Trends in financial satisfaction: does poverty make a difference?

Gerontological studies on financial satisfaction have been limited by the dearth of longitudinal research and the lack of research that includes the concept of poverty. In order to bridge these gaps, this longitudinal study examines and compares the intracohort and intercohort effects on financial satisfaction trends by poverty status among Americans age 45 and above, using data from the General Social Surveys. The results suggest that for both the poor and the non-poor, changes in financial satisfaction trends are mostly due to strong negative intercohort effects, indicating that younger cohorts are less satisfied financially than the older ones. There appears to be a significant difference in the intercohort effects of financial satisfaction trends between the poor and the non-poor. However, such difference can be accounted for by the differences in the effects of education and social comparison (or relative deprivation) on financial satisfaction between the poor and the non-poor.     

Relationship with others and life satisfaction in later life: do gender and widowhood make a difference?

In this study we investigated whether social relationship is a stronger determinant of life satisfaction in older women than in older men, and whether this is more obvious in widowed than in married persons, in a representative sample of Chinese individuals aged 60 or older in Hong Kong (N=1,616). We tested the moderating effect of gender and widowhood by means of a multigroup analysis in structural equation modeling that incorporated other major predictors of life satisfaction. Consistent with predictions, relatedness was much more important for women than for men. Furthermore, relatedness was the most important determinant of life satisfaction in women, regardless of marital status, but it was only a moderate predictor in married men, and even an irrelevant factor in widowers. We discuss the results in terms of how gender roles shape relationship goals, and thus how men and women evaluate life satisfaction differently in the context of relationship with others.     

Real patient learning integrated in a preclinical block musculoskeletal disorders. Does it make a difference?

Although musculoskeletal disorders are the most common reason for general practitioner visits, training did not keep pace. Implementation of learning from patients with rheumatologic disorders linked together with the teaching of theoretical knowledge in the preclinical medical education might be an important step forward in the improvement of quality of care for these patients. The Leiden Medical School curriculum has implemented two non-obligatory real patient learning (RPL) practicals integrated within the preclinical block musculoskeletal disorders. This study investigates the educational effectiveness of the practicals, the expectations students have of RPL, and students’ satisfaction. Participants’ grades on the end-of-block test served as the test results of the educational effectiveness of the practicals and were compared with those of the non-participants. Qualitative data was collected by means of questionnaires generated by focus groups. The participants in practicals scored significantly higher at the end-of-block test. The expected effects of the contact with real patients concerned positive effects on cognition and skills. ‘Contextualizing of the theory’, ‘better memorizing of clinical pictures’, and ‘understanding of the impact of the disease’ were the most frequently mentioned effects of the practicals. Overall, the participants were (very) enthusiastic about this educational format. The RPL practicals integrated within a preclinical block musculoskeletal disorders are a valuable addition to the Leiden medical curriculum. This relatively limited intervention exhibits a strong effect on students’ performance in tests. Future research should be directed towards the long-term effects of this intervention.     

Does early diagnosis and treatment of myelodysplastic syndromes make a difference?

Patients diagnosed with myelodysplastic syndromes (MDS) often ask their physicians whether earlier detection of disease or more prompt initiation of treatment might have resulted in a better outcome. The concept of starting therapy at an early point in the disease process when the clonal burden of abnormal hematopoietic stem cells may be lower and somatic mutational complexity less, and therefore treatment more likely to be effective, is attractive. However, at present there is no evidence that therapy with any of the available drugs for MDS (ie, erythropoiesis stimulating agents, lenalidomide, azacitidine or decitabine) early after diagnosis is associated with better outcomes than later initiation of drug therapy. For those patients who are eligible for allogeneic hematopoietic cell transplant and have a suitable donor, early transplant of lower-risk MDS is associated with worse outcomes compared to nontransplant approach, whereas early transplant therapy of higher-risk disease improves outcomes compared to delaying transplant. Here I review available data about MDS diagnostic patterns and early versus later diagnosis and therapy initiation.     

