Helicobacter pylori is categorized into two phenotypes on the basis of the presence or absence of the CagA protein. CagA protein-positive H. pylori are more closely associated with peptic ulcer disease and cancer. Whether CagA-positive strains are similarly represented among racial or ethnic groups in northern California was investigated. Sera from 152 H. pylori-infected healthy young adults were tested by ELISA for IgG against CagA. CagA antibodies were detected in 79.4% of blacks, 63.8% of Hispanics, and 50% of whites. After adjusting for demographic factors, blacks had significantly more infections with CagA-positive H. pylori than did whites (odds ratio [OR] = 5.0; 95% confidence interval [CI] = 1.6-15.3) or Hispanics (OR = 5.5, 95% CI = 1.9-16.0). Also, there was a higher prevalence of CagA in persons born in developing countries than in persons born in industrialized nations (OR = 3.5, 95% CI = 1.3-9.4). This suggests either a genetic predisposition of racial or ethnic groups to infection with particular H. pylori phenotypes or transmission of H. pylori within relatively segregated population groups.

Objective: To determine whether physician gender and patient gender influence the process of communication and parent and child satisfaction during pediatric office visits. DESIGN: Content analysis of videotaped pediatric office visits.

Setting: University-based pediatric primary care practice.

Subjects: Videotaped communication between 212 children, ages 4 to 14 years, parents, and physicians. Thirty-eight percent were child health supervision visits, and 62% were for the management of minor or chronic illnesses.

Main Outcome Measures: An established coding system of physician-patient communication and measures of parent and child satisfaction with medical care.

Results: Female physician visits were 29% longer than those of male physicians (P .001). Compared with male physicians, female physicians engaged in more social exchange (P .01), more encouragement and reassurance (P .01), more communication during the physical examination (P .05), and more information gathering (P .01) with children. Male and female physicians engaged in similar amounts of discussions regarding illness management. Children were more satisfied with physicians of the same gender (P .05), while parents were more satisfied with female physicians (P .05).

Conclusions: Children communicate more with female than with male physicians and show preferences for physicians of the same gender. These findings are consistent with communication patterns in adult patients and may have a significant influence on gender disparities in health care. Efforts at improving the process and outcome of medical care should address gender differences.

Now in its Third Edition, this manual is an accessible, reliable source of guidance on clinical problems that are frequently encountered in the adult ambulatory care setting. More than 90 expert contributors from every branch of clinical medicine provide practical, knowledgeable answers to the questions arising in day-to-day patient care.Coverage encompasses all organ systems, with additional sections on constitutional symptoms, psychiatric and behavioral problems, infectious diseases, women's and men's health issues, and health maintenance. Chapters are either symptom-oriented or disease-oriented, depending on the way a condition presents in practice. Each chapter focuses on the questions clinicians encounter when caring for patients, such as how often the condition occurs, its natural history, and the effectiveness of preventive and therapeutic interventions. The authors offer succinct, practical advice and also explain the rationale for their recommendations. Annotated references at the end of each chapter direct the reader to additional information.

Now in its Third Edition, this manual is an accessible, reliable source of guidance on clinical problems that are frequently encountered in the adult ambulatory care setting. More than 90 expert contributors from every branch of clinical medicine provide practical, knowledgeable answers to the questions arising in day-to-day patient care.Coverage encompasses all organ systems, with additional sections on constitutional symptoms, psychiatric and behavioral problems, infectious diseases, women's and men's health issues, and health maintenance. Chapters are either symptom-oriented or disease-oriented, depending on the way a condition presents in practice. Each chapter focuses on the questions clinicians encounter when caring for patients, such as how often the condition occurs, its natural history, and the effectiveness of preventive and therapeutic interventions. The authors offer succinct, practical advice and also explain the rationale for their recommendations. Annotated references at the end of each chapter direct the reader to additional information.

The Writing Group for the Bypass Angioplasty Revascularization Investigation (BARI) Investigators (Alderman EL, Andrews K, Bourassa M, Brooks MM, Chaitman BR, Detre K, Faxon DP, Follman D. Frye RL, Hlatky M, Jones RH, Kelsey SF, Rogers WJ, Rosen AD, Schaff H, Sellers MA, Sopko G, Sutton-Tyrell K, Williams DO).

This book presents cutting edge thinking on the management of health care organizations. Practical and conceptual skills are taught to help students focus on more efficient health care delivery. Also covered is development of leadership skills, future trends in health care management, guidelines for designing effective work groups and a section on managing conflict.