Conventional wisdom holds that coronary heart disease is an illness of older men, and that may be why doctors have difficulty diagnosing it in women. But do female doctors at least do a better job than male doctors? Apparently not, a new study finds.
The study, did find significant differences in the ways male and female doctors diagnosed the illness. It reported that male doctors might be less biased by the gender and age of the patient being examined. "We're not trying to say that one group of doctors is better than another," John B. McKinlay, the principal investigator said. "What we're trying to do is for the first time describe and explain how much variability there is in doctors' behavior when they look at exactly the same clinical presentation in different patients."
The scientists videotaped professional actors portraying patients of varying gender, age, race and socioeconomic status who all had medically apparent symptoms of heart disease. Then 112 male and female primary care doctors, half in Massachusetts and the
rest in Britain, watched the videos. The physicians were asked to think of the patient as one of their own, make a diagnosis and suggest a treatment plan. Finally, they were asked to describe what factors they considered in arriving at their decisions.
Both male and female doctors picked up more psychological cues from female patients than from male patients. A characterization like "seemed very low" or "very depressed" was more likely to be made about a female patient than a male one.
Comments about a patient's self-presentation like, "He doesn't give a very cogent history," or, "She's a passive victim," were more common among female doctors, and they made significantly more such observations of female patients.
Male doctors noticed fewer such cues in general, and only slightly more from male than female patients. This suggests that doctors, and especially female doctors, may be more sensitive to such information in patients of their own gender.
Even though older age is a significant risk factor for heart disease in both men and women, female doctors paid significantly less attention to female patients' ages than those of males.
Dr. Alexandra J. Lansky, an associate professor of clinical medicine in cardiology at the Columbia University Medical Center who was not involved in the study, found the paper revealing. "The old statement that female docs are better prepared to take care of female patients does not stand," Dr. Lansky said. "Female docs are missing
one big point that the male docs don't miss, and that's the age-related factor."
Not all experts found the report convincing. "This study clearly says that female and male doctors approach the patient interview differently, " said Dr. Elizabeth A. Jackson, an assistant professor of medicine at the University of Michigan. "But they appear to have a similar knowledge base. This was not a real-life situation, and you can't take conclusions from one study in isolation. I'd like to see if these results can be replicated."
Dr. McKinlay, who is head of the New England Research Institutes in Watertown, Mass., said the study offered a new way to look at the disparities between men and women in treating coronary heart disease. "A lot of the time," he said, "health disparities have been explained by characteristics of the patient - race or economics, women versus men, older versus younger. But here the variability is explained by characteristics of the doctor." [NYT]
Selasa, 16 Oktober 2007
More Doctors After Malpractice Caps
That is not for an appointment. That is the time it can take the Texas Medical Board to process applications to practice. Four years after Texas voters approved a constitutional amendment limiting awards in medical malpractice lawsuits, doctors are responding as supporters predicted, arriving from all parts of the country to swell the ranks of specialists at Texas hospitals and bring professional health care to some long-underserved rural areas.
The influx, raising the state's abysmally low ranking in physicians per capita, has flooded the medical board's offices in Austin with applications for licenses, close to 2,500 at last count. "It was hard to believe at first; we thought it was a spike," said Dr. Donald W. Patrick, executive director of the medical board and a
neurosurgeon and lawyer. But Dr. Patrick said the trend - licenses up 18 percent since 2003, when the damage caps were enacted - has held, with an even sharper jump of 30 percent in the last fiscal year, compared with the year before.
"Doctors are coming to Texas because they sense a friendlier malpractice climate," he said. Some experts say the picture may be more complicated and less positive. They
question how big a role the cap on malpractice awards has played, arguing that awards in malpractice lawsuits showed little increase in the 12 years before the law changed.
And some critics, including liability lawyers, question whether the changes have left patients more vulnerable. With doctors facing reduced malpractice exposure, they say, many have cut back on their insurance, making it harder for plaintiffs to collect damages. Moreover, the critics say that some rural areas have fewer doctors than before. The measure changing Texas' malpractice landscape, Proposition 12, was
narrowly approved in a constitutional referendum on Sept. 12, 2003. It barred the courts from interfering in limits set by the Legislature on medical malpractice recoveries.
For pain and suffering, so-called noneconomic damage, patients can sue a doctor and, in unusual cases, up to two health care institutions for no more than $250,000 each, under limits adopted by the Legislature. Plaintiffs can still recover economic losses, like the cost of continuing medical care or lost income, but the amount they can win was capped at $1.6 million in death cases.
