Terrence E. Steyer

The relationship between attendance at religious services and cardiovascular inflammatory markers.

Objective: Previous studies have shown an association between attendance at religious services and health, particularly cardiovascular morbidity and mortality. Little research has focused on religious attendance and physiological markers of cardiovascular risk. The purpose of this study was to explore the relationship between religious attendance and inflammatory markers of cardiovascular risk. Method: Nationally representative sample of non-institutionalized United States adults aged 40 and over derived from the National Health and Nutrition Examination Survey III 1988–1994 (n = 10,059). The main outcome measures were the inflammatory system markers C-reactive protein, fibrinogen, and white blood cell count. Results: 40.8 percent of the population attended religious services 40 or more times in the previous year while 22.4 percent attended services less than 40 times and 36.8 percent attended no religious services at all. Non-attenders of religious services were more likely than attenders to have elevated white blood cell counts (p = .001), highly elevated C-reactive protein (p = .02), and elevated fibronogen (p = .05). After adjusting for demographic variables, health status, and BMI, the association between religious attendance and cardiovascular markers remained. Once current smoking was added to the model the independent effect of religious attendance dropped below conventional confidence limits. Conclusions: These findings suggest that people who have attended religious services in the previous year are less likely to have elevated levels of certain inflammatory markers, however, current smoking has significant shared variance with religious attendance.

Virtual Medical Care: How Are Our Patients Using Online Health Information?

An increasing percentage of Internet users are seeking health information online. The purpose of our study was to determine the extent of Internet access and online health-seeking and the feasibility of implementing Internet services for our urban, residency-based practice. Using a self-administered survey, we obtained information on use of the Internet, demographics and socioeconomic profile, presence of a chronic medical condition and self-rated health from 300 consecutive patients. Complete surveys were obtained by 203 (68 percent). Responses were compared based on demographic, socioeconomic, and medical variables using Chi-square analysis. Results showed that our sample population tended to be under age 50, female, non-Hispanic Black, low income, and healthy. Seventy-seven percent of respondents had accessed the Internet at least once, 79 percent had used the Internet to find health-related information, 73 percent used the online information to make a health-related decision, 50 percent shared the information with their provider. In conclusion, we confirmed a high rate of Internet usage in our specific patient population, characterized by low socioeconomic status, low education level, and high minority percentages. Our patients not only access online health information, but also make changes based on this information, with only about half of all patients sharing this information with their physicians. It is unclear how this system of ‘virtual medical care’ influences overall patient health.

Use of a Modified Dosing Weight for Heparin Therapy in a Morbidly Obese Patient

OBJECTIVE: To report a case of successful anticoagulation using a modified dosing weight (DW) for unfractionated heparin (UFH) therapy in a morbidly obese female. CASE SUMMARY: A 54-year-old morbidly obese (182.4 kg, 155 cm) white female presented to the emergency department with tachycardia, shortness of breath, and chest pain, and was diagnosed with a pulmonary embolism. Anticoagulation with UFH was initiated. A modified DW of 120 kg was obtained from the average of the actual body weight (ABW) and ideal body weight (~50 kg). We selected this modified DW to account for heparins altered volume of distribution in an obese patient and avoid potentially supratherapeutic activated partial thromboplastin times (aPTTs) using ABW and subtherapeutic aPTTs using DW. Therapy was initiated with a bolus dose of 9600 units (80 units/kg x 120 kg) and continuous infusion rate of 2160 units/h (18 units/kg/h x 120 kg). This infusion rate was maintained throughout the course of heparin therapy and was successful in maintaining therapeutic aPTTs. DISCUSSION: Proper diagnosis and rapid initiation of therapy prevent mortality in patients with PE. Although weight-based heparin nomograms provide standardization through initial bolus and continuous infusion recommendations, many do not address dosing in morbidly obese patients. Several retrospective studies have evaluated actual, dosing, and ideal body weights for heparin therapy in obese patients; however, none has evaluated modified DW. In our patient, successful anticoagulation was objectively confirmed. CONCLUSIONS: Further investigation is necessary to determine the optimal DW for UFH in morbidly obese patients presenting with acute thrombosis.

Complementary and Alternative Therapies for Weight Loss

Although many complementary therapies are promoted for the treatment of obesity, few are truly therapeutic. Evidence suggests that food containing diacylglycerol oil, acupuncture, and hypnosis are the only evidence-based complementary therapies for the treatment of obesity, and, at best, these should be used as adjuvants to the more conventional therapies of calorie restriction and exercise.

The Presidential Scholars Program at the Medical University of South Carolina: An extracurricular approach to interprofessional education

The Medical University of South Carolina (MUSC) developed a Presidential Scholars Program (PSP) in order to foster interprofessional collaboration among students from the different health professions on campus. Now in its seventh year, the program provides approximately 40 selected students each year from six different colleges with a two-semester interprofessional educational experience. Students work in small interprofessional teams on a project designed to address a broad-based health care issue; they also participate in other structured educational sessions throughout the year. As one means for assessing student impressions of the interprofessional collaborative experience, a survey was administered prior to and immediately after the experience. Additionally, a sample of non-scholar MUSC students was randomly selected for completion of the survey as a control group. Results indicate that PSP students have a significantly greater understanding of each other and deeper appreciation of the value of interprofessional collaboration at the end of the year. The Presidential Scholars Program at MUSC provides a unique and innovative opportunity for students to work with individuals within other health care disciplines, reduces stereotypes of the various professions and teaches important team skills. Future research would involve alumni follow-up in order to further evaluate the long-term impact of the program.

Use of Nutritional Supplements for the Prevention and Treatment of Hypercholesterolemia

OBJECTIVE Hypercholesterolemia is a major risk factor for the development of coronary artery disease. Studies have shown that several vitamins and nutritional supplements may contribute to a reduction in total and low-density lipoprotein cholesterol. This goal of this study was to document the use of vitamins and nutritional supplements that may treat or prevent hypercholesterolemia. METHODS Secondary analysis of the National Health and Nutrition Examination Survey III responses from 13,990 patients were available to use for making population estimates. RESULTS Of those individuals with a known diagnosis of hypercholesterolemia, 3.6% were taking at least one vitamin or nutritional supplement to decrease cholesterol levels. For individuals trying to prevent hypercholesterolemia, 1.2% were using one of these vitamin or nutritional supplements. Only 0.7% of individuals without or trying to prevent hypercholesterolemia used one of these specific supplements. We used multivariate analysis to control for several factors, and individuals with a diagnosis of hypercholesterolemia had an adjusted odds ratio of 2.10 (95% confidence interval, 1.38-3.21) for vitamin use compared with those without or trying to prevent high cholesterol. Those trying to prevent hypercholesterolemia had an adjusted odds ratio of 0.69 (95% confidence interval, 0.48-1.00) for vitamin use compared with those without or trying to prevent high cholesterol. CONCLUSIONS The use of vitamins and nutritional supplements that may reduce total and low-density lipoprotein cholesterol levels is low in the United States. Future research is needed to confirm the effectiveness of these products, examine the quality and purity of currently available products, and explore whether using these supplements are an adequate low-cost alternative to pharmaceuticals now available.

The role of medical students in curriculum committees.

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