in the number of schools reporting curriculum in family violence, there does not appear to be increased attention to this problem, at least as measured by time devoted to teaching. Insights from this descriptive survey can promote ongoing efforts toward comprehensive curriculum development in family violence.

A domestic violence primer for clinicians.

Physician awareness of domestic violence is vital. Adult domestic violence should be distinguished from other types of violent behavior. This article defines domestic violence and offers physicians guidelines for identifying domestic violence victims in any clinical setting.

A domestic violence primer for clinicians.

The authors offer clinical treatment strategies for domestic violence victims. Physician awareness, management, and referral can reduce morbidity and mortality. The major therapeutic goals are to increase the patient's safety, provide support, and offer options.

Is exercise good or bad for arthritis in the elderly?

Recreational exercise has achieved great popularity. Possible benefits to participants include increased longevity, decreased risk of cardiovascular disease, improved psychologic well-being, and greater fitness. Important but as yet incompletely answered concerns are whether exercise or physical overuse conditions play a role in the pathogenesis of osteoarthritis, which is virtually universal among the elderly, and whether there are any circumstances in which exercise might be beneficial for elderly patients with arthritis. In humans, anecdotal observations have suggested relationships between certain recreational activities and degenerative joint disease. The few controlled studies that exist, however, have indicated that exercise need not be deleterious to joints. Available data may be interpreted to suggest that reasonable recreational exercise--carried out within limits of comfort, putting joints through normal motions, and without underlying joint abnormality--need not inevitably lead to joint injury, even over many years. We are also witnessing thoughtful reevaluation of physical exercise as a therapeutic modality for arthritis patients. It is possible that certain patients may achieve psychologic and clinical benefit from selected exercise programs.

In vitro phagocytosis by crevicular phagocytes in various forms of periodontitis.

Phagocytes from the gingival crevice fluid (CF-cells) of 11 patients with localized juvenile and post-juvenile periodontitis (LJP/PJP), 14 with rapidly progressive periodontitis (RPP), 11 with adult periodontitis (AP), and 14 controls without periodontal disease were examined. Phagocytic activity in vitro was assessed. Crevicular washings were obtained from healthy sites of controls and diseased sites of patients after completion of the oral hygiene phase (professional and home care). The cells were carefully processed to avoid mechanical damage. The in vitro phagocytosis by uptake of opsonized C. albicans was performed in a moist chamber (30 minutes, 37 degrees C) and examined by light microscopy. CF-cells were differentiated on the basis of their morphological appearance. The majority of cells in crevicular washings were PMNs, some macrophages, and few lymphocytes. Phagocytic activity in patients with LJP/PJP and RPP was significantly decreased in comparison with that from AP and the control group. The decreased percentage of cells phagocytosing opsonized C. albicans was associated with the enhanced adherence of opsonized C. albicans. Moreover cell viability of CF-cells from LJP/PJP sites was significantly reduced. The data from the present study suggest that the in vitro phagocytosis of crevicular phagocytes in juvenile and rapidly progressive periodontitis lesions is diminished.

Increase in plasma total and lipoprotein cholesterol during incubation of whole blood samples at 37 degrees C--influence of LCAT inhibitors.

Incubation of whole blood samples at 37 degrees C caused a time-dependent increase in plasma cholesterol concentrations. In samples from 40 fasting healthy males, plasma cholesterol rose by 13.6 +/- 3% during 24 h (P less than 0.001). Changes in cholesterol concentrations were found in both the HDL fraction and the VLDL/LDL fraction. The increase in lipoprotein cholesterol concentrations correlated positively with the initial levels of HDL cholesterol and apo A-I; and with the original levels of VLDL/LDL cholesterol, apo B and triglycerides. The increase in plasma total cholesterol was not related to the HDL cholesterol and apo A-I concentrations. It was more pronounced in samples with elevated plasma concentrations of total cholesterol, VLDL/LDL cholesterol, apo B and triglycerides. The elevation in plasma total cholesterol resulted from an increase in cholesteryl esters, whereas free cholesterol decreased. After LCAT inhibition no changes in total, free and esterified cholesterol were observed. Therefore, increase in plasma cholesterol seems to represent a LCAT-dependent cholesterol transport out of blood cells.

Comparison of food intakes of selected populations in former East and West Germany: results from the MONICA Projects Erfurt and Augsburg.

The intakes of selected food groups in former East and West Germany were compared, based on data from the dietary surveys of the MONICA project Erfurt 1987 and of the MONICA project Augsburg 1984/85. Three-day records from 132 middle-aged men from the city of Erfurt (response 73%) and 3-day records from 424 middle-aged men from the city of Augsburg (response 70%) could be included in the comparison. The differences in the consumption of animal products were rather small. The intake of bread and baked goods, potatoes and cooked vegetables was higher in Erfurt, whereas the intake of raw vegetables was lower. The most striking differences appeared in the consumption of fat.

