Demographic Correlates of Fatigue in a University Family Health Centre

To delineate the demographic correlates of the fatigued patient,297 patients attending a family practice centre were investigated.Women were more frequently tired than were men; patients withless than a college education were over-represented, and employedpersons were more robust than the unemployed. Fatigue was alsoassociated with lack of exercise, nightly wakening and the presenceof children less than six years old in the household. Therewere no significant relationships between fatigue and age, smokingor ‘reducing’ diets. The results of the study shednew light on the correlates of fatigue and confirmed some long-standingbeliefs.     

Occupational Physicians' Attitudes and Practices in Relation to Occupational Cancer Prevention A Qualitative Study in Southeastern France

Abstract

We conducted a qualitative survey of 20 occupational physicians (OPs) in southeastern France in 2008 to study their attitudes and practices regarding the prevention of occupational cancers. Occupational physicians' practices regarding occupational cancers centered mainly on prevention. Numerous difficulties impeded these activities: attitudes that minimized the carcinogenic risks by employers and employees, the absence or inadequacy of mandatory risk assessment to identify health hazards, and difficulties in obtaining individual exposure forms, which employers are supposed to complete to identify employees exposed to carcinogens. Other problems were related to the resources available to OPs and the constraints on their time. Finally, some OPs reported that they lacked selfefficacy. The results of this study suggested the need to strengthen OPs' initial training, draft and adopt good practice guidelines for various aspects of their practices, and improve collaborations between OPs and other professionals specialized in the prevention of occupational risks.     

A Two Year Study of Alcoholics in General Practice

This study attempts to evaluate the feasibility of a familydoctor diagnosing and treating all the patients with a drinkingproblem in his London practice. Patients were selected from an ongoing register of suspectedpathological drinkers. In a practice population of 9,108 patients,134 names were on the register in April 1972, and 61 were addedto it during the two subsequent years. 133 patients underwent a full assessment for alcoholism withdetails of personal, social, medical and drinking history andincluding a physical examination and biochemical profile. 69 patients (51·8%) of the sample were diagnosed as alcoholicson evidence of physical, mental, personal, familial and socialharm due to alcohol abuse. 37 of them (53·6%) also hada history of physical dependence on alcohol. 32 (46·4%)had no history of dependence. They all shared a wide spectrumof physical, social and psychiatric pathology. Treatment was offered by the same family doctor and a researchworker. Patients were seen in a series of short therapeuticsessions with more lengthy re-assessment at six-monthly intervals.Relatives were involved. Attendance rates were unsatisfactoryin 23·2% of cases. During the two year period of the study (1972–1974), patientswere visited at home at regular intervals by the research worker. Based on information and impressions of the general practitioner,his partners, his research assistant and relatives, treatmentwas evaluated at the end of the study. 11 patients (19·3%) remained sober for two years, 26(45·6%) had improved, 20 (35·1%) were left unchanged. Only 3 patients had sought help or found help from any treatmentagency outside general practice and none were known to them. It is concluded that the majority of alcoholics can be identifiedand treated by the family doctor, who has a vital role in theprevention and treatment of alcoholics in the community.     

多点执业背景下医师薪酬管理模式的研究

自2009年我国关于医师“多点执业”相关政策出台并逐步开展试点以来,多点执业在实际操作层面的推广并不理想.文章从实施多点执业的必要性展开论述,总结多点执业提出以来的政策沿革及试点工作现状,最后提出构建以服务项目核算为基础,以绩效为导向的薪酬体系,旨在从推动人事制度、薪酬分配改革的角度出发,健康、高效地践行多点执业.     

