Self-reported illnesses in family members of alcoholics.

This study explores the association between familial alcoholism and the presence of certain conditions in nonalcoholic family members. Depression, obesity, functional bowel syndrome, asthma/emphysema, trauma, and genitourinary problems are conditions suggested by prior studies to be more common in families of alcoholics than in those without an alcoholic family member. Cross-sectional data were collected from a convenience sample of adults in the waiting room of a midwestern, university based family practice clinic. The respondents were classified in two groups: those with little likelihood of familial alcoholism and those with probable familial alcoholism. The groups were matched for race and age, creating two demographically similar groups which were then analyzed as cohorts. The prevalence rates of the conditions of interest in the respondents were calculated in the two groups and compared using the chi-square test for statistical significance. Significant differences in prevalence rates of depression and obesity were found. Trends were found for differing rates of functional bowel syndrome and asthma/emphysema. No differences were found for trauma and genitourinary problems. If differences in disease prevalence truly exist between family members of alcoholic and nonalcoholic individuals, this awareness could enhance the diagnosis and treatment of the conditions of interest in the nonalcoholic relative as well as the alcoholic individual. Family members could be a powerful screening tool for alcoholism.

Alcohol, tobacco and illicit drug use among women.

Although the prevalence of alcohol, tobacco, and illicit drug use among women is lower than that among men, women suffer unique adverse health effects from these substances. Furthermore, the use of these substances during pregnancy poses special risks to mother and fetus, including placental accidents, intrauterine growth retardation, congenital anomalies, and premature birth. Primary care clinicians should ask all women about their patterns of alcohol, tobacco, and illicit drug use and should offer targeted interventions to those using these products.

A comparison of morbidity and mortality for family physicians' and internists' admissions.

The quality of medical care delivered by physicians of different specialties has been the subject of debate for some time. Studies have suffered from a variety of flaws. This study used the MedisGroups comparative database to compare outcome measures in hospitalized patients aged 65 years and older treated either by the family physicians or internists as attending physicians. Using the 10 most common diagnostic related groups for internal medicine, 10,353 admissions to internists were compared with 5,473 admissions to family physicians. Patients admitted by family physicians had a significantly higher admission illness severity and were significantly older. There was no significant difference in morbidity and mortality. The lower average charges for patients admitted to family physicians were statistically significant.

Diphenhydramine toxicity in a child with varicella. A case report.

Varicella may be associated with serious complications including encephalitis, Reye's syndrome, and drug toxicity. In this case, a 19-month-old child with varicella was brought to the family practice clinic by her parents when she began behaving abnormally. At the time of presentation the child exhibited dilated pupils, ataxia, urinary retention, and facial grimacing. The child's parents had treated her with acetaminophen, diphenhydramine syrup, colloidal oatmeal baths, and frequent applications of Caladryl lotion. The results of her immediate laboratory tests were within normal limits, and she was admitted to the hospital for observation. She recovered without therapeutic intervention. Although not available at the time of admission to the hospital, her diphenhydramine serum level was 1948 ng/mL. Diphenhydramine levels above 100 ng/mL have been associated with toxicity.

Prevalence and predictors of problem drinking among primary care diabetic patients.

BACKGROUND: Alcohol abuse among patients with diabetes mellitus is dangerous and complicates therapy, but its prevalence and the factors that predict it are unknown. This study examined the prevalence of problem drinking among a large number of primary care diabetic patients, exploring its relation to age, race, sex, psychological factors, and other health behaviors. METHODS: Volunteers with insulin-dependent diabetes mellitus and non-insulin-dependent diabetes mellitus were surveyed at three primary care practice sites. Patients completed a health risk appraisal designed to elicit alcohol use and other health practices, and two psychometric instruments: the Brief Encounter Psychosocial Instrument and the Affect Balance Scale. Fasting blood glucose and hemoglobin A1C levels were also determined. RESULTS: Of 395 diabetic patients, 32 (8.1%) had a drinking problem as defined by answering yes to the question "Have you ever had a drinking problem?" or reporting their last drink to be within 24 hours, or both. Patients with a drinking problem coped less well with psychological stress and had a more highly negative affect than those without a drinking problem. Depression, black race, and male sex were significantly associated with problem drinking (odds ratios = 8.42, 2.70, and 3.80, respectively). Problem drinking did not predict glycemic control but was associated with smoking and less frequent glucose monitoring. CONCLUSIONS: The prevalence of problem drinking among patients with diabetes mellitus appears lower than among other medical outpatient populations and is in keeping with the prevalence found in community surveys. While the lack of association between problem drinking and glycemic control in diabetic patients may be surprising, these data help define the characteristics of this subgroup of diabetic patients and highlight the need for family physicians to intensify alcohol screening efforts in this population.

Morbidity, mortality, and charges for hospital care of the elderly: a comparison of internists' and family physicians' admissions.