All but 15 states have adopted some limits on medical damage awards, according to the National Conference of State Legislatures. But the restrictions in Texas go further than in many states, where the limits are often twice as high as they are here. "Other states have passed tort reform, but Texas implemented big changes all
at once," said Lisa Robin, a vice president for government relations at the Federation of State Medical Boards, a national umbrella group based in Dallas.
Some experts say that the lack of a state income tax, combined with what William M. Sage, a law professor at the University of Texas in Austin, called a "relatively rapid transition in its tort reputation as a plaintiff-friendly state," has contributed to the state's appeal to doctors.
Dr. Timothy George, 47, a pediatric neurosurgeon, credits the measure in part with attracting him and his sought-after specialty last year to Austin from North Carolina. "Texas made it easier to practice and easier to take care of complex patients," he said.
The increase in doctors - double the rate of the population increase - has raised the state's ranking in physicians per capita to 42nd in 2005 from 48th in 2001, according to the American Medical Association. It is most likely considerably higher now, according to the medical association, which takes two years to compile the standings. Still, the latest figures show Texas with 194 patient-care physicians per 100,000 population, far below the District of Columbia, which led the nation with 659.
The Texas Medical Board reports licensing 10,878 new physicians since 2003, up from 8,391 in the prior four years. It issued a record 980 medical licenses at its last meeting in August, raising the number of doctors in Texas to 44,752, with a backlog of nearly 2,500 applications. Of those awaiting processing, the largest number, after Texas, come from New York (145), followed by California (118) and Florida (100).
In some medical specialties, the gains have been especially striking, said Jon Opelt, executive director of the Texas Alliance for Patient Access, a medical advocacy group: 186 obstetricians, 156 orthopedic surgeons and 26 neurosurgeons.
Adding to the state's allure for doctors, Mr. Opelt said, was an average 21.3 percent drop in malpractice insurance premiums, not counting rebates for renewal.
To help state officials monitor the influx of doctors, the medical board recently got money to hire six more employees, said Dr. Patrick, the director since 2001. It now has 17 lawyers, compared with no more than four when he arrived, he said.
Since 2003, investigations of doctors have gone up 40 percent, patient complaints have gone up 25 percent, and disciplinary actions about 8 percent, said Jill Wiggins, a board spokeswoman. But the figures may reflect greater regulatory diligence rather than more misconduct, Ms. Wiggins said. Of the 10,878 physicians licensed since 2003, she said, 14 have been the subject of disciplinary actions, on charges as diverse as addiction problems and record-keeping infractions, with none accused of harming patients.
But there are those who are skeptical about the caps on malpractice. "We've lost our system of legal accountability, said N. Alex Winslow, executive director of Texas Watch, a consumer advocacy group. "Just having more doctors doesn't make patients safer. It remains to be seen who is coming to our state."
Demian McElhinny, 33, a former hospice pharmacy technician in El Paso, recently settled claims against a neurological surgeon for spinal surgery that left him disabled and his family impoverished; he said he emerged with "pennies on the dollar." His wife, Kelly, found work as a school bus driver, he said, while "I'm at home being a housewife to my two boys."
Mr. McElhinny's surgeon, Dr. Paul Henry Cho, later admitted to the medical board that he was addicted to a narcotic cough syrup and had written fraudulent prescriptions. Dr. Cho's license to prescribe drugs was suspended, although it was soon restored, and he moved from El Paso to a hospital in Fort Worth. He did not return a call to his office, and his lawyer declined to comment.
Paula Sweeney, a leading Dallas liability lawyer and a past president of the Texas Trial Lawyers Association, said, "A lot of legislators are aware they went too far in '03."
Texas Watch, in a report last February, questioned the decline in malpractice insurance rates, saying they must be seen in light of increases of as much as 147 percent before the 2003 referendum. And Bernard S. Black, a law professor at the University of Texas, has published studies showing little increase in Texas insurance awards from 1990 to 2002, casting doubt, he said, on the "malpractice insurance crisis."
Professor Black also said that data was too scant to attribute the rise in the number of doctors to the damage caps. "I don't doubt there's an effect," he said, "but I think it's a small one." Texas Watch also contends that many poor rural areas of Texas remain underserved, and rural West Texas has actually lost several physicians since 2003. But Dr. James Baumgartner, a pediatric neurosurgeon at Memorial Hermann Hospital in Houston, is among many doctors who believe the new
malpractice caps have helped.
