Candida Transmission and Sexual Behaviors as Risks for a Repeat Episode of Candida Vulvovaginitis

Objective: To assess associations between female and male factors and the risk of recurring Candida vulvovaginitis. Methods: A prospective cohort study of 148 women with Candida vulvovaginitis and 78 of their male sexual partners was conducted at two primary care practices in the Ann Arbor, Michigan, area. Results: Thirty-three of 148 women developed at least one further episode of Candida albicans vulvovaginitis within 1 year of follow-up. Cultures of Candida species from various sites of the woman (tongue, feces, vulva, and vagina) and from her partner (tongue, feces, urine, and semen) did not predict recurrences. Female factors associated with recurrence included recent masturbating with saliva (hazard ratio 2.66 [95% CI 1.17-6.06]) or cunnilingus (hazard ratio 2.94 [95% CI 1.12-7.68]) and ingestion of two or more servings of bread per day (p ≤ 0.05). Male factors associated with recurrences in the woman included history of the male masturbating with saliva in the previous month (hazard ratio 3.68 [95% CI 1.24-10.87]) and lower age at first intercourse (hazard ratio 0.83 [95% CI 0.71-0.96]). Conclusions: Sexual behaviors, rather than the presence of Candida species at various body locations of the male partner, are associated with recurrences of C. albicans vulvovaginitis.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/63382/1/154099903322643901.pd

Japanese and United States Family Medicine Resident Physicians’ Attitudes about Training

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/136490/1/jgf20009.pd

Monte Carlo simulation of uncoupled continuous-time random walks yielding a stochastic solution of the space-time fractional diffusion equation

We present a numerical method for the Monte Carlo simulation of uncoupled continuous-time random walks with a Levy alpha-stable distribution of jumps in space and a Mittag-Leffler distribution of waiting times, and apply it to the stochastic solution of the Cauchy problem for a partial differential equation with fractional derivatives both in space and in time. The one-parameter Mittag-Leffler function is the natural survival probability leading to time-fractional diffusion equations. Transformation methods for Mittag-Leffler random variables were found later than the well-known transformation method by Chambers, Mallows, and Stuck for Levy alpha-stable random variables and so far have not received as much attention; nor have they been used together with the latter in spite of their mathematical relationship due to the geometric stability of the Mittag-Leffler distribution. Combining the two methods, we obtain an accurate approximation of space- and time-fractional diffusion processes almost as easy and fast to compute as for standard diffusion processes.Comment: 7 pages, 5 figures, 1 table. Presented at the Conference on Computing in Economics and Finance in Montreal, 14-16 June 2007; at the conference "Modelling anomalous diffusion and relaxation" in Jerusalem, 23-28 March 2008; et

An Integrative Medicine Patient Care Model and Evaluation of Its Outcomes: The University of Michigan Experience

Abstract Background: The demand for integrative medicine care is increasing rapidly among patient consumers, yet the integrative medicine model is not the norm in clinical practice, nor is this approach a focus in traditional medical schools. Furthermore, patient well-being and satisfaction outcomes within an integrative care model are not common in the literature. Objectives: The purpose of this paper is to offer a summary of a model of integrative medicine patient care and its evaluation and outcomes from the University of Michigan Integrative Medicine Clinic. Methods: Using three tools to evaluate patient outcomes and satisfaction, statistically significant outcomes were noted. The SF-12 showed positive change in the physical component score, the Holistic Health Questionnaire showed improvements in all of the subscales of body, mind, and spirit, and a unique Integrative Medicine Patient Satisfaction Tool suggested high satisfaction with an integrative approach to care. Conclusions: Findings, limitations, and implications are discussed.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/63379/1/acm.2008.0154.pd

The Effects of Insurance Coverage on the Quality of Prenatal Care

Objective: To compare the quality of prenatal care provided to patients with traditional fee-for-service, health maintenance organization, and Medicaid insurance using an evidence-based, community-derived prenatal care guideline. Design: Retrospective cohort study. Setting: Seven private and hospital-based prenatal care sites in a suburban county in southeast Michigan. Patients: A stratified random sample of 267 patients (93 with Medicaid, 92 with health maintenance organization, and 82 with fee-for-service insurance) receiving prenatal care from community physicians (obstetriciansgynecologists and family practitioners) between January 1, 1991, and December 31, 1992. Main Outcome Measure: Adherence to explicit prenatal care criteria as measured by an evidence-based prenatal care guideline developed by a community panel. Quality scores were compared across groups in 4 areas: performance of prenatal screening procedures or tests, visit-based screening, substance use screening, and clinician management of abnormal clinical findings. Results: Patients with Medicaid insurance presented for prenatal care significantly later in pregnancy (14.5 vs 10.5 weeks, P\u3c.01). No significant differences were seen between groups in quality scores for screening tests, clinician management of abnormal clinical findings, visit-based screening, or substance use screening. The overall similarity in quality scores did obscure some significant differences in adherence to individual criteria, particularly in the area of screening tests. Significantly more patients with Medicaid were screened for genital infection (P\u3c.001) and fewer for gestational diabetes (P\u3c.001) or anemia (P\u3c.001) than patients in the other 2 groups. Conclusions: Although patients with Medicaid presented for prenatal care later in pregnancy and received a different package of screening tests than the other 2 groups, there was no overall measurable difference in the quality of prenatal care provided to patients with Medicaid, health maintenance organization, and fee-for-service insurance. Clinicians may have altered screening protocols based on preexisting perceptions of patient risk. Although summary quality measures are a promising tool for comparative research, they provide an incomplete picture of the quality of the prenatal care process and must be interpreted with caution