BACKGROUND: In an atmosphere of cost containment, an important question is whether there are differences in quality or cost of medical care provided by physicians with different specialty training. METHODS: This study is an analysis of Pennsylvania hospital admissions from the 1989 MedisGroups Comparative Database, consisting of 31,321 hospital admissions by internists and family physicians. It encompasses the top 10 admission diagnostic-related groups in patients 65 years and older. Outcome measures of morbidity, mortality, length of stay, and hospital charges were compared between patients of internists and family physicians while controlling for patient variables, such as age, sex, Medicaid insurance payment, admission from nursing home, and admission severity scores, and hospital characteristics, such as number of beds, teaching status, and available technologies and procedures. RESULTS: Admission diagnoses were similar for patients of family physicians and internists. After adjusting for relevant patient and hospital characteristics, there were no differences in mortality or hospital charges; however, the patients of internists experienced slightly higher morbidity (odds ratio = 1.07, 95% confidence interval, 1.017 to 1.123) and longer mean length of stay (10.80 vs 10.54 days, P < .05). The mean age of patients and the proportion of Medicaid patients was similar in the two specialty groups. Family physicians' patients were more likely to be female (60% vs 57%, P < .01), were less likely to be admitted from nursing homes (4% vs 5%, P < .01), and had a lower mean admission severity score (1.940 vs 1.964 on a scale of 0 [least seriously ill] to 4 [most seriously ill], P < .01). Internists were more likely to work in teaching hospitals and hospitals with sophisticated technology (P < .01). CONCLUSIONS: It makes little difference in medical outcomes or hospital charges whether family physicians or internists manage the hospital care of elderly patients for common medical problems. Previously documented lower costs of care by family physicians may be due to outpatient rather than inpatient care.

Absence of sex differences in the evaluation of patients hospitalized for transient ischemic attacks.

BACKGROUND: Sex has been shown to affect the extent of evaluation and treatment of patients with coronary artery disease. This study investigates potential differences in the evaluation of hospitalized men and women with transient ischemic attacks to determine whether a similar bias exists. METHODS: The 1989 MedisGroups comparative database was used to analyze a convenience sample consisting of all family and internal medicine patients with the primary admission diagnosis-related group (DRG) of "transient ischemic attack." RESULTS: Women comprised 1933 of the 3165 admissions. The mean age for women was 1.88 years older than for men (P < .01). Women were three times more likely to reside in a nursing home before admission (P < .01), but had a lower prevalence of dementia (P < .05). The 1232 men had a higher severity of illness score at admission (P < .05), and were 5.3% more likely to be admitted to a teaching hospital than women (P < .01). Men were also more likely than women to be admitted to large hospitals (P < .01). There were no differences between sexes in the use of cranial computed tomography, carotid or cardiac Doppler, or carotid arteriography. Adjusted means for hospital charges, morbidity, and mortality did not differ between sexes, but length of stay was longer by 1.5 days for women compared with men (P < .01). CONCLUSIONS: In-hospital evaluation of elderly patients with transient ischemic attacks did not differ significantly between men and women. This finding does not exclude the possibility of a difference in workup for men as compared with women in the ambulatory management of this condition.

Core body temperature in the elderly and factors which influence its measurement.

Several studies have reported that core body temperature decreases with age and has greater variability in older populations. Furthermore, oral measurement, the most frequently used clinical method for determining fever, may not accurately reflect core body temperature. This study was designed to compare accurate measurements of oral and core body temperatures in a group of 93 healthy subjects, aged 62-96, under controlled conditions. Increasing age, presence of dentures, and type of thermometer were examined to determine if they affect body temperature measurements. Core temperatures did not show a negative relationship with advancing age (r = -0.02) nor did variation in temperatures increase with age. Neither the type of thermometer nor the presence of dentures significantly affected the measurement of temperature.

The influence of gender and race on mean body temperature in a population of healthy older adults.

Body temperature is known to vary with environmental conditions, physical activity, and illness. There is also some suggestion that body temperature is higher in women than men, and higher in blacks than whites. This study was undertaken to determine if previously described differences in body temperature found in relatively uncontrolled settings associated with gender and race can be reproduced under carefully controlled conditions. Temperature was measured orally with calibrated mercury-in-glass thermometers in 92 healthy community-dwelling volunteers aged 64 years and older. Environmental conditions were carefully controlled and patients with physical conditions or medication regimes known to alter body temperature were excluded. The mean body temperature for all subjects was 36.86 degrees C +/- 0.23 degrees C. The means for white men and women did not differ significantly. There was a statistically significant difference between black and white women, with blacks having 0.13 degrees C higher temperature. We conclude that body temperature varies with race in older women. No significant gender-related difference in normal body temperature was found in these healthy elderly white men and women. Differences in body temperature between men and women found in younger patient populations may reflect the temperature elevations in women associated with menstruation.