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This paper considers medical care given by physicians to men and women in the United States. It asks how often significant sex differences in care occur, and if these differences are attributable to medically relevant factors or not. Sex differences in diagnostic services, therapeutic services, and dispositions for follow-up are studied for All Visits, 15 major groups of complaints, and 5 specific complaints (fatigue, headache, vertigo/dizziness, chest pain, and back pain). Data are from the 1975 National Ambulatory Medical Care Survey (NAMCS). The analysis reveals that medical care is often similar for men and women, but a sizable numbers of significant sex differences occur (about 30 to 40 per cent of the services and dispositions studied), and they tend to show more medical care for women. Most of the differences persist even after controlling for medically relevant factors (patient age, seriousness of problem, diagnosis, prior visit status, and reasons for visit). Notably, women still receive more total prescriptions, and return appointments for many complaint groups. They receive more services for back pain and headaches and more follow-up plans for vertigo/dizziness and back pain. Remaining sex differences may be due to missing medical factors, patient requests for care, patient distress and needs for nurturance, and physician sex bias. In contrast to a recent San Diego study, national data show few significant sex differences in the extent and content of diagnostic services given for five common complaints.
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PMID:Physician treatment of men and women patients: sex bias or appropriate care? 726 12

This paper reports on the prevalence of some common psychosomatic symptoms as a part of a larger study of health state and health risk behaviour of a medical student population in Szeged. The prevalence of psychosomatic symptoms was considered as a health-related variable. In the study 691 students participated, the investigation was carried out by survey method, using self-completed questionnaire. In both sexes, backache and sleeping disorders were the most frequent symptoms. Furthermore, men reported stomach ache and palpitation in higher occurrence, while in women stress-related headache and chronic fatigue were the most common among the self-reported symptoms. The index of symptoms were significantly higher among women than men (p < 0.0001). Prevalence of psychosomatic symptoms proved an important variable affecting self-perceived health. The literature reviewed by the authors suggests that health state of medical students are significantly better than students of other colleges. Unfortunately, the morbidity and mortality data of physicians show inverse results among other intellectual populations. The authors suggestion is applying standardised method and cooperation among epidemiological teams working on this question.
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PMID:[Epidemiology of psychosomatic symptoms and its effect on the self-evaluation of general health in university students]. 763 88

Human intervertebral discs undergo age-related degenerative changes that contribute to some of the most common causes of impairment and disability for middle aged and older persons: spine stiffness, neck pain, and back pain. Potential causes of the age-related degeneration of intervertebral discs include declining nutrition, loss of viable cells, cell senescence, post-translational modification of matrix proteins, accumulation of degraded matrix molecules, and fatigue failure of the matrix. The most important of these mechanisms appears to be decreasing nutrition of the central disc that allows accumulation of cell waste products and degraded matrix molecules, impairs cell nutrition, and causes a fall in pH levels that further compromises cell function and may cause cell death. Although aging changes of the disc appear to be inevitable, identification of activities and agents that accelerate these changes may help decrease the rate and severity of disc degeneration; and recent work suggests that methods can be developed that will regenerate disc tissue.
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PMID:Aging and degeneration of the human intervertebral disc. 766 Feb 43

