Health care trends, Part 2. The new health care team. Panel discussion

In Part 2 of this third annual panel discussion, six experts talk about the growing diversity of health care providers and what it means for consumers and physicians. Americans are getting their wellness and health care services from a wider variety of non-physician practitioners than ever before. The number of allied health and alternative providers with direct patient access is likely to continue growing. This trend is being driven by consumer demand, by the lobbying efforts of non-physician providers, and by federal, state, and private payers who see the potential for reduced health care spending, greater consumer satisfaction, and better outcomes. In practice, this means physicians and non-physician providers, some of whom may not be sanctioned by the medical establishment, are obligated to collaborate as a team. Members of this new provider team will have to communicate effectively (with each other, with consumers, and with payers) and make evidence-based clinical decisions. Physicians may have to share decision-making with other members of this new health care team.     

Comparison of Six Dose-Response Models for Use with Food-Borne Pathogens

Food-related illness in the United States is estimated to affect over six million people per year and cost the economy several billion dollars. These illnesses and costs could be reduced if minimum infectious doses were established and used as the basis of regulations and monitoring. However, standard methodologies for dose-response assessment are not yet formulated for microbial risk assessment. The objective of this study was to compare dose-response models for food-borne pathogens and determine which models were most appropriate for a range of pathogens. The statistical models proposed in the literature and chosen for comparison purposes were log-normal, log-logistic, exponential, -Poisson and Weibull-Gamma. These were fit to four data sets also taken from published literature, Shigella flexneri, Shigella dysenteriae,Campylobacter jejuni, and Salmonella typhosa, using the method of maximum likelihood. The Weibull-gamma, the only model with three parameters, was also the only model capable of fitting all the data sets examined using the maximum likelihood estimation for comparisons. Infectious doses were also calculated using each model. Within any given data set, the infectious dose estimated to affect one percent of the population ranged from one order of magnitude to as much as nine orders of magnitude, illustrating the differences in extrapolation of the dose response models. More data are needed to compare models and examine extrapolation from high to low doses for food-borne pathogens.     

To be or not to be: the effects of aging stereotypes on the will to live

This study examined whether stereotypes of aging might contribute to decisions the elderly make about when to die. Old and young participants (N=64) were subliminally primed with either negative or positive stereotypes of old age and then responded to hypothetical medical situations involving potentially fatal illnesses. Consistent with our prediction, the aged participants primed with negative stereotypes tended to refuse life-prolonging interventions, whereas the old participants primed with positive age stereotypes tended to accept the interventions. This priming effect did not emerge among the young participants for whom the stereotypes were less relevant. The results suggest that societally-transmitted negative stereotypes of aging can weaken elderly people's will to live.     

Reconciling Islam and feminism

This paper objects to the popular view that Islam supports a segregated social system where women are marginalized, and argues that certain Islamic texts are supportive of women's rights. The article proposes that Islam reconcile with feminism by returning to the Qur'an. The Qur'an provides rights which address the common complaints of women such as lack of freedom to make decisions for themselves and the inability to earn an income. One example is a verse in the Qur'an (4:34) that is frequently interpreted as giving women complete control over their own income and property. This article also explains how Islam has been used as a method of controlling women, particularly in the practices of veiling and purdah (seclusion). The article points out the need to engage in Islam from a position of knowing, and to ensure that Muslim women have access to this knowledge. It is only through this knowledge that women can assert their rights and challenge patriarchal interpretations of Islam.     

Criminal history and assault of dating partners: the role of type of prior crime, age of onset, and gender

Some studies of assaults on intimate partners have found that most of the perpetrators are not violent outside the family, which suggests a specialized type of crime. However, other studies found domestic violence offenders tend to have extensive criminal histories. To further investigate the extent to which partner assaults are part of a more general pattern of criminal behavior or a specialized type of crime, we studied the dating relationships of 653 university students. Thirty-one percent reported assaulting a partner in the previous 12 months. The rate of assault on partners by females did not differ significantly for males (29%) and females (32%). We also found high rates of other self-reported crime, and much higher rates by males. For example, over one half of the male students and almost one third of the female students reported having stolen money. The male students reported an average of 3.4 crimes committed, and the female students an average of 1.4 crimes. These high crime rates and gender differences are consistent with many previous studies. Logistic regression analysis revealed that a history of prior criminal acts is associated with an increased probability of assaulting a partner. The relationship was greater when there was prior violent crime compared to property crime, when there was early onset of criminal behavior, and when the offender was female. The implications of the findings for understanding partner assaults, criminal careers, and gender differences in the etiology of violence against intimate partners are discussed.     

The effects of high- and moderate-resistance training on muscle function in the elderly

The purpose of this study was to investigate the effects of a 12-week resistance-training program on muscle strength and mass in older adults. Thirty-three inactive participants (60-74 years old) were assigned to 1 of 3 groups: high-resistance training (HT), moderate-resistance training (MT), and control. After the training period, both HT and MT significantly increased 1-RM body strength, the peak torque of knee extensors and flexors, and the midthigh cross-sectional area of the total muscle. In addition, both HT and MT significantly decreased the abdominal circumference. HT was more effective in increasing 1-RM strength, muscle mass, and peak knee-flexor torque than was MT. These data suggest that muscle strength and mass can be improved in the elderly with both high- and moderate-intensity resistance training, but high-resistance training can lead to greater strength gains and hypertrophy than can moderate-resistance training.     

Challenging intolerance

Social identity is multilayered and complex. Schools, communities, and nations can implement structures and approaches that help youth to understand one another and respect differences.     

Mitochondrial injury: a hot spot for parkinsonism and Parkinson's disease?

The recent identification of genes (parkin, DJ-1, and PINK1) involved in recessive autosomal parkinsonism, and the indications that these proteins may have protective effects on the mitochondria, has led to the reemergence of the notion that mitochondrial dysfunction might play a central role in the etiology of sporadic Parkinson's disease (PD). This idea has previously been supported by biochemical analyses showing reduced mitochondrial activity in PD patients and in animal models of PD generated by the selective inhibition of mitochondria activity. However, the involvement of DJ-1 or PINK1 loss of function in classical idiopathic PD, characterized by pathological inclusions composed of aggregated alpha-synuclein protein, has still not been evaluated. More detailed studies of the possible interactions between parkin, DJ-1, PINK1, and alpha-synuclein and their effects on mitochondria are needed to more adequately define the biological pathways that may convergently or independently lead to parkinsonism.     

Ambivalent sexism and attitudes toward women who engage in premarital sex in Turkey

This study examined the relationship of ambivalent sexism, political conservatism, demographic variables (age, education, and gender), and prior sexual experience to Turkish men s and women s attitudes toward women who engage in premarital sex. Participants included 124 Turkish undergraduate students and 60 nonstudent Turkish adults. Benevolent but not hostile sexism uniquely predicted more negative views of women who engage in premarital sex once other variables were controlled. Regression analyses demonstrated that for both men and women, older, more politically conservative and less sexually experienced respondents and more educated men (but not women) respondents were more likely to disapprove of women who engage in premarital sex. Similarly, regression analysis revealed that men who were older, politically conservative, and less sexually experienced expressed stronger preferences for marrying a virgin. Both hostile and benevolent sexism predicted men s preference for marrying a virgin after all other variables were controlled.