北京市高校大学生避孕知识、态度及避孕行为的现况分析

本文报告了北京市五所高校1310名大学生避孕知识、态度及避孕行为的现状。调查结果表明,半数以上的学生听说过宫内节育器、避孕套和避孕药的名称,但少于1/3的学生回答“知道如何使用”这些避孕措施;半数以上的被调查对象对大学生避孕相关问题持肯定和赞同的态度。15％的男生和13％的女生承认有过婚前性交行为。但首次性行为发生时,只有16％的人回答他们或他们的性对象采用过现代避孕措施(避孕套和避孕药等)。另外,3.1％的被调查对象报告他们曾怀孕过或使对方怀孕过一次或多次。Logistic回归分析结果表明,避孕知识、大学生对怀孕易感性和严重性的认知以及对避孕措施获得性难易程度的认知与避孕行为有关。提示:应在北京大学生中开展适当的避孕知识与技能的教育,同时提供必要的生殖健康服务。     

A Cohort Study of Family Practice Residency Graduates in a Predominantly Rural State: Initial Practice Site Selection and Trajectories of Practice Movement

Limited information is available on long-term patterns of practice location choice among family physicians, although these patterns will significantly affect the quantity, quality, and continuity of health care provided in rural areas. From 1992 through 2000, five biennial surveys were administered to graduates of three family practice residency programs. Graduates were asked the location of their current and previous practice site locations, specific practice information, and global satisfaction with family practice. Identifiable practice sites were assigned a U.S. Department of Agriculture rural-urban continuum code based on the county in which the practice was located. The use of rural-urban continuum codes as a measure of rurality was believed to be particularly applicable to the small rural and frontier counties typical of the Great Plains region. For purposes of this study, practice locations were considered rural if they were in rural-urban continuum codes 7, 8, or 9. Of 593 graduates, 514 (87%) returned at least one questionnaire. Overall, about one-third of graduates had chosen their first practice sites in counties with rural-urban continuum codes of 7, 8, or 9. While most graduates remained in their initial practice site, almost half moved at least once. Those who left nonmetropolitan practices tended to move to less rural locations, though a few moved against this gradient. Moves away from the initial practice site occurred after a median of 3 years, and the likelihood of a first move decreased rapidly 5 to 6 years after graduation. Much remains to be learned about decisions to enter or leave practice in rural-urban continuum code 7, 8, and 9 counties.     

Adoption,Family Ideology,and Social Stigma: Bias in Community Attitudes,Adoption Research,and Practice

This article explores the impact of the dominant North American genetic family ideal on community attitudes toward adoption, on adoption research, and on the beliefs and attitudes of adoption case workers. It examines how the failure to recognize the stigmatized social position of adoptive families has shaped not only current public opinion about adoption, but adoption research and practice as well. In conclusion, the article offers suggestions for erasing negative bias from adoption research and practice.     

安徽医科大学学生营养知识、态度及饮食行为调查

目的：了解医科大学生的营养知识、态度和饮食行为及其之间的关系。方法：采用问卷调查方法，对某医科大学学生780名进行营养知识、态度及饮食行为调查。结果：大学生对营养知识缺乏全面深入的了解，营养知识问题回答正确率最低为22．6％；对营养知识不想了解或无所谓的占9．1％，只有29．7％的学生选择食物时考虑食物的营养价值或自身的营养需要。但他们多具有较好的营养态度，愿意接受更多的营养和健康方面的知识。结论：应采取多种开式对医科大学中强营养知识的宣传和饮食行为的正确引导。     

Iron Deficiency in Cystic Fibrosis: A Cross-Sectional Single-Centre Study in a Referral Adult Centre

Iron deficiency (ID) diagnosis in cystic fibrosis (CF) is challenging because of frequent systemic inflammation. We aimed to determine the prevalence and risk factors of ID in adult patients with CF. We conducted a single-centre prospective study in a referral centre. ID was defined by transferrin saturation ≤16% or ferritin ≤20 (women) or 30 (men) μg/L, or ≤100 μg/L in the case of systemic inflammation. Apparent exacerbation was an exclusion criterion. We included 165 patients (78 women), mean age—31.1 ± 8.9 years. ID prevalence was 44.2%. ID was significantly associated with female gender (58.9% vs. 38%), lower age (29.4 ± 8.5 vs. 32.5 ± 9.1), lower body mass index (20.5 ± 2.2 vs. 21.3 ± 2.5), and Pseudomonas aeruginosa colonization (70.8% vs. 55.1%). Diabetes mellitus, antiacid drug use and low pulmonary function were more frequent in patients with ID with no statistical significance. The use of CFTR correctors was not associated with ID. In the multivariate analysis, ID was associated with female gender (OR 2.64, CI95% 1.31–5.31), age < 30 years (OR 2.30, CI95% 1.16–4.56), and P. aeruginosa (OR 2.09, CI95% 1.04–4.19).     

