Editorials

Physicians play key role in improving women’s health

Thomas C. Meyer, MD, Medical Editor

As we delve into the topic of women’s health, we are honored and flattered to have guest editorials from Helene Nelson, surely one of the most knowledgeable people about health and social services in Wisconsin, and Sue Ann Thompson, who has made valued contributions to the WMJ previously. Both are significant figures in women’s—and men’s—health and we are grateful for their thoughts. Ms Nelson (p 13) reminds us that our counseling can have a significant impact on changing patients’ behaviors and that an extra minute or two spent doing that is well worthwhile. Ms Thompson, in turn, points out that women make over 80% of family health care decisions (p 15) and it behooves us to ensure that they be provided with appropriate information to guide those decisions.


Author Affiliations: Medical Editor

Corresponding Author: Please address correspondence to Wisconsin Medical Society at 608.442.3800

Public Health and physicians: Working together to improve Wisconsin women’s health

Helene Nelson

I congratulate the Wisconsin Med-ical Society and the WMJ and its readers for your interest in promoting the health of all people in our state, and for addressing the specific health care needs of women. I also appreciate the willingness of physicians to serve poor and elderly women through the Medicaid program.



Author Affiliations: Ms Nelson is Secretary, Wisconsin Department of Health and Family Services.


Corresponding Author: Please address correspondence to the Wisconsin Department of Health and Family Services

From Researcher to Provider to Consumer...Outreach Works

Sue Ann Thompson

As scientific evidence points to the significant impact that daily lifestyle choices have on health, individuals are becoming increasingly responsible for their personal wellness. Likewise, individuals must view their relationship with their health care provider as a partnership; doctors make recommendations based on experience and expertise, but the patient must ultimately make the final decision about the course of treatment.



Author Affiliations: Ms Thompson, former First Lady of Wisconsin, is the Founder and President of the Wisconsin Women’s Health Foundation, a non-profit organization established to present women’s health education and outreach programs, support women’s health

Corresponding Author: The Foundation can be reached at 800.448.5148.

Original Research

Forward for Women’s Health: The State of Women’s Health in Wisconsin

Jennifer Whitfield, BA; Lisette Jehn, MS; Katherine Kvale, PhD; Joy Grotsky, RN, MS; Patrick Remington, MD, MPH; Millie Jones, MPH

Because of the magnitude of women’s health issues within the larger context of public health and healthcare systems, this paper was written to help define the current status of women’s health in Wisconsin. Utilizing critical women’s health areas identified by the Wisconsin Women’s Health Foundation and the Wisconsin Division of Public Health, 16 specific measures of women’s health were chosen for this analysis. The most recent data available for each measure were collected with Wisconsin data being compared to national averages as well as to Healthy People 2010: Objectives for Improving Health targets. Wisconsin women fare better than national averages in nine of the selected health measures; however, there are still many improvements to be made in order to meet Healthy People 2010 targets. The areas where the most improvements are needed include binge drinking, tobacco use, diabetes, and stroke mortality. Other significant findings include the lack of uniformly collected data in the areas of domestic violence, osteoporosis, and mental illness.



Author Affiliations: Ms Whitfield is a medical student at the University of Wisconsin- Madison Medical School and a volunteer at the Wisconsin Women’s Health Foundation. Ms Jehn is the Scientific Development Coordinator at the Wisconsin Women’s Health Foundation.

Corresponding Author: Address correspondence regarding this paper to Lisette Jehn, Wisconsin Women’s Health Foundation, 2503 Todd Dr, Madison, Wis 53713, 608.251.1675.

First Breath Prenatal Smoking Cessation Pilot Study: Preliminary Findings

Lisette Jehn, MS; Nicole Lokker, BS; Debra Matitz; Bruce Christiansen, PhD

Despite the many dangers associated with smoking during pregnancy, it remains a salient public health problem for Wisconsin women. The First Breath pilot program was developed in an attempt to reduce rates of smoking during pregnancy among low-income women. Preliminary results suggest that the First Breath counseling-based approach is effective, with a quit rate of 43.8% among First Breath enrollees at 1 month postpartum. Women receiving First Breath cessation counseling also had higher quit rates at every measurement period versus women in a comparison group who were receiving whatever cessation care was available in their county in the absence of First Breath. The First Breath pilot study has demonstrated success in helping pregnant women quit smoking and in creating a model for integration of cessation services into prenatal health care service provision. It is through this success that First Breath is expanding beyond the pilot study stage to a statewide program in 2003.