A prospective study of patients with neurogenic claudication and lumbar spinal stenosis was undertaken to determine whether measurement of exercise tolerance on the treadmill would be useful in defining baseline functional status and response to surgical treatment. Twenty patients with an average age of 73 years, all of whom had intractable neurogenic claudication and radiographically confirmed severe lumbar spinal stenosis, were studied. Lumbar decompressive laminectomy was performed in all patients. Preoperatively and 2 months postoperatively, quantitative assessment of ambulation was conducted on a treadmill at 0 degree ramp incline at two different speeds: 1.2 mph and the patient's preferred walking speed. The following information was recorded: time to first symptoms, time to severe symptoms, and nature of symptoms (leg pain, back pain, or generalized fatigue). The examination was stopped after 15 minutes or at the onset of severe symptoms. In the preoperative 1.2-mph trial, the mean time to first symptoms was 2.68 minutes (median 1.31) and the mean time to severe symptoms was 5.47 minutes (median 3.42). In the postoperative trial at the same speed, 13 patients (65%) were able to walk symptom free for 15 minutes. The mean time to first symptoms was 11.12 minutes (median 15) and the mean time to severe symptoms was 11.81 minutes (median 15). Similar findings were recorded in the preferred walking-speed trials. There were no complications from the treadmill testing procedure. These findings indicate that exercise stress testing on a treadmill is a safe, easily administered, and quantifiable means of assessing baseline functional status and outcome following laminectomy in patients with symptomatic lumbar spinal stenosis.
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PMID:Measurement of exercise tolerance on the treadmill in patients with symptomatic lumbar spinal stenosis: a useful indicator of functional status and surgical outcome. 778 45

The clinical efficacy of tolfenamic acid and mefenamic acid in the treatment of primary dysmenorrhoea was studied in a prospective, controlled, double-blind, cross-over study comprising 73 patients aged 13-39 with an average body weight of 56 kilos. The patients were randomized to receive either tolfenamic acid (200 mg t.i.d.) or mefenamic acid (500 mg t.i.d.) for 3 days, during 3 consecutive menstrual cycles each, in a sequential design A-B or B-A. At the beginning and at the end of each treatment period, 13 dysmenorrhoeic symptoms were evaluated on a visual analogue scale (lower back pain, interference with daily activities, nausea, vomiting, diarrhoea, headache, dizziness, fatigue, sweating, chills, hot flashes, depressant states, and mood swings). The data were analyzed by using two statistical models. The first one, for the 73 patients, by making paired comparisons regardless of treatment sequence. With respect to the initial values, the results showed that both drugs were statistically significant (P < 0.05) in reducing the intensity of the evaluated symptoms. When comparing both treatments, tolfenamic acid showed a significant difference as to interference with daily activities (P < 0.025) and hot flashes (P < 0.005). In the result analysis with the second model, the groups were divided according to the first assigned treatment and paired comparisons were made. It was observed that the group receiving tolfenamic acid in the last sequence reached a higher level of response and statistical significance was demonstrated in 8 of 13 evaluated symptoms.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Tolfenamic acid and mefenamic acid in the treatment of primary dysmenorrhoea. 781 93

We examined the efficacy of percutaneous cervical cordotomy (PCC) and subarachnoid phenol block using fluoroscopy (SAPB-F) for control of chest and/or back pain from costopleural syndrome. The efficacy of each block was evaluated by changes in pain score (PS), analgesic dose and performance status 1 week after the block, as well as by the complications. Between 1980 and 1986, PCC was performed in 10 patients. SAPB-F was performed in 13 patients between 1987 and 1991. Pain was not well controlled by analgesics in any of these patients. For PCC the follow-up period was 94.7 +/- 71.1 days. PS (VAS, 0-10) reduced from 8.5 +/- 0.9 to 3.0 +/- 2.7. No analgesics were needed in 4 patients. Pain recurred in 1 patient. Hemiparesis occurred in 2 patients. General fatigue occurred in 6 patients. In 4 patients with these complications performance status deteriorated and did not recover during the follow-up period. For SAPB-F the follow-up period was 71.8 +/- 44.0 days. SAPB-F was designed to achieve selective phenol deposit at the targeted nerve root. PS decreased from 7.5 +/- 1.9 to 2.7 +/- 2.6. No analgesics were needed in 5 patients. Pain recurred in 3 patients. There were no complications and no changes in performance status. From this study we concluded that PCC is an effective method of pain control for costopleural syndrome, but a risk of serious complications is involved. SAPB-F is an effective and safe method and should be the first choice of nociceptive pathway block.
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PMID:Percutaneous cervical cordotomy and subarachnoid phenol block using fluoroscopy in pain control of costopleural syndrome. 747 94

