A qualitative study of delay among women reporting symptoms of breast cancer.

BACKGROUND: Delayed presentation of symptomatic breast cancer of three months or more is associated with lower survival rates from the disease, yet 20% to 30% of women wait at least three months before consulting their general practitioner (GP) with breast symptoms. AIM: To explore the factors that influence GP consultation by women with breast cancer symptoms. DESIGN OF STUDY: Qualitative analysis of semi-structured interviews. SETTING: Forty-six women with newly diagnosed breast cancer, selected from 185 women recruited to a larger study. METHOD: Interviews were conducted eight weeks after diagnosis of breast cancer, comparing two groups of women divided according to the extent of delay between onset of symptoms and seeking medical care. Fifteen women had sought advice from their GP within two weeks of symptom discovery ('non-delayers' and 31 had waited 12 weeks or more before seeing their doctor ('delayers'). RESULTS: Women with breast symptoms who presented promptly to GPs recognised the seriousness of the symptom they had discovered more quickly than delayers. Perception of seriousness was influenced by the nature of the initial symptom and how far it matched the individual's expectations of breast cancer as a painless breast lump. Other factors affecting help-seeking included attitudes to GP attendance, beliefs about the consequences of cancer treatment, and perceptions of other priorities taking precedence over personal health. CONCLUSIONS: This analysis suggests that women need further information about the different types of breast cancer symptoms to assist symptom recognition, as well as encouragement to seek medical advice if a symptom is ambiguous. In addition, women may benefit from greater awareness of the benefits of early detection and reassurance about the improvements in quality of breast cancer care.     

Cytomegalovirus recurrence in seropositive pregnant women attending obstetric clinics

To understand reasons for cytomegalovirus (CMV) recurrence, a cohort of 350 CMV-seropositive pregnant women attending obstetric clinics in Taiwan was examined for cervical or urinary CMV shedding. Urine specimens were collected from 350 women and cervical secretion specimens were collected from 220 women. We measured the association of various factors with CMV recurrence, which was defined as viral shedding identified by the presence of a CMV-specific gene sequence amplified by the polymerase chain reaction in seropositive individuals. CMV recurrence status was independently associated with a sexual activity composite variable, which was defined by three sexual activity indicators: age at first sexual intercourse, total years of sexual experience, and average frequency of sexual intercourse prior to pregnancy. Pregnant women with a history of genital tract infection were more likely than women without such history to experience cervical CMV recurrence. Similarly, pregnant women with previous urinary tract infections were more likely to experience urinary CMV recurrence. The findings indicate that multiple exposure to CMV by sexual activity prior to pregnancy is an important determinant of CMV recurrence during pregnancy.     

A prospective study of asymptomatic bacteriuria in sexually active young women

BACKGROUND: Asymptomatic bacteriuria is common in young women, but little is known about its pathogenesis, natural history, risk factors, and temporal association with symptomatic urinary tract infection. METHODS: We prospectively evaluated 796 sexually active, nonpregnant women from 18 through 40 years of age over a period of six months for the occurrence of asymptomatic bacteriuria (defined as at least 10(5) colony-forming units of urinary tract pathogens per milliliter). The women were patients at either a university student health center or a health maintenance organization. Periodic urine cultures were taken, daily diaries were kept, and regularly scheduled interviews were performed. Escherichia coli strains were tested for hemolysin, the papG genotype, and the ribosomal RNA type. RESULTS: The prevalence of asymptomatic bacteriuria (the proportion of urine cultures with bacteriuria in asymptomatic women) was 5 percent (95 percent confidence interval, 4 percent to 6 percent) among women in the university group and 6 percent (95 percent confidence interval, 5 percent to 8 percent) among women in the health-maintenance-organization group. Persistent asymptomatic bacteriuria with the same E. coli strain was rare. Symptomatic urinary tract infection developed within one week after 8 percent of occasions on which a culture showed asymptomatic bacteriuria, as compared with 1 percent of occasions when asymptomatic bacteriuria was not found (P<0.001). Asymptomatic bacteriuria was associated with the same risk factors as for symptomatic urinary tract infection, particularly the use of a diaphragm plus spermicide and sexual intercourse. CONCLUSIONS: Asymptomatic bacteriuria in young women is common but rarely persists. It is a strong predictor of subsequent symptomatic urinary tract infection.     

