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Am Fam Physician. 2001;63(6):1167-1168

Urinary Incontinence Causes Negative Outlook of Overall Health

(28th Annual Meeting of the North American Primary Care Research Group) According to results of a family–practice-based survey of women at least 45 years of age, women who are incontinent perceive themselves as having poorer overall health and becoming sick more easily and more often than do women of similar age and personal factors. A questionnaire was sent to 1,040 women in two family practice teaching units in Hamilton, Canada to assess the effect of urinary incontinence on their daily lives and their attitudes toward their health. The response rate to the survey was 72.6 percent; within the first 565 replies there were 260 women who were affected with urinary incontinence and 226 women who were not. Women in the two groups were similar in age (mean age: 63.8 years), marital status, whether they had given birth, level of education attained and country of origin. They also had similar rates of heart disease, asthma, elevated blood pressure and diabetes. Women with incontinence were significantly more likely to have headaches, constipation, swollen ankles and coughing. Although caffeine is considered to be a factor in incontinence, there was no difference among the two groups in the consumption of caffeine-containing beverages, smoking or alcohol use.—J. GRAHAM SWANSON, M.D., M.SC., C.C.F.P., ET AL., McMaster University, Hamilton, Ontario, Canada.

Illegal Drug Use, Being Overweight Are Predictors of Adolescent Suicide

(North American Primary Care Research Group) Results of a cross-sectional survey of middle school students demonstrated that experimentation with illegal substances and the perception of being overweight among females were the most accurate predictors of suicidal thoughts and actions among adolescents, and that females were significantly more likely than males to have suicidal thoughts and actions. Researchers conducted the Youth Risk Behavior Survey in four eastern North Carolina counties in response to a 1999 report from the surgeon general that called for action to prevent suicide, and regional data that showed a significant increase over the past three years in the percentage of students who reported attempting suicide (from 9.9 to 12.5 percent). A total of 4,838 middle school students who were present and had parental consent participated in the survey. Forty-nine percent were female and 53 percent were black. Multiple logistic regression models examined the following predictors of suicidal thoughts and actions: age, race, single- or two-parent household, grades on report card, weight description and number of illegal drugs with which they experimented. Females were significantly more likely than males to think about suicide (28 percent versus 22 percent, respectively), plan suicide (14 percent versus 11 percent, respectively) and attempt suicide (13 percent versus 10 percent, respectively).—LAUREN M. WHETSTONE, PH.D., ET AL., East Carolina University, Greenville, North Carolina.

Laboratory and Brain Imaging Studies for Dementia May Not Be Helpful

(North American Primary Care Research Group) Laboratory and brain imaging studies detect potentially reversible causes of dementia in only about 1 percent of patients presenting for geriatric assessment, and, therefore, contribute little to the diagnosis. This is the conclusion of a retrospective chart review of all 1,034 patients who presented for geriatric assessment to the University of Nebraska Medical Center, Omaha, between 1991 and 1998. The mean age of the patients was 78.4 years (age range: 49 to 100) and 70.3 percent were female. Of the 1,001 patients who received Clinical Dementia Rating Scale scores, 914 (91.3 percent) scored above 0, indicating probable or definite dementia, and the mean Mini-Mental State Examination (MMSE) score was 20.2 ± 6.0. For most laboratory studies, patients with dementia had fewer abnormal results than patients without dementia: thyrotropin-stimulating hormone (18.3 percent versus 24.4 percent, respectively); vitamin B12 (11.4 percent versus 16.7 percent, respectively); sodium (5.5 percent versus 4.9 percent, respectively); creatinine (22.8 percent versus 28.8 percent, respectively); and calcium (2.4 percent versus 1.2 percent, respectively). In no patients was an abnormal laboratory value the primary cause of the dementia. Brain imaging was conducted in 914 patients, and potentially reversible conditions that were detected included normal pressure hydrocephalus (1 percent of patients) and brain tumor (0.3 percent of patients).—WENDY L. ADAMS, M.D., M.P.H., ET AL., University of Nebraska Medical Center, Omaha, Nebraska.

WAST Is Effective Tool for Identifying Domestic Abuse of Females

(North American Primary Care Research Group) The Woman Abuse Screening Tool (WAST) was found to be a reliable and valid measure of abuse when used in the family practice setting, and family physicians and their patients were comfortable with the WAST being a component of the clinical visit. The cross-sectional study included a random sample of 20 physicians practicing in urban and rural settings and 10 to 15 consecutive women during the course of regular care. The patients' scores correlated well with their scores on the Abuse Risk Inventory (ARI). Using the WAST-Short, 26 of 307 patients (8.5 percent) screened were identified as having experienced abuse. There were significant differences on all eight of the individual WAST items and the overall WAST scores between the women who screened positive for abuse and those who screened negative. Ninety-one percent of patients reported being comfortable or very comfortable when asked the WAST questions by their family physician. After each visit, the family physician reported their level of comfort with the WAST and their previous relationship with that patient, and patients completed a survey about their comfort level in being asked the WAST questions and being evaluated using the ARI.— JUDITH BELLE BROWN, PH.D., ET AL., University of Western Ontario, London, Canada.

Adolescents Are Not Receiving Adequate Counseling On Health Issues

(North American Primary Care Research Group) Family physicians, general practitioners and pediatricians need to significantly increase the frequency and duration of their counseling of adolescents on critical adolescent health issues (such as diet and nutrition, exercise, weight reduction, cholesterol reduction, human immunodeficiency virus transmission, injury prevention and tobacco use) when they present for a clinical visit. This is the conclusion of an analysis of data from the National Ambulatory Medical Care Survey (NAMCS) for the three-year period from 1995 through 1997. Of the 91,395 physician-reported NAMCS visits during this period, 4,242 (4.6 percent) were made by adolescents who were 12 to 19 years of age. Visits to family physicians, general practitioners or pediatricians accounted for 1,846 of adolescent visits. Pediatricians counseled adolescents more than family physicians and general practitioners on all health issues except weight reduction and cholesterol reduction. The average duration of all visits was 14.7 minutes, and 14.2 minutes and 15.6 minutes for family physicians/general practitioners and pediatricians, respectively. The average duration of a visit increased from 13.8 minutes to 17.6 minutes if counseling was performed.—DAN MERENSTEIN, M.D., ET AL., The Robert Graham Center: Policy Studies in Family Practice and Primary Care, American Academy of Family Physicians, Washington, D.C.

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