Annals of family medicine
-
The obesity epidemic in children is spreading at alarming rates. Because musculoskeletal problems can influence physical activity, we compared the frequency of musculoskeletal problems in overweight and obese children with that in normal-weight children. ⋯ This study shows that overweight and obese children more frequently experience musculoskeletal problems than do normal-weight children.
-
Annals of family medicine · Jul 2009
Promise of professionalism: personal mission statements among a national cohort of medical students.
While historic medical oaths and numerous contemporary medical organizations offer guidelines for professionalism, the nature of the professional aspirations, commitments, and values of current medical students is not well known. We sought to provide a thematic catalogue of individual mission statements written by medical students nationally. ⋯ In their personal mission statements, this national cohort of medical students described an expanded view of physicianhood that includes such elements as presence, love, and awe. Medical school curricula may require adaptation to support the personal aspirations of those now entering the profession.
-
Annals of family medicine · May 2009
The contribution of health literacy to disparities in self-rated health status and preventive health behaviors in older adults.
Health literacy is associated with a range of poor health-related outcomes. Evidence that health literacy contributes to disparities in health is minimal and based on brief screening instruments that have limited ability to assess health literacy. The purpose of this study was to assess whether health literacy contributes, through mediation, to racial/ethnic and education-related disparities in self-rated health status and preventive health behaviors among older adults. ⋯ Health literacy contributes to disparities associated with race/ethnicity and educational attainment in self-rated health and some preventive health behaviors among older adults. Interventions addressing low health literacy may reduce these disparities.
-
Annals of family medicine · May 2009
Reconceptualizing the experience of surrogate decision making: reports vs genuine decisions.
We propose a reconceptualization of surrogate decision making when patients lack an advance directive stating their preferences about life-sustaining treatment. This reconceptualization replaces the current 2-standard model of substituted judgment (based on the patient's prior preferences and values) and best interests (an assessment of how best to protect and promote the patient's health-related and other interests). ⋯ Physicians should identify clinically reasonable options and elicit the surrogate's sense of decision-making burden. Some surrogates will be able to make reports, and the physician should make a clear recommendation that implements the patient's reported preference. Some surrogates will confront genuine decisions, which should be managed by negotiating treatment goals. Requests by the surrogate that everything be done may represent a psychosocially burdensome decision, and support should be provided to help the surrogate work through the decision-making process.