March/April 2004 Annals of Family Medicine tip sheet


Patients Predisposed to Iron Overload Face an Increased Risk of Death from All Causes
Consumption of Red Meat and Dietary Iron Linked to Increased Mortality Risk for These Patients
Analyzing population-based data from U.S. National Health and Nutrition Examination Surveys, Mainous and colleagues found that elevated levels of serum transferrin saturation, an indicator of a predisposition for iron overload, were associated with a significantly higher risk of death from all causes. The authors point out that a substantial proportion of adults in the United States approximately 2 percent of the adult U.S. population has transferrin saturation levels greater than 55 percent, and are at increased risk for all-cause mortality.

Research findings from an accompanying study indicate that high-protein diets, such as the increasingly popular Atkins diet, may not be the best choice for everybody. Mainous and colleagues found that among people with elevated levels of serum transferrin saturation, eating large amounts of red meat and other iron-containing foods was associated with increased death rates. Specifically, they found that people with elevated transferrin saturation who reported high dietary iron intake had a mortality risk 2.9 times greater than those who had normal transferrin saturation levels and reported low dietary iron intake. People who had a high transferrin saturation and reported consuming red meat seven or more times per week had a mortalilty risk 2.26 times greater than those who had normal transferrin saturation and reported low red meat consumption. The authors suggest that simple dietary restrictions may help to reduce the mortality risk associated with high transferrin saturation.

Elevated Serum Transferrin Saturation and Mortality
By Arch G. Mainous III, Ph.D., et al

The Mortality Risk of Elevated Serum Transferrin Saturation and Consumption of Dietary Iron
By Arch G. Mainous III, Ph.D., et al

Parental Attitudes About the Pregnancy Predict Birth Weight
Through a prospective cohort study of 162 live births in a low-income population, Keeley and colleagues found that maternal happiness about a pregnancy and her report of the father's happiness were strong predictors of birth weight and the risk of low birth weight. Specifically, the researchers found that birth weight was lower when the mother reported the father was happier than she was about the pregnancy. They also found that women who reported they were ambivalent or unhappy about the pregnancy were more likely to give birth to low weight babies. Low birth weight is the primary cause of neonatal morbidity and mortality in the United States, and has risen steadily during the last 17 years from 6.5 percent to 7.8 percent in 2002. Healthy People 2010 aims to decrease the prevalence of low birth weight to 5 percent by 2010. The authors call for further studies to assess whether maternal report of greater partner happiness is a modifiable factor or a marker for other factors that might be modified with targeted interventions.

Parental Attitudes About a Pregnancy Predict Birth Weight in a Low-Income Population
By Robert D. Keeley, M.D., M.S.P.H., et al

Medical Errors Happening in Family Physician Offices
In a survey of fifteen practicing family physicians without electronic medical record systems, Elder and colleagues found that family physicians identified medical errors and preventable adverse events in almost one quarter (23.6 percent) of their patient encounters. The researchers note the most frequently identified errors were office administration errors. The surveyed physicians further estimated that 23.7 percent of the errors and events led to minor patient harm. The most common descriptions of harm offered by the physicians were increased emotional distress and wasted time for the patient. Other examples included physical discomfort, mild adverse drug reactions, moderate physical injury from a procedure, and progression of a disease. The authors point out that there was great variation in the rate and types of errors identified by physicians in their practices, which is an indication of the challenge in studying error incidence and severity. The authors conclude that clarifying definitions for harm, refining a typology of errors and estimating incidence are important tasks for future medical errors research in primary care.

The Identification of Medical Errors by Family Physicians During Outpatient Visits
By Nancy C. Elder, M.D., M.S.P.H., et al

Two-year Study Produces Recommendations to Transform and Renew Family Medicine
Recognizing fundamental flaws in the fragmented U.S. health care system and the potential offered by an integrative, generalist approach, the leadership of seven national family medicine organizations are releasing a blueprint for improved, patient focused care. The Future of Family Medicine Project report, published as a supplement to the March/April issue, calls for systemic changes to the U.S. health care system, medical education and clinical practice, and the development of a New Model of patient-centered care based on the concept of a "personal medical home" for all Americans. Informed by qualitative and quantitative research, the report offers an objective understanding of what patients want and need from their personal physicians and from America's health care system, and it identifies challenges and opportunities for the specialty of family medicine.

