RESUMEN

BACKGROUND AND OBJECTIVES: Fourfactors have been linked with self-care behaviors in patients with type 2 diabetes: (1) patient demographics, (2) doctor-patient relationship, (3) stress, and (4) social context. This study determined the relationship of each of these factors on self-care behavior in diabetic family practice patients. METHODS: We conducted a cross-sectional survey of patients seeking care in the outpatient clinics of the Residency Research Network of South Texas (RRNeST), a network of six family practice residency programs affiliated with the University of Texas Health Science Center at San Antonio. A total of 397 consecutive adults with type 2 diabetes presenting for appointments with family medicine faculty and family practice residents over a 6-month time period were surveyed about various factors and their relationship to self-care behavior pertinent to diabetes. RESULTS: Self-care was related to age, patient satisfaction with his/her doctor-patient relationship, personal stress, and family context. Social context, as reflected by the statement "My family understands my diabetes," was strongly associated with diet, exercise, and medication adherence. Multivariate analysis demonstrated that, after controlling for patient demographic characteristics andpatient satisfaction, personal stress and social context were strongly associated with self-care, especially diet. CONCLUSIONS: Social context, specifically the family, is significantly associated with self-care behaviors. Attempts to improve self-care behavior should include thefamily members of the diabetic patient. Since family physicians often provide care to multiple members of the family, they are ideally positioned to implement these interventions.

Asunto(s)

Asunto(s)

RESUMEN

Early identification of alcohol-related problems is important because these problems are prevalent, pose serious health risks to patients and their families, and are amenable to intervention. Physicians may be able to help patients change their drinking behaviors. The most effective tool for screening is a thorough history of the patient's drinking behavior, designed to identify patterns of alcohol-related difficulties with physical and mental health, family life, legal authorities and employment. Alcohol drinkers can be categorized as at-risk, problem or alcohol dependent, according to a protocol developed by the National Institute on Alcohol Abuse and Alcoholism. The severity of the alcohol problem and the patient's readiness to change should determine the intervention selected by the family physician.

Asunto(s)

Asunto(s)

RESUMEN

This article addresses two primary issues: partner violence and sexual assault. Partner violence refers to the infliction of harm by one intimate partner to the other, with the intention of causing pain or controlling the other's behavior. Sexual assault is sex without consent, obtained by force or threat. Sexual assault can be perpetrated by spouses, lovers, dates, relatives, parents, acquaintances, and strangers.

Asunto(s)

RESUMEN

AIMS: This study examined the effects of two primary care interventions (a physician intervention and a clinic-based psychoeducational group) on drinking patterns, psychosocial problems and blood test results (MCV, GGT, SGOT and SGPT). DESIGN: Subjects were randomized into one of four treatment groups: physician intervention, psychoeducation, both interventions, or no intervention. Follow-up data were collected at 12 and 18 months. SETTING: Subjects were recruited from a family practice outpatient clinic managed by a public hospital. PARTICIPANTS: Included 175 Mexican-American female and male primary care patients who screened positive for alcohol abuse or dependence. These patients were not seeking help for alcohol problems. INTERVENTIONS: Included a brief physician intervention and a 6-week patient psychoeducational group. MEASUREMENTS: The Diagnostic Interview Schedule assessed subjects for alcohol abuse; the Addiction Severity Index measured alcohol-related problems, including psychosocial issues. FINDINGS: All four treatment groups demonstrated significant improvement over time, with few differences between intervention and control groups. CONCLUSIONS: Assessment can be confounded with brief interventions; future investigators should use non-assessed control groups.

Asunto(s)

