Kidney Single-cell Transcriptomes Predict Spatial Corticomedullary Gene Expression and Tissue Osmolality Gradients

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The influence of gender on the doctor–patient interaction

Objective

This paper discusses the research focused on gender issues in healthcare communication.

Methods

The majority of papers discussed here are based on a research study in which 509 new adult patients were prospectively and randomly assigned to family practice or internal medicine clinics at a university medical center and followed for one year of care.

Results

There are significant differences in the practice style behaviors of female and male doctors. Female doctors provide more preventive services and psychosocial counseling; male doctors spend more time on technical practice behaviors, such as medical history taking and physical examination. The patients of female doctors are more satisfied, even after adjusting for patient characteristics and physician practice style.Female patients make more medical visits and have higher total annual medical charges; their visits include more preventive services, less physical examination, and fewer discussions about tobacco, alcohol and other substance abuse (controlling for health status and sociodemographic variables).The examination of gender concordant and discordant doctor–patient dyads provides a unique strategy for assessing the effect of gender on what takes place during the medical visit.

Conclusion

Doctor and patient gender can impact the physician–patient interaction and its outcomes.

Practice implications

The development of appropriate strategies for the implementation of knowledge about physician and patient gender differences will be crucial for the delivery of high quality gender-sensitive healthcare.     

Determinants and outcomes of patient-centered care

Objective

This paper defines an interactional analysis instrument to characterize patient-centered care and identify associated variables.

Methods

In this study, 509 new adult patients were randomized to care by family physicians and general internists. An adaption of the Davis Observation Code was used to measure a patient-centered practice style. The main outcome measures were visit-specific satisfaction and healthcare resource utilization.

Results

In initial primary care visits, patient-centered practice style was positively associated with higher patient self-reported physical health status (p = 0.0328), higher educational level (p = 0.0050), and non-smoking status (p = 0.0108); it was also observed more often in the interactions of family physicians compared to internists (p = 0.0003). Controlling for patient sociodemographic variables, self-reported health status, pain, health risk behaviors (obesity, alcohol abuse, and smoking), and clinic assignment, patient satisfaction was not related to the provision of patient-centered care. Moreover, a higher average amount of patient-centered care recorded in visits throughout the one-year study period was significantly related to lower annual medical charges (p = 0.0003).

Conclusions

Patient-centered care was observed more often with family physician caring for healthier, more educated patients, and was associated with lower charges.

Practice implications

Reduced annual medical care charges are an important outcome of patient-centered medical visits.     

A qualitative study of the barriers to chronic pain management in the ED

Purpose

This qualitative study sought to identify perceived barriers to diagnosing and treating patients with chronic pain in the emergency department (ED).

Basic Procedure

Semistructured interviews were conducted with 24 ED physicians from 4 hospitals to elucidate their experiences of managing chronic pain in the ED.

Main Findings

Time limitations and a low triage priority were major barriers to caring for patients with chronic pain. But despite the inherent problems of treating a nonurgent condition in a time-limited setting, physicians were strong proponents for treating chronic pain in the ED.

Principal Conclusion

Acknowledging that pain can neither be verified nor disproved, physicians tend to err on the side of the patient, often providing an allotment of opioid medications. They also believe that the ED is not an optimal setting for treating patients in chronic pain but that it is often the last resort for many of these patients, thus, providing the rationale for serving them to the best of their ability.     