The Future of Family Medicine: A Collaborative Project of the Family Medicine Community
By the Future of Family Medicine Project Leadership Committee


Screening for Family and Intimate Partner Violence: Recommendation Statement
By the U.S. Preventive Services Task Force
The U.S. Preventive Services Task Force found the published evidence insufficient to show that routine screening for family violence leads to decreased disability or premature death. As a result, the Task Force could not determine the balance between the benefits and harms of screening for family violence and does not recommend for or against routine screening of parents or guardians for the physical abuse or neglect of children.

Screening Children for Family Violence: A Review of the Evidence for the U.S. Preventive Services Task Force
By Heidi D. Nelson, M.D., M.P.H., et al
Evidence to support the U.S. Preventive Services Task Force recommendation is provided by Nelson and colleagues in their systematic review on screening children for family violence. The authors note that despite the prevalence of child abuse and neglect and its impact on health, there are few studies providing data on its detection and management to guide physicians.

Does Enhancing Partner Support and Interaction Improve Smoking Cessation?
A Meta-Analysis
By Eal-Whan Park, Ph.D., et al
Despite the intuitive appeal of including partners in programs to help patients quit smoking, there is no evidence of effect, even using several definitions of partner. The authors suggest that interventions to enhance partner support for smoking cessation programs might be most effective when implemented with live-in, married and equivalent-to-married partners.

Powerlessness, Control, and Complexity: The Experience of Family Physicians in a Group Model HMO By Linda Gask, M.B., Ch.B., Ph.D., F.R.C.Psych.
Family physicians working in a group model health maintenance organization expressed three main themes of concern about their practice environment powerlessness, control and complexity. To improve family physicians' experience, the authors call for health care organizations to restore to family physicians a sense of professional autonomy and control over their immediate work environment and to assign greater value to the skills in managing clinical and organizational complexity that are unique to family medicine.

Family Physician Self-Efficacy with Screening for Inherited Cancer Risk
By Robert Gramling, M.D., et al
Although most family physicians believe family history screening for cancer is important, less than two thirds believe they are effective at screening.

The Natural History of Asthma By Vince WinklerPrins, M.D., et al
Analyzing a cohort of children from four family practices in the Netherlands, early diagnosis of asthma and abnormal bronchial hyperresponsiveness were found to be poor predictors of subsequent respiratory tract disease. Symptom questionnaires were more successful than bronchial hyperresponsiveness at predicting asthma in young people and may be useful in practice.

A Community-Oriented Primary Care Demonstration Project: Refining Interventions for Cardiovascular Disease and Diabetes By Marcus Plescia, M.D., M.P.H., et al
Plescia and colleagues describe a community-oriented primary care project in which they engaged community members in designing community- and clinic-based interventions for physical activity and healthy diet to reduce cardiovascular disease and diabetes.

Management of Patients with Hepatitis C in a Community Population: Diagnosis, Discussions and Decisions to Treat By Liliana Gazzoula Rocca, M.D.
Studying the patterns of care for hepatitis C patients, Rocca and colleagues identified opportunities for increasing the proportion of infected individuals who are provided options for treatment, particularly among those in emergency departments and chemical dependency programs.

Getting the News By Roger A. Rosenblatt
In a personal essay, Rosenblatt, a family physician at the University of Washington School of Medicine, shares his personal experience with cancer and of cancer care in an academic medical center discussing how the lessons learned from the journey have reverberated through his personal and professional life.

Source: Eurekalert & others

Last reviewed: By John M. Grohol, Psy.D. on 21 Feb 2009
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