RESUMEN

OBJECTIVE: To evaluate the family environment in patients with infrequent panic attacks. DESIGN: Survey. SETTING: Waiting room of a family health center at a university-based family practice residency program. The center primarily serves low-income or underinsured patients, 80% of whom are Hispanic. PATIENTS OR OTHER PARTICIPANTS: Randomly selected patients completed the panic disorder section of the Structured Clinical Interview of the Diagnostic and Statistical Manual of Mental Disorders, Third Edition. Thirty patients with infrequent panic attacks were compared with 30 control patients without panic attacks matched for age, gender, and ethnicity. Both groups completed in-depth interviews. INTERVENTIONS: None. MAIN OUTCOME MEASURES: The in-depth structured interview included family environment instruments--Family Adaptability and Cohesion Evaluation Scales and Duke Social Support and Stress Scale--as well as a genogram. Family violence and sexual abuse were assessed by means of the Conflict Tactic Scales and the Sexual Stress Questionnaire. RESULTS: Although patients with infrequent panic attacks were of lower birth order than patients without panic attacks (Wilcoxon chi 2 = 2.13, P < or = .02), no differences in childhood or current family functioning were found. However, patients with infrequent panic attacks reported higher levels of childhood (paired t = 3.97, P < or = .001) and current (paired t = 3.05, P < or = .005) family stress. Although the prevalence of family violence was similar between groups, the group with infrequent panic attacks reported more violent events in the past year (paired t = 2.60, P < or = .02) than did the group with no panic attacks. Similarly, 60% of patients with infrequent panic attacks reported childhood sexual abuse, as opposed to 13% of patients without panic attacks (McNemar's chi 2 = 10.5, P < or = .005). CONCLUSIONS: Although no association between infrequent panic attacks and family functioning or support were found, the group with infrequent panic attacks reported more frequent violent events currently and higher levels of family stress. The high rate of childhood sexual abuse may have important causative implications for infrequent panic attacks.

Asunto(s)

RESUMEN

The present study examined relationships among ethnicity, gender, alcohol consumption, and sexual behaviors in a community survey sample of 1,392 adults. Predictors included liberal versus conservative orientations (sex role orientation, religiosity); traditional versus liberal attitudes regarding sexuality, typical alcohol consumption patterns, expectancies regarding alcohol's effect upon one's sexuality, and frequency of alcohol use before sex. Findings are consistent with other studies indicating more sex partners among males than females and among Blacks (particularly males) than Anglos. Blacks also reported less involvement in oral sex than Anglos and Mexican-Americans--although observed differences for oral sex were more characteristic of females and less characteristic of unmarried nondrinkers. Unmarried Mexican-American males reported somewhat, though not significantly, more partners than did Anglos. Unmarried Black males (particularly nondrinkers) also reported more frequent risky behaviors than did Anglos. Divorced Black female drinkers reported significantly less frequent risky behavior than their Anglo counterparts. Alcohol use-sexual relationships were independent of psychosocial background characteristics and situated drinking (drinking before sex) was more strongly related to sexual behavior dimensions than were general drinking patterns.

Asunto(s)

RESUMEN

Of 1936 primary care patients screened using the alcohol portion of the Diagnostic Interview Schedule, 100 met criteria for "alcohol abuse and/or dependence." Sixty of the individuals who misused alcohol were matched to 60 who did not. All 160 patients answered questions about psychiatric symptoms and psychotropic drug use. The lifetime prevalence of depression, suicidal thoughts, suicidal attempts, violent behavior, and trouble concentrating was consistently higher for those who misused alcohol. Depression and trouble concentrating were more likely to be experienced by alcohol misusers during the past month. Gender differences were also noted for prevalence of psychiatric symptoms.

Asunto(s)

Asunto(s)

Asunto(s)

RESUMEN

Although the Mexican-American elderly represent a large and rapidly growing subgroup of the ethnic aged, national prevalence data of major chronic diseases among this population are sparse. Data based on physical examinations from three older groups of the southwestern portion of the 1982-1984 Hispanic Health and Nutrition Examination Survey (HHANES) were reviewed to determine rates of hypertension, diabetes mellitus, arthritis, and heart disease. The results show a higher prevalence of diabetes and lower prevalence of heart disease and hypertension when compared with the general population, coinciding with data from previous studies. Findings for the prevalence of arthritis varied widely from other studies, however, and proportions were lower than expected. Further research on arthritis in the Mexican-American elderly is necessary to determine whether protective mechanisms that may lead to a lower prevalence of this disease exist in this ethnic subgroup.