Dr. Baumgartner said it was now far easier to recruit doctors to a state where close to 30 percent of children lack health insurance and Medicaid reimbursements are low.
Dr. Keith Hill, a recently discharged Army doctor with a specialty in foot and ankle reconstruction, said the change in state law was the reason he moved from Georgia to open a practice in Beaumont, a poor city in East Texas long seen as plaintiff-friendly. Had it not happened, said Dr. Hill, 40, "I can say I would not have considered Texas." [NYT]
The influx, raising the state's abysmally low ranking in physicians per capita, has flooded the medical board's offices in Austin with applications for licenses, close to 2,500 at last count. "It was hard to believe at first; we thought it was a spike," said Dr. Donald W. Patrick, executive director of the medical board and a
neurosurgeon and lawyer. But Dr. Patrick said the trend - licenses up 18 percent since 2003, when the damage caps were enacted - has held, with an even sharper jump of 30 percent in the last fiscal year, compared with the year before.
"Doctors are coming to Texas because they sense a friendlier malpractice climate," he said. Some experts say the picture may be more complicated and less positive. They
question how big a role the cap on malpractice awards has played, arguing that awards in malpractice lawsuits showed little increase in the 12 years before the law changed.
And some critics, including liability lawyers, question whether the changes have left patients more vulnerable. With doctors facing reduced malpractice exposure, they say, many have cut back on their insurance, making it harder for plaintiffs to collect damages. Moreover, the critics say that some rural areas have fewer doctors than before. The measure changing Texas' malpractice landscape, Proposition 12, was
narrowly approved in a constitutional referendum on Sept. 12, 2003. It barred the courts from interfering in limits set by the Legislature on medical malpractice recoveries.
For pain and suffering, so-called noneconomic damage, patients can sue a doctor and, in unusual cases, up to two health care institutions for no more than $250,000 each, under limits adopted by the Legislature. Plaintiffs can still recover economic losses, like the cost of continuing medical care or lost income, but the amount they can win was capped at $1.6 million in death cases.
All but 15 states have adopted some limits on medical damage awards, according to the National Conference of State Legislatures. But the restrictions in Texas go further than in many states, where the limits are often twice as high as they are here. "Other states have passed tort reform, but Texas implemented big changes all
at once," said Lisa Robin, a vice president for government relations at the Federation of State Medical Boards, a national umbrella group based in Dallas.
Some experts say that the lack of a state income tax, combined with what William M. Sage, a law professor at the University of Texas in Austin, called a "relatively rapid transition in its tort reputation as a plaintiff-friendly state," has contributed to the state's appeal to doctors.
Dr. Timothy George, 47, a pediatric neurosurgeon, credits the measure in part with attracting him and his sought-after specialty last year to Austin from North Carolina. "Texas made it easier to practice and easier to take care of complex patients," he said.
The increase in doctors - double the rate of the population increase - has raised the state's ranking in physicians per capita to 42nd in 2005 from 48th in 2001, according to the American Medical Association. It is most likely considerably higher now, according to the medical association, which takes two years to compile the standings. Still, the latest figures show Texas with 194 patient-care physicians per 100,000 population, far below the District of Columbia, which led the nation with 659.
The Texas Medical Board reports licensing 10,878 new physicians since 2003, up from 8,391 in the prior four years. It issued a record 980 medical licenses at its last meeting in August, raising the number of doctors in Texas to 44,752, with a backlog of nearly 2,500 applications. Of those awaiting processing, the largest number, after Texas, come from New York (145), followed by California (118) and Florida (100).
In some medical specialties, the gains have been especially striking, said Jon Opelt, executive director of the Texas Alliance for Patient Access, a medical advocacy group: 186 obstetricians, 156 orthopedic surgeons and 26 neurosurgeons.
Adding to the state's allure for doctors, Mr. Opelt said, was an average 21.3 percent drop in malpractice insurance premiums, not counting rebates for renewal.
To help state officials monitor the influx of doctors, the medical board recently got money to hire six more employees, said Dr. Patrick, the director since 2001. It now has 17 lawyers, compared with no more than four when he arrived, he said.