[Basic program of myocardial infarct after-care]. / Basisprogramm Herzinfarktnachsorge.

The further diagnostics and therapy is performed after classification of the patients in groups with different prognosis. The decision, whether or not an invasive diagnostics is necessary and which medicaments are prescribed is based on the results of non-invasive diagnostic measures. The beta-blockers are the most important group of medicaments. Anticoagulants and antiarrhythmic drugs are used within limited and defined indication. A broad application of thrombocyte aggregation inhibitors seems to be justified according to latest studies. The consequent elimination of coronary risk factors has ascertained prognostic effects.

Clinical decision making. Conference on therapeutic and diagnostic options.

A 66-year-old woman was diagnosed with small cell carcinoma of the lung. Different opinions on management led to critical appraisal of therapy literature and a treatment decision.

Clinical decision making. Conference on therapeutic and diagnostic options.

Clinical decision-making conference will be a new quarterly feature. Suggestions or contributions should be addressed to the authors. The authors discuss a 67-year-old male with coronary heart disease and renal failure.

[How does the rate of participation in epidemiologic research affect oral health data?]. / Wie beeinflusst die Teilnehmerrate an epidemiologischen Untersuchungen Angaben zur oralen Gesundheit?

The question to which extent an unintended selection is linked with incorrect estimations of oral disease indicators by the readiness of subjects to participate is looked into within the framework of an epidemiological study. 896 primarily cooperative subjects and 70 originally noncooperative subjects aged from 25 to 64 years were examined. According to statistics, non-cooperative subjects were found to have more caries-infected teeth and less teeth filled. Generally, a smaller degree of dental care could be detected in these subjects, which should cause a critical discussion of the hitherto published parameters of oral diseases.

[Is there a connection between coronal and root caries involvement?]. / Besteht ein Zusammenhang zwischen koronalem und radikulärem Kariesbefall?

The relationship between coronal and root caries was analyzed in a sample of 963 people aged 25 to 64 years. Subjects with root caries had fewer teeth, more teeth with untreated coronal caries, and more teeth which need conservative treatments and extractions than did people with no root caries. In the age older than 55 years those with root caries had more teeth in the average of 2.5 teeth for both sexes. The other parameters of dental health showed the same differences compared with younger subjects.

[Dose-reduced antihypertensive agents--use in complex nonmedicamentous therapy of hypertension]. / Dosisreduzierte Antihypertensiva--Anwendung bei komplexer nichtmedikamentöser Hochdrucktherapie.

In order to estimate the influence of a non-medicamentous therapy (CNT) on the consumption of medicaments and coronary risk in high blood pressure 73 hypertensives of a medicamentously stabilized CNT-group were examined in comparison to a group of the same size of patients with hypertension who were managed exclusively medicamentously for behaviour of blood pressure, need of antihypertensive drugs and changes of hypertension-associated risk factors. After an exactly controlled 6-month treatment hypertensives with additionally recommended far-reaching CNT showed an economization of medicaments by scarcely the half in comparison to the reference group. By means of suitable control methods a causal non-medicamentously conditioned decrease of blood pressure could be excluded. A different need of antihypertensive drugs was simulated by the exacter intake of medicaments in the index-patients. Notwithstanding the metabolic effects of the additional therapy have induced a positive change of atherogenic lipids. The examinations indicate in general the difficulty of the judgement of efficacy of non-medicamentous therapeutic measures in connection with a rational dose-reduced long-term therapy with antihypertensive drugs.

[Status and perspectives of prevention in coronary heart disease]. / Stand und Perspektive der Prävention der koronaren Herzkrankheit.

The outstanding objective prerequisites for the protection of life and health of the whole population, which are at our disposal, have quite significantly widened the possibilities for individual decisions and actions concerning the influence on health and functional capacity as well as responsibility and cooperation of every citizen. Comprehensively, also in our country the readiness of all citizens must be stimulated to form the personal way of life according to the scientific knowledge fully using the abundantly given possibilities. In this respect we too have to solve still great problems.

[Nifedipine therapy in uncomplicated essential hypertension and hypertensive problem cases]. / Nifedipin-Therapie bei unkomplizierter essentieller Hypertonie und Hochdruck-Problemfällen.

In altogether 54 patients with high blood pressure of the clinical degrees of severity I-IV the blood pressure-reducing effectiveness of the calcium antagonist nifedipine was investigated both in the framework of an oral long-term therapy and especially in problematic situations of high blood pressure. According to the results of own treatment nifedipine is particularly suited for the antihypertensive combination therapy with beta-receptor blockers. Monotherapeutically favourable possibilities of application exist in hypokinetic types of the regulation of circulation as well as in elderly hypertensives. Therapy-resistant as well as crisis-like developments of high blood pressure react with excessive, well tolerable and persisting reductions of blood pressure. Above all with regard to this still little considered indication in the meantime nifedipine represents an unavoidable enrichment in the therapeutic basis spectre of the hypertonus.