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Biomedical subjects

M F Fleming

Publications and source records attributed to M F Fleming.

At least 55 records · Page 3Linked to original sources
PubMed1991

Health locus of control in a primary care sample of alcoholics and nonalcoholics.

This study examined differences between alcoholics and nonalcoholics in a primary care population on the internal, chance, and powerful others subscales of the Multidimensional Health Locus of Control Scale (MHLC). Two hundred eighty subjects were divided into four groups (alcoholics with a family history of alcoholism, alcoholics with no family history of alcoholism, nonalcoholics with a family history of alcoholism, and nonalcoholics with no family history of the disease) based on DSM-III criteria for alcoholism and a family history of alcoholism. There were no differences between groups on the internal and powerful others scales. Nonalcoholics with a family history of alcoholism scored significantly lower on the chance scale than did alcoholics with a family history of the disease.

Adolescent↗
PubMed1991

The effectiveness of alcoholism screening in an ambulatory care setting.

Two hundred and eighty subjects in three ambulatory care clinics participated in this study designed to assess the psychometric properties of the SMAST using DSM-III criteria for alcoholism as the diagnostic standard. Eighty-two subjects (30%) who completed the NIMH Diagnostic Interview Schedule met DSM-III criteria for alcohol abuse and/or dependence. The sensitivity of the SMAST, using the generally accepted weighted cut-off score of five or greater, was .56 and the specificity was .83. An unweighted cut-off score of two or greater produced a sensitivity of .72 and a specificity of .64. The results of this study suggest that, when the SMAST is used for screening in an ambulatory care clinic population, the optimum balance of sensitivity and specificity is achieved using an unweighted cut-off score of two or greater. In addition, the alcohol subscale of the Diagnostic Interview Schedule was easy to administer and should be considered for use as the diagnostic standard in clinical settings.

Adolescent↗
PubMed1991

Risk factors associated with alcohol abuse in college students.

A survey of 989 college students was conducted to investigate risk factors--gender, family history of alcohol abuse, family history of depression and mental illness, childhood hyperactivity, and antisocial personality-associated with alcohol abuse. Two hundred ninety-four subjects (29%) completing the alcohol subscale of the Diagnostic Interview Schedule met lifetime DSM-III criteria for alcohol abuse. Utilizing a loglinear model, expression of childhood and early adolescent deviant behavior, family history of depression, and gender were shown to be significantly associated with alcohol abuse among students.

Adult↗
PubMed1991

The alcohol use disorders identification test (AUDIT) in a college sample.

This study was conducted to estimate the psychometric properties of the questionnaire section of the Alcohol Use Disorders Identification Test (AUDIT) in a college sample using DSM-III criteria for alcohol abuse as the criterion standard. This alcohol screening test was developed for the 10 country AMETHYST project. In this young adult sample the instrument exhibited a sensitivity of .84 and specificity of .71 when utilizing the recommended cut-off score of 11. The 10-item questionnaire section of the AUDIT appears to have important advantages over other alcohol screening instruments such as the CAGE and the MAST.

Adult↗
PubMed1991

A three-sample test of a masked alcohol screening questionnaire.

The study tested an expanded version of a masked alcohol screening instrument developed by Wallace and Haines [Use of a questionnaire in general practice to increase recognition of patients with excessive alcohol consumption. British Medical Journal 290, 1949-1953 (1985)]. The alcohol subscales include the CAGE, consumption, trauma, medical advice, past problems, and present problems with alcohol. There is preliminary evidence of the construct validity and reliability of the Health Screening Survey (HSS). As expected the HSS was sensitive in known populations of alcoholics (0.96; 0.95) correctly identifying at least 95% of the alcoholic patients recruited from two treatment centers. Specificity was adequate with identified nonalcoholics (0.80; 0.70). It was also sensitive in a community primary care sample, correctly classifying 78% of the subjects meeting DSM-III criteria for alcohol abuse and/or dependence. There were gender differences in the validity of the subscales in the community sample with alcoholic males more likely to report problems on the questionnaire than alcoholic females. Based on results, the HSS was revised to improve validity.

Adult↗
PubMed1990

Family cohesion, expressiveness and conflict in alcoholic families.

This study estimated family cohesiveness, expressiveness, and conflict in a primary care sample of alcoholics and non-alcoholics with and without a family history of alcoholism. Subjects completed the NIMH Diagnostic Interview Schedule alcohol subscale, based on DSM-III criteria, and a family environment scale. Alcoholics with a family history of alcoholism (Alc+FH+) reported significantly less cohesion and expressiveness, and more conflict in their present families than did either non-alcoholics with a family history of alcoholism (Alc-FH+) or non-alcoholics with no family history of alcoholism (Alc-FH-). Non-alcoholics who grew up in alcoholic families (Alc-FH+) reported present family relationships similar to non-alcoholics with no family history of alcoholism (Alc-FH-). Results suggest a family history of alcoholism alone was not associated with differences in perceptions of present family relationships. The findings of this study raise questions about the general perception that individuals who grew up in alcoholic families experience more family dysfunction in adulthood. The presence of two factors together--family history and alcohol problems in the subject--produced the perception of family dysfunction.

