American Medical Association Recommends Research Articles

Readability of Healthcare Literature for Hepatitis B and C.

Patients increasingly use the Internet for educational material concerning health and diseases. This information can be utilized to teach the population of hepatitis B and C if properly written at the necessary grade level of the intended patient population. We explored the readability of online resources concerning hepatitis B and C. Google searches were performed for "Hepatitis B" and "Hepatitis C." The Internet resources that were intended for patient education were used with specific exclusions. Articles were taken from 19 and 23 different websites focusing on the symptoms, diagnosis, and treatment of hepatitis B and C, respectively. The articles were analyzed using Readability Studio Professional Edition (Oleander Solutions, Vandalia, OH) using 10 different readability scales. The results were compared and averaged to identify the anticipated academic grade level required to understand the information. The average readability scores of the 10 scales had ranges of 9.7-16.4 for hepatitis B and 9.2-16.4 for hepatitis C. The average academic reading grade level for hepatitis B was 12.6 ± 2.1 and for hepatitis C was 12.7 ± 2.1. There was no significant discrepancy between the hepatitis B and C Internet resource averaged grade levels. The resources accessed by patients are higher than the previously determined necessary grade level for patients to properly understand the intended information. The American Medical Association recommends material should be simplified to grade levels below the sixth grade level to benefit the ideal proportion of the patient population.

Therapeutic Plasma Exchange: Core Curriculum 2008

Therapeutic Plasma Exchange: Core Curriculum 2008

Strengthening the Supply of Routinely Recommended Vaccines in the United States: A Perspective from the American Medical Association

Influenza virus vaccine shortages and delays in distribution require continued collaborative efforts by all stakeholders to ensure that Healthy People 2010 goals are met. Problems with supplies of other vaccines jeopardize at-risk populations. The American Medical Association recommends that the US Department of Health and Human Services establish a task force to explore the causes of vaccine shortages and maldistribution. The task force should commission an appropriate body of experts to identify solutions for breakdowns in vaccine manufacturing and distribution systems. Potential areas for improvement include earlier notification of shortages to the US Food and Drug Administration, improved communication to physicians, financial incentives to market medically necessary but unprofitable products, and a national stockpile of certain vaccines. The American Medical Association believes that the strategies proposed by the National Vaccine Program Office (i.e., increasing financial incentives, streamlining the regulatory process, establishing government-directed programs, creating and maintaining vaccine stockpiles, and increasing liability protection) could improve vaccine availability; however, increasing vaccine stockpiles is the most promising strategy.

Assessing infertility information on the Internet: Challenges and possible solutions

Although patients frequently visit consumer-related Internet sites to help them make informed decisions about treatment, there is no clear way for these consumers to evaluate content within these sites. This article reviews the problem and offers suggestions to remedy the situation.

The effect of office-based physician's advice on adolescent exercise behavior

Background. This study examines whether the adolescents' current levels of physical activity are increased by their physicians' advice provided in the office, in accordance with the American Medical Association recommendation. Methods. The first adolescent (12–21 years old) of whichever age and gender, passing through six family physicians' offices during a 6-month period was assigned to the intervention group, and the second adolescent of the same age and gender was assigned to the control group. Each patient was classified as active, partially active, and inactive, according to how they answered the questions about their physical activity levels, and patients in the intervention group were then provided with reinforcement, increase, or initiation counseling, respectively. Identical procedures were repeated at the 6- and 12-month office visits. Changes in prevalence of activity, as well as, duration, frequency, and intensity of exercise and/or sports were verified at each visit. Results. Of the 87.5% of the original sample that completed the survey, 6- and 12-month data were available for 70.1%. Among the 392 adolescents that finished the study, those provided with counseling had 41.5% more active adolescents, as well as 26.8%, 38.0% and 26.2% higher duration, frequency and intensity, respectively, than the control group. Conclusions. The proportion of active adolescents, as well as, the duration, frequency and intensity of leisure time exercise and/or sports are increased by physician advice.