Since 2003, investigations of doctors have gone up 40 percent, patient complaints have gone up 25 percent, and disciplinary actions about 8 percent, said Jill Wiggins, a board spokeswoman. But the figures may reflect greater regulatory diligence rather than more misconduct, Ms. Wiggins said. Of the 10,878 physicians licensed since 2003, she said, 14 have been the subject of disciplinary actions, on charges as diverse as addiction problems and record-keeping infractions, with none accused of harming patients.
But there are those who are skeptical about the caps on malpractice. "We've lost our system of legal accountability, said N. Alex Winslow, executive director of Texas Watch, a consumer advocacy group. "Just having more doctors doesn't make patients safer. It remains to be seen who is coming to our state."
Demian McElhinny, 33, a former hospice pharmacy technician in El Paso, recently settled claims against a neurological surgeon for spinal surgery that left him disabled and his family impoverished; he said he emerged with "pennies on the dollar." His wife, Kelly, found work as a school bus driver, he said, while "I'm at home being a housewife to my two boys."
Mr. McElhinny's surgeon, Dr. Paul Henry Cho, later admitted to the medical board that he was addicted to a narcotic cough syrup and had written fraudulent prescriptions. Dr. Cho's license to prescribe drugs was suspended, although it was soon restored, and he moved from El Paso to a hospital in Fort Worth. He did not return a call to his office, and his lawyer declined to comment.
Paula Sweeney, a leading Dallas liability lawyer and a past president of the Texas Trial Lawyers Association, said, "A lot of legislators are aware they went too far in '03."
Texas Watch, in a report last February, questioned the decline in malpractice insurance rates, saying they must be seen in light of increases of as much as 147 percent before the 2003 referendum. And Bernard S. Black, a law professor at the University of Texas, has published studies showing little increase in Texas insurance awards from 1990 to 2002, casting doubt, he said, on the "malpractice insurance crisis."
Professor Black also said that data was too scant to attribute the rise in the number of doctors to the damage caps. "I don't doubt there's an effect," he said, "but I think it's a small one." Texas Watch also contends that many poor rural areas of Texas remain underserved, and rural West Texas has actually lost several physicians since 2003. But Dr. James Baumgartner, a pediatric neurosurgeon at Memorial Hermann Hospital in Houston, is among many doctors who believe the new
malpractice caps have helped.
Dr. Baumgartner said it was now far easier to recruit doctors to a state where close to 30 percent of children lack health insurance and Medicaid reimbursements are low.
Dr. Keith Hill, a recently discharged Army doctor with a specialty in foot and ankle reconstruction, said the change in state law was the reason he moved from Georgia to open a practice in Beaumont, a poor city in East Texas long seen as plaintiff-friendly. Had it not happened, said Dr. Hill, 40, "I can say I would not have considered Texas." [NYT]
Warning Against Over-prescribing Tamiflu
Sewage systems do not break down Tamiflu, which means the main weapon against bird flu could seep into natural waters and make certain viruses resistant to the drug during a pandemic, Swedish researchers said on Wednesday.
Because of this, doctors should take care to not overprescribe Roche Holding AG's market-leading antiviral drug, they said in a study published in the Public Library of Science.
``Antiviral medicines such as Tamiflu must be used with care and only when the medical situation justifies it,'' Bjorn Olsen, a researcher at Uppsala University and the University of Kalmar said in a statement.
``Otherwise there is a risk that they will be ineffective when most needed, such as during the next influenza pandemic.'' Roche, which the researchers said donated the drug for their study, said it was unlikely such resistance would arise.
``In the highly unlikely event that such resistance was generated, this must be balanced against the fact that influenza viruses with the associated mutational changes have been shown to have lower transmissibility, '' the company said.
Tamiflu, known generically as oseltamivir, was having lacklustre sales as a drug to prevent and treat seasonal flu until it was the first treatment to show real efficacy in helping people with bird flu. Health experts agree that a pandemic of something is inevitable. They cannot specify the disease, but the H5N1 avian flu virus currently wiping out flocks from Indonesia to Africa and parts of Europe is the main suspect.
It rarely infects people but has killed 201 out of 329 people sickened since the virus re-emerged in Hong Kong in 2003, according to the World Health Organisation.
In their study, the Swedish team said low levels of oseltamivir, the active substance in Tamiflu, passed virtually unchanged through basic sewage treatment processes.
People had long suspected that Tamiflu would not break apart during such treatment but this is the first time researchers have actually shown this, the researchers said.
