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Biomedical subjects

A V Graham

Publications and source records attributed to A V Graham.

At least 19 recordsLinked to original sources
PubMed1999

Comparison of symptoms in Japanese and American depressed primary care patients.

BACKGROUND: Depression is a highly prevalent, worldwide problem with multiple social and health consequences. It often presents in primary care with physical symptoms. Little research has been done on cross-cultural expression of depression in primary care. This paper examines the hypothesis that depressed Japanese patients present with more and with more distinct somatic complaints than depressed American patients. METHODS: Data were collected by chart audit for patients with a diagnosis of depression at two sites: Minamikawachi Tochigi, Japan and Cleveland, Ohio, USA. Patient demographics and type and number of presenting symptoms in the two populations were compared. Logistic regression was used to determine whether there were differences between countries in physical symptoms and to adjust for relevant demographic characteristics. RESULTS: Japanese family physicians charted more somatic complaints from patients diagnosed as depressed than did American family physicians. Specific physical symptoms differed by country: Japanese patients had more abdominal distress, headaches, and neck pain. These symptoms have strong cultural significance for Japanese patients. CONCLUSIONS: This study clearly indicates the prominence and importance of physical symptoms in the presentation of depression in Japanese primary care patients. Their physicians must be alerted to the possibility of depression, especially when patient complaints include abdominal, neck or head pain.

Adult↗
PubMed1999

Screening, early identification, and office-based intervention with children and youth living in substance-abusing families.

All health care professionals with clinical responsibility for the care of children and adolescents must be able to recognize, as early as possible, associated health problems or concerns in children of substance-abusing parents, and to be able to assist these children and families in seeking treatment and promoting health. Health care providers can have a tremendous influence on families of substance-abusing parents because of their understanding of family dynamics and their close long-standing relationship with the family. Information about family alcohol and other drug use should be obtained as part of routine history-taking and when there are indications of family dysfunction, child behavior or emotional problems, school difficulties, and recurring episodes of apparent accidental trauma, and in the setting of recurrent or multiple vague somatic complaints by the child or adolescent. In many instances, family problems with alcohol or drug use are not blatant; rather, their identification requires a deliberate and skilled screening effort. Combining the principles of anticipatory guidance, screening, and early identification, with the acknowledgment that families should be included in the process, leads to a clear conclusion that screening for children affected by parental substance abuse must occur at all ages across infancy, childhood, and adolescence. Health care providers need to be trained in the identification and management of children and youth exposed to parental addiction. Such training must begin during undergraduate education in the health professions and be reinforced by role-modeling among health professions faculty as well as practicing providers.

Adolescent↗
PubMed1997

Long-term evaluation of a substance abuse fellowship program in family medicine.

BACKGROUND: Faculty development fellowship programs provide avenues for physicians to develop careers in academic medicine. However, the long-term impact of these programs has not been evaluated. This paper examines the impact of an 18-month substance abuse faculty development fellowship administered by the Society of Teachers of Family Medicine (STFM) 7 years after the fellowship's completion. METHODS: Fellows were interviewed by telephone. Their CVs were examined to assess how their present substance abuse teaching, clinical, research, administrative, scholarly, and networking activities compared with those prior to the fellowship. RESULTS: Initially, fellows contributed modules to an STFM publication and increased substance abuse teaching in their home institutions. Seven years later, fellows reported increased activity in substance abuse teaching, clinical, administrative, and research activities over those prior to the fellowship and attributed these increases to the fellowship. Fellows' CVs reflected increased publications, presentations, and networking activities with each other, including the creation of the STFM Group on Substance Abuse. CONCLUSIONS: In a 7-year follow-up, STFM's substance abuse fellowship program met its original goals, strengthened the academic and professional achievements of the fellows, and fostered the development of several fellows as leaders within the substance abuse field.

Faculty, Medical↗
PubMed1994

Physician documentation of family alcohol problems.