Gender verification of female Olympic athletes

Gender verification of female athletes has long been criticized by geneticists, endocrinologists, and others in the medical community. Problems include invalid screening tests, failure to understand the problems of intersex, the discriminatory singling out of women based only on laboratory results, and the stigmatization and emotional trauma experienced by individuals screened positive. Genuine sex-impostors have not been uncovered by laboratory-based genetic testing; however, gender verification procedures have resulted in substantial harm to a number of women athletes born with relatively rare genetic abnormalities. Individuals with sex-related genetic abnormalities raised as females have no unfair physical advantage and should not be excluded or stigmatized, including those with 5-alpha-steroid-reductase deficiency, partial or complete androgen insensitivity, and chromosomal mosaicism. In 1990, the International Amateur Athletics Federation (IAAF) called for ending genetic screening of female athletes and in 1992 adopted an approach designed to prevent only male impostors from competing. The IAAF recommended that the "medical delegate" have the ultimate authority in all medical matters, including the authority to arrange for the determination of the gender of the competitor if that approach is judged necessary. The new policy advocated by the IAAF, and conditionally adopted by the International Olympic Committee, protects the rights and privacy of athletes while safeguarding fairness of competition, and the American Medical Association recommends that it become the permanent approach.

Late-term abortion.

Recent proposed federal legislation banning certain abortion procedures, particularly intact dilatation and extraction, would modify the US Criminal Code such that physicians performing these procedures would be liable for monetary and statutory damages. Clarification of medical procedures is important because some of the procedures used to induce abortion prior to viability are identical or similar to postviability procedures. This article reviews the scientific and medical information on late-term abortion and late-term abortion techniques and includes data on the prevalence of late-term abortion, abortion-related mortality and morbidity rates, and legal issues regarding fetal viability and the balance of maternal and fetal interests. According to enacted American Medical Association (AMA) policy, the use of appropriate medical terminology is critical in defining late-term abortion procedures, particularly intact dilatation and extraction, which is a variant of but distinct from dilatation and evacuation. The AMA recommends that the intact dilatation and extraction procedure not be used unless alternative procedures pose materially greater risk to the woman and that abortions not be performed in the third trimester except in cases of serious fetal anomalies incompatible with life. Major medical societies are urged to collaborate on clinical guidelines on late-term abortion techniques and circumstances that conform to standards of good medical practice. More research on the advantages and disadvantages of specific abortion procedures would help physicians make informed choices about specific abortion procedures. Expanded ongoing data surveillance systems estimating the prevalence of abortion are also needed.

Sleepiness, driving, and motor vehicle crashes. Council on Scientific Affairs, American Medical Association.

To assess the contribution of driver sleepiness to highway crashes and review recent recommendations to change federal hours-of-service regulations for commercial motor vehicle drivers. Information was derived from a search of the MEDLINE, Transportation Research Information Service (TRIS), and Bibliographic Electronic Databases of Sleep (BEDS) databases from 1975 through 1997 and from manual review of the reference lists in relevant journal articles, government publications, conference proceedings, and textbooks. Driver sleepiness is a causative factor in 1% to 3% of all US motor vehicle crashes. Surveys of the prevalence of sleepy behavior in drivers suggest that sleepiness may be a more common cause of highway crashes than is reflected in these estimates. About 96% of sleep-related crashes involve passenger vehicle drivers and 3% involve drivers of large trucks. Risk factors include youth, shift work, alcohol and other drug use, over-the-counter and prescription medications, and sleep disorders. Increased awareness of the relationship between sleepiness and motor vehicle crashes will promote the health and safety of drivers and highway users. Physicians can contribute by encouraging good sleep habits, recognizing and treating sleep-related problems, and counseling patients about the risks of driving while sleepy. To protect public health and safety, the American Medical Association recommends continued research on devices and technologies to detect the signs of sleepiness and prevent the deterioration of driver alertness and performance. Educational programs about the risks of falling asleep while driving are needed for physicians, the public, and commercial truck drivers.