Adolescent↗
PubMed1989

Informed consent, deception, and the use of disguised alcohol questionnaires.

In preparation for a physician intervention trial to determine the effectiveness of treatment of alcoholism in a primary care setting, a study was conducted to determine patient reaction to a masked alcohol screening questionnaire. The disguised questionnaire was developed to improve the accuracy of self-reported drinking behavior and facilitate blinded randomization to an intervention and control group. Patient reaction was determined by a face-to-face structured interview. The interview was structured to elicit responses before and after the patient was informed of the true nature of the questionnaire. The sample consisted of 21 alcoholic and 33 nonalcoholic patients in a primary care clinic. Seventy-five percent of the respondents were comfortable not being fully informed when research procedures involve the use of disguised alcohol questionnaires. There was some discomfort over the deceptive nature of the questionnaire, but 83% of the subjects believed the deception was justified and necessary. Males and alcoholics in the sample were more comfortable not being fully informed about research procedures suggesting greater trust in the medical profession. Females, on the other hand, were more concerned than males about how a family member would react to the disclosure of family health information. Alcoholics and persons with only a high school education felt the use of disguised questionnaires improved their accuracy significantly more often than nonalcoholics or individuals in the sample who attended graduate school.

Adult↗
PubMed1988

Synthesis of phosphatidylethanol--a potential marker for adult males at risk for alcoholism.

Phosphatidylethanol, whose synthesis is catalyzed by a phospholipase D in a transphosphatidylation reaction, is a unique metabolite of ethanol. Phorbol 12-tetradecanoate 13-acetate, a tumor-promoting phorbol ester and stimulator of protein kinase C, activates this enzyme in peripheral blood lymphocytes. This system has been developed into an assay for measuring the potential of this pathway in human subjects. A pilot study of phosphatidylethanol synthesis in lymphocytes of adult males who have both an alcohol dependency and a family history of alcoholism has revealed that the average potential for phosphatidylethanol synthesis in this population is significantly elevated over that of control subjects.

Adult↗
PubMed1987

Responses of patients to nutrition counseling by family physicians.

This paper examines patient responses to nutrition counseling activities of their family physicians. Two hundred-six patients (seen by one of nine family physicians) were asked whether the physician inquired about their dietary practices and whether they were asked to change any of these practices. Patients were also asked whether they understood, agreed with, and changed any of their dietary practices as a result of the consultation. Responses are examined in light of the self-reported physical condition of the patient. Patients without nutrition-related conditions were just as likely to be asked about their eating habits as patients with nutrition-related conditions. Patients with nutrition-related conditions were far more likely to report being asked to change their practices than patients with no nutrition-related conditions (p less than .001). However, self-reported change in dietary practices as a result of physician counseling did not vary by nutrition related condition.

Adolescent↗
PubMed1986

Effect of case mix on provider continuity.

A random sample of 265 patient charts was selected to assess the degree of provider continuity at the University of North Carolina Family Practice Center from July 1, 1983, to June 30, 1984. Continuity was measured using usual provider continuity, the ratio of the number of visits with the assigned physician divided by total visits. Usual provider continuity rates varied as predicted for three types of visits: acute illness (0.55), chronic illness (0.76), and health maintenance (0.86). The average rate of usual provider continuity was 0.68. Case mix had a statistically significantly effect on provider continuity when comparing acute care with either chronic or health maintenance care (P less than .01). Because case mix is relevant and varies from site to site, a method of rate standardization was suggested using data on case mix from the National Ambulatory Medical Care Survey. Direct rate adjustment, a standard epidemiologic technique, would make continuity rates directly comparable for sites with different case mixes.

Adolescent↗
PubMed1985

Treatment of intractable hiccups with intramuscular haloperidol.

Two patients with intractable hiccups were treated with intramuscular haloperidol; remission occurred within 1 hour. With its rapid action and low incidence of adverse effects, intramuscular haloperidol should be considered a therapeutic alternative in the treatment of intractable hiccups.

Adult↗
PubMedDate not supplied

Prevalence of gambling disorders in a primary care setting.

BACKGROUND: Pathologic gambling prevalence seems to be increasing as opportunities for gambling increase. Prevalence may be different in a primary care setting compared with population-based studies. OBJECTIVES: To determine the gambling disorder prevalence in a primary care setting and to investigate associations between gambling disorders and proximity to a casino, substance abuse, health ratings, age, sex, and socioeconomic status. DESIGN: Cross-sectional survey of 1394 patients presenting to their primary care physicians between November 1, 1997, and April 1, 1998. SETTING: Three primary care clinics in Wisconsin. PATIENTS: Adults aged 18 years and older. MAIN OUTCOME MEASURES: Gambling disorders, defined by scores of 3 or greater on the South Oaks Gambling Screen (SOGS), and information about drug use (alcohol, tobacco, and marijuana), overall health, specific health symptoms, age, sex, race, and socioeconomic status. RESULTS: A total of 1051 patients completed the survey. More than 80.0% of the patients had gambled, and 6.2% met the criteria for gambling disorders. Gambling disorders were more prevalent in men, nonwhites, and patients from lower socioeconomic groups. Patients with gambling disorders were more likely to use tobacco and abuse alcohol compared with nonproblem gamblers. No relation was seen between marijuana use and gambling disorders. Patients with gambling disorders rated their health more poorly and reported more severe symptoms of heartburn and backache. CONCLUSIONS: A considerable percentage of patients presenting to primary care clinics are affected by their need to gamble. There is significant comorbidity with tobacco use and alcohol abuse. Primary care physicians should consider asking about gambling habits in high-risk patients.

