Pap smears involve the collection of cells around the cervix and are used to detect irregularities that may indicate cervical cancer. Mammograms find breast abnormalities that may be cancerous by taking an X-ray of the breast. According to medical guidelines, Pap smears should be performed annually in sexually active women or in women age 18 or older, and mammograms should be performed yearly in women over the age of 40. Both screening methods can detect cancers at an early, more treatable stage.

Previous studies have also shown that obese women receive fewer medical services to prevent disease than do non-obese women.

78% of obese and overweight women aged 17 to 74 reported having had a Pap smear in the previous 3 years, compared with 84 percent of normal-weight women of the same ages. In women aged 50 to 75, 64 percent of overweight women and 62 percent of obese women had received mammograms in the previous 2 years. In contrast, 68 percent of normal-weight women in this age group reported having been screened for mammograms.

Compared to women who are not overweight, obese women face higher rates of death from breast and cervical cancer. Obesity is also associated with an increased risk of dying from cardiovascular disease, including heart disease and stroke.

“It’s my feeling that women who are overweight and obese have lower self-esteem and poor self-image, which may influence their decisions,” said the study’s lead author, Christina C. Wee, M.D., M.P.H.

Wee suggested that these factors might make women more reluctant to undergo screening procedures. Wee also hypothesized that the constraints of the current healthcare system may limit the time doctors can spend counseling patients on the importance of breast and cervical cancer screening.

“I hope that as the results of this study are publicized and as awareness about this disparity is raised,” Wee said, “physicians will spend more time making sure that women, especially overweight women, are informed about the benefits of screening.”

An editorial accompanying Wee’s report expressed some criticism of the study and cautioned against over-interpreting the findings.

“The study by Wee and colleagues must be confirmed in other patient groups by using methods other than self-report,” said Dr. Russell Harris, M.D., M.P.H. of the University of North Carolina School of Medicine. He emphasized the need for effective communication between patients and their physicians.

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One place of business, two men exposed to an extremely rare strain of anthrax. Do those numbers add up to terrorism? The world of medical science may only be able to provide part of the answer.

The disease itself doesn’t leave a telephone card to let doctors know where it came from, said Dr. Martin Hugh-Jones, a professor at Louisiana State University and a leading anthrax expert. Instead, the clues lie in the circumstances.

“Basically, what gives these things away is the wrong thing happening in the wrong place at the wrong time,” Hugh-Jones said.

Until last week, only 18 cases of inhaled anthrax had been diagnosed in the country in the last 100 years, most recently in 1976. But now — less than a month after the Sept. 11 attacks — one man is dead from inhaled anthrax and anthrax bacteria has been found in the nasal passages of one of his co-workers and in the Florida newspaper building where they both worked.

U.S. Attorney General John Ashcroft announced today that the FBI is investigating the incidents to see if terrorism was behind them.

The Sun, became ill from an inhaled strain of anthrax. He died on Friday.

At the time, the U.S. Centers for Disease Control and Prevention said the case could simply be an isolated incident. But health officials announced today that they had detected anthrax in another Sun employee.

The co-worker, who had been hospitalized for pneumonia, apparently hasn’t developed the disease. According to news reports, he is 73 and expected to survive.

A company official told the Associated Press that the latest victim worked in the company mailroom.

Officials also found anthrax bacteria on a computer keyboard in the tabloid newspaper’s building in Boca Raton.

The anthrax cases are unprecedented, and the investigation will be too, experts said. One of the first steps will be to determine what the two victims have in common.

“You take these clues, and you track like mad,” said Dr. Philip Brachman, a professor at Emory University. “You [test] those environmental areas where these two people would have had contact with each other. I’m sure they’re looking at the office where they worked very carefully.”

Although the strain of anthrax in question is inhaled, it is not considered to be contagious, said Brachman, who helped develop an anthrax vaccine in the 1950s and 1960s. The anthrax bacteria bypass the lungs — meaning they cannot be exhaled through respiration or coughing — and instead attack the lymph nodes around the lungs, Brachman said.