The Effects of Insurance Coverage on the Quality of Prenatal Care

Objective: To compare the quality of prenatal care provided to patients with traditional fee-for-service, health maintenance organization, and Medicaid insurance using an evidence-based, community-derived prenatal care guideline. Design: Retrospective cohort study. Setting: Seven private and hospital-based prenatal care sites in a suburban county in southeast Michigan. Patients: A stratified random sample of 267 patients (93 with Medicaid, 92 with health maintenance organization, and 82 with fee-for-service insurance) receiving prenatal care from community physicians (obstetriciansgynecologists and family practitioners) between January 1, 1991, and December 31, 1992. Main Outcome Measure: Adherence to explicit prenatal care criteria as measured by an evidence-based prenatal care guideline developed by a community panel. Quality scores were compared across groups in 4 areas: performance of prenatal screening procedures or tests, visit-based screening, substance use screening, and clinician management of abnormal clinical findings. Results: Patients with Medicaid insurance presented for prenatal care significantly later in pregnancy (14.5 vs 10.5 weeks, P\u3c.01). No significant differences were seen between groups in quality scores for screening tests, clinician management of abnormal clinical findings, visit-based screening, or substance use screening. The overall similarity in quality scores did obscure some significant differences in adherence to individual criteria, particularly in the area of screening tests. Significantly more patients with Medicaid were screened for genital infection (P\u3c.001) and fewer for gestational diabetes (P\u3c.001) or anemia (P\u3c.001) than patients in the other 2 groups. Conclusions: Although patients with Medicaid presented for prenatal care later in pregnancy and received a different package of screening tests than the other 2 groups, there was no overall measurable difference in the quality of prenatal care provided to patients with Medicaid, health maintenance organization, and fee-for-service insurance. Clinicians may have altered screening protocols based on preexisting perceptions of patient risk. Although summary quality measures are a promising tool for comparative research, they provide an incomplete picture of the quality of the prenatal care process and must be interpreted with caution

Sexual Behaviors and Other Risk Factors for Candida Vulvovaginitis

Sexual behaviors are associated with many genital infections, but the role of sexual variables as risk factors for Candida vulvovaginitis has not been clearly determined. To assess the association between sexual behaviors and other risk factors with the presence of Candida vulvovaginitis, we performed a case-control study comparing these potential risk factors in women with and without culture-documented Candida vulvovaginitis in two Midwestern community-based medical offices. Participants included 156 women with Candida vulvovaginitis and 92 controls, ages 18-60. Risk factors for Candida vulvovaginitis, including sexual and partnership behaviors, demographic data, past genital infections, exposures, and diet, were investigated using logistic regression. The presence of Candida vulvovaginitis was positively associated with recent cunnilingus (odds ratio [OR] = 2.22 for five times a month compared with no times, 95% confidence interval [CI] 1.36, 3.84), but was less likely in women who masturbated with saliva in the previous month (OR = 0.30 if masturbated five times vs. no times, 95% CI 0.09, 0.99). Other independent risk factors included knowing the sexual partner a shorter period of time (OR = 1.56 for 1 year vs. 5 years, 95% CI 1.16, 2.13) and lower milk ingestion (OR = 3.57 for no servings vs. two servings per day, 95% CI 2.00, 6.67). Increased number of sexual partners, early age at first intercourse, and increased frequency of intercourse are not related to risk.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/63309/1/15246090050118170.pd

A comparison of the diabetes-related attitudes of health care professionals and patients

The following study compares the diabetesrelated attitudes of sampled health care professionals and patients with diabetes. Attitudes were measured with a revised version of the Diabetes Attitude Scale (DAS) which includes seven factors representing attitudes towards: (1) the need for special training in order to provide diabetes care; (2) patient compliance; (3) the seriousness of noninsulin-dependent diabetes (NIDDM); (4) the relationship between blood glucose levels and the complications of diabetes; (5) the impact of diabetes on the patient's life; (6) patient autonomy; and (7) team care. The highest levels of agreement among patients and professionals concerned the seriousness of NIDDM and the relationship between blood glucose control and the development of the complications of diabetes. The most striking finding of the study was that patients tended to express a significantly more judgmental, moralistic attitude toward patient behavior than did health care professionals.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/30752/1/0000402.pd

Cancer disclosure in Japan: Historical comparisons, current practices

Although Japanese physicians historically have not disclosed cancer diagnoses to patients, pressures upon physicians to disclose have increased in recent years. We questioned physicians practicing at a private medical hospital in rural Japan about their current approach to cancer disclosure. We compared their responses with responses of physicians in a 1991 study conducted in Japan, and two studies conducted in the United States, in 1961 and in 1977. Seventy-seven clinically active physicians with experience treating cancer patients responded (73% response rate). Forty percent of respondents reported usually telling patients of a cancer diagnosis, over three times more than the 13% who reported such a policy in Japan in 1991. Physicians were significantly more likely (PJapan cancer disclosure informed consent