Influence of patient characteristics on doctors' questioning and lifestyle advice for coronary heart disease: a UK/US video experiment.

BACKGROUND: Risk factors for coronary heart disease (CHD) vary with patient characteristics but we do not know how this influences doctors' questioning and advice giving. AIMS: To find out whether four patient characteristics - age (55 versus 75 years), sex, class, and race - influence primary care doctors' questioning style and advice giving in the United Kingdom (UK) and United States (US). DESIGN OF STUDY: A factorial experiment using video simulation of a patient consulting with CHD symptoms, designed to systematically alter their age, sex, class, and race. SETTING: Surrey, south east London and the West Midlands in the UK, and Massachusetts in the US. METHOD: A stratified random sample of 128 general practitioners (GPs) in the UK and 128 primary care doctors in the US were shown video vignettes in their practices of patient consultations, and interviewed about patient management strategies. RESULTS: Sex and age influence doctors' questioning of patients presenting with CHD. Men are asked more questions overall, particularly about smoking and drinking. Middle-aged patients are asked more about their lifestyle. Advice about smoking is given to more men than women, and to more mid-life than older patients. Women doctors question patients about their lifestyle more often, and give more advice to patients about their diet. CONCLUSION: Doctors' questioning strategies are influenced by patients' sex and age, suggesting that doctors may miss smoking- and alcohol-related factors among women and older patients with CHD. Doctors give more advice about smoking to men, despite sex equality in smoking prevalence. Therefore, doctors' information seeking and advice giving do not match known patient risk factors.     

Sexual violence against adult women primary care attenders in east London.

BACKGROUND: Sexual violence against women is common. The prevalence appears to be higher in north America than Europe. However, not all surveys have differentiated the experience of forced sex by a current or former partner. Few women are thought to report these experiences to their general practitioner (GP). AIM: To measure the prevalence of rape, sexual assault, and forced sexual intercourse by a partner among women attending general practices, to test the association between these experiences of sexual violence and demographic factors, and to assess the acceptability to women of screening for sexual violence by GPs. DESIGN OF STUDY: Cross-sectional survey. METHOD: A self-administered questionnaire survey of 1207 women aged over 15 years was carried out in 13 general practices in Hackney, east London. RESULTS: Eight per cent (95% confidence interval [CI] = 6.2 to 9.6) of women have experienced rape, 9% (95% CI = 7.0 to 10.6) another type of sexual assault, and 16% (95% CI = 13.6 to 18.1) forced sex by a partner in adulthood: 24% (95% CI = 21.2 to 26.5) have experienced one or more of these types of sexual violence. Experiences of sexual violence demonstrated high levels of lifetime co-occurrence. Women forced to have sex by partners experienced the most severe forms of domestic violence. One in five women would object to routine questioning about being raped and/or sexually assaulted, and one in nine about being forced to have sex by a partner. CONCLUSION: Experiences of sexual violence are common in the lives of adult women in east London, and they represent a significant public health problem. Those women who have one experience appear to be at risk of being victims again. A substantial minority object to routine questions about sexual violence.     

