The association between inquiry about emotional distress and women's satisfaction with their family physician: findings from a national survey

BACKGROUND: Women appear to be more vulnerable than men to emotional distress (ED) However, ED often goes unrecognized by family physicians. PURPOSE: To (1) assess the rate of inquiry about ED by family physicians and (2) explore the association between physician's inquiry about ED and women's satisfaction with care. METHODS: Telephone interviews were conducted in 2003 using a structured questionnaire in a representative sample of 991 Israeli women aged 22 years or older, with a response rate of 84%. RESULTS: 33% of women reported ED during the past year but only 15% of women reported having discussed ED with their family physician in the last year. Higher rates of discussion of ED with the physician were found among women who had experienced ED (22.5%), those who had a chronic illness (20.1%) had low income (22.7%), and were Arabic (29.5%) or Russian speakers (26.3%). Multivariate analysis indicated that women who had discussed ED with their physician expressed higher satisfaction with the physicians professional level (OR = 6.85), attitude (OR = 2.45), spending enough time (OR = 2.90), and listening to the patient (OR = 3.19), compared with women who had not discussed ED with their physician. CONCLUSIONS: Given the current low rates of inquiry about ED, it appears that developing sensitivity to women's emotional concerns and encouraging physicians to inquire about ED should be given higher priority in medical education at all levels. Furthermore, since inquiry about ED not only improves the appropriateness of care but is also associated with higher satisfaction with the physician, organizations in a competitive health care environment may have a particular interest in promoting this practice.     

Public-health epidemiology in Vanuatu

Vanuatu, which formerly was known as the New Hebrides, is an archipelago in the southwest Pacific Ocean with a tropical humid climate. The national health system and the state of health of the population generally are satisfactory. The main diseases of public-health importance are malaria and tuberculosis. Their epidemiology and control are discussed. An epidemic of Plasmodium falciparum malaria, which commenced in 1980, is described; this possibly can be explained by an increase in chloroquine-resistant P. falciparum over the same period. Other diseases also are reviewed. Many tropical diseases of great significance elsewhere are not of much significance in Vanuatu. Medical advice for visiting travellers is provided.     

Malaria in Vanuatu. Recent epidemiological data

The Republic of Vanuatu, ex-Condominium of New-Hebrides, is an archipelago in the South Pacific, between Solomon Islands and New-Caledonia. Although the health system is quite satisfactory, malaria has become the major health problem in the whole country. Its epidemiological characteristics are reviewed, and particularly the biology of the only known vector, the Anopheles farauti complex. A sudden and severe aggravation of the malaria morbidity since 1980 is then evidenced. This increase of the yearly incidence (from 21% to 183% between 1980 and 1984) has privileged the rising of Plasmodium falciparum which reached 75% of the national paraside index. Moreover, it has clearly followed a geographical progression from north to south within the group during the four years. Various possible causes to this alarming situation are examined, among which the emergence of chloroquin-resistant strains of P. falciparum, and the possibility of modifications in the vector's population, particularly hold the attention.     

Large differences in the genome organization of different plant Trypanosomatid parasites (Phytomonas spp.) reveal wide evolutionary divergences between taxa

All currently known plant trypanosomes have been grouped in the genus Phytomonas spp., although they can differ greatly in terms of both their biological properties and effects upon the host. Those parasitizing the phloem sap are specifically associated with lethal syndromes in Latin America, such as, phloem necrosis of coffee, ‘Hartrot’ of coconut and ‘Marchitez sorpresiva’ of oil palm, that inflict considerable economic losses in endemic countries. The genomic organization of one group of Phytomonas (D) considered as representative of the genus has been published previously. The present work presents the genomic structure of two representative isolates from the pathogenic phloem-restricted group (H) of Phytomonas, analyzed by pulsed field gel electrophoresis followed by hybridization with chromosome-specific DNA markers. It came as a surprise to observe an extremely different genomic organization in this group as compared with that of group D. Most notably, the chromosome number is 7 in this group (with a genome size of 10 Mb) versus 21 in the group D (totalling 25 Mb). These data unravel an unsuspected genomic diversity within plant trypanosomatids, that may justify a further debate about their division into different genera.     

The choice between splenectomy and medical treatment in patients with advanced agnogenic myeloid metaplasia.

The objective of the study was to explore the risks and benefits of splenectomy in advanced agnogenic myeloid metaplasia (AMM). We searched the literature (Medline, 1970-1987) for studies of postoperative survival, operative mortality and effects of splenectomy on painful splenomegaly, and portal hypertension or transfusion requirements in patients with AMM. We employed formal decision analysis to determine the relative value of medical and surgical treatment of advanced AMM. Results of data synthesis showed that splenectomy in AMM is associated with an operative mortality of 13.4% (95% confidence intervals (CI): 9.5-17.2%), an early morbidity of 45.3% (CI: 39.6-51.1%), and a late morbidity of 16.3% (CI: 9.9-22.5%). Almost all patients with portal hypertension and painful splenomegaly, but only about half of those with thrombopenia and anemia were reported to have experienced relief in their symptoms or signs after splenectomy. We found no evidence that splenectomy affects survival in AMM. We concluded that splenectomy in advanced AMM is a palliative procedure that carries a substantial risk. It may be considered for symptomatic patients after they have been informed about the operative mortality, morbidity, and chances of palliation. Decisions about treatment of advanced AMM should be guided predominantly by the patient's preferences.     

Between‐center disparities in access to heart transplantation in France: contribution of candidate and center factors — A comprehensive cohort study

Transplantation represents the last option for patients with advanced heart failure. We assessed between‐center disparities in access to heart transplantation in France 1 year after registration and evaluated the contribution of factors to these disparities. Adults (n = 2347) registered on the French national waiting list between January 1, 2010, and December 31, 2014, in the 23 transplant centers were included. Associations between candidate and transplant center characteristics and access to transplantation were assessed by proportional hazards frailty models. Candidate blood groups O and A, sensitization, and body mass index ≥30 kg/m² were independently associated with lower access to transplantation, while female gender, severity of heart failure, and high serum bilirubin levels were independently associated with greater access to transplantation. Center factors significantly associated with access to transplantation were heart donation rate in the donation service area, proportion of high‐urgency candidates among listed patients, and donor heart offer decline rate. Between‐center variability in access to transplantation increased by 5% after adjustment for candidate factors and decreased by 57% after adjustment for center factors. After adjustment for candidate and center factors, five centers were still outside of normal variability. These findings will be taken into account in the future French heart allocation system.     

Factors associated with microhematuria in asymptomatic young men

The prevalence of asymptomatic microhematuria (two to four or more erythrocytes per high-power field) in 1341 male Air Force personnel was 5.4%. The most powerful predictor of microhematuria (nearly 15-fold increased prevalence) was a history of recurrent microhematuria during the previous five years. Recurrent microscopic hematuria was present in 14.5% (8/55) of men with a history of urethritis, accounting for 26% (8/31) of the cases of recurrent microscopic hematuria. The prevalence of microhematuria was not affected by physical exercise, flight duty, or sexual intercourse during the 24 h preceding the urinalysis.