Serious Illness and Family Dynamics. 1. Changes in Consulting Patterns of the Unafflicted Family Members

Van EIjk J Th M (Department of Family Medicine, University ofNijmegen, St Annastraat 284, 6525 HC Nijmegen, The Netherlands).Serious illness and family dynamics. 1. Changes in consultingpatterns of the unafflicted family members. Family Practice1985; 2: 61–69. This article examines the effect of an acute serious illnessin one member of a family on the health behaviour of other members.The number of consultations made by 92 family members beforeand after an acute serious illness was measured and comparedwith a control group of 102 people who had experienced no seriousillness in their family. The coping resources of the family—definedin terms of flexibility of parental relationships, conflictavoidance and family strain—were assessed and relatedto the changes in consultation pattern. It was shown that an acute serious illness affecting one memberof a family which lacks adequate coping resources can lead toan increase in reporting of serious complaints in other familymembers. In families which have adequate coping resources, however,the health of the remaining family members can apparently improve.This refutes the view that a serious life event necessarilyhas only a harmful influence on health.     

Effect of Bereavement on the Health of the Remaining Family Members

Van Eijk J, Smits A, Huygen F and van den Hoogen H. Effect ofbereavement on the health of the remaining family members. FamilyPractice 1988; 5: 278–282. This investigation focusses on the effect of the death of afamily member on the number and type of diagnosed illnessesof the remaining members. The data on mortality and morbiditywere obtained from a continuous morbidity register. A totalof 225 cases of death were selected, involving 313 family members.A control group of 4909 people who had not been confronted witha death of a family member were selected. A comparison of morbidityrates for the two groups showed that morbidity rates, both forminor and serious illnesses, were affected by the death of afamily member. Increases in minor illnesses occurred more oftenwhen people had been confronted with death after a chronic illness;increases in serious illnesses were mainly found among peopleconfronted with sudden death. Surprisingly, people with nervousdisorders in their medical history showed fewer diagnoses forminor illnesses after a sudden death of a family member. Anexplanation may be found in the basic principles of family medicine.     

How is your health in general? A qualitative study on self-assessed health

Background: The single-item measure on self-assessed healthhas been widely used, as it presents researchers with a summaryof an individual's general state of health. A qualitative studywas initiated to find out which particular aspects are includedin health self-assessments; which aspects do people considerwhen answering the question ‘How is your health in general?’.Subgroup differences were studied with respect to gender, age,health status and health assessment. Methods: Qualitative studywith stratification by background characteristic, health statusand health assessment (n=40). Results: Almost 80% of the participantsreferred to one or more physical aspects (chronic illness, physicalproblems, medical treatment, age-related complaints, prognosis,bodily mechanics, and resilience). However, when assessing theirhealth, participants also include aspects that go beyond thephysical dimension of health. In total, 80 percent of the participants—whetheror not in addition to physical aspects—referred to otherhealth dimensions. Besides physical aspects, participants consideredthe extent to which they are able to perform (functional dimension–28%), the extent to which they adapted to, or their attitudetowards an existing illness (coping dimension –28%), andsimply the way they feel (wellbeing dimension –20%). Inthis study, health behaviour or lifestyle factors (behaviouraldimension –3%) proved to be relatively unimportant inhealth selfassessments. Conclusions Self-assessed health provedto be a multidimensional concept. For most part, subgroup differencesin self-assessed health could be attributed to experience withill health: being relatively inexperienced with health problemsversus having a history of health problems.     

Doctors, their mental health and capacity for work

Background Information about doctors’ mental ill-healthis limited. This study looks at doctors’ careers followingmental illness and the strategies that helped them return towork. Aim To examine the effect of mental ill-health on doctors’careers. Methods Questionnaire survey of members of the Doctors SupportNetwork (DSN). The DSN is a peer support group for doctors whohave experienced, or are experiencing, mental ill-health. Results One hundred and sixteen doctors (35% response rate)returned completed questionnaires (n = 116, 63% female, 37%male). Prior to their ill-health, 80% worked full time, 15%part-time, 2% were not working and 3% were medical students.Following illness, 33% worked full time (P < 0.05), 36% part-time(P < 0.05) and 29% were not working (P < 0.01). Flexibleworking practices were the most helpful reported strategy forenabling a doctor to return to work. Conclusions Following mental ill-health, a doctor’s capacityto work full time is reduced. Most doctors return to full-timeor part-time work. With improved support, more doctors may beable to return to work.     