Author Affiliations: Ms Jehn is the First Breath Program Coordinator and Ms Lokker is the First Breath Program Assistant, both at the Wisconsin Women’s Health Foundation. Ms Matitz is a Consultant and Dr Christiansen is a Managing Consultant, both at APS Healthcare, Inc

Corresponding Author: Address correspondence to Lisette Jehn, Wisconsin Women’s Health Foundation, 2503 Todd Dr, Madison, Wis 53713; 608.251.1675. Funding for the First Breath pilot study was provided by the Wisconsin Tobacco Control Board.

Current Cervical Cancer Screening Practices of Dane County, Wisconsin Primary Care Clinicians

Lucille Marchand, MD; Maureen Van Dinter, MS, CPNP, FNP-C; Marlon Mundt, MS; Wendy Dingel, BS; Gail Klein, CT (ASCP)

Purpose: This study explores clinician Papanicolaou (Pap) smear collection and management strategies in light of current research, guidelines, and recommendations. Methods: Two hundred thirty eligible obstetrician/gynecologists, family physicians, and advance practice nurses in Dane County, Wisconsin completed a survey. Descriptive statistics. Results: The wooden spatula is most frequently (68%) used to collect ectocervical cells; the Cytobrush™ (75%) for endocervical cells. Most clinicians (63%) collect ectocervical cells first, endocervical cells second. Eighty-nine percent of clinicians are familiar with liquid-based Pap smears; 57% use them. Most clinicians (59%) prepare the cervix as needed prior to collecting a sample. Management of inflammation is variable. Forty-five percent of clinicians have no age limit in discontinuing Pap smears; 43% continue after benign hysterectomy. Training for doing Pap smears occurs primarily in residency (89%) or graduate nursing education (83%). Conclusions: Despite current research and guidelines, great variability exists among clinicians in Pap smear collection and management. Textbooks, articles, and clinician training must emphasize optimal collection technique and management to improve Pap smear quality and decrease unnecessary costs.



Author Affiliations: Doctor Marchand, Ms Van Dinte and Mr Mundt are with the University of Wisconsin, Department of Family Medicine, Madison, Wis. Doctor Marchand is Associate Professor; Van Dinter is Distinguished Nurse Practitioner; Mundt is Statistician. Ms Dingel is a med

Corresponding Author: Reprint requests to Lucille Marchand, MD, BSN, Associate Professor, University of Wisconsin, Department of Family Medicine, 777 S. Mills St, Madison, Wis 53715-1896; 608.263.4905; fax 608.263.5813; e-mail lmarchan@ fammed.wisc.edu.

Strangulation Injuries

Maureen Funk, BS; Julie Schuppel, RN

Strangulation accounts for 10% of all violent deaths in the United States. Many people who are strangled survive. These survivors may have minimal visible external findings. Because of the slowly compressive nature of the forces involved in strangulation, clinicians should be aware of the potential for significant complications including laryngeal fractures, upper airway edema, and vocal cord immobility. Survivors are most often assaulted during an incident of intimate partner violence or sexual assault, and need to be specifically asked if they were strangled. Many survivors of strangulation will not volunteer this information. Accurate documentation in the medical chart is essential to substantiate a survivor’s account of the incident. Medical providers are a significant community resource with the responsibility to provide expert information to patients and other systems working with survivors of strangulation. This case study reviews a strangulation victim who exhibited some classic findings.



Author Affiliations: Ms Funk, a social worker, is coordinator of the Gundersen Lutheran Medical Center Domestic Abuse/Sexual Assault Program, La Crosse, Wis. Ms Schuppel is a program coordinator for SANE, Gundersen Lutheran Medical Center, La Crosse, Wis.

Corresponding Author: Please address correspondence to Wisconsin Medical Society at 608.442.3800

Hyperemesis Gravidarum: Literature Review

Binu Philip, DO

Nausea and vomiting commonly occur in pregnant women. Hyperemesis gravidarum is a severe form of nausea and vomiting rarely occurring in pregnancy. Between 0.3% and 2% of all pregnant women suffer from hyperemesis gravidarum. The objective of this paper is to review current literature focusing on the definition, incidence, etiology, prognosis, and treatment of hyperemesis gravidarum. A MEDLINE search of the English literature from 1982 through 2001 utilized the keywords hyperemesis gravidarum, nausea, and pregnancy. Current data pertaining to the epidemiology, etiology, clinical presentation, various treatment modalities, and prognosis are presented. Review of the literature supports that hyperemesis gravidarum is a multifactorial disease. The cause is unknown. Various treatments are recommended although few studies have evaluated effectiveness. A case report of molar pregnancy presenting with hyperemesis gravidarum introduces this literature review.