This study was conducted to determine whether family medicine residents' documentation of patient and family alcohol problems corresponded with patients' assessments. A random sample of 180 patient charts from a university-based family practice was audited and 78% (n = 140) of these patients participated in telephone interviews. Of those who participated in the telephone interview, 40% (n = 56) reported a positive family history of drinking problems, 28% (n = 39) indicated that they were currently concerned about the alcohol use of someone in their family, and 24% (n = 34) reported that at least one family member currently had an alcohol problem. Ninety-six percent (n = 134) of the subjects indicated that they believed physicians should ask about family alcohol problems and 91% (n = 128) believed physicians could be helpful in alcohol treatment at least some of the time. The audit of the 180 medical records indicated that residents charted a positive family history on 13% (n = 23) of the records and noted impact upon the family due to a member's drinking in 2% (n = 4) of the records. The study revealed that residents frequently did not identify alcohol problems or related family difficulties and highlighted the need for training and education in this area.

Adult↗
PubMed1993

Alcohol abuse. A family disease.

Alcohol problems have a serious impact on families. Physicians who identify alcohol-abusing persons in their practices will note that these people belong to families who seem "stuck" in a confusing family situation with no ready solution. Research and clinical observations have demonstrated that families adopt roles, rules, and interactional patterns around the alcohol abuse problems that can be destructive to individual development. These consequences of alcohol abuse are particularly troubling when we consider that family dysfunction, like the disease itself, is transmitted from generation to generation. Physicians can be most helpful to these families when they understand how to identify the presence of alcohol use problems, evaluate the impact on both the alcohol abuser and the family members, and facilitate the necessary treatment for these patients.

Alcoholism↗
PubMed1993

Substance abuse among women.

Physicians' attitudes are important in dealing with issues of substance abuse in women. The primary care physician is in a unique position to take advantage of the doctor-patient relationship and initiate diagnosis and treatment of substance abuse. When the primary care physician is supportive of the patient, both begin from a position of strength. Patients are no more to blame for contracting the disease state than for getting other medical conditions for which they are at risk. Treatment of substance abuse in women must acknowledge that significant differences exist between men and women patients. Most treatment programs have been based on research studies in men. Current efforts are under way to update the information necessary to deal effectively with the problem of substance abuse among women.

Alcoholism↗
PubMed1993

Educational strategies for clinicians.

Largely because of a lack of training, many primary care physicians are unaware of how they can prevent, detect, or manage substance abuse within their clinical practice. The educational process used to develop a teaching unit can be simplified by initially asking a few directed questions. The answers to these questions determine what needs to be taught while facilitating the subsequent steps of determining learning goals and objectives and selecting appropriate teaching materials and strategies. Evaluating the teaching unit on at least a cursory level provides useful information for future planning. A variety of curriculum manuals and clinical text parts can be readily incorporated into teaching units. These same sources can alternatively be adapted to an individual's own self-directed course of study. Incorporation of experimental educational strategies is especially useful in substance abuse instruction. Including recovering individuals, attendance at self-help group meetings, and role play exercises are all useful experimental strategies for engaging the learner. Tapping into organizational resources and networking with others involved in similar activities enhances one's potential through the sharing of information and through the synergism created by networking with others.

Alcoholism↗
PubMed1992

Use of the Family CAGE in screening for alcohol problems in primary care.