In certain countries, the level discharged through these outlets may be so high that influenza viruses in nature could develop resistance to Tamiflu, they said.
``Use of Tamiflu is low in most countries, but there are some exceptions such as Japan where a third of all influenza patients are treated with Tamiflu,'' Jerker Fick, a researcher at Umea University who led the study, said in a statement.
The biggest threat is from waterfowl such as ducks that often forage near sewage outlets, Fick said. These birds could encounter oseltamivir in high enough concentrations to develop resistance to flu viruses they carry, the researchers said.
In turn, the viruses could combine with other viruses that make humans sick and mutate into strains resistant to currently available antiviral drugs like Tamiflu, they added. [SMH]
Because of this, doctors should take care to not overprescribe Roche Holding AG's market-leading antiviral drug, they said in a study published in the Public Library of Science.
``Antiviral medicines such as Tamiflu must be used with care and only when the medical situation justifies it,'' Bjorn Olsen, a researcher at Uppsala University and the University of Kalmar said in a statement.
``Otherwise there is a risk that they will be ineffective when most needed, such as during the next influenza pandemic.'' Roche, which the researchers said donated the drug for their study, said it was unlikely such resistance would arise.
``In the highly unlikely event that such resistance was generated, this must be balanced against the fact that influenza viruses with the associated mutational changes have been shown to have lower transmissibility, '' the company said.
Tamiflu, known generically as oseltamivir, was having lacklustre sales as a drug to prevent and treat seasonal flu until it was the first treatment to show real efficacy in helping people with bird flu. Health experts agree that a pandemic of something is inevitable. They cannot specify the disease, but the H5N1 avian flu virus currently wiping out flocks from Indonesia to Africa and parts of Europe is the main suspect.
It rarely infects people but has killed 201 out of 329 people sickened since the virus re-emerged in Hong Kong in 2003, according to the World Health Organisation.
In their study, the Swedish team said low levels of oseltamivir, the active substance in Tamiflu, passed virtually unchanged through basic sewage treatment processes.
People had long suspected that Tamiflu would not break apart during such treatment but this is the first time researchers have actually shown this, the researchers said.
In certain countries, the level discharged through these outlets may be so high that influenza viruses in nature could develop resistance to Tamiflu, they said.
``Use of Tamiflu is low in most countries, but there are some exceptions such as Japan where a third of all influenza patients are treated with Tamiflu,'' Jerker Fick, a researcher at Umea University who led the study, said in a statement.
The biggest threat is from waterfowl such as ducks that often forage near sewage outlets, Fick said. These birds could encounter oseltamivir in high enough concentrations to develop resistance to flu viruses they carry, the researchers said.
In turn, the viruses could combine with other viruses that make humans sick and mutate into strains resistant to currently available antiviral drugs like Tamiflu, they added. [SMH]
Senin, 15 Oktober 2007
Kesiapan Fisik dan Pengetahuan Remaja Perempuan Sebagai Calon Ibu dalam Membina Tumbuh Kembang BAlita dan Faktor-faktor yang Mempengaruhinya
By Wan Nedra, Soedjatmiko, Agus Firmansyah
Latar Belakang.
Dua puluh satu persen penduduk Indonesia adalah remaja. Hanya 11,6% lulusan SMU yang melanjutkan ke perguruan tinggi, yang tidak melanjutkan antara lain memasuki jenjang perkawinan, padahal perkawinan pada usia muda sangat mengundang risiko yang tidak bisa diabaikan. Mereka yang memasuki jenjang perkawinan, umumnya mempunyai kesiapan fisik dan pengetahuan yang belum memadai, sehingga perlu disiapkan. Seorang ibu yang mempunyai pengetahuan yang baik akan menghasilkan tumbuh-kembang balita yang baik pula, khususnya dalam tiga tahun pertama usia anak.
Tujuan Pustaka.
Penelitian ini bertujuan untuk melihat kesiapan fisik, dan pengetahuan remaja perempuan terhadap tumbuh kembang balita.
Metoda.
Penelitian merupakan studi analitik potong lintang pada remaja perempuan siswi SMU di 7 sekolah di Jakarta Timur, yang dilaksanakan Januari 2006 sampai Maret 2006. Setelah mendapat persetujuan penelitian maka dilakukan pemeriksaan fisis dan pengambilan sampel darah untuk pemeriksaan hemoglobin. Selanjutnya responden mengisi
kuesioner untuk mengetahui pengetahuan mereka tentang tumbuh kembang balita.