Victims of inhaled anthrax develop the disease within days or weeks of infection. Then, within a day or two after developing initial symptoms, they may begin to have breathing problems and bleeding. The death rate is unclear but was very high in the days before antibiotics were common. In 1979, 79 people inhaled the bacteria in an accident at a Soviet military facility, and 68 died.

Normally, tests for anthrax are fairly quick and take only six to eight hours, said Hugh-Jones. The U.S. Navy has developed a test that is even faster; it takes just five minutes, he said.

If investigators do determine that humans are behind the anthrax outbreak, they will have to consider possibilities other than international terrorism, experts said.

“Is there someone else with a motive to contaminate them or the building? It doesn’t have to come from Osama bin Laden or Saddam Hussein,” said Samuel Watson, director of the BioMedical Security Institute at the University of Pittsburgh and a former national security official in the vice presidential administration of George H.W. Bush, the president’s father.

Watson said he also wondered why a terrorist would choose South Florida for an attack instead of New York City or Washington, D.C. “It could be someone developed this stuff and wanted to see if what they have grown actually worked. It’s just a real mystery.”

Although the past will be helpful in determining the cause of the anthrax cases, the future may settle the issue for good.

“If it’s terrorism, one would think that there’d be more cases,” Brachman said.

While some club professionals might be concerned that using high-tech equipment in a club setting might eliminate the human interaction with staff, it should be noted that equipment not supported by “high touch” interaction with staff is usually unsuccessful with members. Members want interaction, support, encouragement and compliments. They also want accurate, usable information. High tech does not have to be exclusive of high touch.

High-tech equipment should provide reports that are easily understood by members, and should also provide information that is meaningful and comparative. This must be followed with an understandable explanation by staff members that responds to what members want to know.

If this information and an explanation are not available, high-tech devices might gain initial interest from a member because they are new, but that interest will be short-lived.

High-tech asset

Clubs of the 21st century will increasingly include high-tech equipment that allows and enhances high-tech support from trained staff. Additionally, compact, user-friendly equipment that provides accurate information will be an asset to clubs. Technology that relates to member performance and progression will be paramount to a club’s success. Health club owners and managers should embrace technology that will help them to meet their members’ needs.

(Just now, should I have not capitalized “Dude?” It’s not really a proper noun, but then again, it’s being used as a name. I tried to look up “Dude etiquette” in my Chicago Manual of Style but it wasn’t addressed. I think I’ll not capitalize it from now on. There is only one time it should be capitalized and that is when I discuss my aunt who is actually called Dude. I’ve never heard her real name and I couldn’t tell you what it is. All I know is that when she was little, my mother and her sisters called her “Doodle-bug” and the nickname just shortened over time to “Dude.” So, yes folks, it’s true. I have an aunt named Dude and although this caused a bit of confusion while growing up as to what a dude really is, I’m quite proud of this fun Rob-family fact.)

Once again, I just entirely love Shii Ann’s words, “Robb, idiot that he is, he talks so much. There is no way a logical thought goes through his brain, ’cause his mouth is always flapping.”

Robb continues his rant as Erin and several others look at him like he’s that embarrassing uncle at a wedding, “We got beat today, dude. But it wasn’t by somebody better than us. Ok, I’m not going to be a sore loser. We lost, dude. We lost by a bunch of rules. You know what, though, who gives a sh**. Because I got a good shot at old homeboy from the backwoods and big Teddy wasn’t so big. That’s what I’m saying.”

There are so many things in this one little paragraph to comment about! In the same breath, he mentioned that he wasn’t going to be a sore loser and that they lost only by a bunch of rules. I guess that maybe he was hoping that his team could stand anywhere and push people off while the other team was allowed only to do it in the small attack zone. Damn those rules. Just like football and baseball. People should be allowed to just run all over the field and score touchdowns in either end zone and hit home runs from anywhere they wanted.

And then he had to somehow turn it around so that in his mind he won. “I lost the challenge but I pushed off a little guy a foot shorter than me and even though Ted flipped me 3-feet into the air, he wasn’t so big. That’s what I’m saying.”

But it didn’t end there. He played down the reward, like it wasn’t really anything he would’ve wanted. “I was a little bit disappointed when I saw what the reward was. I mean it could’ve been useful for the Red Berets maybe help us with our shelter. But otherwise, I was hoping it would be like a big turkey or something.”