The impact of Family Practice

Someone once remarked that only three things matter if a restaurantis to be successful—position, position and position. Thesame could be said about journals, where the most importantcriteria are citation, citation and citation. It was a particularpleasure, therefore, to learn that the steadily rising ImpactFactor of Family Practice now stands at 1.16, which is higherthan journals such as the American Family Physician (0.94),the Canadian Family Physician (0.35), the Journal of the RoyalCollege of Physicians of London (0.83), the Journal of the RoyalSociety of Medicine (0.72), the Postgraduate Medical Journal(0.44), Primary     

Family Practice and the new era of electronic publishing

It is now nearly two years since I became editor of Family Practice.In that time there have been many changes to the journal, withthe introduction of electronic submissions, e-letters, online-firstpublication of PDFs and a new journal website. Family Practiceis unique as the only ‘international’ primary careresearch journal, and we have taken steps to consolidate thejournal in that role. The editorial board has recently expandedto include more members from North America and Southern Europe,as well as adding more capacity in both qualitative researchand epidemiological methods. I am indebted to our existing associateeditors, Professor Paul Little (Southampton, UK) and     

Physician Redistribution: A Worldwide Medical Problem

Verby J (Department of Family Practice and Community Health,University of Minnesota, Medical School, Box8l, Mayo MemorialBuilding, 420 Delaware Street SE, Minneapolis, Minnesota 55455,USA). Physician redistribution: a worldwide medical problem.FamilyPractice 1985; 2: 151–158. The Rural Physician Associate Program may be the only undergraduatemedical education programme in the world that has been ableto successfully redistribute family physicians into geographicallyisolated areas where there are serious shortages of doctors.A number of factors are essential to this success of the scheme:(1) absolute moral and economic support from the people andtheir elected leaders; (2) a willingness of medical school facultyto give academic and clinical support to an ongoing, long-termeffort with undergraduate medical students and practising familyphysicians; (3) the free volunteering by rural practising physiciansto make the commitment to teach the medical students for overnine months and to pay these students up to $5000; (4) the emphasisof the programme to be placed on the importance of using a biopsychosocial-sexualmodel in creative problem solving; audiovisual taping, behaviouralmedicine seminars and family therapy sessions are additionalcurriculum tools in helping students and physicians care forpeople with somatic complaints; (5) the student's spouse andchildren to be included in the professional conditioning experience;there is no legal commitment for the student and family to returnto rural Minnesota after the programme.     

The Submerged Part of the Iceberg and the Family Physician

Biderman A and Antonovsky A. The submerged part of the icebergand the family physician. Family Practice 1988; 5: 174–176. The paper describes an effort to make contact with a part ofthe population registered with a family practice in an Israelineighbourhood health centre. Of 407 files reviewed, of patientsaged 45 years and over, 15.5% Showed there had been no contactwith the family doctor for at least three years. The patientswere invited to make an appointment for an examination. Theexperience of the study led to the following conclusions: (1)filesare often out-of-date, containing patients no longer in thepractice; (2) an invitation is insufficient motivation for mostpatients to visit the doctor but it can serve as a trigger whenthere is an existing problem; (3) a considerable number of patientswith some direct contact with the health care system obtaincare in what is called ‘corridor medicine’; (4)significant health problems were identified among those whocame and ease of mind was provided for others; (5) data in thefiles for earlier periods indicated significant untreated illnessin all patients. If this survey in a single practice is in anyway typical, a serious problem of health care delivery confrontsthe family practitioner.     

