Diagnosis of Pit-and-fissure Caries Using Three-dimensional Scanned Images

Diagnosis of the extent of pit-and-fissure caries has been subjective and thus difficult to teach and categorize for treatment planning. This in vitro study compares occlusal caries diagnosis of extracted posterior teeth (n=49) using three-dimensional (3D) scanned images vs visual examination, according to the International Caries Detection and Assessment System (ICDAS). The surfaces chosen for study represent all ICDAS classifications. Five experienced restorative faculty members examined scanned images for 60 seconds from a standardized series of views of each surface and scored them independently. One month later, the same teeth were examined visually by the same five raters with magnification and LED headlamps, with compressed air available. Intrarater and interrater agreement and validity were assessed using intraclass correlation coefficients (ICCs). The ICCs, ranging from 0.90 to 0.93, indicated excellent agreement between and within raters and between the raters and the gold standard ICDAS determination. This suggests that both photographs and 3D scans of pits and fissures are equally effective in diagnosing caries.

The Effect of Subject Age on the Microtensile Bond Strengths of a Resin and a Resin-modified Glass Ionomer Adhesive to Tooth Structure

For the materials tested, there was no difference in adhesion to young and aged tooth structure.

Activity participation and affect among nursing home residents: support for a behavioural model of depression

One focus of interventions being developed for depression in nursing homes is increasing pleasant events. The conceptual foundation of such interventions requires establishing links among activity levels, depressive symptoms and positive affect. We observed activity and affect among 28 nursing home residents, five-days-a-week for four weeks, and concurrently collected self-reported affect and depression data. Inclusion of intra-individual analyses using random effects models demonstrated considerable individual variability in the relationship between positive affect and activity, although the results broadly supported the association. Participants differed with regard to what types of events were pleasurable and with regard to the relationships among pleasure, interest and activity. Depression levels were related to some of these individual differences. Activity was related primarily to interest rather than pleasure and higher interest was related to fewer depressive symptoms. Our findings emphasize the importance of individually tailoring pleasant events interventions and suggest that prescriptive group activities are unlikely to prove effective as means for improving positive affect.

Effect of music on anxiety of women awaiting breast biopsy

The authors investigated the effect of music on the state anxiety of a sample of 20 patients awaiting breast biopsy at a suburban medical facility. The patients were assigned alternately to either the control or experimental group. The individuals in the experimental group were given a 20-minute music-based intervention in a preoperative holding area, whereas the patients in the control group received the customary preoperative care. Clinicians measured blood pressure, heart rate, and respiration in both groups of patients, and the participants completed the State portion of the self-administered State-Trait Anxiety Inventory (STAI). After the patients completed the 20 minutes of music or of preoperative care without music, clinicians again measured the participants' vital signs and the patients completed the STAI. The authors' findings indicated that the posttest state anxiety and respiratory rates of the patients in the experimental group were significantly lower than those of the patients in the control group.

Effects of a minimal intervention to increase physical activity in women: daily activity records

BACKGROUND

Effective interventions to increase physical activity levels are critical in a nation where inactivity is a national public health problem.

OBJECTIVE

This pilot study examined whether a minimal intervention (daily records of physical activity) increased activity levels in a community sample of working women.

METHODS

In a longitudinal, pretest-posttest design, 49 working women were randomly assigned at the work site level to the control (n = 25) or intervention group (n = 24). At pretest and posttest, subjects completed self-report questionnaires that measured psychological, social-environmental, physical activity, and demographic variables. Subjects in the intervention group kept daily records of their physical activities during the 12-week study, while those in the control group kept no records. In order to compare activity in the two groups, all subjects wore pedometers daily that recorded number of steps.

RESULTS

There was a significant difference between groups in the pedometer values (mean number of daily steps) at the end of the study period (mean difference +/- SE 2147 +/- 636, p = .022) (2000 steps = approximately 1 mile). Multiple regression analysis showed that only the intervention (p = .003) was a significant predictor of the pedometer values. Hierarchical data analysis was used to account for the intra-class correlation of 0.48 within work site.