Hasil.
Dari 300 responden diperoleh rerata umur 17,2 tahun, suku Jawa 40,2 % dan umumnya tinggal dengan orang tua (75,7%). Responden yang anemia sebanyak 25,36%, gizi kurang 18,5%, gizi baik 74,4%, gizi lebih 4,7%, dan obesitas 2,3%. Sumber informasi yang berhubungan dengan masalah tumbuh kembang balita hanya 13,6% berasal dari sumber formal yaitu orang tua, guru dan tenaga kesehatan. Remaja yang berpengetahuan tinggi didapatkan sebanyak 19%, pengetahuan sedang 33%, dan pengetahuan rendah 48%. Remaja yang tidak siap menjadi calon ibu secara fisik didapatkan pada 42,3%. Kesiapan pengetahuan didapatkan pada 63,7% remaja, sedangkan kesiapan fisik dan pengetahuan yang memadai didapatkan pada 31,3%. Tidak ada hubungan antara kesiapan responden untuk menjadi calon ibu dengan demografi keluarga dan sumber informasi.
Kesimpulan.
Lebih dari separuh remaja (57,7%) telah mempunyai kesiapan fisik untuk menjadi calon ibu. Kesiapan pengetahuan remaja terhadap materi tumbuh kembang balita sebesar 63,7 %. Tingkat kesiapan fisik dan pengetahuan remaja menjadi calon ibu sebesar 31,3%. Tidak ada hubungan antara karakteristik keluarga dan sumber informasi dengan kesiapan remaja perempuan SMU di Jakarta Timur untuk menjadi calon ibu.
Kata kunci: kesiapan fisik, pengetahuan, remaja.
Sari Pediatri, Vol. 8, No. 3, Desember 2006
Latar Belakang.
Dua puluh satu persen penduduk Indonesia adalah remaja. Hanya 11,6% lulusan SMU yang melanjutkan ke perguruan tinggi, yang tidak melanjutkan antara lain memasuki jenjang perkawinan, padahal perkawinan pada usia muda sangat mengundang risiko yang tidak bisa diabaikan. Mereka yang memasuki jenjang perkawinan, umumnya mempunyai kesiapan fisik dan pengetahuan yang belum memadai, sehingga perlu disiapkan. Seorang ibu yang mempunyai pengetahuan yang baik akan menghasilkan tumbuh-kembang balita yang baik pula, khususnya dalam tiga tahun pertama usia anak.
Tujuan Pustaka.
Penelitian ini bertujuan untuk melihat kesiapan fisik, dan pengetahuan remaja perempuan terhadap tumbuh kembang balita.
Metoda.
Penelitian merupakan studi analitik potong lintang pada remaja perempuan siswi SMU di 7 sekolah di Jakarta Timur, yang dilaksanakan Januari 2006 sampai Maret 2006. Setelah mendapat persetujuan penelitian maka dilakukan pemeriksaan fisis dan pengambilan sampel darah untuk pemeriksaan hemoglobin. Selanjutnya responden mengisi
kuesioner untuk mengetahui pengetahuan mereka tentang tumbuh kembang balita.
Hasil.
Dari 300 responden diperoleh rerata umur 17,2 tahun, suku Jawa 40,2 % dan umumnya tinggal dengan orang tua (75,7%). Responden yang anemia sebanyak 25,36%, gizi kurang 18,5%, gizi baik 74,4%, gizi lebih 4,7%, dan obesitas 2,3%. Sumber informasi yang berhubungan dengan masalah tumbuh kembang balita hanya 13,6% berasal dari sumber formal yaitu orang tua, guru dan tenaga kesehatan. Remaja yang berpengetahuan tinggi didapatkan sebanyak 19%, pengetahuan sedang 33%, dan pengetahuan rendah 48%. Remaja yang tidak siap menjadi calon ibu secara fisik didapatkan pada 42,3%. Kesiapan pengetahuan didapatkan pada 63,7% remaja, sedangkan kesiapan fisik dan pengetahuan yang memadai didapatkan pada 31,3%. Tidak ada hubungan antara kesiapan responden untuk menjadi calon ibu dengan demografi keluarga dan sumber informasi.
Kesimpulan.
