Smoking-Related Attitudes and Knowledge Among Medical Students and Recent Graduates in Argentina: A Cross-Sectional Study

BACKGROUND: Physicians in Argentina smoke at rates similar to the general population, and do not have a clear role in tobacco control strategies. OBJECTIVE: To describe the attitudes and knowledge of medical students and recent graduates towards smoking behavior in Argentina. DESIGN: Cross-sectional self-administered online survey conducted in 2011. PARTICIPANTS: Medical students and recent medical graduates from the University of Buenos Aires. MAIN MEASURES: Attitudes and knowledge were evaluated by responses to 16 statements regarding the effects of smoking cigarettes and the role of physicians in tobacco control. Rates of agreement with a full ban on indoor smoking in different public settings were assessed. KEY RESULTS: The sample included 1659 participants (response rate: 35.1 %), 453 of whom (27.3 %) were current smokers. Only 52 % of participants agreed that doctors should set an example for their patients by not smoking, 30.9 % thought that medical advice had little effect on patients’ cessation behavior, and 19.4 % believed that physicians could decline to care for smoking patients who failed to quit. In adjusted logistic regression models, current smokers had less supportive attitudes about tobacco control and were less likely than non-smokers to agree with a full indoor smoking ban in hospitals (OR: 0.30; 95 % CI 0.16–0.58), universities (OR: 0.55; 95 % CI 0.41–0.73), workplaces (OR: 0.67; 95 % CI 0.50–0.88), restaurants (OR: 0.42; 95 % CI 0.33–0.53), cafes (OR: 0.41; 95 % CI 0.33–0.51), nightclubs (OR: 0.32; 95 % CI 0.25–0.40), and bars (0.35; 95 % CI 0.28–0.45). Recent medical graduates had more accurate knowledge about cessation and were more likely to agree with a full smoking ban in recreational venues. CONCLUSIONS: Although most participants reported a strong anti-tobacco attitude, a proportion still failed to recognize the importance of their role as physicians in tobacco control strategies. Current smokers and current students were less likely to support indoor smoking bans. Specific educational curricula could address these factors.Fil: Salgado, Maria Victoria. Centro de Estudios de Estado y Sociedad; Argentina. Universidad de Buenos Aires. Facultad de Medicina; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Mejia, Raul Mariano. Centro de Estudios de Estado y Sociedad; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Kaplan, Celia. University of California; Estados UnidosFil: Perez Stable, Eliseo. National Institutes of Health; Estados Unido

Identification of Limited English Proficient Patients in Clinical Care

BackgroundStandardized means to identify patients likely to benefit from language assistance are needed.ObjectiveTo evaluate the accuracy of the U.S. Census English proficiency question (Census-LEP) in predicting patients' ability to communicate effectively in English.DesignWe investigated the sensitivity and specificity of the Census-LEP alone or in combination with a question on preferred language for medical care for predicting patient-reported ability to discuss symptoms and understand physician recommendations in English.ParticipantsThree hundred and two patients > 18 who spoke Spanish and/or English recruited from a cardiology clinic and an inpatient general medical-surgical ward in 2004-2005.ResultsOne hundred ninety-eight (66%) participants reported speaking English less than "very well" and 166 (55%) less than "well"; 157 (52%) preferred receiving their medical care in Spanish. Overall, 135 (45%) were able to discuss symptoms and 143 (48%) to understand physician recommendations in English. The Census-LEP with a high-threshold (less than "very well") had the highest sensitivity for predicting effective communication (100% Discuss; 98.7% Understand), but the lowest specificity (72.6% Discuss; 67.1% Understand). The composite measure of Census-LEP and preferred language for medical care provided a significant increase in specificity (91.9% Discuss; 83.9% Understand), with only a marginal decrease in sensitivity (99.4% Discuss; 96.7% Understand).ConclusionsUsing the Census-LEP item with a high-threshold of less than "very well" as a screening question, followed by a language preference for medical care question, is recommended for inclusive and accurate identification of patients likely to benefit from language assistance

Thiazide-induced disturbances in carbohydrate, lipid, and potassium metabolism

Long-term thiazide diuretic therapy for hypertension is associated with disturbances in carbohydrate, lipid, and potassium metabolism that theoretically may have serious adverse effects. It appears that diuretic-induced hypokalemia interferes with production of insulin, producing mild elevations of blood glucose in nondiabetic patients. The insulinopenia worsens glucose metabolism in prediabetic and type II diabetic patients. Increases in low-density lipoprotein cholesterol, triglycerides, and the low-density lipoprotein/high-density lipoprotein cholesterol ratio are frequently seen following thiazide treatment of hypertension. These changes are more pronounced in younger patients. Decrements of serum potassium of 0.6 mEq/L are commonly observed with diuretic therapy. Usually, patients remain asymptomatic and no potassium replacement is necessary. In patients with underlying heart disease, however, alterations in potassium metabolism may produce increased frequency and complexity of ventricular ectopic activity. All these metabolic disturbances appear to be, in part, dose related, and there is currently no evidence that they have clinical significance

Pharmacotherapy of Hypertension

Pharmacological treatment of hypertension continues to be the most effective and perhaps only practical management of hypertension. There is a rising tide of sentiment in this country for managing hypertension and other chronic diseases with diet, exercise, and a variety of behavioral modification techniques, including relaxation response, biofeedback, and transcendental meditation to the exclusion of drugs. There is no convincing evidence from well-controlled studies that any of these various techniques have a permanent or prolonged antihypertensive effect (1)

Workup of the Newly Discovered Hypertensive Patient

Newly discovered hypertensives should be evaluated to determine type of hypertension, to identify coexisting conditions that may alter therapy, and to search for correctable underlying causes. Workup should be minimal, rapid, and inexpensive. Intravenous pyelography should not be done routinely

Tobacco epidemic in Argentina: The cutting edge

Argentina has an annual production of 150,000 tons of tobacco and 70% of this is exported. Since 1972, the state subsidy of the national tobacco industry is through a special fund supported by a 7% tax on each pack of cigarettes. Phillip Morris and British American Tobacco control over 90% of the tobacco market in Argentina through subsidiaries. Overall, 37% of adults over the age 16 years currently smoke cigarettes and second hand smoke exposure affects 70% of homes. Tobacco use accounts for 15% of all deaths in persons under age 65 years and this represents an economic cost equivalent to 0.17% of the gross national product. Health care for diseases caused by tobacco use accounts for some 16% of the total health care expenditures in the country. The transnational tobacco industry views Argentina as an expansion market and has developed an intense advertising campaign including targeting all persons 16 years of age and older. Psychographic profiles similar to those used in the US market have been developed in Argentina to target adolescents and young adults. There is no comprehensive tobacco control law in Argentina. Even though the President has signed the WHO Framework Convention on Tobacco Control, ratification is being delayed by the active lobbying of regional legislators from the tobacco growing provinces who in turn are influenced by industry positions