John C. Cassel

THE CONTRIBUTION OF THE SOCIAL ENVIRONMENT TO HOST RESISTANCE1

An improved structure for a microwave generated plasma light source for emitting radiation in the ultraviolet and visible portions of the spectrum. Microwave energy generated by a microwave source is coupled to a plasma forming medium which is confined in a longitudinally extending tube. The tube is surrounded along its length by a microwave chamber, a portion of which comprises a means for reflecting the emitted radiation and a portion of which comprises a mesh-like member which is substantially transparent to the emitted radiation, but which is relatively opaque to the microwave energy. The microwave energy may be fed to the microwave chamber either from the end thereof, or from the top or sides if the microwave sources is housed in a waveguide located on the top or sides of the chamber. The plasma forming medium is confined at a relatively high pressure and the microwave energy is coupled thereto at a high enough power density to create electron densities in the plasma in excess of the cutoff density. Electrons are excited by the transformation of waves and wave absorption and collide with the heavy particles of the plasma which emit ultraviolet and visible radiation upon de-excitation.

Social support and health

IN HUMAN COMMUNICATION SYSTEMS, what is the function of social support in the etiology, precipitation, course and recovery from disease? In what way does social support ameliorate stress? In what ways does social support act to promote health? While many researchers30 have speculated on the importance of social support and a few have proclaimed it to be significant in myocardial infarction8 49 there is little strong empirical evidence to confirm the role it may play in health and illness. This is not surprising: attempts at conceptualization and measurement have been inadequate, discipline-bound (or study-bound), and usually formulated for post-hoc interpretation of unexpected, but striking findings.

Communication, compliance, and concordance between physicians and patients with prescribed medications.

Forty-six practicing physicians and 357 patients with diabetes mellitus or congestive heart failure were the subjects for this study, which focuses on the impact of medication regimen and doctor-patient communication in affecting patient medication-taking behavior and physician awareness of these behaviors. Four types of medication errors were defined: omissions, commissions, scheduling misconceptions and scheduling non-compliance. The average error rates were 19 per cent, 19 per cent, 17 per cent and 3 per cent, respectively. The combined average error was 58 per cent; scheduline non-compliance on the part of the patient was a minor component. Specific aspects of the medication regimen were associated with increased errors: (1) the more drugs involved between the doctor-patient pair, the greater the errors of omission and commission; and (2) the greater the complexity of the scheduling, the greater the errors of commission and scheduling misconceptions. If the patient did not know the function of all his drugs, errors of commission and scheduling misconception increased. Neither characteristics of patients nor the severity of disease were influential in determining the extent of medication errors. For patients with congestive heart failure, good communication of instructions and information from physician to patient was associated with low levels of all types of errors.

Influence of race, sex and weight on blood pressure behavior in young adults.

This study is concerned with blood pressure behavior in young adults (aged 15 to 29 years) in the biracial community of Evans County, Ga., on two occasions 7 years apart. On the basis of casual blood pressure recordings the prevalence of systolic pressure equal to or greater than 140 mm Hg or diastolic pressure equal to or greater than 90 mm Hg, or both, showed race/sex differences as follows: white males 19.0 percent, white females 12.7 percent. black males 34.0 percent, black females 31.6 percent. Similar differences were noted in the incidence during the 7 year interval. The problem presented by the variability of the casual blood pressure recording is apparent in this interval study. Of particular interest is the association of weight with blood pressure in this youthful group, particularly among white males and females and black females, in relation to both initial and subsequent pressure levels. The data suggest that in this population under 30 years, weight is a risk factor for hypertension, and that maintenance of ideal weight, instituted in youth, may be a preventive measure.

Medication use and misuse: Physician-patient discrepancies☆

INTRODUCTION DURING recent years a substantial literature has developed on the subjects of physician prescribing patterns [IA], medication use by various population groups [5-71, and patient compliance with taking prescribed medications [S-15]. Physician-patient communication has been reviewed under the assumption that compliant behavior can only occur as the result of appropriate communication [I 1, 12, 151. Methodological studies have been done to compare the accuracy of various methods for measuring patient compliance [13, 14, 16-201. The present paper introduces a quantitative method for analyzing data on medication use and misuse among patients with either adult onset diabetes mellitus or congestive heart failure. This study was undertaken within the context of a more comprehensive research effort. Representatives from two organizations, the American Academy of Family Physicians and the Department of Epidemiology at the University of North Carolina, undertook the development of a research design, which was both original in concept and feasible to implement, as a method of assessment of primary medical care [21]. Two of the areas for assessment are physician-patient communication and patient compliance. Communication represents the extent to which the physician is successful in transmitting information and instructions to the patient, while compliance measures the extent to which the patient’s behavior is modified by these instructions. Medicationtaking behavior is an important indicator of both communication and compliance. Study of medication use has the potential for introducing another concept into the evaluation scheme; that is, the recognition that communication is a two-way phenomenon. Not only should the patient take drugs as recommended by the