Lebih dari separuh remaja (57,7%) telah mempunyai kesiapan fisik untuk menjadi calon ibu. Kesiapan pengetahuan remaja terhadap materi tumbuh kembang balita sebesar 63,7 %. Tingkat kesiapan fisik dan pengetahuan remaja menjadi calon ibu sebesar 31,3%. Tidak ada hubungan antara karakteristik keluarga dan sumber informasi dengan kesiapan remaja perempuan SMU di Jakarta Timur untuk menjadi calon ibu.
Kata kunci: kesiapan fisik, pengetahuan, remaja.
Sari Pediatri, Vol. 8, No. 3, Desember 2006
Sabtu, 13 Oktober 2007
Change in CPR May Make It More Effective
Performing only rhythmic abdominal compressions, rather than the standard chest compressions, may increase the flow of blood that is achieved during cardiopulmonary resuscitation (CPR), according to the results of a study conducted with animals.
The biggest finding of the study is that performing CPR using only rhythmic abdominal compressions can provide "blood flow and artificial respiration, "lead author Dr. Leslie Geddes, from Purdue University in West Lafayette, Indiana, told Reuters Health.
CPR using rhythmic abdominal compressions does not require chest compression and it does not require mouth-to-mouth breathing, which "eliminates the riskof rib fractures and transfer of infection," Geddes explained.
Previous research has shown that conventional CPR has success rates of just 5 percent to 10 percent. Plus, for every minute that passes before CPR is started, the chance of success falls by 10 percent." In other words, at 10 minutes, the resuscitation is absolutely ineffective, " Geddes said in a statement.
"Any medical procedure that hadthat low a success rate would be abandoned right away. But the alternative is not very good either -- don't do CPR, and the person is going to die.
"Rhythmic abdominal compression- CPR works by forcing blood from the blood vessels around the abdominal organs, an area known to contain about 25 percent of the body's total blood volume. This blood is then redirected toother sites, including the circulation around the heart.
Geddes' team tested rhythmic abdominal compression- CPR on pigs with experimentally induced ventricular fibrillation, a cardiac disturbance in which the heart muscle beats abnormally, preventing oxygen-enriched blood tobe pumped to the rest of the body.
The researchers found that 60 percent more blood was pumped to the heartusing rhythmic abdominal compression- CPR than with standard chest compression- CPR, using the same amount of effort.Plus, there was no evidence that rhythmic abdominal compressions damaged the abdominal organs and the risk of rib fracture was avoided. [Am J of EmergMed]
The biggest finding of the study is that performing CPR using only rhythmic abdominal compressions can provide "blood flow and artificial respiration, "lead author Dr. Leslie Geddes, from Purdue University in West Lafayette, Indiana, told Reuters Health.
CPR using rhythmic abdominal compressions does not require chest compression and it does not require mouth-to-mouth breathing, which "eliminates the riskof rib fractures and transfer of infection," Geddes explained.
Previous research has shown that conventional CPR has success rates of just 5 percent to 10 percent. Plus, for every minute that passes before CPR is started, the chance of success falls by 10 percent." In other words, at 10 minutes, the resuscitation is absolutely ineffective, " Geddes said in a statement.
"Any medical procedure that hadthat low a success rate would be abandoned right away. But the alternative is not very good either -- don't do CPR, and the person is going to die.
"Rhythmic abdominal compression- CPR works by forcing blood from the blood vessels around the abdominal organs, an area known to contain about 25 percent of the body's total blood volume. This blood is then redirected toother sites, including the circulation around the heart.
Geddes' team tested rhythmic abdominal compression- CPR on pigs with experimentally induced ventricular fibrillation, a cardiac disturbance in which the heart muscle beats abnormally, preventing oxygen-enriched blood tobe pumped to the rest of the body.
The researchers found that 60 percent more blood was pumped to the heartusing rhythmic abdominal compression- CPR than with standard chest compression- CPR, using the same amount of effort.Plus, there was no evidence that rhythmic abdominal compressions damaged the abdominal organs and the risk of rib fracture was avoided. [Am J of EmergMed]
Are Physicians Giving the Right Message About Antibiotic Use?
Background:
Inappropriately prescribing antibiotics is a common occurrence in the management of upper respiratory tract infections (URIs), many of which have a viral etiology.
Previous studies show that 55 percent of the antibiotics prescribed for acute respiratory tract infections are consideredunnecessary.
Declines in antibiotic prescriptions for URIs have occurredrecently; however, this may be because of a decrease in office visits for this type of infection.