It’s so easy to make fun of Robb. And what makes it so easy is that I don’t have to do anything except print what he says.

By the way, the “dude” count is at least 3 in this episode alone, not counting any that spewed forth during the challenge. I imagine fraternities have already devised a drinking game based on Dude Spewage.

There is a six-lane, 25-yard lap pool that is used for individual exercise and youth and master team competitions. Akron General also lets the local high school swim team use the pool for practices and meets. A separate therapy pool is used for warm-water exercise classes and the Aqua Arthritis program. The center’s gymnasium hosts basketball and volleyball tournaments and is used by cardio therapy patients. Gym facilities include a 15,000-square-foot fitness floor with 200 pieces of cardiovascular and resistance-training machines, and a separate 2,000-square-foot free-weight area. The two aerobics studios have suspended flooring and are used for 70 classes each week, including high- and low-impact aerobics, yoga, tai chi, extreme cycling and boxercise. Additional features include a three-lane indoor track, sauna, steam rooms and locker rooms. KidStyles, a children’s fitness program, and babysitting services are provided as well.

This special combination of medically-based programs and superior physical design has been very popular. After less than two years of operation, LifeStyles has more than 6,000 members, including many couples and families.

This is due in part to a highly successful pre-sale campaign that offered discounts on the center’s one-time enrollment fee, which helps pay for a health screening and a meeting with an exercise physiologist.

LifeStyles has been able to positively impact the lives of many mature and formerly sedentary people in the Akron area. In fact, its attrition rate is only 16 percent compared to an industry average of 45 percent. The center’s unique building design provides a physical and visual flow that connects activities and creates a supportive community environment for all of its members. When you add in the highly qualified staff and the hospital’s standards for cleanliness, it’s no wonder that LifeStyles has become Fitness Management’s award-winning facility design this year

But, before vilifying a potential cause for precocious puberty, we must be sure that the phenomenon exists. In order for researchers to show an earlier onset of puberty, they must get reliable developmental data pertaining to girls in the present and past.

Herman-Giddens measured sexual characteristics in modern girls. Her subjects, however, all visited participating pediatric practices and thus did not constitute a random sample. Likewise, the data from the past come from Marshall and Tanner’s research, which examined only girls at a British orphanage. Their data were not derived from a random sample either and thus cannot be used as a reliable norm reference to Herman-Giddens study.

Further, according to Herman-Giddens, while some secondary sexual characteristics — namely pubic hair and breast development — occur earlier in girls, the age of menarche (the first menstrual period) has remained constant for the past 40 years in white girls and has decreased by only a year in black girls. This data suggests that puberty is becoming a longer process that starts — but is not completed — earlier.

Despite a lack of certainty behind the occurrence of precocious puberty in girls, activists point disapproving fingers at a number of chemical and environmental factors they claim are likely causes of the hormonal abnormalities responsible for premature sexual development. In fact, last week Environmental Media Services (EMS) hosted a conference in Washington, D.C., searching for causes of early puberty. Speakers at the conference identified possible causes ranging from obesity to number of males in a household.

Not surprisingly, at the top of conference’s list of probable causes were environmental chemicals called phthalates. Phthalates have long offended the ideologies of many environmentalists. Associating phthalates with precocious puberty appears to be the latest attempt of activists to force unnecessary regulations on safe and beneficial chemicals. Phthalates are used as softeners in plastics allowing for the production of products ranging from medical devices to nail polish.

EMS speakers label phthalates as “endocrine disruptors,” exogenous chemicals that interfere with the synthesis or function of hormones. However, epidemiological data fail to support phthalates’ supposed adverse effects in humans. While some assert that “endocrine disruptors” act as estrogenic mimics to promote earlier development, there is no evidence to support this theory.

If puberty in girls is in fact starting earlier than in the past, the cause is likely a combination of biological, psychological and environmental factors. Obesity is the most significant factor in the opinion of most scientists because heavier girls usually reach puberty earlier than smaller girls. Since obesity in young girls is on the rise in the United States, it should receive the bulk of our attention, rather than chemicals with contrived associations with precocious puberty.