CONCLUSION

Results from this sample of 49 women indicated that mean activity was greater in the intervention group compared to the control group. Recording daily activity is a cost-effective and acceptable intervention that may increase activity levels in women. However, more research is recommended to study the dual role of activity records as a data collection method as well as a potential intervention to increase physical activity.

Dental metal allergy in patients with oral, cutaneous, and genital lichenoid reactions

BACKGROUND

The subject of lichen planus (LP) and dental metal allergy long has been debated. An overwhelming majority of the existing literature focuses on mercury and gold salts in relation to oral lichen planus.

OBJECTIVE

Our objective was to expand current knowledge regarding LP and lichenoid lesions (LL) and dental metal allergy by investigating more metals and investigating cutaneous and genital disease in addition to oral disease.

METHODS

Fifty-one patients with known LP or LL were patch tested to a series of dental metals. Patients chose to replace their dental metals or make no revision. A telephone survey was conducted after 1 year to determine disease state.

RESULTS

Thirty-eight of 51 patients (74.5%) had at least 1 positive reaction. Twenty-five of 51 patients (49.0%) showed sensitivity to at least 1 mercurial allergen. Prevalence data for patients patch tested by the North American Contact Dermatitis Group (NACDG) from 1996 to 1998 was available for chromate, cobalt, gold, nickel, and thimerosal. The prevalence of positive reactions was higher in our group than in the NACDG group for all 5 of these allergens, and statistical significance was achieved for chromate (P = .028), gold (P = .041), and thimerosal (P = .005). Of patients who had a positive patch test reaction to 1 or more metals, 100% (9 of 9) reported improvement after metal replacement, whereas 62.5% (15 of 24) reported improvement without metal replacement.

CONCLUSION

Sensitization to dental metals is more common among LP and LL patients than in routinely tested patients, and might be an etiologic or triggering factor in the disease.

Can recovering alcoholics help hospitalized patients with alcohol problems?

OBJECTIVE

The researchers evaluated the relative effectiveness of 2 interventions for patients with alcohol problems.

STUDY DESIGN

A nonrandomized intervention study was used to compare usual care (control) with a 5- to 15-minute physician-delivered message (brief intervention) and with the physician message plus a 30- to 60-minute visit by a recovering alcoholic (peer intervention). Telephone follow-up was obtained up to 12 months after hospital discharge that focused on patient behaviors during the first 6 months following discharge.

POPULATION

The study included 314 patients with alcohol-related injuries admitted to an urban teaching hospital.

OUTCOMES MEASURED

Researchers measured complete abstinence from alcohol during the entire 6 months following hospital discharge, abstinence from alcohol during the sixth month following hospital discharge, and initiation of alcohol treatment or self-help within 6 months of hospital discharge.

RESULTS

Valid responses were obtained from 140 patients (45%). Observed success rates were: 34%, 44%, and 59% (P=.012) for abstinence from alcohol since discharge in the usual care group, the brief intervention group, and the peer intervention group, respectively; 36%, 51%, and 64% (P=.006) for abstinence at the sixth month following hospital discharge; and 9%, 15%, and 49% (P &it.001) for initiation of treatment/self-help. During the telephone follow-up interview, several patients in the peer intervention group expressed gratitude for the help they received with their drinking problems while in the hospital. A few patients dramatically changed their lives. They went from being unemployed and homeless to full-time employment and having a permanent residence. They credited the peer intervention as being the most important factor that motivated them to seek help for their alcohol use disorder. One of these individuals serves as a volunteer, visiting hospitalized patients with drinking problems.

