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Biomedical subjects

M F Fleming

Publications and source records attributed to M F Fleming.

At least 37 records · Page 2Linked to original sources
PubMed1996

Screening for problem drinking in older primary care patients.

OBJECTIVES: To describe potentially hazardous alcohol use among elderly patients in the primary care setting and to assess the widely used CAGE questionnaire (cut down, annoyed by criticism, guilty about drinking, eye-opener drinks) as a tool for detecting self-reported heavy and binge drinking among these patients. DESIGN: Cross-sectional study. SETTING: The offices of 88 primary care physicians at 21 sites in southeastern Wisconsin. PATIENTS: A total of 5065 consecutive consenting patients older than 60 years. MEASURES: A previously validated self-administered questionnaire that included beverage-specific questions about the quantity and frequency of regular drinking in the last 3 months, the number of episodes of binge drinking (> or = 6 drinks per occasion), and the CAGE questionnaire. RESULTS: Fifteen percent of men and 12% of women regularly drank in excess of limits recommended by the National Institute of Alcohol Abuse and Alcoholism (>7 drinks per week for women and >14 drinks per week for men). Nine percent of men and 2% of women reported regularly consuming more than 21 drinks per week. When we administered the CAGE questionnaire, 9% of men and 3% of women screened positive for alcohol abuse within 3 months. The CAGE performed poorly in detecting heavy or binge drinkers; fewer than half were CAGE positive when the standard cutoff of 2 positive answers was used. CONCLUSIONS: Alcohol consumption in excess of recommended limits is common among elderly outpatients. The CAGE questionnaire alone is insufficient to detect such drinking. Asking questions on the quantity and frequency of drinking in addition to administering the CAGE increases the number of problem drinkers detected.

Aged↗
PubMed1996

Substance use and other health risk behaviors in collegiate athletes.

OBJECTIVES: To (a) determine the prevalence of alcohol and other drug use, and health risk behaviors among a general university population; and (b) compare health risk-taking behaviors between genders, and varsity athletes and their non-athlete peers. DESIGN: Descriptive survey of multiple health risk behaviors, including physical, mental health, alcohol and other drug, and sexual risk taking. SETTING: Two large midwestern universities. PARTICIPANTS: A convenience sample of 86% of 1,210 eligible students (271 athletes and 775 nonathlete peers) completed a self-administered, anonymous questionnaire during team meetings or class sessions. INTERVENTION: None. MAIN OUTCOME MEASURES: Differences between gender and athlete status were assessed using Cochran-Mantel-Haenszel statistics for the following variables, determined by questionnaire responses: physical risk, mental health, alcohol and other drug use, and sexual behaviors. RESULTS: Common risk behaviors in the entire collegiate sample included riding in a car with a driver who was under the influence of alcohol, driving and swimming under the influence of alcohol, binge drinking, and low rate of condom use for all types of sexual intercourse. Risk-taking behaviors varied by gender, with men showing more risk behaviors than women, except for suicide and sexual behaviors. Male athletes had a higher prevalence of risk behaviors than their male nonathlete counterparts, in contrast to female athletes, who had fewer risk behaviors than their female nonathlete counterparts. CONCLUSION: In contrast to previous studies, results of the present study show, when results are stratified by gender, that not all athletes engage more frequently than nonathletes in high risk behaviors. Results suggest that educational and early intervention strategies to decrease risk may need to be tailored according to gender and athletic status.

Adolescent↗
PubMed1996

Characteristics of persons with severe mental illness and substance abuse in rural areas.

A cross-sectional study of 1,551 clients receiving care in ten community-based rural mental health care systems assessed problem behaviors and psychiatric symptoms among three groups of severely mentally ill clients: those with a current substance abuse problem, those with a history of substance abuse but no current problem, and those with no history of substance abuse problems. Clients with a current substance abuse problem were younger than clients who had no history of such problems and had more symptoms of anger, more trouble with the law, and more suicidal threats than clients in the other two groups.