Until further research shows a causal relationship to sexual development, nothing is gained by avoiding chemicals and products otherwise known to be safe and, in the case of phthalates, beneficial. Anguishing over putative environmental chemical effects points concerned parents in the wrong direction. They would do their daughters more good by helping them stay active and slim.

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The 55,000-square-foot Life-Styles is an integral part of the 198,000-square-foot Akron General Health and Wellness Center. Located in a western suburb of the Akron metropolitan area, the Wellness Center contains a wide range of services. These include the Women’s Center (devoted to health education for women), Reflections (a specialized facility for breast health), the Consumer Medical Resource Library, a restaurant, spa, conference center and 37,000 square feet of office space for physicians. Also provided are complete diagnostic programs and facilities for sports medicine, physical therapy, cardiopulmonary rehabilitation and outpatient surgery. What makes the Wellness Center unique is that all of these facilities utilize the same staff and fitness equipment. Rather than putting independent services side by side, everyone uses the resources of the LifeStyles and benefits from the same team of specialized experts. The end result is a highly successful and profitable facility that gives new meaning to the term comprehensive care.

This combination of services has provided a continuum of care that benefits members and management alike. Usually, once hospital patients finish their reimbursable therapy, they are on their own. There is no connection with the health maintenance and disease prevention programs that can keep patients healthy in the long term.

“At LifeStyles, members continue to receive services from the staff that helped them get well in the first place,” notes Douglas Ribley, director of fitness and wellness for Akron General. “Also, if a member develops muscular or skeletal problems while at LifeStyles, physical therapists and other professionals are here to help.”

This has proven to be an important benefit for members, the majority of whom had never before belonged to a health club. With an average age of 49, many members had been sedentary for more than half of their lives. In fact, some 60 percent of the center’s membership is considered to be “high risk” and suffers from high blood pressure, obesity, diabetes, arthritis, or other joint and muscular/skeletal problems. These individuals are usually more comfortable exercising at a medically supervised facility, and many even had their babies at Akron General or had gone there when they were sick. They welcome the opportunity to continue their association with the hospital, finding value in the LifeStyles’ service and its focus on safety and cleanliness. The use of shared space, equipment and personnel has enabled the facility to deliver a high-end product at an affordable price.

Childhood Abuse
Victim of psychological (insults or threats), physical (pushing, slapping, hitting), or sexual (any form) abuse.
Witnessed substance abuse, mental illness, violence or criminal behavior in the household.

Adult Health Risks
Severe obesity
Depression or attempted suicide
Drug or alcohol abuse
Sexual promiscuity
Diagnosed with cancer, stroke, heart disease, diabetes, or chronic bronchitis/emphysema.

A strong relationship was found between the number of childhood exposures and the number of health risk factors.

Eighty-six percent of the participants who reported exposure to four or more categories of childhood exposure had at least one risk factor as adults: 56% of those with no childhood exposures had no risk factors.

Child abuse is an atrocity that can have lifelong effects on physical and emotional health and well-being. If you suspect child abuse, report it to the proper authorities immediately.

Before the Visit:
1. Create your health history. It’s not enough to rush through a form in the waiting room while you’re distracted; take the time to do your own record in the relative quiet of home when information is more accessible to you. Wallis’ recommendations include:
your personal situation, from who your insurance carrier is to what triggers stress in you
the major health issues of close family members
your record of injuries, accidents, surgeries, harmful exposures
copies of lab reports, tests, dates of immunizations
a system to keep the records available and up-to-date

2. Analyze your present illness and chief complaint. Dr. Wallis suggests answering questions as specifically as you can, including:
When did the symptoms start?
How have they changed?
What makes them better, or worse?
What is the precise location of the problem?
What questions do you want the doctor to answer?

3. Prepare a list of questions that you want to bring with you to the doctor. Prioritize them so that, given time constraints, you can ask the most important questions first.

4. Spend time and effort to find the right doctor at the outset, said Keene. That includes doing the following:
Self-analysis — For example, would you rather cool your heels in the waiting room so you have more time in the office, or do you want a doctor who runs a tight ship and gets you out quickly? If you have a serious illness, do you want a doctor who sticks with the standard, or one who aggressively pushes for everything that is possible?