Author Affiliations: Doctor Philip is with the University of Wisconsin, Department of Family Practice, Eau Claire, Wis.

Corresponding Author: Address reprint requests to Binu Philip, DO, 807 S Farwell, Eau Claire, Wis 54701

Osteoporosis Prevention in Primary Care

Sarina Schrager, MD

Osteoporosis is a devastating disease that is increasing in prevalence as our population ages. Prevention of osteoporosis is important to decrease osteoporosis-related fractures. Primary care practitioners are in the ideal position to actively screen women for osteoporosis and counsel them on risk reduction. This paper reviews population-based strategies for osteoporosis prevention and identification of high-risk women in a primary care practice. Practical methods of incorporating osteoporosis prevention counseling into a busy practice are presented.



Author Affiliations: Doctor Schrager is with the Department of Family Medicine, University of Wisconsin.

Corresponding Author: For reprint requests, contact Sarina Schrager, MD, University of Wisconsin Department of Family Medicine, 777 S Mills St, Madison, Wis 53715; 608.241.9020; e-mail sbschrag@wisc.edu

Your Practice

Finding financial answers to caring for an aging adult

Debbie Oswald, Financial Consultant, SVA Planners, Inc., Registered Investment Advisor

With people living longer and health care costs rising at a staggering rate, caring for an aging spouse, parent, or relative is taking a financial toll on many families. In fact, the Journal of the American Medical Association recently found that one third of families caring for a seriously ill relative spend most or nearly all of their life savings. In addition, more and more families are facing this financial, and often emotional, crisis. According to the American Association for Retired Persons, approximately one in four households is now providing caregiving to a relative or friend aged 50 and over.



Author Affiliations: Ms Oswald is a fee-only financial consultant with SVA Planners Inc., Registered Investment Advisor. She assists clients with a full spectrum of financial services, including creating financial plans, providing investment consulting, and managing assets. O

Corresponding Author: For more information, call 866.442.3810.

Your Profession

New research, perspectives required to understand impact of gender on health

Philip M. Farrell, MD, PhD

Everyone has known for quite some time that some diseases occur disproportionately in women, while others occur more frequently in men. Until very recently, we assumed that hormones and reproductive systems alone were responsible for these differences. Ever so slowly, however, the medical and research communities are beginning to recognize that underlying biological factors play a critical role in such discrepancies.



Author Affiliations: Doctor Farrell is Dean, University of Wisconsin Medical School, and Vice Chancellor for Medical Affairs at UW-Madison.


Corresponding Author: Please address correspondence to the Wisconsin Medical Society

Task force report Part III Ways to reduce barriers

Wisconsin Medical Society Task Force on Professionalism

The first two installments in this series documented the stress facing our profession and the need for the medical profession to recover. We defined professionalism and listed the barriers to implementation of professionalism. In this issue we address how physicians and patients can work together to reduce the barriers we all face. We document a variety of strategies designed to improve the physician/patient relationship. Many of these strategies have in common the idea of promoting a better dialogue, be it with patients, with businesses, in our communities, or with other professionals. This is just a beginning though. This fall, we will continue the dialogue with a Patient Congress. By bringing together patients and physicians we hope to directly work toward improving and strengthening the special relationship that patients and physicians have historically had. More information on the Patient Congress will appear in a future issue of the WMJ.


Author Affiliations: Wisconsin Medical Society

Corresponding Author: Please address correspondence to the Wisconsin Medical Society

Book Review: 184 Years of Medicine in Brown County

Reviewed by Earl Thayer

Between those two paragraphs Benson L. Richardson, MD, a retired internist-endocrinologist from Green Bay, delivers a eulogy on the death of independent medical practice in his 141-page book History of Medicine in Brown County, Wisconsin 1816-2000. Under the subtitle A Transition, Independent Medical Practitioner to Multispecialty Clinic Provider, Richardson expresses frequent longing for the “golden years” of patient-doctor relationships, yet nowhere does he suggest that patients aren’t better off for the enormous changes that have come to health care since those years of which he writes with such aching nostalgia.



Author Affiliations: Earl Thayer served the Wisconsin Medical Society for 35 years, 15 of those as its Secretary/General Manager. He also served as the President of the American Association of Medical Society Executives in 1976-1977. He authored an award-winning history of th

Corresponding Author: Please address correspondence to the Wisconsin Medical Society