CONCLUSIONS

Among trauma victims with injuries severe enough to require hospital admission, brief advice from a physician followed by a visit with a recovering alcoholic appears to be an effective intervention. Although further study is needed to confirm these findings, in the meantime physicians can request that members of Alcoholics Anonymous (AA) visit their hospitalized patients who have alcohol use disorders. Interventions by recovering alcoholics are part of their twelfth-step work (an essential part of the AA program) and are simple, practical, involve no costs, and pose little patient risk. They can be arranged from the patient's bedside telephone. Some patients will show a dramatic response to these peer visits.

Meta-analysis of erythrocyte Na,K-ATPase activity in bipolar illness

Sodium, potassium-activated adenosine triphosphatase (Na,K-ATPase) pump activity has been variously reported to be increased, decreased, or unchanged in bipolar patients. To explore this association we conducted a meta-analysis of the available literature. All papers containing data on erythrocyte Na,K-ATPase activity were reviewed independently by both authors. A meta-analysis of these data was accomplished by standard procedure. We found a significant mood-state-related decrease in Na,K-ATPase activity in both manic and bipolar depressed patients when compared to euthymic bipolar patients, but not when ill patients were compared to normal controls. The overall change can be characterized as small to moderate in magnitude.

Minimum time interval adjustment for 4-3-1 immunization rates among two-year-old children

BACKGROUND

The purpose is to determine the administrative validity of the 4-3-1 immunization rates for DPT-OPV-MMR vaccines for 2-year-old children in a community health status assessment project by accounting for premature administration of specific vaccine doses according to ACIP recommended minimal timing intervals.

METHODS

A retrospective survey of immunization certificates was made on a random sample of 1,059 kindergarten enrollees in the county, including public, private, and parochial schools. The immunization rates by the crude 4-3-1 counting method were compared with the same method adjusted for minimal time interval vaccine dosing.

RESULTS

By the crude 4-3-1 counting method, 55.5% of the students had complete immunizations by their second birthdate, and 11.8% did not meet the minimum interval recommendations on at least one of 4-3-1 vaccine series. The adjustment for minimum time interval reduced the percent in compliance with the 4-3-1 counting method by age 2 in the community to 50.7%.

CONCLUSION

The premature timing of vaccine doses is a threat to the validity of the 4-3-1 counting method. The crude 4-3-1 method over-estimates the completed immunization rates for 2-year-olds in this community-based study by about 4.8%.

Which medical school applicants will become generalists or rural-based physicians?

The hypotheses that data, available at the time when a medical school admission decision is made, can be used to predict generalist specialty choice and rural practice location were tested. Applicant data, available to admissions committee members at the University of Louisville in 1986 and 1987 about the classes of 1990 and 1991 respectively, were correlated with specialty choice and practice location in a retrospective cohort study. Data collected from 1994 to 1996 about the 1990 and 1991 graduates were used to develop a mathematical model to predict specialty choice and practice location using stepwise logistic regression. These models were more accurate in predicting which applicants would not select a generalist career (negative predictive value = 80.7%) than those who would (positive predictive value = 42.7%) and in predicting those who would not practice in a rural location (negative predictive value = 91.9%) than those who would (positive predictive value = 37.8%). We conclude that applicant data, available at the time admission decisions are made, are of limited value for identifying those who will eventually become generalist physicians or practice in a rural area. However, the data are useful for identifying those who will not.

Do parotid duct abnormalities occur in patients with chronic alcoholic pancreatitis?

OBJECTIVE

Several studies have suggested that ethanol affects the pancreas and parotid gland. We performed a prospective study to determine whether ductal lesions of ethanol-induced chronic pancreatitis occur in the parotid.

METHODS

Parotid sialograms were performed in 11 alcoholic patients who had endoscopic retrograde pancreatograms. Sialograms and pancreatograms were examined in all subjects for ductal abnormalities.

RESULTS

Seven of nine patients (77.8%) with ductal lesions of the pancreas had coexistent ductal abnormalities of the parotid gland (Kendall's tau = 0.578, p = 0.035).