Family Tuberculosis Contacts: Resource-Contingent Management

Pust R E (Department of Family and Community Medicine, Universityof Arizona College of Medicine, Tucson, Arizona 85724, USA).Family tuberculosis contacts: resource-contingent management.Family Practice 1985; 2: 30–34. Recent findings in tuberculosis research have questioned theefficacy of bacille Calmette-Guérin (BCG) vaccinationand demonstrated the effectiveness of combined-drug chemotherapyand isoniazid (INH) chemoprophylaxis, both in regimens of under12 months duration. Because of the renewed emphasis on drugtreatment in tuberculosis control, family physicians and thehealth personnel they supervise need to be involved in thiseffort. Despite differences in health care resources in differentregions, rational and effective management of active cases andtheir contacts in the family can be devised. While the priorityremains treatment of the active index case, family physicianshave a unique opportunity to utilize family relation ships tofind and to treat other active cases and to reinforce compliancewith INH chemoprophylaxis by high-risk family contacts.     

Treatment Options for Cutaneous Warts in Family Practice

Steele K and Irwin W G. Treatment options for cutaneous wartsin family practice. Family Practice 1988; 5: 314–319. Natural regression should not be advocated as a treatment optionfor cutaneous warts, given the infectious nature of this condition.Although there are numerous treatments for this condition reportedin the literature, many trials are uncontrolled and many regimensare unsuitable for general practice. Specific treatment is influencedby age of patients, number and sites of warts and availabilityof treatment. This paper reviews the international literatureon treatment methods, with particular emphasis on effectiveness,patient acceptability and application in family practice.     

Family function in families of children with Duchenne muscular dystrophy

This article investigates the relationships of child- and family-related variables with family function in families with children who have Duchenne muscular dystrophy. Child-related variables included level of disability (indicator: Barthel Index) and age at diagnosis. Family-related variables included caregiver health status (indicator: Duke Health Profile), family income and employment, family support (indicator: Family APGAR), family hardiness (indicator: Family Hardiness Index), and family functioning (indicator: Family Assessment Device). Family function displayed a significant correlation with age at diagnosis, but not with disability level. It was also significantly correlated with family hardiness, caregiver health status, and levels of family support, but not with income or employment variables. These findings highlight the need to assist families to cope with the presence of serious illness in their children.     

A new editor for Family Practice

Martin Luther believed that no-one should stay in a professionalrole for more than 10 years before moving on, and I am surethat you can think of many other aphorisms that would indicatethat I have been in this job too long. Well, Family Practicehas a new Editor, but before I tell you who it is, I would likethe opportunity to reflect on Family Practice, primary care,publishing and research. John Howie, one of Glasgow's most distinguished sons and certainlyEdinburgh's most distinguished primary care researcher, wasthe founding editor of Family Practice. This was a joint venturebetween Oxford University Press and the Royal College of GeneralPractitioners, to whom we must be grateful for helping to launchthe journal. For several years, ‘WONCA News’     

Acute cooling of the feet and the onset of common cold symptoms

Background. There is a common folklore that chilling of thebody surface causes the development of common cold symptoms,but previous clinical research has failed to demonstrate anyeffect of cold exposure on susceptibility to infection withcommon cold viruses. Objective. This study will test the hypothesis that acute coolingof the feet causes the onset of common cold symptoms. Methods. 180 healthy subjects were randomized to receive eithera foot chill or control procedure. All subjects were asked toscore common cold symptoms, before and immediately after theprocedures, and twice a day for 4/5 days. Results. 13/90 subjects who were chilled reported they weresuffering from a cold in the 4/5 days after the procedure comparedto 5/90 control subjects (P = 0.047). There was no evidencethat chilling caused any acute change in symptom scores (P =0.62). Mean total symptom score for days 1–4 followingchilling was 5.16 (±5.63 s.d. n = 87) compared to a scoreof 2.89 (±3.39 s.d. n = 88) in the control group (P =0.013). The subjects who reported that they developed a cold(n = 18) reported that they suffered from significantly morecolds each year (P = 0.007) compared to those subjects who didnot develop a cold (n = 162). Conclusion. Acute chilling of the feet causes the onset of commoncold symptoms in around 10% of subjects who are chilled. Furtherstudies are needed to determine the relationship of symptomgeneration to any respiratory infection. Keywords. Cold exposure, common cold, infection, nose.     