An Analysis of the American Medical Association's Recommendations for Change in the Medical Care Sector of the United States

In several recent publications, the American Medical Association has provided explanations of the current crisis in the medical sector of the United States. This article presents empirical information that questions the basic assumptions behind the AMA's explanations of the U.S. realities and the AMA's recommendations on how to solve the current crisis. The author also critically reviews some of the major proposals--such as employer mandated coverage--that are being put forward by several forces in the United States, including the AMA, for resolving the twin problems of high costs and limited health benefits coverage for the U.S. population. The political context in which the AMA's calls for reforms are being made is also discussed.

Physicians Infected With HIV

To the Editor.— We read with dismay the statement regarding human immunodeficiency virus (HIV)-infected physicians issued by the American Medical Association (AMA) on January 17,1991, and reported in the New York Times on January 18, 1991 (p A17). This statement recommends that HIV-infected physicians abstain from performing that pose identifiable risk of or inform their patients of their infection. The AMA also advises physicians who are at risk of acquiring HIV infection and who perform invasive procedures to be tested for HIV infection. We agree that the safety of patients is paramount when there is a known risk. We believe, however, that the AMA's recommendations are unwarranted, imprecise, and not in the public interest. First, the risk of HIV transmission from an infected physician to a patient is not identifiable. A serosurvey of patients of an HIV-infected surgeon failed to identify a single HIV-infected patient without

Tobacco in Hospitals

To the Editor.— Following the article by Ho, 1 we conducted a telephone survey of hospital administrators in the state of Georgia regarding their individual hospital policies for tobacco use and sales. Of the 185 Georgia hospitals, 141 were successfully contacted, and 135 of the administrators agreed to respond (73% of all Georgia hospitals). Sixty-nine percent of the responding hospitals were accredited by the Joint Commission on the Accreditation of Hospitals (JCAH). Ninety percent of the responding hospitals had established written cigarette and tobacco use policies. Seventy-six percent of hospital administrators were aware of the American Medical Association's recommendations and the JCAH regulations concerning tobacco use. 2,3 However, 16% of the administrators at JCAH-accredited institutions had no knowledge of the JCAH smoking regulations and 7% had not established written policies. Ninety-seven percent of those hospitals with written policies stated that their policies were enforced. Nursing staffs were primarily responsible for

American Medical Association concepts of nutrition and health. Council on Scientific Affairs.

Although human need for various nutrients is well-established, the exact requirements for the different nutrients are not well-known. Nutrient requirements are affected by genetics; environment; nature of the diet; and hemeostatic demands under changing physiological conditions expressed as growth, reproduction and response to the stress of injury or disease. Pregnant and lactating women should be properly nourished if well-nourished infants are desired. Nutrient and energy needs are considerably increased during pregnancy and lactation. The most rapid growth of infants occurs during the 1st 4 to 6 months of life. Because of the many advantages of breast milk over artificial milk, full-term newborn infants should be breastfed, unless there are specific contraindications or breastfeeding is unsuccessful. The American Medical Association (AMA) urges that better efforts be made to educate the public and the medical profession as to the advantages of breastfeeding. The 4th to the 6th months of life constitute the transitional period in infant feeding. The baby should be introduced to single-ingredient foods in small quantities, one at a time, to isolate food sensitivities. Good eating habits can be formed early in life through the proper and gradual introduction of varied and nutritional meal patterns. Energy balance is a nutritional problem in late childhood and once maturity is achieved, while calorically and nutritionally inadequate diets are a growing concern for the elderly. Immoderate eating habits (e.g., overeating) may aggravate or contribute to the development of degenerative diseases and should be discouraged. The AMA recommends that the American public focus on the achievement and maintenance of the most desirable body weight through a proper combination of dietary control and exercise. Specific dietary modifications (sodium restriction, weight control) are necessary in the management of hypertension, diabetes, coronary heart diseases and other medical problems. The medical profession should assume a more active role in teaching people how to achieve and maintain good health habits through behavioral modification.