CONCLUSIONS

Chronic ethanol intake induces ductal alterations in the parotid gland similar to those seen in the pancreas. These results suggest a common histopathological effect of alcohol in the ductal system of the parotid gland and pancreas and raise the possibility that the parotid sialogram could be useful as an adjunct in the diagnosis of ethanol-induced chronic pancreatitis.

An update on biostatistics requirements in U.S. medical schools

PURPOSE

To update the results of previous surveys of medical schools in the United States concerning their courses in introductory biostatistics and to acquire additional information about these courses.

METHOD

In 1993, the authors sent a questionnaire to each of the 125 U.S. medical schools listed in the 1992-93 AAMC Directory of American Education. The questionnaire sought information about biostatistics courses and the subjects covered therein.

RESULTS

One hundred of the 125 medical schools (80%) responded to the survey. Of those, 74 required a course in biostatistics as part of their undergraduate medical curriculum. The courses had large enrollments (median, 134) and a median of only 20 hours of instructional time. Most courses included a large amount of material, with 25 possible topics covered by at least 75% of the schools with required courses.

CONCLUSION

While efforts have been made to incorporate innovative instructional techniques into these courses, most still follow the traditional lecture format and make minimal use of computers. Nevertheless, medical students appeared to have a favorable attitude toward these courses at over half of the schools surveyed.

A retrospective review of 61 patients with antiphospholipid syndrome. Analysis of factors influencing recurrent thrombosis

BACKGROUND

Antiphospholipid syndrome (APS) is a disorder of recurrent venous or arterial thrombosis, pregnancy losses, and thrombocytopenia. Recurrent thrombosis has particularly adverse effects on patients prognosis. The factors that influence recurrence and management techniques that prevent these events remain controversial. To add further insight regarding predisposing factors and the prevention of thrombotic recurrence, 61 well-characterized patients with APS were followed up for a median time of 77 months.

METHODS

A retrospective cohort study was conducted in which the following factors were examined to determine their influence on thrombotic recurrence: primary vs secondary syndrome; the presence of hypertension, hyperlipidemia, diabetes, or smoking; patient age, sex, and race; pregnancy and oral contraceptives use; and treatment with warfarin sodium, warfarin plus aspirin, aspirin alone, prednisone, or no treatment.

RESULTS

There was no difference between patients with primary and secondary APS with respect to recurrent arterial (55% vs 38%, respectively) or recurrent venous (47% vs 50%, respectively) thrombotic events. In all patients with APS, white race (P = .02) was associated with recurrent arterial events. Venous thrombosis occurred during pregnancy or in the postpartum period in 16 (30%) of 53 women and in 8 women taking oral contraceptives. Recurrent arterial and venous thromboses were significantly decreased with prophylactic warfarin use when compared with prednisone use or no treatment. Recurrences were infrequent in patients with prothrombin ratios of 1.5 to 2.0.

CONCLUSIONS

Treatment with warfarin was most effective in preventing recurrent arterial and venous thrombosis. Pregnancy and the use of oral contraceptives or prednisone may also influence recurrence.

Prevalence of positive Osler's manoeuver in 3387 persons screened for the Systolic Hypertension in the Elderly Program (SHEP)

The purpose of this study was to examine the prevalence of a positive Osler's manoeuver (OM) among persons screened for the Systolic Hypertension in the Elderly Program (SHEP). Information obtained from all individuals included age, gender, and race; history of antihypertensive, anticoagulant, insulin, or cardiac pacemaker use; and history of heart attack, coronary bypass surgery, or stroke. Among the persons aged 60 and over that were screened for eligibility at the Louisville SHEP Center, OM was performed on 3387 subjects. Of these, 7.2% (243 of 3387) were determined to be Osler maneuver positive (O+). O+ was more prevalent among males than among females (P = 0.025). A higher prevalence of O+ was associated with both higher age (P < 0.001) and higher blood pressure (P < 0.001). There were significantly more Osler positives among those who responded positively to 'Have you had a stroke?' (P = 0.007) and 'Are you taking anticoagulants' (P = 0.044) than among those who responded negatively to these questions. O+ was also less prevalent among those that were normotensive at the time of the screening (P = 0.046). The results of this study, when taken with those of previous studies of OM, support the cautious use of OM as a screening tool for pseudohypertension in the elderly population and as an adjunct in determining the cardiovascular risk profile of individual patients. However, further study of OM is required before it can be recommended for routine use in the assessment of hypertension among the elderly.