Does sterile or nonsterile technique make a difference in wounds healing by secondary intention?

After observing inconsistencies in care of acute surgical wounds healing by secondary intention and reviewing the potential cost savings of implementing clean dressing change technique policies, surgical nurses at a university-based medical center monitored supply usage and infection rates of these wounds using a nonexperimental, longitudinal study design. Staff from two acute care surgical units provided data for 3 months before and 3 months after standardization of wound care to a clean wound care technique. All adult patients requiring dressing changes three times per day with normal saline moistened gauze of their open surgical wound(s) participated in the study. Before changing the wound care procedures, nine (9) of 1,070 (0.84%) admissions to the two surgical units had a surgical site infection. During the 3 months following implementation of clean wound care protocols, eight (8) surgical site infections were documented in 963 admissions (rate.83%). Dressing supply costs were $380 less. In this study, using nonsterile wound care procedures for wounds healing by secondary intention did not negatively impact infection rates and saved supply costs.     

Is patients' perception of time spent with the physician a determinant of ambulatory patient satisfaction?

BACKGROUND: Time management in ambulatory patient visits is increasingly critical. Do patients who perceive a longer visit with internists report increased satisfaction? METHODS: Prospective survey of 1486 consecutively encountered ambulatory visits to 16 primary care physicians (PCPs) in an academic primary care clinic. Patients were queried regarding demographics, health status, perception of time spent before and after ambulatory visits, whether the physician appeared rushed, and visit satisfaction. Physicians were queried regarding time spent, estimated patient satisfaction, and whether they felt rushed. RESULTS: In 69% of 1486 consecutive visits, patient previsit expectation of visit duration was 20 minutes or less. Patient and PCP postvisit estimates of time spent significantly exceeded patient previsit time expectation. Patients who estimated that they spent more time than expected with the PCP were significantly more satisfied with the visit. When patient postvisit estimate of time spent was less than the previsit expectation, visit satisfaction was significantly lower independent of time spent. Patient worry about health and lower self-perceived health status were significantly associated with patient expectation for longer visits. Primary care physicians felt rushed in 10% of encounters. Although PCPs estimated patient satisfaction was significantly lower when they felt rushed, patient satisfaction was identical when PCPs did and did not feel rushed. Patients indicated that PCPs appeared rushed in 3% of encounters, but this perception did not affect patient satisfaction. CONCLUSION: Perceived ambulatory visit duration and meeting or exceeding patient expectation of time needed to be spent with the physician are determinants of patient satisfaction in an ambulatory internal medicine practice.     

Does physician gender affect satisfaction of men and women visiting the emergency department?

OBJECTIVE: To assess the association of physician gender with patient ratings of physician care. DESIGN: Interviewer-administered survey and follow-up interviews 1 week after emergency department (ED) visit. SETTING: Public hospital ED. PATIENTS/PARTICIPANTS: English- and Spanish-speaking adults presenting for care of nonemergent problems; of 852 patients interviewed in the ED who were eligible for follow-up, 727 (85%) completed a second interview. MEASUREMENTS AND MAIN RESULTS: We conducted separate ordered logistic regressions for women and men to determine the unique association of physician gender with patient ratings of 5 interpersonal aspects of care, their trust of the physician, and their overall ratings of the physician, controlling for patient age, health status, language and interpreter status, literacy level, and expected satisfaction. Female patients trusted female physicians more (P =.003) than male physicians and rated female physicians more positively on the amount of time spent (P =.01), on concern shown (P =.04), and overall (P =.03). Differences in ratings by female patients of male and female physicians in terms of friendliness (P =.13), respect shown (P =.74), and the extent to which the physician made them feel comfortable (P =.10) did not differ significantly. Male patients rated male and female physicians similarly on all dimensions of care (overall, P =.74; friendliness, P =.75; time spent, P =.30; concern shown, P =.62; making them feel comfortable, P =.75; respect shown, P =.13; trust, P =.92). CONCLUSIONS: Having a female physician was positively associated with women's satisfaction, but physician gender was not associated with men's satisfaction. Further studies are needed to identify reasons for physician gender differences in interpersonal care delivered to women. KEY WORDS: patient satisfaction; gender; physician-patient relations; delivery of care; health care quality.     

