Viewing the candidates as risk managers

After one of the most chaotic political primary seasons that we've seen in many years, election season began early this time around. It promises to be one of the most entertaining in decades as we head towards the respective national conventions in late summer. The candidates are touting “change” as one of the central themes for their campaigns, but I must say that a more appropriate word might be “choice.” I doubt that there has ever been a more diverse field of candidates.     

Life: Coming to grips with the balancing act

At the Annual Conference & Exhibition this fall in Boston, I met a young man who took the time to tell me that he had enjoyed my last President's Message. He appreciated what I had to say about the importance of relationships, and he suggested that I write about work/life balance. He had a young family, and he seemed to be struggling with the competing priorities of work and home.     

Physical Activity and BMI: Evidence From the Panel Study of Income Dynamics Child Development Supplement

BACKGROUND: This study assessed the association between amount of physical activity and body mass index (BMI) percentile among middle and high school children. Total daily physical activity needs to include both in and out of school physical activity. METHODS: A secondary data analysis was performed on 1306 children drawn from the Panel Study of Income Dynamics Child Development Supplement (CDS III, 2007). The dependent variable in this study was BMI percentile, while the independent variable was physical activity. The multinomial logistic regression model was used to assess the associations between physical activity and BMI percentile controlling for age, gender, race/ethnicity, parental income, and neighborhood safety. RESULTS: Children who engaged in low daily physical activity levels had 1.8 times the odds of being obese versus normal weight than those who engaged in moderate levels [odds ratio (OR) = 1.80, confidence interval (CI) = 1.31, 2.48]. African‐American children had 1.6 times the odds of being obese than normal weight (OR = 1.55, CI = 0.99, 2.43) and Hispanic children had approximately 1.8 times the odds of being obese than normal weight in comparison to non‐Hispanic white children (OR = 1.79, CI = 1.00, 3.21). Females had about 1.5 times the odds of being overweight than normal weight than males (OR = 1.49, CI = 1.04, 2.13). CONCLUSIONS: This study suggests that the accumulation of 30 minutes or more of daily physical activity may be effective in decreasing obesity prevalence among middle and high school‐aged children.     

Maternal Adaptive Capacity: A Strengths-Based Theory to Guide Maternal Health Research

The United States is experiencing a rise in maternal morbidity and mortality that disproportionately affects marginalized groups. Maternal health research is often designed through a lens of deficit, which perpetuates bias and negatively affects care. The purpose of this article is to describe the development of the theory of maternal adaptive capacity, a strengths-based approach to maternal health research that has the potential to promote new discovery in research, reduce biases, empower individuals and improve health outcomes. Walker and Avant's approach to theory derivation is applied to the framework of vulnerability to climate change, a theory commonly used in environmental research. In this derivation the authors explore the parallels between the concept of adaptive capacity related to climate change and maternal health. The new theory of maternal adaptive capacity should be applied and tested in various research modalities to confirm its utility.     

Long-Term Follow-Up After Complete Resection of Well-Differentiated Cancer Confined to the Thyroid Gland

Background  

Papillary or follicular thyroid carcinomas exhibit a relatively benign course. Hence, long-term follow-up studies with well-defined disease stages and treatment details are needed to evaluate treatment strategies.     

How Do Physicians and Midwives Manage the Third Stage of Labor?

ABSTRACT: Background: Current practice guidelines recommend active management of the third stage of labor. We compared practices of three maternity care provider disciplines in management of third‐stage labor and the justifications for their approach. Methods: This study is a cross‐sectional survey of maternity practitioners in usual practice settings in British Columbia. All 199 obstetricians, all 82 midwives, and a random sample of family physicians practicing intrapartum maternity care (one‐third, or 346) were surveyed The three main outcome measures by discipline were the method preferred in managing third‐stage labor, the reasons given for the chosen method, and views on the appropriateness of the current third‐stage labor guideline. Results: The overall response rate was 57.8 percent. Response rates indicating that the participants were “aware of guideline” were the following: obstetricians, 85.3 percent; family physicians, 53.7 percent; and midwives, 97.8 percent. Response rates indicating that the participants “agreed with guideline” were the following: obstetricians, 95.2 percent; family physicians, 97.6 percent; and midwives, 51.2 percent. Response rates indicating that “oxytocin should be given with anterior shoulder” were the following: obstetricians, 71.1 percent; family physicians, 68.3 percent; and midwives, 26.7 percent. Response rates indicating that “routine active management of third stage of labor should be the norm” were the following: obstetricians, 79.2 percent; family physicians, 60.2 percent; and midwives, 17 percent. All results were statistically significant (p < 0.01). Conclusions: A major difference was found between physicians and midwives in the management of third‐stage labor. Physicians routinely implemented active management of the third stage of labor; midwives preferred expectant approaches, principally based on women’s preference. Provincial data did not show differences in postpartum hemorrhage or transfusion rates by practitioner type. (BIRTH 35:3 September 2008)     

Changing physician practice of physical activity counseling

We conducted a prospective controlled trial to determine whether an educational intervention could improve resident physician self-efficacy and counseling behaviors for physical activity and increase their patients' reported activity levels. Forty-eight internal medicine residents who practiced at a Department of Veterans Affairs hospital received either two workshops on physical activity counseling or no intervention. All residents completed questionnaires before and 3 months after the workshops. The 21 intervention physicians reported increased self-efficacy for counseling and increased frequency of counseling compared with the 27 control physicians. Approximately 10 patients of each resident were included in the study and surveyed before and 6 months after the intervention. Of 560 patients, 465 (83%) returned both questionnaires. Following the intervention, there were no significant differences between patients of intervention and control physicians on any outcome measures. We conclude that educational interventions can improve physicians' reported self-efficacy of physical activity counseling but may not increase patient physical activity levels. Alternative approaches that emphasize overcoming the substantial barriers to exercise in chronically ill outpatients clearly will be important for facilitating changes in physical activity.