Sexual functioning throughout menopause: the perceptions of women in a British cohort

OBJECTIVE: Previous studies on menopausal transition and sexual functioning have mixed findings. Most are cross-sectional, exclude hormone therapy users and hysterectomized women, and are unable to separate the effects of age from menopause or account for psychosocial, vasomotor, and somatic factors. We examine relationships between women's reports of a change in sex life and difficulties with intercourse and their experience of menopausal transition, use of hormone therapy, and hysterectomy. DESIGN: A British cohort study with 1,525 women were followed since their birth in 1946 and annually from age 47 to 54 years. The outcome measures were self-reported change in sex life and difficulties with sexual intercourse over 8 consecutive years. RESULTS: Compared with women who remained premenopausal, peri- and postmenopausal women reported a decline in sex life (mean difference [95% CI]: perimenopausal, -0.1 [-0.2 to -0.03]; became postmenopausal, -0.1 [-0.2 to -0.1]) and were more likely to report difficulties with intercourse (perimenopausal, 0.6 [0.1 to 1.1]; postmenopausal, 1.0 [0.5 to 1.5]) beyond the effects of aging and other psychosomatic factors. Women reported difficulties with intercourse more often if they had been on hormone therapy for more than a year (0.5 [0.03 to 1.0]) or if they had undergone a hysterectomy (0.6 [0.1 to 1.1]); no differences were found for change in sex life. For both outcomes, vaginal dryness was the major risk factor. Married women were also more likely to report adverse outcomes. Somatic symptoms and hot flushes/cold sweats were associated with difficulties with intercourse, whereas psychological symptoms, stressful lives, increasing age, and smoking were associated with a decline in sex life. CONCLUSIONS: Menopausal transition status had an independent effect on the reported change in sex life and difficulties with intercourse. The results support health professionals in their development of management strategies that (a) consider treatments directly for vaginal dryness, (b) identify somatic symptoms for difficulties with intercourse, (c) investigate psychological factors for a reported decline in sex life, and (d) for both outcomes, consider the potential role of intimate partners.     

Self-reported sexual behaviour among adolescent girls in Uganda: reliability of data debated

Objective

To compare self-reported information about sexual behaviour in a research interview to information retrieved during a clinical consultation.

Method

595 sexually experienced women below 20 years, were interviewed by a social worker about genital symptoms and sexual behaviour. A midwife interviewed, examined, and took vaginal samples for gonorrhoea and chlamydia. Four questions were embedded in both the social workers interviews and among midwife''s questions. The women were asked if they perceived their latest /current partner to be faithful, if he had complained about any genital symptoms, if a condom was used at latest sexual intercourse and if the woman knew her HIV status.

Results

The prevalence of gonorrhoea and/or chlamydia was 7.1% but for women who reported that their partner had complained about genital symptoms it was significantly higher. Agreement between answers given in the research interview and to the midwife was good for HIV status but only fair or moderate for perceived faithfulness, partner''s symptoms and recent condom use.

Conclusion

Information about risk factors revealed in individual interviews and by the midwives taking a history was incongruent. Any approach for management of STIs, which is built on self-reported risk factors, needs careful assessment of reliability.     

Can general practitioners influence the nation's health through a population approach to provision of lifestyle advice?

BACKGROUND: Lifestyle advice from general practitioners (GPs) has been shown to have a positive effect on population health. In practice, GPs provide lifestyle advice to a minority of their patients only, those who are high risk or already have symptoms. AIM: To look in depth at GPs' attitudes towards adopting a population approach to lifestyle advice and to use these results to identify ways of maximising the potential of GPs to affect population health. METHOD: Thirty-six GPs, purposively sampled by identifying characteristics likely to affect their health promotion activity, participated in a focus group study. Data from the focus groups were transcribed verbatim and analysed using standard methods. RESULTS: The main themes that emerged suggested that GPs do not take a population approach to lifestyle advice because they prefer a high risk approach and doubt their ability to be effective in a population approach. GPs believed that social, cultural, and environmental factors were the most important determinants of population health. Furthermore, they were concerned about the detrimental effects on the doctor-patient relationship of providing lifestyle advice to all patients. GPs believed that a multi-agency, centrally co-ordinated approach was the preferred way to improve population health and that their role should be limited to secondary prevention. CONCLUSION: Large amounts of resources would be necessary to convince GPs to adopt a population approach to lifestyle advice. Measures to tackle the social and environmental determinants of health may be a more effective and efficient means of improving the nation's health.     

