Archives of family medicine最新文献

Background: Concern has been expressed about the nutrition and health impact of high rates of soft drink consumption. Caffeine is an added ingredient in approximately 70% of soft drinks consumed in the United States. The soft drink manufacturers' justification to regulatory agencies and the public for adding caffeine to soft drinks is that caffeine is a flavoring agent.

Objective: To examine the claim that caffeine plays an integral role in the flavor profile of soft drinks, by examining the effect of caffeine on the threshold for detection of flavor differences in cola beverages.

Design: Double-blind crossover study starting November 1998 and ending July 1999.

Setting: An academic research center.

Participants: Twenty-five adult regular consumers of cola soft drinks. Based on a screening session, all were able to detect a flavor difference between cola containing sugar and diet cola.

Intervention: A sensitive version of a forced-choice flavor-detection procedure was used to evaluate the effects of a wide range of caffeine concentrations (range, 0.05-1.6 mg/mL) on the ability to detect flavor differences between caffeinated and caffeine-free cola beverages. Repeated tests permitted determination of significant detection at each concentration in individual subjects.

Main outcome measures: Percentage of subjects significantly detecting a flavor difference and mean percentage of trials correct at each caffeine concentration.

Results: Detection of flavor differences increased as a function of caffeine concentration. At the 0.1-mg/mL concentration, which is the approximate concentration in the majority of cola soft drink products, 2 subjects (8%) significantly detected a flavor difference and the mean percentage correct (53%) was at chance levels.

Conclusions: The finding that only 8% of a group of regular cola soft drink consumers could detect the effect of the caffeine concentration found in most cola soft drinks is at variance with the claim made by soft drink manufacturers that caffeine is added to soft drinks because it plays an integral role in the flavor profile. It is valuable for the general public, the medical community, and regulatory agencies to recognize that the high rates of consumption of caffeinated soft drinks more likely reflect the mood-altering and physical dependence-producing effects of caffeine as a central nervous system-active drug than its subtle effects as a flavoring agent. Arch Fam Med. 2000;9:727-734

Objective: To determine if family physicians can increase the commitment of patients to organ donation.

Design: Prospective, systematically randomized, cross-sectional study.

Setting: Family practice residency medical center associated with an urban, community-based teaching institution.

Patients: A total of 300 patients aged 18 years or older, able to give consent, and being seen for non-life-threatening visits; 247 patients returned valid second questionnaires.

Interventions: Instruments included 2 self-administered questionnaires. All patients received questionnaire 1 to be completed in the examination room. They also received an informational brochure, a Michigan Secretary of State driver's license sticker (donor sticker) and questionnaire 2. Group 1 received the written materials only. Group 2 received written materials plus a brief verbal discussion by the investigators following a standard protocol. Questionnaire 2 was to be completed and returned after the interventions.

Main outcome measures: Self-reported completion of donor sticker was used to evaluate commitment to organ donation. Knowledge scores were summed for preintervention and postintervention means.

Result: Thirty-three percent of patients had already committed to organ donation prior to the study. Of those not previously committed, 40% decided to do so after the interventions. There was no statistical difference in the recruitment of donors between the 2 intervention groups. Of new donors identified, 65% stated their decision was due to written materials provided, while 34% attributed this to discussion with a physician. Thirty-five percent of the family members made arrangements to donate their own organs after the discussion with the patient. There was a significant difference between mean pretest and posttest knowledge scores (10 questions; 7.9 vs 9.2; P<.01).

Conclusion: Family physicians can increase the commitment to organ donation through a relatively simple intervention.

Amylophagia, or the practice of consuming purified starch, is a particular expression of the more general phenomenon of pica. This compulsive dietary aberration, observed in many pregnant patients worldwide, is common among rural African American women in the southern United States. The effect this practice has on the course of gestational diabetes has not been examined. We report 2 cases of gestational diabetes, refractory to initial dietary management, in which the patients were consuming one-half to 1 box of cornstarch per day. Following cessation of amylophagia, the gestational hyperglycemia spontaneously resolved. Amylophagia is a complex behavioral phenomenon arising from the interplay of biochemical, hematological, psychological, and cultural factors. In some patient populations, it may represent an often overlooked etiologic or exacerbating factor in the condition of gestational diabetes. Family physicians practicing obstetrics should inquire about amylophagia in patients who are at risk for this behavior and in patients who present with gestational hyperglycemia.

Objective: To examine sociodemographic characteristics as possible predictors of late-stage melanoma diagnosis. We hypothesized that late-stage diagnosis would be associated with the following: older age, male sex, unmarried status, lower educational attainment and income level, rural residence, and cigarette smoking.

Methods: We used data from the state tumor registry to study all incident cases of melanoma occurring in Florida during 1994 whose stage at diagnosis was available (N = 1884). We used multiple logistic regression to determine the effects of sociodemographic characteristics on the odds of late-stage (regional or distant metastases) diagnosis.