Asunto(s)

RESUMEN

As a part of an on-going effort to assess the prevalence of alcoholism among hospitalized patients, a structured technique was devised to document the prevalence of alcoholism in a large teaching hospital. A system of inpatient chart audit classification was developed to assess direct evidence of patient alcoholism. In addition, the reported prevalence of alcoholism as a discharge diagnosis was determined. An assessment of the degree of alcoholism was used to classify patients into severity levels. A determination was made of the relationship of hospital chart data classification level to other medical problems or treatments directly addressed by the physician(s) that would indicate that the alcohol abuse, if present, was considered. A retrospective chart audit was conducted for 809 consecutive adult admissions to a 350-bed urban university teaching hospital using a specific classification scheme for determining evidence of alcoholism. This technique revealed a reported prevalence of alcoholism in 4.3% of all nonobstetric admissions to this university hospital. However, a chart review technique using specific criteria for the diagnosis of probable alcoholism raised the estimated prevalence to 15.9%. When the chart contained a primary diagnosis of alcoholism, physicians' responses reflected treatment plans that addressed acute management of alcohol related medical complications but often did not document efforts to assist the patient with the underlying alcoholism/substance abuse.

Asunto(s)

RESUMEN

Violence against women is prevalent and is understood to produce adverse physical and psychological consequences for its victims. Victimized women frequently visit family physicians seeking relief from their distress; yet violence against women has not been identified by medical professionals as a relevant concern. This paper discusses health issues of women who are victims of violence, and encourages family physicians, who are in a position to have a powerful effect on this social problem, to reframe this phenomenon as a pertinent issue.

Asunto(s)

RESUMEN

The Mexican-American elderly have long been a focus of interest as a unique ethnic subgroup. A paucity of data, however, exists concerning Mexican-Americans in extended care facilities. The current retrospective study, conducted at a community based nursing facility, compared medical records of 54 Mexican-Americans to 30 non-Hispanic whites (Anglos). The records were reviewed with respect to demographics, major/minor diagnoses, functional status, and mental status data. Several differences were noted. Mexican-Americans were significantly more functionally impaired (mean = 22.2) than Anglos (mean = 20.0, P = .008). Further, Mexican-Americans demonstrated a significantly higher degree of mental impairment (mean = 3.2) than Anglos (mean = 2.3, P = .040). Finally, investigators noted that although statistically nonsignificant, a greater percentage of Mexican-Americans (40.7%) suffered cerebrovascular attacks (CVAs) than did Anglos (23.3%, P = .11). These results indicate that Mexican-Americans are entering nursing homes more functionally and mentally impaired than their Anglo counterparts, due in part perhaps to CVAs. This study suggests that an extended family structure may help Mexican-Americans stay in the community until greater degrees of disabilities have been reached.

Asunto(s)

RESUMEN

This study had two goals--to evaluate critically the literature regarding the quality and stability of physicians' marriages and to present national data regarding the divorce-proneness of physicians in comparison with other occupational groups. The conclusions from the literature review were that (a) there is no sound evidence that physicians have lower marital quality than other groups, and (b) methodological weaknesses in past research leave open the question of whether physicians are more prone or less prone to divorce than other groups. The conclusion from new analyses of 1970 and 1980 US census data was that both male and female physicians have a lower tendency to divorce than other occupational groups, including other groups of professionals.

Asunto(s)

RESUMEN

Training in systemic therapy necessitates a structured approach to teaching systemic thinking. The Systemic Therapy Sessions Summary Form, a record-keeping method, is presented as a tool for enhancing training in systemic therapy. The purpose of this form is to provide the structure for the trainee to develop circular hypotheses, to connect reflexively the assessment and intervention components of therapy, and to maintain a sense of the evolving nature of therapy across sessions. A case example illustrates the use of this record-keeping format.

Asunto(s)

RESUMEN

This study began as an investigation of the feasibility of a brief, multifaceted primary care smoking cessation intervention in two primary care medical settings. When the investigators experienced a series of problems and setbacks in implementing the protocol in both settings, they turned their attention to the ecological disturbances created in the health care settings when outside researchers intervened. This paper analyzes the interaction patterns that complicated the research enterprise, particularly the triangles among the research team, the nurses, and the physicians. It also describes steps taken by the research team to deal with these ecological/systems problems. The authors raise these issues to help other researchers who encounter similar problems in community-based research, problems which are rarely discussed in the research literature.

Asunto(s)