Factors associated with regular episodes of dysuria among women in one rural general practice.

The aim of this study was to ascertain the factors associated with frequency-dysuria (urethral) syndrome in a population of women. The study included all women aged 25 years and over on 1 May 1987 who had been registered with one rural, dispensing practice over the study period, 1 May 1985 to 1 May 1989. A self-administered questionnaire was sent to the women on 1 May 1987 and a second, similar, questionnaire was sent two years later. A total of 721 women responded to the two questionnaires (response rate 97%). Regular symptoms of frequency and dysuria were reported by 8% of women in 1987 and 14% in 1989. Four percent of women reported symptoms throughout the four year study period. Symptoms were found to be least common in the 55-74 years age group. Although none of the women who were sexually inactive reported regular symptoms no association was reported between recent sexual intercourse and symptoms. Neither was an association demonstrated between type of contraception used and symptoms. However, it was found that premenopausal women reported significantly more symptoms than postmenopausal women. The number of women involved in this study was too small to allow the importance of change of sexual partner to be determined. Significantly more of the women who reported regular symptoms had been treated for urinary tract infection than of those who did not report regular symptoms. Although a history of regular frequency and dysuria points to a diagnosis of urethral syndrome, general practitioners must assess each case in order to exclude urinary tract infection.     

Characteristics of children consulting for cough, sore throat, or earache.

BACKGROUND: GPs are often consulted for respiratory tract symptoms in children. AIM: To explore characteristics of children, their parents, and their GPs that are correlated with consulting a GP for cough, sore throat, or earache. DESIGN OF STUDY: Second Dutch National Survey of General Practice (DNSGP-2) with a health interview and an additional questionnaire. SETTING: Children aged 0-17 years registered with 122 GPs in Dutch general practice. METHOD: Characteristics of patients and their GPs were derived from the DNSGP-2 health interview and a questionnaire, respectively. Characteristics of the illness symptoms and GP consultation were acquired by means of an additional questionnaire. Data were analysed using multivariate logistic regression. RESULTS: Of all children who completed the questionnaire, 550 reported cough, sore throat, or earache in the 2 weeks preceding the interview with 147 of them consulting their GP. Young children more frequently consulted the GP for respiratory symptoms, as did children with fever, longer duration of symptoms, those reporting their health to be 'poor to good', and living in an urban area. When parents were worried, and when a child or their parents were cued by someone else, the GP was also consulted more often. GP-related determinants were not associated with GP consultation by children. CONCLUSION: This study emphasises the importance of establishing the reasons behind children with respiratory tract symptoms consulting their GP. When GPs are aware of possible determinants of the decision to consult a GP, more appropriate advice and reassurance can be given regarding these respiratory symptoms, which are generally self-limiting.     

Reproductive health perceptions,beliefs and sexual risk-taking among youth in Addis Ababa,Ethiopia

Appropriate knowledge and beliefs about sexuality and necessary life skills do not often precede sexual behaviours among young people. This study outlines a profile of sexual risk factors and the underlying sexual and reproductive health perception and beliefs among youth (aged 15-24 years) in Addis Ababa, Ethiopia. Five hundred and sixty-one youth residing in two of the six zones of Addis Ababa filled a self-administered questionnaire. Three outcome variables: history of sexual activity in the past, use of condom during recent sexual intercourse and use of alcohol, were used to construct a pyramid of sexual risk categories. Being a female, age group of 20-24 years and out-of-school significantly increased the likelihood of belonging to the most vulnerable category. Although young people were heterogeneous in their sexual risk-taking, they were equally uninformed on reproductive health matters related to puberty and sexuality. Their respective beliefs also tended to be flexible and unstable to consistently predict their behaviour. Possible reasons for such heterogeneity and its practical implications in sex education strategies are discussed.     