Correlates of Satisfaction and Dissatisfaction with Medical Care: A Community Perspective

The attitude of the public toward physicians and medical services is an issue of current concern and debate. To address this problem, an instrument was developed using Thurstone scaling methods in conjunction with a Likert format and a modified scoring technique. Following pretesting of the instrument among both patient and population samples, a survey was conducted among the residents of a probability sample of households in a city of 200,000 people. The attitude questionnaire was completed by 1,713 adults in 1,112 households. Overall, attitudes were favorable toward the professional competency and the personal qualities of physicians. Accessibility, including costs and convenience, were less highly regarded. Men were less satisfied than women and blacks less satisfied than whites. Particularly negative attitudes were expressed toward the personal qualities of physicians by young blacks, whereas among blacks over 60 the negative effect was toward costs and convenience. Having a regular physician and long attendance with that physician were correlated with positive attitudes. The most negative sentiment was expressed by women without a regular source of care. Medical services are being sought and obtained by a large segment of society, but problems of costs and acceptability for the elderly, low social class persons, members of large families, and for blacks still remain.

Black-white differences in serum lipids and lipoproteins in Evans County

Abstract The Evans County Cardiovascular Disease Survey has demonstrated a higher prevalence and incidence of coronary heart disease in white than in black men. Prior studies by us have disclosed similar associations of CHD with the risk factors of elevated blood pressure, serum cholesterol, and smoking in Evans County as have been reported elsewhere. The lower frequencies of CHD in black than in white males are present, controlling for the standard risk factors in univariate and in multivariate logistic risk function analyses. Black-white differences in total serum triglyceride and in cholesterol within lipoprotein fractions at identical total serum cholesterol levels are described in this report. Significantly higher LDL cholesterol and total triglycerides are present in whites, and higher HDL cholesterol was found in blacks in an age, sex, and total serum cholesterol matched comparison. The determinants of the black-white differences in lipid and lipoprotein fraction distributions are still to be elucidated, but in this sample, lipid differences are not explained by social characteristics, such as occupation and social class. The black-white lipoprotein fraction differences in Evans County are consistent with a negative, coronary risk factor role of elevated HDL cholesterol, which has been postulated based on other experimental and prevalence studies.

Scale for the measurement of "satisfaction" with medical care: modifications in content, format and scoring.

The methodological development of a scale to measure attitudes toward physicians and primary medical care, and efforts to ascertain its reliability and validity have been reported previously. As a direct result of further experience with this scale, several modifications were incorporated and the revised scale subjected to additional evaluation. The modifications specifically address the methods employed in developing a revised set of items, the rationale for changing the response alternative format, and the derivation of a modified Scale Product scoring method. When compared to the traditional Thurstone scoring method, the reliabilities of the Scale Product method, using corrected split-half reliability coefficients, were found to be consistently superior. The complete scale is published with scale values and direction of affect, such that it can be used without modification or additional information by other investigators.

DOCTOR-PATIENT COMMUNICATION AND OUTCOMES AMONG DIABETIC PATIENTS

This study reports on 242 diabetic patients from the practices of 42 physicians. Communication from physician to patient was studied to determine the effect of communication on subsequent patient outcomes. Patients and physicians were questioned on instructions provided for diabetic management and self-care. The average level of effective communication for all patients in the study was 67 percent. Insulin-dependent diabetics had the best communication scores, those controlled on diet alone the poorest, while oral medication patients were intermediate.Although overall communication scores showed to significant correlation with diabetic control status, patient satisfaction, compliance in taking prescribed medication, or frequency of hospitalization, specific communication items were highly correlated with corresponding behavioral outcomes.

Health consequences of culture change—II: The effect of urbanization on coronary heart mortality in rural residents

Abstract 1. 1. Death rates from coronary heart disease in white males aged 55–64 who are rural residents of North Carolina increased with increasing urbanization of their county of residence in the years 1951–1953 and also in 1959–1961. 2. 2. It was shown that these differences in mortality could not in all likelihood be explained by differences in diagnostic custom. 3. 3. This gradient of mortality was predicted in advance of the study on the basis of postulated incongruities between the culture of rural residents and the demands and expectations of increasing urbanization. 4. 4. The data suggest that whatever deleterious influences accompany urbanism as far as coronary heart disease is concerned, they have, by 1960. in this age, race, and sex group in North Carolina, reached a plateau for urban residents but are continuing to exert their effects on the less adapted rural residents.