Competency check — Is the doctor board-certified and experienced in your particular issues?

“Face time” — Meet the doctor in person when you’re fully clothed and healthy. Ask direct questions that concern you about the practice. Yes, people do go and interview doctors beforehand. Note: find out if you have to pay for the visit.

During the Visit:
5. State your symptoms or ask your questions all at once. What often happens, said Keene, is that the doctor is finished and walking out the door when the patient says something like, “Oh, one more thing. I’ve also been getting dizzy a couple of times a day. Is that a problem?” It’s unfair to do that, she said. And extremely frustrating for the doctor, Wallis said. If you have more concerns, schedule another appointment or a follow-up call.

6. Speak up if something about the visit bothers you. For example, if you hate those paper gowns that leave you feeling chilled and vulnerable, don’t seethe or shrink. Politely and clearly tell the doctor that if it is not convenient for the practice to carry other types of cover-ups (for example, flannel ones) then you would prefer discussing your condition after the exam, fully clothed.

7. Understand the diagnosis, prescription and treatment. Ask for an explanation in language you can understand. Basic, but not condescending, works for most. But if you are well versed in your condition, let your doctor know that the conversation matches your level of knowledge. Make sure you understand the treatment plan and any prescriptions. If you don’t know what you’re taking, and when, how can you be sure your prescription was filled accurately?

After the Visit:
8. Follow the treatment plan. Often patients do not follow instructions and then come back to the doctor with the same symptoms. It can be one of the most frustrating aspects of treating patients, Wallis said. “Doctors are taught to take it stoically, be patient, repeat things.” They may get through it, but how are you being helped if you don’t follow through on the best plan the doctor has devised for you?

9. Find out when the doctor takes phone calls and when yours are likely to be returned. There are often questions remaining after a visit, results of tests, etc. Leave the numbers where you can be reached and when. It is very difficult to reach anyone in these busy times, so make the effort to be available and learn when the doctor is, too. Sometimes it helps to use your primary care doctor — who may be more willing and able to explain matters — as the intermediary in getting test results rather than speaking to the specialist, Wallis said.

10. Acknowledge work well done. If you find a doctor you like to work with, “Care for the doctor,” by doing such things as complying with directions and not abusing the amount of time you take after hours on the phone, Wallis said. Many good physicians are retiring at the peak of their profession and going into other types of medical work. It’s tough in the trenches, she said. On the other hand, Keene said, “Kindness, thank you notes and words of appreciation lubricate all human relationships.”

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Further, he said, “In a tightly run managed care setting, the average outpatient visit with a primary care physician is six minutes.”

This comes at a time when the whole nature of the visit to the doctor has changed for many patients. It used to be that the greatest causes of suffering and death were acute diseases, especially infectious ones, said Ludmerer. You got pneumonia, went to the doctor, did what you were told. “That allowed for a more paternalistic, authoritarian role for the physician and a more passive one for the patient,” he said.

Now, the prevalence of acute diseases has been overtaken by chronic ones – such as cancer and cardiovascular disease — that may not be cured, but can be managed and controlled over time. They call for patient involvement that is greater than ever, including reading about medical issues on the Internet and in print and preparing questions based on that information.

“Best results are obtained when patients are motivated and become knowledgeable about matters like what to do to prevent a complication,” he said.

Given all of this, you may well find yourself needing more of an information exchange with your doctor at the same time that you have fewer minutes in which to get it.

It’s a challenge. But rather than being a disappointed patient, become a smarter one. That calls for taking steps before, during and after your visit with the doctor.

First of all, a good office visit starts at home, said Dr. Lila A. Wallis, clinical professor of medicine at Weill Medical College of Cornell University in New York City and past president of the American Medical Women’s Association (AMWA) an organization of female physicians and medical students.

She recommends that you prepare and maintain a detailed, accurate record of your health and your family’s health. In her book, “The Whole Woman: Take Charge of Your Health in Every Phase of Your Life” (Avon, 1999, $17.50), she provides a format on how to do that. If it sounds like a lot of work, consider whether it isn’t just as important to keep track of your health as your tax records or repairs on your car.

“You not only know what’s going on with yourself, you are a better patient,” Wallis said.

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