Andersen Air Force Base in Guam boasts the tallest control tower in the Air Force. In 1986, an air traffic controller was struck by lightning as the bolt proceeded through the tower. Although he received only a backache, the lightning left a hole with surrounding scorch marks on his fatigue shirt and his undershirt. The lightning strike also ignited a portion of the field lighting panel, which caused the runway lights to go out immediately. Lack of a lightning rod is the most likely reason the controller was struck. Proper precautions against lightning strikes can prevent such occupational safety hazards.
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PMID:Air traffic controller lightning strike. 796 36

The study was conducted in order to describe the extent and content of advice on common ailments in pregnancy given by doctor or midwife during prenatal visits and to describe the frequency of ailments in the period before the visits. The design was a nationwide cross-sectional study based on questionnaires completed by pregnant women who had seen a general practitioner (GP), midwife or hospital doctor for prenatal care. Ailments and advice in connection with one specific visit were reported. The questionnaires were completed by 517 women after a prenatal visit to their GP (92% of eligible), by 514 women after a prenatal visit to the midwife (91% of eligible), and by 203 women after a prenatal visit to a doctor in the maternity department in pregnancy week 16-18 (84% of eligible). The results showed that nausea, pollakisuria, tiredness and heartburn had been present during the period before the visit in about half the women. Between a third and a fourth of the women had been discomforted by back pain, discharge or cramps. From 15 to 58 percent had been given advice, depending on the symptom. The advice was of many different kinds. To a large extent the women wanted to talk to the health professionals about the ailments, and most often they wanted to talk to a midwife about the ailments. We conclude that common ailments of pregnancy are frequent and they should be investigated more. Nearly all pregnant women want to talk about the subject during prenatal visits. The objectives of giving advice should be clearer, and clinical studies of the effectiveness of the advice are needed.
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PMID:[Preventive check-ups of pregnant women in Denmark. Common ailments in pregnancy]. 800 27

While the number of mothers resuming employment soon after the birth of a child is growing, knowledge about the effect that having both a baby and a job has on mental and physical health is still scarce. In this paper, we studied the health of 141 Italian first-time mothers, who were all employed during pregnancy. When their child was 15 months old, 84% were back at work; 24-36% suffered from lack of sleep, extreme tiredness and backache; more than half had experienced some feelings of depression since the birth. Considering the whole sample, poorly educated and unmarried mothers reported more physical health problems. Being employed per se showed no influence, but poorly educated mothers and those with a less qualified job reported more problems. On the basis of our results, we suggest that future research on new mothers, work and health should systematically include "domestic" variables and the characteristics of the paid job; and should analyze more thoroughly the influence of marriage status and educational level on health.
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PMID:Mothers' health after the birth of the first child: the case of employed women in an Italian city. 807 81

The present study is part of a major questionnaire survey of work environment and health of air crew in the Scandinavian Airline System (SAS) Norway in 1989. The 1240 respondents (response rate 83%) answered 250 questions about health, job-strain, well-being, sleep problems, organization, and communication. The study charts self-reported incidences of health problems focusing on differences between cockpit and cabin crews. The study also evaluates possible effects of transmeridian and short distance flying on health, taking into account gender, job demands, working conditions of the respondents, and aircraft design. Common problems, reported by more than 30%, are dry skin, lower back pain, colds, fatigue, and sleep disturbances. Pilots report least, while female cabin attendants register most problems. Crews flying long distance transmeridian routes report more health problems than short distance personnel. Among pilots, irritability, fatigue, sleep disturbances, and low back pain are the most frequently reported problems. Cabin attendants more often complain of skin and eye disorders, digestive disturbances, and musculoskeletal pains. The study supports earlier findings that transmeridian air travel causes digestive disturbances, fatigue, and sleep disturbances in both cockpit and cabin crews of both genders. Among female cabin attendants, there is a nonsignificant tendency of more menstrual disorders among those flying long hauls.
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PMID:Health, sleep, and mood perceptions reported by airline crews flying short and long hauls. 811 22


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