Recording Patients' Consumption of Social Drugs in a Family Medicine Residency: a Longitudinal Study

Rodney W M (Department of Family Practice, San Bernardino CountyMedical Center, 780 East Gilbert Street, San Bernardino, CA92415-0935, USA), Nutter D and Widoff B. Recording patients'consumption of social drugs in a family medicine residency:a longitudinal study. Family Practice 1985; 2: 86–90. ‘Social drugs’ such as nicotine, alcohol and caffeinemay be risk factors in a variety of disorders. Over a five-yearperiod an audit of 954 medical records was carried out in auniversity-based family medicine training programme. The aimwas to investigate ways of improving physicians' compliancewith the recording in the data base of the consumption of thesesubstance by patients. Instruction through lectures and remindersproduced no change in the recording of social drug usage inyear 2, but the distribution of model dictations led to a significantchange in year 3 for the recording of nicotine and alcohol consumption.This effect was sustained in years 4 and 5. Visual cues in themedical record led to a significant improvement in the notationof caffeine usage in year 4 and the effect was sustained inyear 5. Additional audit sessions did not increase compliancewith caffeine notation. Faculty and resident compliance withthe recording of social drug history were not significantlydifferent.     

The relevance of continuity of care: a solution for the chaos in the emergency services

Background. In Brazil, there continues to be an excessive useof emergency services by patients with elective medical problems.Those patients who report having a primary care physician areless likely to utilize the emergency department for non-urgentconsultations. Objective. The objective of this study was to compare patientswho have a primary care physician with those who do not in relationto severity of their chief complaint at presentation in theemergency department. Methods. The study was carried out as a cross-sectional interview-basedsurvey at the Conceição Hospital Emergency Servicein Porto Alegre (Brazil). The sample was 553 patients selectedthrough a systematic random sampling, and the response ratewas 88%. The data entry and analysis were performed using thesoftware Epi-info, EGRET and SPSS. The analysis included simplestatistics to determine the prevalence of the conditions beinginvestigated and the effect of independent variables (regulardoctor) in relation to the dependent variable (severity of disease)through logistic regression. Results. The chief complaints were divided up as follows: 15%emergency cases, 46% urgent cases and 39% elective. The chiefcomplaint was defined as urgent or emergency if it exhibiteda significantly statistical association with the following independentvariables, after being analysed by a logistic regression model:patients who reported having a primary care physician [oddsratio (OR) = 2.98, 95% confidence interval (CI) = 1.84–4.80]and patients who usually go to the emergency room by car (OR= 2.67, 95% CI = 1.75–4.05). Conclusion. One strategy to reduce the number of non-urgentconsultations at emergency rooms is to establish a close out-patientrelationship between patients and physician. There is a needto optimize the health care of patients who have non-urgentproblems but still seek the emergency department through strategiesat the primary health care level—especially when continuouscare is available—and where a comprehensive approach withan emphasis on prevention would stimulate better quality ofcare at a lower cost. Keywords. Continuity of care, emergency, epidemiology, primary health care.     

Acute Toxoplasma gondii Infection among Family Members in the United States

We investigated 32 families of persons with acute toxoplasmosis in which >1 other family member was tested for Toxoplasma gondii infection; 18 (56%) families had >1 additional family member with acute infection. Family members of persons with acute toxoplasmosis should be screened for infection, especially pregnant women and immunocompromised persons.     

A Graduate Programme for Academic Family Physicians

Brennan M, McWhinney I R, Stewart M (Department of Family Medicine,University of Western Ontario, London, Ontario, Canada N6A 5C1)and Weston W. A graduate programme for academic family physicians.Family Practice 1985; 2: 165–172. The paper describes a graduate studies programme designed toprepare outstanding family physicians for academic leadershipand reports an evaluation of the programme. The programme aimsto produce academic family physicians who exhibit certain qualities:outstanding clinical skills, professional interest in the organizationand transmission of knowledge, and a scholarly approach throughresearch and skills of leadership. The course includes clinicaland teaching practice, formal course work and a scholarly thesis;the emphasis is on teaching and learning, theoretical foundationsof family medicine, whole person medicine, research design andtechniques, ethical decision making, and administration of organizations.A survey of the first 30 graduates of the programme indicatedthat the majority did more clinical teaching, small group teaching,research, writing and administration than before the course.The graduates' opinions of the programme indicated the extentto which the programme goals have been met: to provide a coherentlearning experience integrating the art, science and technologyof the discipline of family medicine.