Egg consumption in relation to cardiovascular disease and mortality: the Physicians' Health Study

BACKGROUND: A reduction in dietary cholesterol is recommended to prevent cardiovascular disease (CVD). Although eggs are important sources of cholesterol and other nutrients, limited and inconsistent data are available on the effects of egg consumption on the risk of CVD and mortality. OBJECTIVE: We aimed to examine the association between egg consumption and the risk of CVD and mortality. DESIGN: In a prospective cohort study of 21,327 participants from Physicians' Health Study I, egg consumption was assessed with an abbreviated food questionnaire. Cox regression was used to estimate relative risks. RESULTS: In an average follow-up of 20 y, 1550 new myocardial infarctions (MIs), 1342 incident strokes, and 5169 deaths occurred. Egg consumption was not associated with incident MI or stroke in a multivariate Cox regression. In contrast, adjusted hazard ratios (95% CI) for mortality were 1.0 (reference), 0.94 (0.87, 1.02), 1.03 (0.95, 1.11), 1.05 (0.93, 1.19), and 1.23 (1.11, 1.36) for the consumption of <1, 1, 2-4, 5-6, and > or = 7 eggs/wk, respectively (P for trend < 0.0001). This association was stronger among diabetic subjects, in whom the risk of death in a comparison of the highest with the lowest category of egg consumption was twofold (hazard ratio: 2.01; 95% CI: 1.26, 3.20; P for interaction = 0.09). CONCLUSIONS: Infrequent egg consumption does not seem to influence the risk of CVD in male physicians. In addition, egg consumption was positively related to mortality, more strongly so in diabetic subjects, in the study population.     

Physicians' Communicative Strategies in Interacting With Internet-Informed Patients: Results From a Qualitative Study

This article describes the strategies used by physicians to interact with Internet-informed patients, alongside illustrating the motives underlying such strategies. Semistructured interviews were conducted with a sample of 17 physicians from primary care and medical specialist practices in the Italian part of Switzerland. The sample was diversified in terms of specialty, age, and gender. Data collection and analysis were driven by grounded theory and supported by a computer-assisted qualitative analysis program. A typology of four communicative strategies has been outlined. The adoption of these strategies is shaped by physicians' general attitude toward Internet-informed patients, based on their conception of medical information for lay people through the Internet. However, this general attitude is mediated by doctors' interpretation of the specific communicative context, that is, their appraisal of three aspects: the patient's health literacy, the relevance of the online information to be discussed, and their own communicative efficacy. At the end, the process of interpretation underlying the strategies is discussed to expand on it and to identify implications for practice and research.     

Scientific Rigour in Qualitative Research--Examples From a Study of Women's Health in Family Practice

The increase in qualitative research in family medicine raisesa demand for critical discussions about design, methods andconclusions. This article shows how scientific claims for truthfulfindings and neutrality can be assessed. Established conceptssuch as validity, reliability, objectivity and generalizationcannot be used in qualitative research. Alternative criteriafor scientific rigour, initially introduced by Lincoln and Guba,are presented: credibility, dependability, confirmability andtransferability. These criteria have been applied to a researchproject, a qualitative study with in-depth interviews with femalepatients suffering from chronic pain in the locomotor system.The interview data were analysed on the basis of grounded theory.The proposed indicators for scientific rigour were shown tobe useful when applied to the research project. Several examplesare given. Difficulties in the use of the alternative criteriaare also discussed.     