Seasonal patterns of outdoor PM infiltration into indoor environments: review and meta-analysis of available studies from different climatological zones in Europe

Epidemiologists have observed higher risks for exposure to ambient particulate matter (PM) in the summer than in other seasons. This increased risk may be partly due to seasonal behaviour and higher exposures to indoor PM in the summer in relation to outdoor pollutant levels during winter when windows are kept closed and less time is spent outdoors. In this report, we analyse data from six European studies, based on three different methods of estimating outdoor to indoor infiltration factors, with the aim of characterizing the geographical and seasonal patterns of PM infiltration. The highest infiltration levels were observed for the summer in both a European combined dataset consisting of 382 observations of the average PM_2.5 infiltration factor for 1 day to 2weeks in regional data sets for Northern, Central and Southern Europe as well as for all ten cities individually. Th lowest values were observed for the winter, with spring and autumn displaying intermediate values. In all datasets and cities, the variability between residences and days within each season was much higher than the seasonal trend. PM₁₀ data were available from two studies, revealing that the PM₁₀ infiltration factors ranged from 70 to 92% of the corresponding PM_2.5 values. Some differences between the studies may be associated with the study designs and applied methods of determining the infiltration factor. The ratio of summer to winter PM_2.5 infiltration ranged from 1.3 in Rome to 2.3 in Helsinki, and the corresponding regional ratio ranged from 1.5 in Central Europe to 1.8 in Northern and Southern Europe. It is suggested that similar differences can be expected in epidemiological concentration–response relationships due to the modification in seasonal exposure associated with buildings and time spent indoors.     

Air temperature and inflammatory responses in myocardial infarction survivors

BACKGROUND: Temperature changes have been associated with increased cardiovascular risk, but the role of inflammatory markers in this relationship is not well understood. The objective of this study was to analyze the association between air temperature and C-reactive protein, interleukin-6 and fibrinogen in postmyocardial infarction patients. METHODS: In a multicenter panel study, the 3 inflammatory blood markers were measured repeatedly. In total, 5813 blood samples in 1003 subjects were collected in 6 European cities representing different climates. Data on patient characteristics and disease history were gathered at the baseline visit. Meteorologic data were obtained from the city-specific network stations. The association was analyzed using a semiparametric model with random patient effects. RESULTS: A 10 degrees C decrease in the 5-day-average of air temperature before the blood withdrawal was associated with a 4% increase in C-reactive protein (4.3% [95% confidence interval = 0.2% to 8.1%]). Correspondingly, an increase of interleukin-6 was observed for the same time window (3.3% [0.1% to 6.3%]) whereas fibrinogen showed an increase of 1.3% (0.2% to 2.4%) with a lag of 3 days. CONCLUSION: A decrease in air temperature, particularly the average temperature of the last 5 days, was associated with an increase in both C-reactive protein and interleukin-6, whereas fibrinogen seemed to react to temperature changes after 3 days. In susceptible patients this might lead to an additional risk for cardiovascular events and suggests a biologic mechanism for the observed seasonal variation in death from ischemic heart disease and stroke in the elderly.     

Modifier effect of the Glu298Asp polymorphism of endothelial nitric oxide synthase gene in autosomal-dominant polycystic kidney disease

Autosomal-dominant polycystic kidney disease (ADPKD) is one of the most common monogenic diseases. It is characterized by a substantial variability in the severity of renal phenotype, primarily assessed by the age at end-stage renal disease (ESRD). The role of modifier genes has been shown in various hereditary diseases, including ADPKD. The gene coding for the endothelial nitric oxide synthase (NOS3) is considered to have a modifier effect on the severity of ADPKD, even if there are studies among different populations that have shown contradictory results. In this study, we investigated the influence of one of the most studied polymorphisms of the NOS3 gene, the Glu298Asp polymorphism, on the age at ESRD in ADPKD. We analyzed a total of 100 ADPKD unrelated patients and 107 healthy cohorts from the Greek population. ADPKD patients were classified into two subgroups: patients with early (rapid progressors) and late (slow progressors) age at ESRD. The results suggested that the Glu298Asp polymorphism of NOS3 gene is associated with the onset age of ESRD. The distribution of C/T alleIes is significantly different between rapid and slow ADPKD progressors leading to the conclusion that the T allele of the Glu298Asp polymorphism of NOS3 gene is associated with earlier progression to ESRD in ADPKD patients.