Migraine in general practitioners.

A self-administerd questionnaire was posted to 1 129 medical general practitioners in an urban and in a rural area of England. The prevalences of headache, and of the features of migraine, in the year immediately preceding the survey were similar in the two areas. After allowing for the different age and sex composition of the populations, these prevalences were also similar to those found in the general population during an early survey in Wales. About 13% of the male and 25% of the female general practitioners thought that they had had migraine in the previous year. There was little evidence that doctors with 'classic' migraine differed from those with 'common' migraine in the proportion who experienced other migrainous features (unilateral distribution of headache and accompanying nausea) or in their response to treatment with ergotamine.     

Neurological teleconsultation for general practitioners

A neurology teleconsulting network was implemented between a university hospital in Lisbon and five nearby health centres. PCs equipped for videoconferencing were installed, connected by ISDN lines at 128 kbit/s. Fifty-three general practitioners (GPs) were surveyed. The survey showed that the GPs had difficulties in using computers, but they had definite intentions to use teleconsultation for neurology cases and 83% of the respondents stated that they would probably use the technique. During the study, 90 neurology teleconsultations took place over 55 weeks. The average consultation rate was 1.6 teleconsultations per week (SD 1.3, range 0-6). The conferences lasted 10-45 min. Longer teleconsultations were mainly due to technical difficulties in using computers on the part of users with a low level of computer literacy. The patients were 42 males and 46 females, with a mean age of 38 years (SD 20, range 1-84); two patients were discussed twice. The benefits consisted mainly of advice on patient medication, diagnosis and the prevention of unnecessary specialist consultations or laboratory examinations. Doctor-doctor teleconsultation allows the rapid resolution of queries which otherwise cause stress to patients and increase the cost and complexity of care.     

面向农村社区培养全科医学人才的探讨

20 0 2年 10月 2 9- 30日由国务院召开的全国农村卫生工作会议 ,发出了大力加强农村卫生工作 ,全面提高农民健康水平的指示。农村卫生工作的目标主要包括 :建立基本设施齐全的农村卫生服务网络 ,建立具有较高专业素质的农村卫生服务队伍 ,建立精干高效的农村卫生管理体制 ,建立以大病统筹为主的新型合作医疗制度和医疗救助制度 ,使农民人人享有初级卫生保健 ,主要健康指标达到发展中国家的先进水平。沿海经济发达地区要率先实现上述目标。培养医学人才是高等医学院校的主要工作 ,高等医学院校应如何针对我国农村卫生实际需要 ,通过改革培养…     

Health and lifestyle of general practitioners and teachers.

General practitioners (408) and secondary teachers (385) responded to a questionnaire about their health and lifestyle with a response rate of 48 and 45 per cent respectively. Their answers were corroborated by a separate questionnaire completed by their spouse or domestic partner. A sub-group of 50 general practitioners and 50 teachers were examined to assess their physical fitness and mental health. Half of each group was below average fitness compared to the general population. General practitioners were more likely than teachers to practise disease prevention. Ten per cent of general practitioners and 13 per cent of teachers were smokers; 8 per cent of general practitioners and 14 per cent of teachers reported an alcohol consumption that exceeded recommended limits. General practitioners took remarkably little sickness absence compared to teachers. Symptoms of anxiety and depression were more common in teachers: a need for alcohol, binge eating and sleep difficulties were frequently experienced in both groups. Medication taken by the two groups was similar and self-medication was common amongst the general practitioners. Less than half the general practitioners thought they would use an occupational health service if it were established.     

Sustainable rural practice for female general practitioners

An expert panel of female rural and remote doctors have nominated updating professional skills as the most important strategy for sustainable rural general practice for women. The panel was comprised of members of the Australian College of Rural and Remote Medicine (ACRRM). The panel was asked to identify and prioritise strategies they had used to make rural practice work for them. They identified and ranked the following eight groups of strategies: (i) structure medical practice to work for you; (ii) implement personal strategies; (iii) obtain and update professional skills; (iv) establish professional and personal boundaries; (v) gain exposure to rural practice; (vi) engage with the community; (vii) implement professional strategies; and (viii) engage with women. Detailed strategies within these groups have been identified and will form the basis of grounded knowledge about how to structure rural and remote practice to work for women. This will complement the work of ACRRM, the Rural Doctors Association and workforce agencies in developing models of sustainable rural medical practice.     

Using general practitioners to measure community morbidity.

Randomly-selected patients drawn from randomly-selected General Practitioners (GPs) (two-stage cluster sample) were compared with a sample of the general population, who had visited a GP, selected using close approximations to standard household survey methods (area probability) of the Australian Bureau of Statistics. If GP patients drawn in this way resemble a random sample of the Australian community who have recently used GP services, then confidence should increase in this much cheaper method as a source of morbidity statistics. Interviews focused upon each person's last visit to the GP, with questions about reasons for attending, diagnoses and treatments, and various demographic items. In univariate analyses of 22 demographic items, 17 consultation items and 27 diagnoses and treatments, only five items were differently distributed between the GP patients and the area sample. Pairs of data items were also similar in the two groups. Items were examined using multidiscriminant analysis, to determine those that discriminated between the two groups and to calculate predicted group membership on the basis of these items. This analysis correctly classified only 56.7% of study subjects into their true group (GP patient or area sample) when based on items that were differently distributed between the groups, and 53.3% when all items were used, indicating that discrimination was only slightly better than chance. This result increases the confidence with which GP patients can be used to estimate levels of morbidity in the community if random selection is used to select GPs and if their patients are also randomly selected.     

Methadone treatment by general practitioners in Amsterdam.

In Amsterdam, a three-tiered program exists to deal with drug use and addiction. General practitioners form the backbone of the system, helping to deal with the majority of addicts, who are not criminals and many of whom desire to be free of addiction. Distinctions are made between drugs with "acceptable" and "unacceptable" risks, and between drug use and drug-related crime; patients who fall into the former categories are treated in a nonconfrontational, nonstigmatizing manner; such a system helps prevent the majority of patients from passing into unacceptable, criminalized categories. The overall program has demonstrated harm reduction both for patients and for the city of Amsterdam.     

Types of work stress and implications for the role of general practitioners.

This study investigated a wide range of job-related characteristics which had the potential of acting as stressors for General Practitioners (GPs). Three hundred and four GPs completed a detailed questionnaire which sought audit information including practice workload factors, coping approaches and attitudinal information including sources of stress and the value of management training. Ten independent factors were identified as underpinning GP stress and using multi-variate analysis, it was shown that each of these factors is predicted by a separate and distinct set of variables. This finding suggests that it is inappropriate to simply talk about GP stress since it is a multi-dimensional concept. This finding has important implications for identifying potentially successful mechanisms of coping and support.