Patient Requests in Family Practice: A Focal Point for Clinical Negotiations

A growing body of literature has stressed the importance ofeliciting the patient's views on the management of health andillness. In particular, it is recognized that patients frequentlyenter into clinical encounters with specific requests for services,that is ideas about how they hope to be helped. The presentinvestigation examined the following two questions: (1) whatkinds of requests do adult patients coming to a family practicecentre have prior to seeing the doctor; and (2) will factoranalysis of a 25-item patient request questionnaire provideevidence of the basic or most common dimensions of patient requestsin this population? Two newly-developed instruments were administeredto a sample of 144 adult patients before their visit to thedoctor. Factor analysis yielded five major request factors—‘medicalinformation’, ‘psycho-social assistance’,‘therapeutic listening’, ‘general health advice’,and ‘biomedical treatment’ —partially replicatingthe findings of an earlier pilot study. The clinical implicationsof eliciting patient requests in the light of current behaviouraland social science research into the doctor-patient relationshipare discussed. Future research directions are also outlined.     

Computerized Protocol for Preventive Medicine: A Controlled Self-Audit in Family Practice

A protocol for adult health maintenance was designed for displayon a desk-top microcomputer in the general practitioner's office.Two hundred and twenty-two patients were entered into a randomizedstudy comparing the outcome of the computerized protocol withmanual records. The doctor had the option of displaying thesingle-screen protocol for the experimental group and actingon its prompts in the course of his normal clinical consultations.At the end of 30 months, significantly more preventive medicineitems—smoking, height, blood group, tetanus and rubellaimmunization status and family planning—had been recordedfor patients in the computerized group. For other items, requiringmore frequent measurements, computerization produced an advantageonly for blood pressure and breast examination, but not forweight, occult blood and serum cholesterol. Recording ratesincreased significantly for patients in both the control andthe computerized groups for all the items. Using the computerlengthened the average consultation time from 8.5 minutes to10 minutes. Such systems area valuable aid to encouraging doctorsto increase the amount of preventive medicine they incorporateinto their routine practice.     

苏州市4～5岁流动人口家庭儿童行为问题与家庭环境关系的研究

目的了解苏州市4～5岁流动人口家庭儿童行为问题发生率与家庭环境关系。方法采用Achenbach’s儿童行为量表、自制家庭环境问卷对244名4～5岁流动人口家庭儿童和282名4—5岁常驻儿童的行为及家庭环境进行调查，对结果进行多元回归分析。结果流动人口家庭儿童行为问题发生率明显高于常驻儿童。影响流动人口家庭儿童行为问题的因素有父母职业、婚姻状况、母亲的生育年龄、是否为亲生母亲和独生子女、家庭经济收入、家庭结构、儿童健康状况、主要抚养人以及学历等。这些影响存在明显的性别差异。结论提示要加强流动人口家庭儿童的心理卫生宣传教育和管理，可通过改善家庭环境因素，帮助儿童建立良好的行为，减少行为问题的发生。     

A Multidisciplinary Approach to Treating Obesity in a Community Health Centre

Objectives

The aim of the study is to assess the weight loss programme with regards to the long-term effectiveness of weight reduction and weight maintenance, using completion rate and BMI, blood sugar, cholesterol and blood pressure levels as outcomes. The aim of the study also includes identifying the factors associated with adherence to the programme.

Methods

The programme was developed by a multidisciplinary team. It included 6 months of introduction and another 18 months of maintenance. The data for 397 participants was collected after 24 months.

Results

346 participants have completed the introduction and 123 have completed the programme. In the introduction, the average weight loss was 12% of the initial weight. The participants, who completed the full programme, lost 9.4% of their initial weight. The participants also significantly (p<0.05) reduced their blood sugar and cholesterol levels, as well as their blood pressure. The factors associated with adherence to the programme are: age over 50, lower educational levels, lower initial weight and higher weight loss in the introduction.

Conclusions

The multi-disciplinary approach to obesity treatment was effective for a selected group of people. The proportion of dropouts was relatively high, but still low compared to similar programmes. Group treatment and mutual support are of a great importance in bringing about and maintaining the changes.