General practitioners and women with urinary incontinence.

BACKGROUND: Urinary incontinence is a common problem for adult women. It results in a large financial and psychosocial cost. Much urinary incontinence goes unreported. Women with urinary incontinence can be successfully assessed and treated in general practice but studies have shown that many GPs manage the condition inadequately. AIM: This study aims to examine GPs' awareness of urinary incontinence in women and their management of, and attitudes to, female urinary incontinence. METHOD: A qualitative study was conducted with 21 GPs responding to semi-structured interviews. Thematic analysis was carried out on these interviews, with recurrent views and experiences being identified and grouped. RESULTS: The interviews of 11 male and nine female GPs were suitable for analysis. GPs were aware of the prevalence and under-reporting of urinary incontinence in women. Many were unhappy with their own management of the condition and with the management options available to them. Male GPs in particular were reluctant to carry out gynaecological examinations, and few GPs expressed enthusiasm for teaching pelvic floor exercises or bladder drills. Medications were frequently used but generally considered ineffective or intolerable. The services of both public health nurses and practice nurses were under-used, largely because of lack of training in this area. Although incontinence nurses were employed in the area, many GPs did not know of their availability and, of those who did, few referred to them more than infrequently. CONCLUSION: This study demonstrates that many GPs avoid dealing with the problem of urinary incontinence in women and that they find it to be a difficult, chronic problem to treat. Specialist options seem not to be useful in general practice. The findings need to be explored in other GP settings.     

Doctors' use of euphemisms and their impact on patients' beliefs about health: an experimental study of heart failure

Doctors often use a range of euphemisms as a means to facilitate communication in the consultation. The present experimental study aimed to assess whether GPs use or avoid the term 'heart failure' and to evaluate the relative impact of the term 'heart failure' versus their preferred euphemism on patients' beliefs about the illness. This two part study involved a cross sectional survey of GPs and an experimental study of patients' beliefs and was based on one General Practice in a semi-rural area of the UK. For the first part, 42 GPs completed a questionnaire about their preferred terms to describe symptoms of heart failure. The results showed that GPs rated the majority of euphemisms as preferable to the term 'heart failure'. Their preferred euphemism was 'fluid on your lungs as your heart is not pumping hard enough'. For the second part, 447 patients completed ratings of their beliefs about a condition, which was described as either 'heart failure' or the GPs' preferred euphemism. Patients who received the condition described as 'heart failure' believed that the illness would have more serious consequences for their life, that the problem would be more variable over time and that it would last for longer and reported feeling more anxious and depressed than those who received the condition described using the euphemism. GPs are encouraged to be open with their patients and to respect their experience. The choice of language, therefore, presents a dilemma for doctors. The term 'heart failure' may be in line with the current climate of openness but may evoke a more negative response from the patient. In contrast, a euphemism may be less open but more protective of the patient's experience. This study suggests that the area of heart failure may be one where GPs may chose to compromise openness for the sake of the patient's experience and that this fear of upsetting the patient is well founded.     

Urinary tract infection in young women, with special reference to Staphylococcus saprophyticus.

Acute urinary tract infections in young women attending a clinic for sexually transmitted diseases were caused by the same bacteria, in the same proportions, as those that caused infections in women students. Staphylococcus saprophyticus biotype 3 (formerly called Micrococcus subgroup 3) was the commonest organism after coliform bacilli and caused about 30% of the infections. It was uncommon in women over 25 years of age and rarely caused asymptomatic bacteriuria in pregnancy. Most infections, irrespective of the causative organism, started soon after sexual intercourse, but neither the staphylococci nor the other organisms were associated with promiscuity, as judged by numbers of sexual partners or the incidence of sexually transmitted diseases. There was no evidence that the staphylococci were sexually transmitted. The reasons for the virulence of Staph. saprophyticus and its predilection for the urinary tract of young women remain unknown.     