Adolescent↗
PubMed1995

Assessment of alcohol and other drug disorders in the seriously mentally ill.

Brief assessment methods are needed to determine the presence of alcohol and drug problems in persons with severe mental illness. The purposes of this study were to determine the prevalence of alcohol and other drug problems in a rural population of 253 clients with severe mental illness and to determine the accuracy of case manager responses to specific alcohol and drug assessment questions about their clients. Clients were assessed for the presence of past and present alcohol and drug disorders by means of a face-to-face diagnostic interview. The specific questions the case managers were asked to complete were designed to assess the quantity and frequency of recent alcohol and drug use and the presence of three criteria for alcohol or drug dependence and to differentiate present versus past history of substance problems. On the basis of the Diagnostic Interview Schedule- Revised, 35 percent of the clients met current DSM-III-R alcohol or drug criteria for abuse, dependence, or both. There were differences between client and case manager reports on the clients' use of alcohol, marijuana, cocaine, narcotics, and unprescribed tranquilizers in the last year. The best predictor of a client's present alcohol or drug problem was whether the case manager thought that the client had substance use problems at some time in his or her life (sensitivity = 0.86, specificity = 0.75). This report provides additional evidence that case manager reports are a valid method of determining the prevalence of substance use problems in persons with severe mental illness.

Adult↗
PubMed1995

A model alcohol and other drug use curriculum for pediatric residents.

While alcohol and other drug (AOD) use is a major health risk for adolescents in the United States, there is a paucity of AOD training for pediatric residents. In 1991-92, the University of Wisconsin Medical School developed an experiential, community-based AOD curriculum for pediatrics residents. The curriculum included resident participation in a community-based AOD adolescent assessment and intervention program, interactive didactic sessions, role-playing practice, and interviewing skills sessions. The residents who participated in the curriculum (n = 25) were compared with a control group (n = 19). Evaluation included pre- and post-curriculum written tests, objective structured clinical examinations, and residents' ratings of the curriculum components. The residents who participated showed significant gains in AOD knowledge, utilization of screening techniques, and clinical management skills as compared with the controls. The residents gave positive ratings to all curriculum components. This well-received curriculum can serve as a national model both for AOD education in pediatrics and for curriculum development in other areas of adolescent health-risk-taking.

Adolescent↗
PubMed1995

Hospital-based alcohol and drug specialty consultation service: does it work?

The goals of this report are to describe the development of an inpatient-based alcohol and drug abuse consultation service in a university hospital. At the University of Wisconsin Hospital, we collected data on baseline diagnosis, health services, and costs for inpatients who received such a consultation in 1992-1993 (n = 1,098, 3.5% of all admissions). Follow-up interviews were conducted on a sample of 175 subjects. At the initial assessment, 65% were nicotine dependent, and 50% met criteria for alcohol dependence, 19% for alcohol abuse, 13% for alcohol and drug abuse/dependence. The average cost to patients for a consultation was $220. At the 6-month follow-up interview (n = 175), 42% of the subjects reported complete abstinence, 70% reported reductions in use, and 56% participated in an alcohol and drug treatment program. An inpatient-based alcohol and drug abuse consultation service provides a critical benefit that has not previously been offered in most academic medical centers.

Adolescent↗
PubMed1995

Correlates of depression in primary care.

BACKGROUND: Depression is a significant health problem in the United States. This study examined the relationship between depression and substance use, substance problems, conduct disorders, and sociodemographic factors in primary care settings. METHODS: A survey of 1898 patients in 88 primary care offices was conducted using a self-administered health-habits questionnaire. Depression was assessed for both lifetime and for the past 30 days using the Diagnostic and Statistical Manual of Mental Disorders, Third Edition Revised (DSM-III-R) criteria. RESULTS: A total of 21.7% of women and 12.7% of men met DSM-III-R criteria for depression in the 30 days prior to completing the survey. Lifetime rates of depression were 36.1% for women and 23.3% for men. Young women who smoke, drink, or use marijuana, and both men and women with antisocial personality disorder and a family history of mental health problems are particularly at high risk for depression. CONCLUSIONS: One in 5 women and one in 10 men who see their primary care physicians have recently been depressed.