The practicality of using the SMAST and AUDIT to screen for alcoholism among adolescents in an urban private family practice

We assessed the practicality of using the Short Michigan Alcoholism Screening Test (SMAST) and the Alcohol Use Disorders Identification Test (AUDIT) in screening adolescents for alcoholism in a primary care setting. In addition, we sought to determine the prevalence of alcohol use among adolescents, 16-21 years of age, presenting to a private Family Medicine practice for medical care. A consecutive sample of 67 subjects presenting for medical care were asked to complete the SMAST and AUDIT questionnaires. Overall, 52 (78%) of the questionnaires were returned with complete data. Of the 52 patients, 25 (48%) admitted to drinking. Using a "positive" score on either the SMAST or AUDIT as a positive test for alcohol use yielded a sensitivity of 40% and a predictive value positive of 100%. Using a "negative" score on both the SMAST and AUDIT as a negative test for alcohol use yielded a specificity of 100% and a predictive value negative of 64%. Although alcohol use was relatively common considering the age group, using the SMAST and AUDIT to screen for alcoholism is labor intensive and is not practical in this situation. Because patients appeared to misinterpret some questions and were often accompanied to the office by their parents, their answers may not be valid. History of alcoholism taken upon typical office examination and relevant advice appears to be a better alternative to the use of questionnaires in determining the prevalence of alcohol use in this age group.

Nerve conduction velocity and H-reflex recovery in bipolar illness

Bipolar illness may be characterized by dysregulation and dysfunction of biologically active ions and ion pumps, respectively. In an effort to examine whether purported physiologic abnormalities may have functional counterparts, nerve conduction velocities (NCVs) and H-reflex recovery were examined in 7 acutely manic, 11 euthymic bipolar, 13 remitted schizophrenic, and 6 normal control individuals. All electrophysiologic tests were clinically normal. However, euthymic bipolar patients had significantly slower NCVs than either manic or normal individuals. Percent decrement of H-reflex recovery was nonsignificantly increased in manic versus euthymic bipolar subjects. Data analysis suggests lithium was not responsible for these changes. These data indicate that different mood states in bipolar illness are associated with alterations in electroneurophysiologic function.

Standardization of clinical criteria required for use of the 12.5 millimeter barium tablet in evaluating esophageal lumenal patency

BACKGROUND

Although the barium tablet is commonly used in evaluating lumenal patency of the esophagus, the conditions under which the tablet should traverse a normal esophagus have not been established. This study was designed to standardize the minimal criteria required to ensure successful esophageal transit of a commercially available barium tablet in normal subjects.

METHODS

Each of 20 volunteers swallowed a standard 12.5 mm barium tablet under fluoroscopy in the supine, 45 degrees incline, and upright positions. Tablets were swallowed dry and with fixed volumes of water (15, 30, 60, and 100 cc). Success of pill passage into the stomach was determined by fluoroscopy at 20, 40, 60, and 90 seconds.

RESULTS

Successful pill passage correlated significantly with position (passing 17.0%, 66.5%, and 69.7% in the supine, incline, and upright position, respectively; p < .0001) and volume of water ingested (passing 9.1% when swallowing dry, and 38.7%, 55.8%, 70.0%, and 81.6% with 15, 30, 60, and 100 cc of water, respectively; p < or = .004). Duration of time beyond 20 seconds failed to affect rate of pill passage. Ingestion of 60 cc of water in the incline position was associated with a 95% pill passage, a rate significantly greater than any position at lower volumes. Increasing water volume above 60 cc or assuming the upright position did not increase this passage rate further.

