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It has been suggested that internists and family practitioners have somewhat different "disease" perspectives, which may be generated by use of different explanatory models during medical training (pathophysiological vs. biopsychosocial, respectively). This article explores differences between internists and family practitioners in their suggested diagnoses, level of diagnostic certainty, test and prescription ordering, when encountering exactly the same "patient" with coronary heart disease (CHD). Internists were more certain of a CHD diagnosis than family practitioners and were more likely to act on this diagnosis. Family practitioners were more likely to diagnose (and were more certain of) a mental health condition. While many physicians simultaneously entertain several alternate diagnoses, diagnostic certainty has shown to have an important influence on subsequent clinical actions, such as stress testing and prescription of beta blockers. These results may inform future educational strategies designed to reduce diagnostic uncertainty in the face of life-threatening conditions, such as CHD.

Purpose: We investigated the association between lower urinary tract symptoms and chronic illness, such as heart disease, diabetes, hypertension and depression, in men and women. In addition, we determined whether a dose-response relationship exists in the association between the severity and duration of urological symptoms and major chronic illnesses., Materials and Methods: The Boston Area Community Health Survey used a multistage stratified design to recruit a random sample of 5,503 adults who were 30 to 79 years old. Urological symptoms in the American Urological Association symptom index were included in analysis., Results: Statistically significant associations that were consistent by gender were observed between depression and all urological symptoms. Nocturia of any degree of severity or duration was associated with heart disease in men and with diabetes in women. In men a dose-response relationship was observed for the association of symptom severity and/or the duration of urinary intermittency and frequency with heart disease, and for the association of urinary urgency with diabetes. In women a history of heart disease was associated with a weak stream and straining, while a history of hypertension was associated with urgency and a weak stream., Conclusions: Results indicate a dose-response relationship in the association of the severity and duration of urological symptoms with major chronic illnesses. An association between urinary symptoms and depression was observed in men and women. In contrast, the association between lower urinary tract symptoms and heart disease, diabetes or hypertension varied by gender, suggesting different mechanisms of association in men and women.

Context: Low sex hormone levels have been associated with the metabolic syndrome (MetS)., Objectives: Our objective was to determine whether the association between sex hormone levels and MetS varies by race/ethnicity among men and to investigate the relationship of sex hormones and individual components of MetS., Design: We conducted a population-based observational survey., Participants: A multistage stratified design was used to recruit a random sample of 2301 racially/ethnically diverse men age 30-79 yr. Blood samples were obtained on 1899 men. Analyses were conducted on 1885 men with complete data on total testosterone (T), free T, and SHBG., Interventions: There were no interventions., Main Outcome Measure: MetS was defined using a modification of the Adult Treatment Panel III guidelines. The association between MetS and sex hormone levels was assessed using odds ratios and 95% confidence intervals estimated using logistic regression models., Results: A strong inverse association was observed, in both bivariate and multivariate analyses, between hormone levels and MetS. The odds of MetS increased about two-fold with a 1 sd decrease in hormone levels. The association between sex hormones and MetS was statistically significant across racial/ethnic groups. Although the magnitude of this association was largest among White men, racial/ethnic differences were not statistically significant. The strength of the association of sex hormones with individual components of MetS varied; stronger associations were observed with waist circumference and dyslipidemia and more modest associations with diabetes and elevated blood sugar., Conclusions: A robust, dose-response relationship between sex hormone levels and odds of the metabolic syndrome in men is consistent across racial/ethnic groups.

Background: A randomized trial was conducted to test the effectiveness of a videotape for increasing mammography screening among a multiethnic sample of older women., Methods: A multiethnic sample of Caucasian, African-American, and Hispanic women between the ages of 50 and 70 was recruited from Resident Lists compiled by the State of Massachusetts. After completing a baseline questionnaire, women were randomized to receive either a videotape or pamphlet about mammography and recontacted at 2 and 12 months after baseline to assess attitudes, beliefs, and mammography screening. A total of 581 women completed questionnaires at all three time points., Results: At baseline, approximately 75% of women reported having a mammogram in the past year and 90% reported having one in the past 2 years. Rates did not differ between groups. At the 12-month follow-up, mammography rates, adjusted for baseline screening, were 80.4% in the video and 74.8% in the pamphlet group. Logistic regression analysis of mammography at 12 months (within past year vs. >1 year ago) controlling for baseline mammogram produced an odds ratio of 1.48 for the video group that was not significantly different from unity (95% CI = 0.95-2.28)., Conclusions: The videotape had a small effect on increasing mammography screening. Although the effect was smaller than more intensive interventions, the video is a convenient, low cost, and easily implemented method to increase mammography screening.