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Objective: The researchers wanted to determine the weight management experiences of patients in primary care, and what those patients want from their physicians., Study Design: Patients completed a survey in a primary care waiting room. Afterward they were measured for body mass index (BMI)., Population: A total of 410 consecutive adult patients in 2 primary care practices at the University of California, San Francisco, were approached, and 366 (89%) completed the survey., Outcomes Measured: The primary outcomes were patient attitudes about weight loss, previous weight management experiences with their current physicians, and future preferences for weight management within the primary care relationship., Results: Ninety-seven percent of the obese patients (BMI > 30), 84% of the overweight patients (BMI=25-30), and 39% of the non-overweight patients (BMI < 25) thought they needed to lose weight. Forty-nine percent of the obese patients, 24% of the overweight patients, and 12% of the non-overweight patients had discussed weight with their current physicians. The types of weight management assistance that patients most wanted from their physicians were: (1) dietary advice, (2) help with setting realistic weight goals, and (3) exercise recommendations., Conclusions: Although most patients believe they should lose weight, this is often not discussed during office visits. Most patients (especially those who are overweight or obese) want more help with weight management than they are getting from their primary care physicians.

Significant eosinophilia is a prominent feature in Churg-Strauss syndrome but has only rarely been described in Wegener's granulomatosis (WG). We describe two Wegener's granulomatosis patients with > 30% eosinophilia on their initial presentations. Other etiologies that could account for their eosinophilia were excluded. Both patients had pulmonary alveolar hemorrhage, sinusitis, arthritis, high-titer cytoplasmic antineutrophil cytoplasmic antibodies (cANCA), and proteinase-3 antibodies, but no evidence of renal disease. Herein we discuss eosinophilia, the differential diagnosis of pulmonary infiltrates and eosinophilia, the role of cANCA in vasculitis and autoimmune disease, compare Wegener's granulomatosis and Churg-Strauss syndrome, and review possible pathogenic mechanisms.

Public hospitals and clinics in the United States provide health care for the needs of large numbers of people who are medically indigent, homeless, chronically mentally ill, and suffer medical and social disorders associated with poverty. These "safety-net" healthcare providers traditionally struggle with barriers to providing high-quality, patient-sensitive care, including decaying physical facilities, burdensome bureaucracies, underfunded capital equipment and construction programs, and complex, politically driven budgets and governance. However, these same institutions now must compete for their own Medicaid and Medicare clientele because the private sector is marketing to those patients. They also must continue to provide increasing services to growing numbers of uninsured patients. To accomplish this, these institutions must reinvent themselves as patient-focused, high-quality, cost-effective healthcare providers. The Denver Health system is the public safety-net provider for the city and county of Denver. This large public institution has instituted a multifaceted performance-improvement program. The program includes training employees for patient-focused service, implementing continuous quality-improvement practices, instituting clinical pathways, revising the preexisting ambulatory quality-management program, reengineering key aspects of ambulatory clinic services, and redesigning the hospital-based patient-care services. Major successes have been achieved in some initiatives, but not in all. Many key "lessons learned" may guide others.

Nurses are continually promoting health and healthy lifestyles. This contribution requires that nurses understand client values and priorities. Traditionally, women have had responsibility for their own and their families' health. Nurses must recognize and understand the complex influences shaping the value women place on health. The literature indicates that women want to participate actively in their own health care by assuming more responsibility for their health and well-being. This research evolved as a result of nursing student and faculty interactions with mothers of pre-school children enrolled in a Headstart program. During these experiences, observations related to the needs of the mothers included poor health practices (smoking, being overweight), lack of motivation, statements of feeling depressed, difficulty making decisions, feelings of being overwhelmed by parenting demands, powerlessness, and disenfranchisement. This descriptive, correlational study was designed to determine the value of health, incidence of depression, and characteristics of self-esteem among low-income mothers of pre-school children. This sample of convenience was comprised of 133 low-income mothers who responded to a mailed survey. Three instruments were used in the study: the Wallston and Wallston Health Values Scale, the Center for Epidemiologic Studies Depression Scale (CES-D), and the Rosenberg Self-Esteem Scale. Data were analyzed by collection of frequency of response, which was then converted to a percentage. To determine if differences existed in respect to demographic variables, ANOVA (self-esteem and depression) and Chi Square (health) measures were used. Participation in activities outside the home accounted for a significant difference in self-esteem. Mothers involved in activities reported higher self-esteem. The findings suggest that participation in activities may increase self-esteem and lower depression. Over three-quarters (85%) of mothers placed a high value on health. Based on their high valuing of health and the potential for increasing self-esteem through activity, it can be concluded that the women in this sample will benefit from planned health activities. It is also anticipated that, because of the strong relationship between self-esteem and depression, women who participate in these activities will demonstrate lower levels of depression.