CONCLUSIONS

The minimum criteria required to optimize successful transit of a 12.5 mm barium tablet through a normal esophagus is to perform the test in the 45 degrees incline position with 60 cc of water for a period of 20 seconds. Failure of the pill to pass under these conditions may suggest a true structural abnormality of the esophagus.

Quality of life and functional status among homeless men attending a day shelter in Louisville, Kentucky

The homeless present important social and medical problems in most parts of the United States, including urban areas of Kentucky. While some studies have examined the health status of the homeless, very little is known about their quality of life or functional status. In the present study, 188 homeless men attending St. John's Day Shelter in Louisville completed an interviewer-assisted instrument that assessed self-perceived quality of life using the Perceived Quality of Life (PQOL) scale and self-perceived functional status using the Dartmouth COOP charts. The instrument also included questions on demographics and health risk behaviors of the homeless men. The results show that the typical homeless male attending St. John's is an unmarried, white, middle-aged high school graduate who is unemployed. In terms of quality of life, these men indicate general satisfaction with their physical and cognitive abilities, but significantly lower satisfaction with the social aspects of their lives. With regard to functional status, the homeless men report that they function best in terms of physical fitness and ability to perform daily activities. They report lower assessments of overall health, feelings, quality of life, and social support. These results suggest that poor social role functioning among homeless men is a major contributor to their poor quality of life. Thus, improving their health and quality of life may require an emphasis on social services in addition to routine medical care.

Predicting the health-related values and preferences of geriatric patients

BACKGROUND

Those who must make health care decisions on behalf of persons who lack decision-making capacity often have too little information. The purpose of this study was to determine whether and to what degree sociodemographic factors, social support, religious involvement, and functional status served as predictors of the health-related values and preferences of geriatric patients.

METHODS

A retrospective chart review involving 178 cognitively intact patients enrolled at a geriatric clinic at a university medical center was conducted. Patient variables included age, race, sex, marital status, years of education, participation in formal religious activities, self-reported functional status, and adequacy of social and family support. These were compared with responses to a modified version of the Values History questionnaire, an established method of evaluating patient values that includes advance directives.

RESULTS

Patients were likely to value quality (82%) over quantity of life (18%) and the ability to think clearly (64%) over 13 other specific health-related values. They were likely (93%) to want to be taken to a hospital emergency department on losing consciousness or becoming confused. Seventy-eight percent expressed a desire to be resuscitated using cardiopulmonary resuscitation (CPR), and 76% expressed a preference for use of a respirator, if necessary. Most (85%) considered a permanent vegetative state to be worse than death. High functional status predicted a preference for quality of life over length of life and the perception of a persistent vegetative state as worse than death (positive predictive value = 89%). Persons with better social and family support were more likely to accept treatment with CPR or a respirator and less likely to consider a permanent vegetative state to be worse than death. No single patient factor was strong enough to increase the probability of a particular value or preference by more than 17% above baseline.

CONCLUSIONS

Sociodemographic and functional status variables are relatively weak predictors of personal values and directives. This reinforces the importance of routinely eliciting patient values and preferences and of updating the information, particularly following changes in functional status or family support. Baseline information regarding the health-related values and preferences of this primary care geriatric clinic population may provide valuable information about the values and preferences of decisionally impaired older patients.

The role of parkinsonism and antiparkinsonian therapy in the subsequent development of tardive dyskinesia

Tardive dyskinesia (TD) is a side effect of prolonged neuroleptic treatment presenting as abnormal involuntary movements. This troublesome disorder occurs in only 15-30% of patients taking neuroleptics, suggesting that these individuals may be physiologically distinct so as to be predisposed. This study analyzed possible factors contributing to TD development. Fifty patients on depot neuroleptics for more than 7.1 years were prospectively examined for TD and drug-induced parkinsonism (DIP) using the Smith-Trims rating scale for an average of 5 years. The patients were assessed for the severity of the movement and if the movement increased or decreased with respect to neuroleptic dosage, anticholinergic dosage, parkinsonism, and other related factors. Both TD and DIP increased over time. In the patients whose dose of neuroleptic decreased, the increase in TD ratings was not significant. Using a forward stepwise regression DIP was found to increase as TD worsened but did not appear to predict subsequent TD development. Anticholinergic treatment showed a less significant correlation with the change in TD. These results have implications for the management of combined TD and DIP presentation.

