Publications

Systolic heart failure is a major problem for Americans today, with 550,000 new cases diagnosed per year, and ultimately contributes to 287,000 deaths annually. While pharmacologic therapy has drastically improved outcomes in patients with systolic heart failure, hospitalizations from systolic heart failure continue to increase and remain a major cost burden. In response to this unmet need, recent years have seen dramatic improvements in device-based therapy targeting one cause of systolic dysfunction: dyssynchronous ventricular contraction. Cardiac resynchronization therapy aims to restore mechanical synchrony by electrically activating the heart in a synchronized manner. This review summarizes the rationale for cardiac resynchronization therapy, evidence for its use, current guidelines, and ongoing and future directions for research.

We describe correlates of drug use-consequences related variables (addiction concern, problem consequences, and drinking alcohol/using drugs while driving) among two samples of high school students, one in the Russian Federation (n = 365), and one in the United States (n = 965). The correlates used in the analyses are based on the Theory of Triadic Influence, which organizes predictors of adolescent substance misuse into intrapersonal (e.g., depression), cultural/attitudinal (e.g., perceived harmfulness of drug use), and interpersonal (friend and family drug use) types of influence. We examined measures from each type of influence, along with drug use (cigarette and alcohol use) as correlates. Overall, correlates from each of the types of influence were significant predictors of substance use consequences variables in both samples. The most consistent predictors of consequences across countries were depression, perceived harmfulness of drug use, family substance abuser, friends' substance use, and last 30-day cigarette use. These results suggest that the Theory of Triadic Influence is relevant to both countries. We speculate that drug prevention efforts may share common features among some U.S. and Russian youth populations.

OBJECTIVE

This study sought to examine the independent effect of patient race or ethnicity on the use of family planning services and on the likelihood of receiving counseling for sterilization and other birth control methods.

METHODS

This study used national, cross-sectional data collected by the 2002 National Survey of Family Growth (NSFG). Our analysis included women aged 18-44 years who had heterosexual intercourse within the past 12 months, who were not actively seeking to get pregnant, and who had not undergone surgical sterilization. The primary outcome was receipt of family planning services within the past 12 months. Specific services we examined were (1) provision of or prescription for a method of birth control, (2) checkup related to using birth control, (3) counseling about sterilization, and (4) counseling about birth control.

RESULTS

Although we found no racial/ethnic differences in the overall use of family planning services, there were racial/ethnic differences in the specific type of service received. Hispanic and black women were more likely than white women to receive counseling for birth control (adjusted OR 1.5, 95% confidence interval [CI] 1.2, 1.8, and adjusted OR 1.3, 95% CI 1.1, 1.7, respectively). Hispanic women were more likely than white women to report having been counseled about sterilization (adjusted OR 1.5, 95% CI 1.0, 2.3).

CONCLUSIONS

Minority women were more likely to receive counseling about sterilization and other birth control methods. However, there were no differences in access to family planning services by race or ethnicity. Future studies are needed to examine the quality and content of contraceptive counseling received by minority compared with nonminority women.

BACKGROUND

Internists care for women of reproductive age, but little is known about internists' training in contraceptive counseling or provision of contraceptive methods.

METHODS

We surveyed 152 residents in nine internal medicine programs in Los Angeles County during the 2004-2005 academic year. The self-administered, 29-item survey included demographic, contraceptive practice pattern, and training variables. Descriptive statistics and multivariable logistic regression were used to illustrate counseling and prescribing practices and to identify predictors of counseling and provision of contraceptives.

RESULTS

Most (95%) future internists surveyed reported clinical responsibility for women of reproductive age. However, few (17%) routinely provided contraceptive counseling, and 39% rarely or never provided contraceptive counseling. Residents had prescribed contraception on a median of 2 (range 0-30) occasions in the past year. Some formal education in contraceptive methods was reported by 51% of respondents; however, 75% of residents reported a desire for more training about contraception.

CONCLUSIONS

Internal medicine residents commonly care for women of reproductive age but infrequently assess or address contraceptive needs. Further training on how to provide contraception is desired by many internal medicine residents.