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Table of Contents

March 01, 2004; Volume 2,Issue 2

The Issue In Brief

March-April 2004


Cumulative list of Issues In Brief

A Community-Oriented Primary Care Demonstration Project: Refining Interventions for Cardiovascular Disease and Diabetes
By Marcus Plescia, MD, MPH, et al.
Community-oriented primary care (COPC) applies public health principles in the primary care setting. In this COPC project, community residents gathered and helped interpret information about diet and exercise patterns in their community. The information is being used to design programs to reduce cardiovascular disease and diabetes.

The Natural History of Asthma in a Primary Care Cohort
By Vince WinklerPrins, MD, et al.
In children and young adults, a single test for overreactiveness of the airway does not help predict whether the patient will develop respiratory tract illness, including asthma. Questionnaires about symptoms were more successful at predicting asthma and may be useful in practice.

Management of Patients With Hepatitis C in a Community Population: Diagnosis, Discussions, and Decisions to Treat
By Liliana Gazzoula Rocca, MD, et al.
Chronic hepatitis C is a treatable condition, but little is known about its treatment in the community practice setting. In a Minnesota county, generalist physicians (general internists and family physicians) diagnosed more cases of hepatitis C than any other group of physicians. Generalist physicians may also have central roles in monitoring and treating hepatitis C patients and referring them for specific therapies.

The Identification of Medical Errors by Family Physicians During Outpatient Visits
By Nancy C. Elder, MD, MSPH, et al.
Fifteen practicing family physicians identified medical errors and preventable problems in almost one quarter (23.6%) of their patient visits. Office administration errors were most frequently identified. According to the physicians� estimates, 23.7% of the errors and events led to minor patient harm, especially increased emotional distress and wasted time for the patient. In this and other studies, participants had different views of when an error is a �nuisance� and when it is a �harm.� Future primary care research is needed to clarify definitions for harm, refine a classification system for errors, and estimate the occurrence of errors.

Family Physician Self-Efficacy with Screening for Inherited Cancer Risk
By Robert Gramling, MD, et al.
Most family physicians believe it is important to screen patients for an inherited risk of cancer. However, less than two thirds believe that they are effective at this type of screening. This suggests that many practicing family physicians would welcome strategies aimed at improving effectiveness in screening patients for inherited cancer risk.

Elevated Serum Transferrin Saturation and Mortality
By Arch G. Mainous III, PhD, et al.
Excess iron and iron overload can contribute to the occurrence of certain conditions and diseases. Serum transferrin saturation can indicate a predisposition for iron overload. This study found that elevated levels of serum transferrin saturation were associated with a significantly higher risk of death from all causes. Further research is needed to determine if measuring serum transferrin produces useful information about the likely course and outcome of some diseases.

The Mortality Risk of Elevated Serum Transferrin Saturation and Consumption of Dietary Iron
By Arch G. Mainous III, PhD, et al.
Serum transferrin saturation can indicate an overload of iron. Among people with elevated levels of serum transferrin saturation, eating large amounts of red meat and other iron-containing foods was associated with increased death rates. Specifically, people with elevated transferrin saturation who reported high dietary iron intake had a 2.9 times greater risk of death than those who had normal transferrin saturation levels and reported low dietary iron intake. People who had a high transferrin saturation and reported eating red meat seven or more times per week had a risk of death 2.26 times greater than those who had normal transferrin saturation and reported eating low amounts of red meat. Simple dietary restrictions may help to reduce the risk of death associated with high transferrin saturation.

Parental Attitudes About a Pregnancy Predict Birth Weight in a Low-Income Population
By Robert D. Keeley, MD, MSPH, et al.
Low birth weight is the primary cause of illness and death in newborns in the United States, and has risen steadily during the last 17 years from 6.5% to 7.8% in 2002. In a low-income population, pregnant women who reported that the father was happier than they were about the pregnancy were at greater risk of having a low--birth-weight baby. If future research shows that attitudes toward pregnancy predict birth weight in other populations, this information may be useful in programs to reduce the occurrence of low--birth-weight babies.

Powerlessness, Control and Complexity: The Experience of Family Physicians in a Group Model HMO
By Linda Gask, MB, ChB, PhD, FRCPsych, et al.
More than half of the family physicians in a group model health maintenance organization feel they lack power to change or control their working environment, although some physicians have developed coping skills to help retain a sense of control. The physicians value the variety and complexity of family practice. The authors call for physicians and health care organizations to work together to restore family physicians� professional independence and involvement, and to incorporate these efforts in programs to improve quality of medical care and reduce costs.

Screening for Family and Intimate Partner Violence: Recommendation Statement
By the U.S. Preventive Services Task Force
Based on its examination of evidence about family and intimate partner violence, the U.S. Preventive Services Task Force found insufficient evidence to recommend for or against routine screening of parents or guardians for the physical abuse or neglect of children, of women for intimate partner violence, or of older adults or their caregivers for elder abuse.

Screening Children for Family Violence: A Review of the Evidence for the U.S. Preventive Services Task Force
By Peggy Nygren, MA, et al.
Nygren and colleagues conducted a systematic review of relevant studies on screening children for family violence. They found that despite the prevalence of child abuse and neglect and its impact on health, there are few studies providing data on its detection and management to guide physicians. These findings provided evidence for the U.S. Preventive Services Task Force recommendation statement on Screening for Family and Intimate Partner Violence.

Does Enhancing Partner Support and Interaction Improve Smoking Cessation? A Meta-Analysis
By Eal-Whan Park, PhD, et al.
Starting and stopping smoking are influenced by other family members. However, programs to quit smoking which involve increased support from smokers� partners do not show higher long-term quit rates. Programs to enhance partner support for stopping smoking might be most effective when they involve live-in and married partners, and when they focus on increasing positive, supportive behaviors by the partner and minimizing behaviors that are negative and critical.

Getting the News
By Roger A. Rosenblatt, MD, MPH
In this essay, a family physician shares his personal experience with cancer � and of cancer care in an academic medical center � discussing how the lessons learned from the journey have reverberated through his personal and professional life.

The Future of Family Medicine: A Collaborative Project of the Family Medicine Community
By the Future of Family Medicine Project Leadership Committee
In response to the flaws and fragmentation of the US health care system, the leadership of seven family medicine organizations have released a blueprint for improved, patient focused care. The Future of Family Medicine Project report calls for large-scale changes to the US health care system, medical education and clinical practice. It proposes a new model of patient-centered care in which all Americans would have a "personal medical home." Based on interviews and focus groups, the report offers an objective understanding of what patients want and need from their personal physicians and from America�s health care system, and it identifies challenges and opportunities for the specialty of family medicine.

Cumulative list of Issues In Brief

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