Does being a woman make a difference in professional practice? A qualitative view to the practice of rheumatology

OBJECTIVE: To explore to what extent female rheumatologists perceived that gender had an influence on their professional practice or on their choice of specialty. METHODS: We collected data from 29 female rheumatologists and used qualitative and quantitative methods to describe the findings. RESULTS: Three groups of respondents were identified (cluster analysis). Most of these rheumatologists perceived that gender influenced the way they practiced, although the specific weights of the topics were different in the 3 groups. Gender also influenced these physicians' choice of specialty field. CONCLUSION: The differences in practice style may have a potential effect on health systems as feminization of the medical profession increases.     

Hepatic steatosis and insulin resistance: does etiology make a difference?

BACKGROUND/AIMS: To ascertain whether the etiology of hepatic steatosis modulates insulin resistance (IR) and to determine the predictors of IR. METHODS: We studied IR through HOMA IR in 146 subjects, 99 of whom had ultrasonographic and/or histologic steatosis. Twenty-two had familial heterozygous hypobetalipoproteinemia (FHBL), 48 had non-alcoholic fatty liver disease (NAFLD), 34 HCV infection (17 with HCV1b, 17 with HCV3a) and 42 were healthy controls without steatosis. RESULTS: Steatosis was present in 77.3% of FHBL and, by enrolment criteria, in all NAFLD and HCV cases. Overall HOMA-IR correlated with BMI and GGT (P<0.01). FHBL and healthy groups had similar HOMA-IR and GGT values, whereas higher levels were observed in HCV and NAFLD. HCV3a and FHBL patients were hypolipidemic. HOMA-IR was similar in FHBL patients and controls and lower than in HCV and NAFLD. FHBL patients had a high extent of steatosis, similar to that observed in HCV3a, but lower grading and staging than NAFLD and HCV. At multivariate analysis, steatosis and GGT predicted HOMA-IR. CONCLUSIONS: Data suggest that not all hepatic fat associates with IR. FHBL patients, for some aspects, resemble HCV3a infection, possibly suggesting a shared steatogenic mechanism. Among steatotic patients serum GGT levels is the independent predictor of IR.     

Symptoms in acute coronary syndromes: does sex make a difference?

Background

Coronary heart disease is a major problem in both men and women, but several studies have shown sex differences in symptoms of acute coronary syndromes (ACS). Some findings, however, have been disparate and inadequate, and thus a comprehensive overview of this literature would be of value.

Method

Fifteen studies that identified symptoms of ACS for both women and men were examined through a review of the literature from 1989 to 2002. Terms used for the search included “myocardial infarction,” “symptoms,” “gender differences,” and “acute coronary syndromes.”

Results

Although chest pain was the most common symptom in both men and women, several differences were also noted. In all types of ACS, women had significantly more back and jaw pain, nausea and/or vomiting, dyspnea, indigestion, and palpitations. In a number of studies, which solely sampled patients with acute myocardial infarction, women demonstrated more back, jaw, and neck pain and nausea and/or vomiting, dyspnea, palpitations, indigestion, dizziness, fatigue, loss of appetite, and syncope. Men reported more chest pain and diaphoresis in the myocardial infarction sample. The designs and methodologies of the studies varied considerably.

Conclusion

In addition to the typical symptom of chest pain in ACS, women experience other atypical symptoms more frequently than men. Thus, there may be sex differences in the symptoms of ACS, differences that have a bearing not only on clinical practice, but also on the interpretation of available clinical studies and the design of future investigations.