Results: There were 243 patients (12.9%) diagnosed as having melanoma that had metastasized to either regional lymph nodes or distant sites. Patients who were unmarried (odds ratio, 1.5; P= .01), male (odds ratio, 2.2; P<.001), or smokers (odds ratio, 2.2; P<.001) or who resided in communities with lower median educational attainment (odds ratio, 1.5; P= .048) had greater odds of having a late-stage diagnosis.

Conclusions: To detect these cancers at an earlier stage and improve outcomes, there should be increased educational efforts directed toward physicians who treat these patients. A recognition that there may be additional risk factors for late-stage diagnosis, beyond the established risk factors, such as family history and excess sun exposure, should be included in the initial assessment. Specific public education efforts should also be targeted to these patients to increase their self-surveillance and surveillance of their partners.

Emergency contraception is used after unprotected intercourse or a contraceptive accident to prevent unwanted pregnancy. It is thought to work by stopping or delaying ovulation or preventing implantation if fertilization has already taken place. Hormonal methods, mifepristone, and intrauterine device insertion are among the methods used worldwide. Combination estrogen-progestin birth control pills are the most commonly used form of emergency contraception in the United States. According to the Yuzpe method, combination pills are taken within 72 hours after intercourse, followed by a second identical dose 12 hours later. With this method, the number of unintended pregnancies is reduced by about 75%. Nausea and vomiting are the most troublesome adverse effects, but these can be controlled with antiemetic medication taken prior to the first dose. The Food and Drug Administration, Washington, DC, has approved an emergency contraception kit consisting of 4 combination pills, a urine pregnancy test, and a patient information book. Most recently, the Food and Drug Administration has approved a progestin-only formulation, which has fewer adverse effects and equal or improved efficacy compared with the combination formula. An intrauterine device can be inserted up to 5 days after unprotected intercourse and is a cost-effective option if it is used as ongoing contraceptive protection. The most readily available form of emergency contraception consists of 2 doses of estrogen-progestin combination birth control pills or 2 levonorgestrel pills taken 12 hours apart. Emergency contraception should not be considered as an alternative to ongoing contraceptive methods, but can prevent unwanted pregnancy.

Background: Despite the availability of effective screening measures, physicians fail to identify and manage many children with psychosocial problems. Physicians are most likely to identify children with psychosocial problems when parents voice concerns about their child's functioning. However, few parents express concerns to their child's physician, and children's perspectives of their own functioning are rarely considered. This study evaluated the potential utility of children's reports of their own functioning.

Methods: The Child Functioning Scale (CFS) was completed by 107 parents and children and compared with the Pediatric Symptom Checklist (PSC) and physician reports on the psychosocial status of each child.

Results: Physicians identified 20% of the children identified by the PSC. Children's self-reported problems on the CFS would have identified 53.3% of these children. Additionally, 11.2% of children who did not meet criteria on the PSC self-reported problems in daily functioning.

Conclusion: Collecting information about children's perceptions of their own daily functioning could provide physicians with an additional tool for the assessment of psychosocial problems.

Objective: To characterize people who want antibiotics for cold symptoms and to suggest reasons for antibiotic expectations.

Design: Cross-sectional telephone survey in the spring of 1997 (March 10 to May 16).

Setting: Three primary care clinics in metropolitan Minneapolis, Minn.

Participants: Two hundred forty-nine parents of symptomatic children and 256 symptomatic adults contacting their medical provider (primary care physician, nurse practitioner, or physician assistant) for care of cold symptoms. MAIN DEPENDENT MEASURE: Wanting an antibiotic prescription for cold symptoms.

Results: Thirty percent of parents and 50% of symptomatic adults wanted an antibiotic prescription. Factors associated with desire for antibiotics differed between groups. Parents who wanted antibiotics for their children were more likely than other parents to report severe symptoms (odds ratio [OR], 2.11; 95% confidence interval [CI], 1.16-3.85), to want relief for their child (OR, 2.63; 95% CI, 1.34-5.46), and to believe that antibiotic therapy helps cold symptoms (OR, 1.95; 95% CI, 1.08-3.55). Symptomatic adults who wanted antibiotics were more likely than other symptomatic adults to report severe cold symptoms (OR, 2.10; 95% CI, 1.22-3.67) that have lasted too long (OR, 2.40; 95% CI, 1.31-4.49), to previously have recovered faster with antibiotic therapy (OR, 2.82; 95% CI, 1.65-4.89), and to be confident that they know how to treat the cold (OR, 1.79; 95% CI, 1.03-3.16). They were less likely to believe that too many people take antibiotics for a cold (OR, 0.57; 95% CI, 0.33-0.98).

Conclusions: Parents may be amenable to clinical messages that other treatments may be more effective than antibiotics in managing cold symptoms. Experiences of symptomatic adults may conflict with this message. Previous cold-related medical management and drug resistance might need to be discussed with adult patients.