Influence of curricular changes in health promotion and disease prevention on residents' behaviors over a five-year period

BACKGROUND

Residents' compliance with guidelines for health promotion and disease prevention (HPDP) often fall short of the ideal.

METHOD

After a year in which faculty developed clinical practice HPDP guidelines, an intervention consisting of curricular changes and chart modifications was planned and pilot-tested in 1985-86 at an ambulatory care clinic of the Family Practice Residency Program, University of Louisville School of Medicine. Approximately 24 residents per year (eight at each level of training) worked in the clinic throughout the study years. The HPDP curriculum required residents to attend 48 one-hour conferences conducted over a three-year period. Four retrospective chart audits were used to measure residents' compliance with the HPDP guidelines during (1) the year before the pilot test (104 charts), (2) the pilot year (113 charts), (3) the year after the pilot test--the first year of full implementation (100 charts), and (4) five years after the pilot test (100 charts). Data from the chart audits were analyzed by using a permutation test for decreasing trend.

RESULTS

Although there was an increase in the residents' compliance with the HPDP guidelines during the pilot year, the residents' HPDP activities tended to return to baseline levels in the following years, despite the ongoing curriculum.

CONCLUSION

The authors conclude that because the frequency of the residents' HPDP activities tended to return to baseline levels, clinical education alone is not enough to sustain residents' compliance with HPDP guidelines.

The results of 20 years of family practice residency training at the University of Louisville

In response to shortages of generalist physicians, especially in rural areas, family practice residency programs were established at both of Kentucky's medical schools. In 1972 a family practice residency program became operational at the University of Louisville. A study was conducted to determine the effectiveness of this program. We were especially interested in those factors that were associated with a physician's choice to practice in rural or urban medically underserved areas. The records of the 100 program graduates were reviewed to determine the physician's gender, ethnic background, hometown, and current practice location. A questionnaire was mailed to program graduates to obtain additional information about factors that influence physician practice location. For the purpose of this study, "rural" was defined as a community of less than 25,000. Sixty-eight of the program's 100 graduates currently practice in Kentucky. Forty-nine graduates serve patients in rural or medically underserved urban areas, and of those, 31 are located in Kentucky. Whites and those from rural hometowns were more likely to practice in rural communities than minorities or those from urban hometowns. However, minorities were more likely than whites to practice in medically underserved urban areas. No association was found between gender and practice location. Initial interest in rural practice and participation in financial aid programs requiring service in a rural area were associated with rural practice location, but participation in rural rotations at the predoctoral or residency training level were not. We conclude that the family practice training program at the University of Louisville has been successful in training generalist physicians to serve rural and medically underserved urban populations.(ABSTRACT TRUNCATED AT 250 WORDS)

Does motor cerebral dominance develop secondary to sensory dominance?

Current research and theoretical frameworks for understanding motor dominance assume that motor dominance is primary. Various developmental clues, however, suggest that the maturation of proprioceptive sensory processing predates that of motor control. We hypothesized that the observed adult pattern of lateralized motor dominance may develop as a consequence of preexisting lateralized "sensory" or "proprioceptive dominance." To test whether motor preference could develop in response to sensory dominance, we investigated sighting eye dominance, eye lid winking, and handedness in 164 individuals. Subjects winked the nondominant eye significantly more frequently than the dominant eye and independently of their handedness, lending partial support to the idea that motor function can develop in response to sensory function. Specific investigation of the development of the proprioceptive system would be needed to evaluate whether lateralization of motor handedness develops as a consequence of "proprioceptive" lateralization.