Adolescent↗
PubMed1995

Improving pediatric residents' alcohol and other drug use clinical skills: use of an experiential curriculum.

OBJECTIVE: To evaluate the effectiveness of an experiential alcohol and other drug curriculum on pediatric residents' knowledge, attitudes, and skills in alcohol and other drug (AOD) issues. DESIGN: Nonrandomized control trial. SETTING: Two university pediatric residency programs. PARTICIPANTS: Pediatric residents (n = 44). INTERVENTION: Intervention residents received an experiential AOD curriculum consisting of participation in an adolescent assessment program, interactive didactic sessions, role-playing practice, and interviewing skills sessions. The control group received no formal training. MAIN OUTCOME MEASURES: Pretesting and posttesting each group using written and Objective Structured Clinical Examination evaluations using standardized patients. Evaluations were videotaped and scored by an expert panel using a standardized scoring process. RESULTS: Pretest comparisons of written knowledge and clinical skills as assessed by the Objective Structured Clinical Evaluation showed no significant differences between the intervention and the control groups. Analysis of written test scores revealed that residents' general knowledge as well as knowledge of screening techniques and management resources related to AOD issues increased significantly more for the intervention group than for the control group from pretest to posttest (P < .001). Evaluation of the videotapes showed significant improvement for the intervention group compared with controls in overall score and in the use of specific screening techniques and interviewing skills (P < .05). Self-assessment of residents' interest, confidence, and competence in AOD issues improved significantly for intervention residents vs controls (P < .05). CONCLUSIONS: Pediatric residents receiving an experiential AOD curriculum increased their knowledge and clinical skills in AOD issues significantly more than residents receiving no formal training. Similar curricula and evaluation could be used by other primary care residency programs and could be implemented in other areas of adolescent health risk behaviors.

Adolescent↗
PubMed1995

Detection of problem drinkers: the Alcohol Use Disorders Identification Test (AUDIT).

This study was conducted to test the predictive validity of a new alcohol screening test, the Alcohol Use Disorders Identification Test (AUDIT), in a general medicine teaching clinic and to assess physician recognition and treatment of alcohol and drug disorders. The research procedures included completion of the AUDIT, a standardized diagnostic alcohol and drug assessment, an exit interview, and a chart review. The random sample comprised 132 recruited subjects. The internal reliability of the AUDIT was .77. The optimal cutoff score for the AUDIT in this sample was 5, with a sensitivity of .61 and specificity of .84. The exit interviews revealed that physicians asked their patients about alcohol use and drug use with 20% (n = 26) and 17% (n = 23) of the sample, respectively. Five of the 28 patients who met DSM-IIIR criteria had a diagnosis recorded in the chart.

Adult↗
PubMed1994

Cigarette, alcohol and other drug use among small city pregnant adolescents.

PURPOSE: To determine the prevalence of cigarette, alcohol and other drug use and associated factors of use among predominantly Caucasian small-city pregnant adolescents, a little-studied population. METHODS: At the initial prenatal visit 117 enrollees completed a self-administered questionnaire. Patients provided urine samples for drug metabolites. Chart review determined medical provider documentation of substance use. RESULTS: Thirty-five percent of patients were positive for alcohol or other drug use by questionnaire self-report, provider report or initial urine drug screening test. Thirteen percent of patients were positive for at least one drug metabolite in the urine. Multiple logistic regression analysis indicated a model with four significant risk factors associated with pregnant adolescent alcohol and other drug use: lack of closeness with the father of the baby, neither parent in the home, patient experiencing consequences of alcohol and other drug use, and father of the baby experiencing consequences of alcohol and other drug use. CONCLUSIONS: The high prevalence of cigarette, alcohol and other drug use in this predominantly Caucasian sample was comparable to previous inner city data. Awareness of risk factors may improve identification and management of substance use among pregnant adolescents.

