Family practice research journal最新文献

Objective: The purpose of this survey study was to test female family practice outpatients for an association between depression and cigarette smoking.

Methods: The survey consisted of demographic items including questions on smoking, and an eight-item self-report depression screening instrument. Eighty percent of the women (ages 18-91) approached agreed to participate in this study (N = 695).

Results: Thirty-two percent scored positive for depression and 28% smoked cigarettes. Cigarette smokers had significantly higher depression scores than did nonsmokers, and heavier smokers (> 10/day) had higher scores than did smokers of 10 or fewer cigarettes/day.

Conclusion: There appears to be an association between smoking and depression among female family practice patients. This warrants both patient care and research attention.

Objective: Family members usually become involved during the course of care for a chronic illness. This study identified the diabetic adult's perceived supportive family member(s) and analyzed whether family participation was associated with the diabetic adults' level of metabolic control.

Methods: A telephone survey of 131 diabetic adults was conducted from a family practice residency office asking patients to identify family members participating in their diabetes care and to enumerate specific support activities. Demographic and metabolic control data were abstracted from patient records.

Results: Two broad categories of family participation exist. The first is the family health monitor (FHM), or internal "health expert" for the family. The other is the often distinct primary supportive family member; or "helper," defined as a family member who performs at least one supportive task in the care of the illness. Three-fourths of diabetic adults identified an FHM within their families. Eighty-seven percent of FHM's were women, usually adult daughters of diabetic women or wives of diabetic men. Forty-nine percent of diabetic women and 70% of diabetic men also identified a "helper." The most frequent helping tasks involved: dietary issues (48%), medication (23%), general support (15%) and blood sugar monitoring (9%). No relationship emerged between the presence or absence of an FHM or a helper and the level of metabolic control as measured by HbA1C level, which was categorized as "poor" in 55% of the sample.

Conclusions: An FHM or some other helping family member is available to most diabetic adults in our patient population. The mere presence of an available FHM or other potential resource person is not necessarily related to a positive influence on metabolic control.

Objective: To explore whether the family doctor recognizes the problem of overweight in his patients and if this problem was addressed in the communication between patient and doctor, especially in diabetic and hypertensive patients.

Method: During a period of three months all patients in a German family practice were weighed and measured to calculate their body mass index (BMI). Overweight patients were asked if this issue had been a topic in the communication with their doctor and if he had recommended weight reduction. In addition, the doctor was interviewed about these patients and his concept of counselling and treating obesity.

Results: For 75% (740/979) of all patients attending the practice, the BMI could be determined: 35% of men (116/331) and 29% of women (117/409) were were overweight, and more than half of these patients were recruited to answer a structured questionnaire. Thirty-four percent of these patients did not know their ideal weight and 51% could not remember talking about this issue with the doctor. Communication/information about this issue was ranked as good in 29% of patients and in 19% as poor. We found a moderate association between information about overweight and patients' willingness for and success in weight reduction. Only 64% of obese patients (BMI > or = 30) were considered at risk for later disease and in need of treatment by the family physician. The doctor tended to overlook overweight in hypertensive or diabetic patients.

Conclusion: Our results suggest that more medical attention should be directed to a reliable measurement and documentation of overweight and to respective communication with overweight patients, especially when hypertension and/or diabetes is present.

Purpose: The need to perform a Pap smear at the time of entry to prenatal care, as well as at the postpartum check-up, is questionable. A comparison of the rates of recovery of endocervical cells and the incidence of dysplasia on the prenatal and postpartum Pap smears may be helpful in determining an optimal preventive care protocol for patients who are pregnant.

Methods: Demographic and clinical data were collected from the records of 1,377 obstetrical patients at a midwest family practice residency. The yield of endocervical cells and the incidence of dysplasia was determined for both the prenatal and the postpartum Pap smears performed for this group of patients.

Results: In women having both exams, endocervical cells were recovered in 44.1% of prenatal Pap smears compared to 82.0% of postpartum smears. The incidence of dysplasia was 2.6% on prenatal Pap smears and 4.8% on postpartum smears. In this study population, 33% of women did not return for their postpartum check-up.

Conclusions: The postpartum Pap smear is of value due to a significant yield of dysplasia. The sensitivity of the prenatal Pap test may be less than desired. Efforts directed toward increased patient compliance regarding the postpartum check-up are needed.

Objective: Diphtheria and tetanus toxoids and whole-cell pertussis vaccine (DTP) and pediatric diphtheria and tetanus toxoids (DT) are not recommended for individuals > or = 7 years of age due to increased adverse reactions and the low pertussis case-fatality rate. Our objective was to determine if reactions to DTP and DT in individuals > or = 7 years of age were due to administration of pediatric DTP or DT instead of adult tetanus and diphtheria toxoids (Td), after adjusting for database inaccuracies.

Methods: We analyzed data from the Vaccine Adverse Event Reporting System (VAERS) reported from July 1, 1990 through March 31, 1992. Vaccine manufacturers were contacted to verify whether lot numbers indicated DTP or DT.

Results: According to VAERS's data, among individuals 7 years of age or older, 26 received DTP and 77 received DT. When lot numbers were compared with manufacturers' records, 8 of the 77 DT doses were confirmed; 11 had incorrect or missing lot numbers; one was a duplicate; 56 were Td; and one was neither DT nor Td. Alleged adverse reactions included fever, headache, and convulsions.

Conclusion: Individuals > or = 7 years of age are inadvertently receiving DTP or DT and may be unnecessarily experiencing adverse reactions. The 1992 VAERS database offers opportunities to investigate hypotheses but should be interpreted with caution due to inaccuracies in reporting and duplicate entries.

Family medicine investigators are beginning to use qualitative approaches to research questions. This paper reviews guidelines for qualitative research from several social sciences, and summarizes discussions of "standards" for qualitative research among health professionals. From these sources, the authors propose desirable characteristics of qualitative research. These include values of empathy, collaboration, service, and moral sensitivity; characteristics of clarity and coherence; techniques of participatory dialogue, triangulation, purposeful sampling, and immersion in context; and outcomes of useful knowledge and behavior effectively shared with readers.

Objective: To compare the efficacy of retroactive sliding-scale insulin therapy, proactive therapy, and a combination of the two methods in establishing glycemic control in hospitalized diabetic patients.

Methods: Medical records of 47 diabetic ketoacidosis inpatients were reviewed retrospectively.

Results: The sliding-scale insulin therapy group's glucose deviation score (167.4) was significantly higher than the deviation for the proactive (112.9) and combination (121.3) groups. The sliding-scale insulin therapy group also had a significantly higher median glucose value (262.5) than the proactive (199.9) and combination (221.2) groups as well as a significantly higher number of nursing shifts (0.70) in which a glucose of 250 mg/dl or greater was recorded than in the proactive (0.37) and combination (0.40) groups. The proactive group was on their treatment regimen significantly less time than the combination group (5.5 vs 10.4 nursing shifts, respectively). The proactive group was hospitalized significantly fewer days (4.4) than the combination (6.3) and sliding-scale insulin therapy (6.3) groups.

Conclusions: The present study lends support to previous concerns that sliding-scale insulin therapy is less effective than preventive therapy in the management of hospitalized diabetic patients.