Adult↗
PubMedDate not supplied

A study examining the psychometric properties of the SMAST-13.

The psychometric properties of the Short Michigan Alcoholism Screening Test (SMAST-13), a 13-question abbreviated form of the MAST, were determined on two samples of alcoholics, with their nonalcoholic family members serving as controls. The study hypothesized that the SMAST-13 has a low specificity when used to screen family members for alcohol problems and would exhibit a low internal reliability coefficient in this population. All participants were interviewed using DSM-III criteria for alcohol abuse or dependence. Only family members who failed to meet these criteria were enrolled in the study. When a weighted cut-off score of 5 or more was used as a positive score for alcohol problems, the sensitivity was .98 in Sample A and .94 in Sample B. Utilizing the scores of the family members as controls, the specificity was .58 in Sample A and .70 in Sample B. The internal reliability of the SMAST-13, using Chronbach's alpha on the total sample, produced a reliability coefficient of r = .57 in Sample A and r = .62 in Sample B. To determine if the specificity of the SMAST-13 could be improved, the weighted cut-off score for a positive response was raised from 5 to 10. In Sample A, the specificity changed from .58 to .90 and the sensitivity dropped slightly from .98 to .92. In sample B, the specificity increased from .70 to .95; the sensitivity decreased from .95 to .85. Suggestions for changing the wording of two questions which explain the majority of the false positives are discussed. Epidemiological studies which have used the SMAST-13 to estimate the prevalence of alcohol problems in family members of alcoholics may need to reconsider their methods of classifying alcoholics.

Adolescent↗
PubMedDate not supplied

Tobacco and alcohol abuse: clinical opportunities for effective intervention.

No behaviors are more costly to the United States from a health or economic perspective than tobacco and alcohol use. One of the primary strategies available to mitigate this exacting toll is to identify and clinically treat the 25% of adults in America who smoke and the 20% of adults who drink alcohol above recommended limits. During the last two decades, researchers have identified a series of brief clinical interventions that can markedly reduce alcohol and tobacco use and significantly decrease the health burdens resulting from such use. This review outlines office-based clinical interventions and the organizational policies that support these interventions that have been shown to decrease tobacco and alcohol use.

Adult↗
PubMedDate not supplied

Creating a substance abuse network in family medicine: lessons learned.

Family practice was one of several primary care specialties awarded federal contracts in 1985 to survey substance abuse training needs. Family medicine has since excelled in creating a viable substance abuse network. Key events were the sponsorship of a fellowship program, the formation of the Society of Teachers of Family Medicine (STFM) Substance Abuse Working Group, and the working group's pursuit of externally funded projects. Tangible measures of the network's success include collective funding exceeding $7.3 million, an increase in the number of substance abuse activities at annual STFM conferences, and a nearly four-fold growth in the group's membership and collaborative publications. Key factors underlying the vitality of the network that may be generalizable include: 1) initial emphasis on training family physician faculty; 2) making optimal use of the existing administrative channels within STFM; 3) acquisition of external funding; 4) some continuity of core persons working together; 5) active networking within and outside family medicine; and 6) promotion of individual success.

Faculty, Medical↗
PubMedDate not supplied

Computerized administration of alcoholism screening tests in a primary care setting.

This study compared the use of computerized versus paper-and-pencil administration of three commonly employed alcohol screening tests--the Short Michigan Alcoholism Screening Test (SMAST-13), CAGE (an acronym for four questions to discern problem drinking), and a quantity-frequency scale. These instruments were administered to 280 adults receiving health care in three primary care clinics in south-central Wisconsin. One hundred forty patients were randomly assigned to complete these instruments on a Macintosh SE, and 140 were assigned to the paper-and-pencil versions. Patients were classified as alcoholic based on responses to the Diagnostic Interview Schedule and DSM-III criteria. Results indicated the sensitivity and specificity of these instruments were similar for the two methods of administration. The sensitivity of the SMAST-13 was 0.56 for computer administration and 0.58 for the pencil-and-paper form. The findings suggest that computer administration of these instruments is at least as effective as use of the standard pencil-and-paper method. The data show that computers can be used for direct entry of information by patients, avoiding separate coding of paper-and-pencil information into a computerized format for clinical systems that use system-wide computerization of medical information.

Adolescent↗