Needs assessment of women with urinary incontinence in a district health authority.

BACKGROUND: The prevalence of urinary incontinence in women is difficult to estimate because definitions vary between researchers and among women, for whom thresholds of complaint differ. However, studies have also shown that only about a quarter of women affected by urinary incontinence consult a doctor for their symptoms, despite evidence of effective treatments and better management of the condition in primary care. AIM: To assess the perceived needs of women with urinary incontinence living at home. DESIGN: Cross-sectional community survey. SETTING: A 1% stratified random sample of women living at home, registered with a local GP, and aged 45 years and over (n = 720) in a north London district health authority with a total population of 308,000. RESULTS: Out of 720 questionnaires, 489 were returned completed (68%). A total of 227 (46%) women had symptoms of significant urinary incontinence. Seventy-eight (16%) had significant symptoms which they said were not a problem, and 149 (30%) of the total number of responders acknowledged that they had significant symptoms and that these symptoms were a problem for them; of these, 48 (32%) sought help from their GP; 16 out of the 48 consulting their GP were happy with the treatment given, and the remaining 101 women who considered their incontinence to be a problem had not consulted their GP and 76 of those had also not told anyone else that they had a problem. The commonest reasons given by the 101 women who admitted having a problem and who had not consulted their GPs were that they thought that they should cope on their own (43 [42.6%]), that incontinence was inevitable with age (26 [25.7%]) or that it was embarrassing to talk about the problem to their GP (14 [13.8%]). CONCLUSIONS: Despite the existence of effective interventions for urinary incontinence, many women who are incontinent do not seek help even when they perceive their incontinence to be a problem. Half of the women who did consult their GP did not find the treatment offered helpful. Achieving health gain for women with urinary incontinence will require a more active approach than currently exists to inform people that better care is available, to help counteract the stigma attached to the problem, and to ensure that primary care professionals are able to provide effective services.     

Young teenagers' attitudes towards general practitioners and their provision of sexual health care.

BACKGROUND: Pregnancy rates in under-16-year old teenagers and sexual risk-taking are both increasing. Ensuring that teenagers access health care--particularly sexual health care--appropriately is problematic. AIM: To find out the opinions and attitudes of 13- to 15-year-old teenagers towards general practice-based sexual health care services. METHOD: A quantitative survey, using a questionnaire completed during school hours. RESULTS: One thousand and forty five children aged 13 to 15 years completed questionnaires. The majority (709 [68%]) were aware of the sexual health services offered by general practitioners (GPs), and 786 (75%) were positive about being given helpful advice at a consultation. However, 567 (54%) teenagers believed they had to be over 16 years old to access sexual health services and 604 (58%) were concerned about their confidentiality not being preserved by their GP. They were also concerned about GPs not having the time or skills to deal with their problems (314 [30%]). CONCLUSIONS: This study suggests that work is needed to improve teenagers' access to, and use of, primary care sexual health services. In particular, identifying strategies that improve teenagers' awareness of services and general practitioners' approaches towards teenagers are priorities.     

Factors influencing discussion of smoking between general practitioners and patients who smoke: a qualitative study.

