Extraverted behaviors will continue to be an important part of medical training and practice, but the merits of introverted behaviors warrant further consideration as both medical training and practice evolve. Educators who make manageable adjustments to current teaching practices can improve the learning for both introverted and extraverted styles of academic engagement.
Purpose: Little information exists on how patients in medical practice use food package nutrition labels. We theorized that patients in a general medical practice might not make the distinction between serving size and total package nutrition information, and this might lead to obesity.Methods: Ninety patients between ages of 18 and 65 attending the St. Francis/University of Tennessee Family Practice Center were interviewed to determine whether they could calculate the total calories in sample snack food packages that contained more than one serving.Results: Ninety percent of our patient sample correctly identified the number of calories per individual serving, but only 37% were able to recognize that the sample packages contained multiple servings. Confusion between calories per serving size and total calories per package was correlated with lower educational levels (P ؍ .011) and with the presence of cardiovascular heart disease in our patient sample.Conclusions: Our patients tended to think of a multiple serving package as one serving. They underestimated and under-reported caloric intake from snack food sources. We conclude that snack food labels as actually used by patients do not lead to informed dietary choices. These findings could impact our understanding and management of the obesity epidemic in the United States. The United States is facing an unprecedented epidemic of obesity. Obesity is commonly assessed by calculating the body mass index (BMI), which is the weight in kilograms divided by height in meters squared. The median percentage of obese adults (BMI Ͼ 30) in the United States has increased from 11.6% in 1990 to 20.1% in 2001.1,2 Obesity and a sedentary lifestyle impose a substantial health risk. According to a recent report by the Surgeon General, 3 obesity is an important factor in up to 300,000 deaths each year in the United States. Even modest increases of 10 to 20 pounds over ideal body weight are associated with measurable differences in the risk of adult onset diabetes, hypertension, myocardial infarction, and stroke. Obese persons have a 50% to 100% higher risk of all-cause mortality than those with a normal BMI of 20 to 25. 3There is increasing evidence of a positive correlation between snack food and/or fast food consumption and rising rates of obesity in the US population.3-5 Several studies have concluded that consumers do not understand food package nutrition information as it is currently provided. 6,7 Studies regarding food labels and fast food intake have been based on population surveys and questionnaires of college students. 8 These studies may not be representative of patients in a general medical practice. There is no accurate information regarding the snack food intake of patients in a primary care practice. Since 1990, US law has mandated that all food packages contain nutrition information in a label form.9 Snack food package labels are based on serving or portion size. However, most snack foods are sold in packages containing multiple servings. Furthermore, the "avera...
A series of adult patients with idiopathic hydrocephalus in whom shunts were placed are presented. Preoperative diagnostic and prognostic criteria were evaluated. Findings on computed tomographic scans (significant ventricular enlargement, the absence of gyral atrophy, and the absence of sylvian fissure enlargement) and the clinical triad associated with hydrocephalus in adults (dementia, ataxia, and especially incontinence of urine) all contributed individually and in combination to the diagnosis of hydrocephalus that could be corrected by surgery. The use of radionucleotide cisternography did not add any additional information. Its use as a diagnostic or prognostic aid is, therefore, suspect. The use of high-pressure shunting systems for the initial shunting procedure is emphasized.
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