OBJECTIVE: To establish the reliability and validity of the Family CAGE (an acronym indicating Cut down on drinking; Annoyed by complaints about drinking; Guilty about drinking; had an Eye-opener first thing in the morning), a four-item instrument intended to assess family alcohol-related problems. DESIGN: Two distinct cross-sectional studies using a survey, and in one study, retrospective chart review. PARTICIPANTS: A random sample of 172 adult patients presenting for nonurgent care to a network of family practice settings and a convenience sample of 107 patients who smoked presenting to a university family practice residency training setting. MAIN OUTCOME MEASURES: The Family CAGE was compared with alcohol-related variables and scales measuring psychosocial constructs. In the first study, these scales included the Family Stress and Coping Scale; Profile of Mood States; the Family Problems Checklist; and the Duke/University of North Carolina Mini-Health Profile. Chart review included medical utilization rates and prescription of medications. In the second study, a revised version of the Family CAGE was compared with other scales such as the standard CAGE questionnaire; an "Anomy" Scale; the Catchment Epidemiologic Study-Depression Scale; a global self-assessment of alcohol-related problems; and a self-report of lifetime history of major depression and recent self-limited depression. RESULTS: The Family CAGE showed strong internal consistency reliability, with Cronbach's alpha coefficients of .84 in the first study and .89 in the second. Construct validity was supported by Family CAGE correlations with family stress, family problems, depression, anxiety, individual stress, and marital dissatisfaction. The Family CAGE was strongly correlated with global assessment of family alcohol-related problems, and was superior to this variable in predicting help-seeking behavior. The Family CAGE was also significantly correlated with a higher sick visit rate and more medications prescribed (despite no difference in functional health status). The standard CAGE was correlated with a recent history of self-limited depression, while the Family CAGE was correlated with a lifetime history of major depression. Sensitivity and specificity rates vary depending on the criterion addressed, but a cutoff score of 2 or more appears to offer the best clinical information. CONCLUSION: The Family CAGE appears to be a reliable, valid, utilitarian measure of family alcohol problems. It offers more information than either a single-item global assessment regarding family alcohol-related problems or the standard CAGE questionnaire. The Family CAGE is strongly correlated with other important psychosocial problems, prescription of psychotropic medications, and health-care utilization. It is brief, understandable, and equally effective in interview and self-administered formats.

Adult↗
PubMed1992

Physician failure to record alcohol use history when prescribing benzodiazepines.

The purpose of this pilot study was (1) to determine the proportion of patients in an ambulatory medical clinic who have an alcohol history recorded when prescribed benzodiazepines, and (2) to assess the adequacy of the alcohol history when obtained. Medical records of 35 outpatients who obtained prescriptions for benzodiazepines at a large inner-city teaching hospital medical clinic were audited. In none of the records was there evidence that the physician had sufficient knowledge of the patient's alcohol use to safely prescribe a benzodiazepine. In 57% of the records, no information about alcohol use was recorded. In the remaining 15 medical records, the information recorded was limited. The implications of prescribing benzodiazepines without knowledge of drinking status are discussed.

Adult↗
PubMed1992

A clinical trial to reduce the rate of low birth weight in an inner-city black population.

BACKGROUND: The goal of our study was to measure the effectiveness of a home-based intervention for prevention of low birth weight with 154 high-risk, low-income black women attending a prenatal clinic in Cleveland. METHODS: Based on previous research, risk was defined by clinic registration between the 17th and 28th weeks of gestation, low family functioning score, and experience of at least one stressful life event prior to registration. Optional factors included being a smoker, a low maternal weight-height ratio, being age 27 or older, and a previous premature birth. A 21-item family function screen previously validated in a similar population was the primary determinant of psychosocial risk. Low birth weight was defined as weight less than 2,500 g regardless of gestational age. RESULTS: There was no decrease in the rate of low birth weight for women who received four home visits focusing on smoking, drug and nutrition education, support, and links with community services, compared to women who received no visits. The number of prenatal visits was significantly higher in the intervention group, but an increased number of prenatal visits did not correlate with a reduced rate of low birth weight. Despite previous research, the family function screen was not an effective predictor of low birth weight in our study. A revised equation involving a history of previous premature birth, smoking, and a low maternal weight-height ratio did predict low birth weight. CONCLUSIONS: These findings question the utility of short-term psychosocial interventions for influencing low birth-weight rates in low-income black clinic populations. The family function screen was not cross validated. Integration of any psychosocial intervention with the routine prenatal care occurring in the obstetrical clinic is suggested for future research.

Adolescent↗
PubMed1991

A critical review of labor and birth care. Obstetrical Interest Group of the North American Primary Care Research Group.