BACKGROUND: Anti-smoking advice from general practitioners (GPs) is effective and recent evidence-based guidelines urge GPs to advise all patients against smoking at every opportunity. GPs do not exploit many opportunities to discuss smoking with patients and the reasons for this are unclear. AIM: To elicit, relate, and interpret GPs' accounts of why they discuss smoking with some patients and not others. METHOD: Thirty-nine Leicestershire GPs were purposively selected so as to have a range of attitudes towards discussing smoking with patients. Each GP had one surgery session video-recorded and afterwards participated in a qualitative, semi-structured interview. Prior to each interview, GPs were shown a video-recording of one of their consultations with a smoker to enhance their recall of events. RESULTS: Being aware of patients' smoking status did not necessarily result in GPs discussing smoking with patients. GPs were keen to preserve good doctor-patient relationships and avoid negative responses from patients once the topic of smoking had been raised, and this was felt to be best achieved by restricting most discussions about smoking to situations where patients presented with smoking-related problems and in circumstances where the doctors perceived the doctor-patient relationship was strong. Doctors also thought it important to address patients' agendas relating to the current consultation before discussing smoking. CONCLUSIONS: General practitioners have strong reasons for preferring to discuss smoking when patients present with smoking-related problems. Those wishing to increase the amount of advice-giving by GPs might be more successful if they encouraged GPs to make greater use of problem-orientated opportunities to discuss smoking.     

Beliefs about the causes and solutions to obesity: a comparison of GPs and lay people

OBJECTIVE: To explore general practitioners (GPs') beliefs about the causes and solutions to obesity, to compare them to those held by a lay sample and to assess the role of beliefs about causes in explaining beliefs about solutions. METHODS: Questionnaires regarding the causes and solutions to obesity were completed by GPs (n=73) and a lay sample (n=311). RESULTS: GPs generally believe that obesity is caused by psychological and behavioural factors and are ambivalent about the effectiveness of the majority of available solutions. When compared to a lay population, GPs show a greater endorsement of behavioural, structural, social and psychological causes of obesity whereas the lay population prefer a more biological model of causality. The present study also provides some evidence for the origins of such beliefs about solutions and indicates consistency between GPs' beliefs about solutions and causes. For example, GPs endorse a medical solution if they believe obesity is caused by biological factors and endorse policy change as a solution if they believe it is caused by social factors. The lay sample did not show such consistency in their beliefs. CONCLUSIONS: GPs believe that obesity does not belong within the medical domain. They hold a coherent model in terms of beliefs about causes and solutions which may limit their perspective on what constitutes a suitable solution to this ever common problem. PRACTICE IMPLICATIONS: If GPs are to take responsibility for the management of obesity they should be encouraged either to change their beliefs or to consider whether solutions need always address causality.     

男女不育患者心理社会因素对照研究

目的：探讨不育症患者心理、社会等影响因素。方法：对１７６例不育患者５ １７９例已生育有子女的健康人群进行心理社会方面的病例对照研究。结果Ｌ：不民健康对照人群相比每周性生活次数少、性生活满意程度低，６８．２％的患者因不育而感到痛苦、有压力，１８．２％的患者导致夫妻关系紧张。症状自评量表结果表明，病例组较对照组心身症状多，心理压力大。Ｅｙｓｅｎｃｋ个性问卷分析发现，不育患者的个性特征表现为性格内向、情     

The reported prevalence of urinary symptoms in women in one rural general practice.

In May 1989 a questionnaire to determine the prevalence of urinary symptoms and vaginal discharge in the community was sent to all women patients born before May 1962 who had been registered with one rural practice for the previous two years. The response rate was 97%. The patients' clinical records were used to validate the replies of those who claimed to have consulted the doctor with these symptoms together with a sample of those who claimed not to have consulted. The reported prevalence of dysuria among the women over the previous two years was 27% and the prevalence of frequency was 34%. However, only 8% of women had received treatment for vaginal infections and 15% treatment for urinary symptoms (10% had confirmed bacteruria). Thirty four per cent of women said they would treat themselves prior to consulting a doctor and 17% would buy proprietary medicines. When asked how long they would wait between the onset of symptoms and seeking medical advice the responses ranged from one to 20 days, with 36% of women reporting that they would wait five days or longer before consulting. Fifty eight per cent of the women patients did not believe that urinary tract infections could have serious consequences and this figure increased to 76% among women who had consulted previously for a urinary tract infection. Patients with recurrent urinary symptoms did not consult any earlier than other women or treat themselves any less often. It can be concluded that there is a need for increased patient education in this area.