Adolescent↗
PubMed1994

Faculty development in addiction medicine: project SAEFP, a one-year follow-up study.

BACKGROUND AND OBJECTIVES: The goal of Project SAEFP (Substance Abuse Education for Family Physicians, pronounced SAFE) was to increase the number of residency teaching faculty with expertise in addiction medicine. This paper reports the results of a 12-month follow-up study conducted to assess changes in residency teaching and clinical practice of 165 residency teaching faculty who participated in this project. METHODS: The Project SAEFP work group conducted a series of 5-day courses in the fall of 1990 at 10 sites around the country. The 165 faculty participants were taught how to use a set of 12 residency teaching modules that focused on clinical areas important to primary care physicians. The follow-up study consisted of a structured telephone interview. The findings were compared to previous interviews conducted before, and 3 months after, faculty participation in the course. RESULTS: The findings suggest long-term increases in the amount of teaching, clinical practice, and consultations conducted by the family medicine faculty who participated in this faculty development project. CONCLUSION: The findings of this study suggest that an intensive 5-day course using learner-centered teaching techniques can have a significant impact on primary care teaching faculty.

Adult↗
PubMed1993

The Alcohol Use Disorders Identification Test (AUDIT) and the SMAST-13: predictive validity in a rural primary care sample.

This study was conducted to compare the validity of a new screening instrument developed by the World Health Organization, the Alcohol Use Disorders Identification Test (AUDIT), to the short version of the MAST in 287 primary care patients. Subjects were classified as meeting a lifetime or current DSM-III diagnosis of alcohol misuse and/or dependence based on the DIS-R interview schedule. Using the original WHO guidelines (score of 11 or more), 37 (13%) scored positive on the AUDIT and 103 (36%) had a weighted score of 5 or more on the SMAST-13. The internal reliability of the AUDIT was 0.86, compared to the SMAST-13 at 0.85. Cut-off scores in this sample for current alcohol problems, utilizing Receiver Operating Curves, were 7-8 for the AUDIT and 5 for the SMAST. This study confirms the utility of the AUDIT for current alcohol problems and the SMAST-13 for lifetime or past problems in a rural clinical sample.

Adolescent↗
PubMed1992

Patterns of substance use among students meeting lifetime DSM-II criteria for alcohol misuse.

A cross-sectional survey of 989 college students was conducted to investigate substance use patterns between students meeting lifetime DSM-III alcohol misuse criteria and students not meeting misuse criteria. Students meeting alcohol misuse criteria (n = 294) reported a significantly greater history of lifetime substance use and were more likely to have used marijuana in the 6 months prior to the receipt of the questionnaire. No significant differences in the frequency of substance use within the 6-month period were indicated between the two student groups with the exception of marijuana. Students meeting lifetime DSM-III alcohol misuse criteria also reported having experimented with marijuana at an earlier age.

Adolescent↗
PubMed1992

Liver transplantation for alcoholic liver disease.

BACKGROUND: Alcoholism is the leading cause of end-stage liver failure in the United States, but the application of liver transplantation to the treatment of alcoholic liver disease remains controversial because of medical and ethical concerns. Information about the outcome of patients who undergo transplantation for alcoholic cirrhosis would help to resolve these concerns. METHODS: The results of 41 patients (Group 1) with alcoholic liver disease were compared with those of patients who underwent liver transplantation for other medical problems (group 2) at this center. Thirty of the 32 survivors from group 1 and 30 matched subjects from group 2 were interviewed to assess substance dependence, recidivism, and activity level. RESULTS: Compared with control subjects, patients with alcoholic liver disease had equivalent patient and graft survival rates and achieved an equal level of postoperative health. These results were achieved even though patients with alcoholic liver disease had significantly worse liver failure and more morbidity before surgery, and one third of the patients in this group were not abstinent before transplantation. CONCLUSIONS: We conclude that patients with alcoholic liver disease merit equal consideration for liver transplantation compared with other causes of liver failure. Treatment of the addictive disorder should be included before and after surgery.

Actuarial Analysis↗