A critical review of the literature regarding important aspects of labor and delivery was conducted by members of the Obstetrical Interest Group of the North American Primary Care Research Group using computerized searches, personal communication, and literature exchange between group members. Each written topic summary was carefully reviewed by a second group member, and a consensus was reached regarding conclusions and recommendations by the group. The topics include family involvement, comfort measures, fetal heart rate monitoring, labor augmentation, birth positions, and episiotomies. Each topic summary is preceded by conclusions and recommendations given in the order of least invasive to most invasive of the woman in labor. The strength of these conclusions and recommendations is based on the amount and type of supportive data in the literature and is indicated by one to three stars preceding that statement. One-star conclusions are not well supported in the literature but reflect a family practice style and were reached through consensus from the group. Three-star conclusions are supported by data from clinical trials.

Delivery, Obstetric↗
PubMed1987

Predicting low birthweight and complicated labor in urban black women: a biopsychosocial perspective.

This study explored demographic, biomedical and psychosocial factors as predictors of two adverse pregnancy outcomes: intrapartum complications and low birthweight, in 140 urban black pregnant women. The intrapartum complication rate was 18%. A four factor equation (low family functioning, advanced maternal age, working during pregnancy, and short stature) predicted intrapartum complications (80% sensitivity, 67% specificity and 35% positive predictive value). The low birthweight rate was 14%. Four factors (low family functioning, stressful events, Quetelet's Index, and cigarette smoking) predicted low birthweight (65% sensitivity, 84% specificity and 42% positive predictive value). Family functioning, alone, predicted low birthweight with 65% sensitivity, 64% specificity and 31% positive predictive value. Family functioning, was the only predictor for both outcomes. Family functioning and other psychosocial risk factors may potentially improve identification of high risk pregnant urban black women.

Adolescent↗
PubMed1986

Defining family in family medicine: perceived family vs household structure in an urban black population.

This paper explores two hypotheses: first, that household structure, the people who live in one's household, and perceived family, the people one considers members of one's family, are different entities among urban black pregnant women; and second, that the perceived family is a stronger predictor of social, psychological, and health outcomes than is household structure. The study data are from the first interview of a prospective study of a consecutive sample of 140 black pregnant women patients of a Cleveland, Ohio, university hospital family practice center. The study hypotheses are supported: household structure and perceived family differ in their size and the inclusion or exclusion of members of the family of origin and the father of the baby. Household structure is strongly correlated with demographic variables such as age, socioeconomic status, and household income, whereas perceived family is less strongly associated with these measures. Perceived family, but not household structure, is associated with family functioning, measures of psychological status, worries about household change, and better family and parental relationships during the woman's childhood.

Adolescent↗
PubMed1983

Troubled marriages and divorce: a prospective suburban study.

A longitudinal survey of adjustment to divorce in Cleveland, Ohio, suburbs was conducted with a matched sample of married persons in order to identify some of the common complaints, feelings, concerns, and health hazards among separated and divorced persons. The study findings show that substantial numbers of divorced and married people turn to their physicians for help with personal problems, suggesting that physicians need to be prepared to help them appropriately. Based upon these findings, opportunities are described that are open to the family physician for detecting distress in the troubled marriage and in divorce, as well as for therapeutic intervention. Types of interventions include anticipatory guidance, counseling, and referral for more intensive therapy. In the troubled marriage there is often an extended period of unhappiness and indecision. A physician alerted to the frequency with which marital distress is exhibited in physical or psychological symptoms may be able to provide assistance in sorting out priorities and options. Following a crisis model of adjustment, the heightened physical and psychological distress experienced during the early stages of the divorce process decreases with time. Many divorced parents are not aware of the im pact of marital turmoil and divorce on their children. The family physician plays an important part in helping parents recognize their continuing role in the lives of their children even if the marital relationship ends.

Counseling↗
PubMed1981

Family home assessment in family practice residency programs.

Physician-patient encounters in the home setting have decreased dramatically in the United States in recent years. This has occurred in spite of the continued important role the home environment plays in family health and family illness care. Although decreasing in frequency, home visits are still an important facet of family practice. A survey of family practice residency programs revealed that home visits are being done in most programs and that faculty members have a positive outlook on their importance. Programs were found to vary widely in the types of learning experiences available to residents. There is an apparent need for residency programs to improve their teaching efforts involving family home visiting by establishing objectives, structured curricular time, clinical experience, and protocols consistent with this purpose.

Attitude of Health Personnel↗