Patient provider communication about the health effects of obesity

Objective

We assessed the influence of race/ethnicity and provider communication on overweight and obese patients’ perceptions of the damage weight causes to their health.

Methods

The study included 1071 overweight and obese patients who completed the 2002 Community Health Center (CHC) User survey. We used logistic regression analyses to examine determinants of patients’ perceptions of the impact of their weight on their health. Models were adjusted for covariates and weighting was used to account for the sampling design.

Results

Forty-one percent of respondents were overweight and 59% were obese. Non-Hispanic Blacks and Hispanics were half as likely as non-Hispanic Whites to believe weight was damaging to their health while controlling for covariates. Overweight/obese CHC patients who were told they were overweight by healthcare providers were almost nine times more likely to perceive that weight was damaging to their health compared to those not told.

Conclusions

We observed large racial/ethnic disparities in the perception that overweight is unhealthful but provider communication may be a powerful tool for helping patients understand that overweight is damaging to health.

Practice implications

Given obesity is a national epidemic, further attention to the role of patient provider communication in illness is essential with important implications for both health professional training and health care provision.     

Masticatory Performance and Chewing Cycle Kinematics—Are They Related?

Objective:To compare chewing cycle kinematics of subjects with better and poorer masticatory performance.Materials and Methods:A cross-sectional study compared masticatory performance, based on the breakdown of the artificial test food Cuttersil®, in 30 subjects with Class I occlusion. Individuals with median particle sizes greater and lesser than the median value for the entire sample were categorized as poorer (15) and better (15) performers, respectively. While chewing Cuttersil, three-dimensional jaw movements of subjects were tracked with an optoelectric computer system. Multilevel linear modeling was used to evaluate differences in estimated cycle shape, cycle duration, and maximum excursions, as well as within-subject variation between the two groups.Results:Poorer performers had a significantly longer opening duration (0.274 ± 0.225 sec vs 0.325 ± 0.270 sec) than better performers. Poorer and better performers also showed significant differences in cycle shape, including a less horizontal path of closure and more posterior jaw movement in the poorer performers. In addition, poorer performers exhibited significantly more cycle-to-cycle (within-subject) variability in chewing cycle duration, excursive movements, and lateral velocity than did better performers.Conclusions:Poorer performers lacked consistency in their chewing cycles, and their cycle shape differs from that of better performers.     

The nursing management of elderly patients with pain in the community: study and recommendations

This study is designed to identify factors which influence quality of life for elderly people suffering from painful conditions. It is based upon a theoretical model of control in which mood state is used as the indicator of coping. One hundred and ninety elderly patients took part in semi-structured interviews about their pain and coping experiences, and data were also collected from their nurses in the community. Multivariate statistical analysis revealed that the key determinants of mood were having regrets about the past, being occupied, perceived level of pain control, additional personal problems (notably bereavement) and feeling informed about the painful condition. Active personal coping strategies were identified as more therapeutic than passive strategies. Nurses' data revealed that pain complaints were associated with perceived exaggeration. Few nurses used formal pain assessment. Recommendations for the management of persistent pain in the community are given.     

Gender Expression,Violence, and Bullying Victimization: Findings From Probability Samples of High School Students in 4 US School Districts

BACKGROUND

Young people may experience school‐based violence and bullying victimization related to their gender expression, independent of sexual orientation identity. However, the associations between gender expression and bullying and violence have not been examined in racially and ethnically diverse population‐based samples of high school students.

METHODS

This study includes 5469 students (13–18 years) from the 2013 Youth Risk Behavior Surveys conducted in 4 urban school districts. Respondents were 51% Hispanic/Latino, 21% black/African American, 14% white. Generalized additive models were used to examine the functional form of relationships between self‐reported gender expression (range: 1 = Most gender conforming, 7 = Most gender nonconforming) and 5 indicators of violence and bullying victimization. We estimated predicted probabilities across gender expression by sex, adjusting for sexual orientation identity and potential confounders.

RESULTS

Statistically significant quadratic associations indicated that girls and boys at the most gender conforming and nonconforming ends of the scale had elevated probabilities of fighting and fighting‐related injury, compared to those in the middle of the scale (p < .05). There was a significant linear relationship between gender expression and bullying victimization; every unit increase in gender nonconformity was associated with 15% greater odds of experiencing bullying (p < .0001).

CONCLUSIONS

School‐based victimization is associated with conformity and nonconformity to gender norms. School violence prevention programs should include gender diversity education.

     

Pyrethroid and organophosphate pesticide-associated toxicity in two coastal watersheds (California, USA)

Portions of the Santa Maria River and Oso Flaco Creek watersheds in central California, USA, are listed as impaired under section 303(d) of the Clean Water Act and require development of total maximum daily load (TMDL) allocations. These listings are for general pesticide contamination, but are largely based on historic monitoring of sediment and fish tissue samples that showed contamination by organochlorine pesticides. Recent studies have shown that toxicity in these watersheds is caused by organophosphate pesticides (water and sediment) and pyrethroid pesticides (sediment). The present study was designed to provide information on the temporal and spatial variability of toxicity associated with these pesticides to better inform the TMDL process. Ten stations were sampled in four study areas, one with urban influences, and the remaining in agriculture production areas. Water toxicity was assessed with the water flea Ceriodaphnia dubia, and sediment toxicity was assessed with the amphipod Hyalella azteca. Stations in the lower Santa Maria River had the highest incidence of toxicity, followed by stations influenced by urban inputs. Toxicity identification evaluations and chemical analysis demonstrated that the majority of the observed water toxicity was attributed to organophosphate pesticides, particularly chlorpyrifos, and that sediment toxicity was caused by mixtures of pyrethroid pesticides. The results demonstrate that both agriculture and urban land uses are contributing toxic concentrations of these pesticides to adjacent watersheds, and regional water quality regulators are now using this information to develop management objectives.