In children, acute respiratory illnesses account for approximately 75 percent of all antibiotic prescriptions, but most of these are viral infections.
In addition, parents who bring their children to theo ffice for URIs often expect to receive antibiotics.
Mangione-Smith and colleagues questioned whether physicians were sending the right message about antibiotic treatment to parents, so they evaluated the relationship between physician-parent communication and the inappropriate use of antibiotics in children with URIs.
The Study:
The cross-sectional study included pediatric visits to 38 subspecialists in 27 community practices.
Parents were asked to participate if their child was between six months and 10 years of age, had symptoms of a respiratory tract infection, and had not taken antibiotics within the previous two weeks.
Parents were given a questionnaire to complete before the visit. The office visit was video taped, and the physician completed a survey after the appointment.
This survey questioned whether the physician thought the parent was expecting antibiotic treatment, and the physician-patient communication was analyzed using a qualitative method of conversation analysis.
The main outcomes measured included the physicians'perceptions of parental antibiotic expectations, inappropriate antibiotic prescribing, and whether the parent questioned the physician about not receiving an antibiotic prescription.
Results:
There were 522 parents of children with URIs included in the study. Of the parents who did not receive antibiotic treatment for their children, 63.8 percent reported that they had expected an antibiotic prescription; however, physicians thought that this group expected antibiotics only 22 percent of the time.
If the physicians thought that the parents expected antibiotics, they were significantly more likely (31.7 percent) to inappropriately prescribe them.
If physicians exclusively decided against prescribing antibiotics after discussing the child's care with the parentsor mentioned this option with other treatment recommendations or homeremedies, parents were 24 percent more likely to question treatment.
This was true even when the physician offered other treatment options.
Conclusion:
The authors conclude that parental questioning of the treatment plan for children with URIs increases the physician's inappropriate use of antibiotics.
They note that treatment plans that do not mention antibiotics,but focus on other, more positive treatment options, may help reduce the overprescribing of antibiotics for viral illnesses. [AAFP]
Inappropriately prescribing antibiotics is a common occurrence in the management of upper respiratory tract infections (URIs), many of which have a viral etiology.
Previous studies show that 55 percent of the antibiotics prescribed for acute respiratory tract infections are consideredunnecessary.
Declines in antibiotic prescriptions for URIs have occurredrecently; however, this may be because of a decrease in office visits for this type of infection.
In children, acute respiratory illnesses account for approximately 75 percent of all antibiotic prescriptions, but most of these are viral infections.
In addition, parents who bring their children to theo ffice for URIs often expect to receive antibiotics.
Mangione-Smith and colleagues questioned whether physicians were sending the right message about antibiotic treatment to parents, so they evaluated the relationship between physician-parent communication and the inappropriate use of antibiotics in children with URIs.
The Study:
The cross-sectional study included pediatric visits to 38 subspecialists in 27 community practices.
Parents were asked to participate if their child was between six months and 10 years of age, had symptoms of a respiratory tract infection, and had not taken antibiotics within the previous two weeks.
Parents were given a questionnaire to complete before the visit. The office visit was video taped, and the physician completed a survey after the appointment.
This survey questioned whether the physician thought the parent was expecting antibiotic treatment, and the physician-patient communication was analyzed using a qualitative method of conversation analysis.
The main outcomes measured included the physicians'perceptions of parental antibiotic expectations, inappropriate antibiotic prescribing, and whether the parent questioned the physician about not receiving an antibiotic prescription.
Results:
There were 522 parents of children with URIs included in the study. Of the parents who did not receive antibiotic treatment for their children, 63.8 percent reported that they had expected an antibiotic prescription; however, physicians thought that this group expected antibiotics only 22 percent of the time.
If the physicians thought that the parents expected antibiotics, they were significantly more likely (31.7 percent) to inappropriately prescribe them.
If physicians exclusively decided against prescribing antibiotics after discussing the child's care with the parentsor mentioned this option with other treatment recommendations or homeremedies, parents were 24 percent more likely to question treatment.
This was true even when the physician offered other treatment options.
Conclusion:
The authors conclude that parental questioning of the treatment plan for children with URIs increases the physician's inappropriate use of antibiotics.
They note that treatment plans that do not mention antibiotics,but focus on other, more positive treatment options, may help reduce the overprescribing of antibiotics for viral illnesses. [AAFP]
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