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Objectives: With the increased use of antiretroviral therapy, more patients with human immunodeficiency virus and acquired immunodeficiency syndrome (HIV/AIDS) are surviving for long periods of time. The aim of this [...]

BACKGROUND. Pregnancy is a period of physical and emotional stress that can have a significant impact on the well-being of an expectant mother. To explore the extent to which normal [...]

BACKGROUND. Acute sinusitis and upper respiratory tract infections (URIs) share many common symptoms and signs. Objective criteria have been identified that are valid for distinguishing between these two clinical problems. [...]

Objective: To examine physician characteristics associated with being a high prescriber of antibiotics for pediatric upper respiratory tract infections (URIs). Design and Setting: Analysis of 34 624 episodes of care for URIs in children (younger than 18 years) in the Kentucky Medicaid program from July 1, 1995, to June 30, 1996. Participants: Primary care physicians with at least 25 episodes of care (n = 205). The proportion of patients with URIs receiving antibiotics stratified the sample into low ([is less than or equal to] 25th percentile) and high ([is greater than or equal to] 75th percentile) antibiotic prescribers. Main Outcome Measures: Bivariate analyses were computed comparing the high and low prescribers. A logistic regression model was computed for likelihood of being a high prescriber by number of URI episodes, proportion of patients receiving antibiotics that were broad spectrum, years since medical school graduation, physician gender, rural/urban practice, and specialty. Results: The high prescriber group (n = 52) included data from 11 899 episodes of care, with a mean prescribing rate of 80%. The low prescriber group (n = 55) included data from 5396 episodes, with a mean prescribing rate of 16%. High prescribers were significantly more years away from medical school graduation (27 vs 19 years; P [is less than] .001) and had managed significantly more URI episodes than low prescribers (229 vs 98; P=.001). In the logistic regression, compared with pediatricians, the odds ratios of being a high prescriber were 409 (95% confidence interval [CI], 29-7276) for family practitioners and 318 (95% CI, 17-6125) for other primary care physicians. Conclusion: With the rise of antibiotic-resistant bacteria, more focused training regarding treatment of URIs is warranted in residency and in continuing medical education forums. Arch Pediatr Adolesc Med. 1998;152:349-352, Pediatricians and younger physicians may be less likely to prescribe antibiotics to children with upper respiratory infections than older doctors and those in family practice. Researchers evaluated 34,624 patient visits for children with colds within the Kentucky Medicaid system. Doctors who prescribed antibiotics to an average of 80% of patients with colds were more years from medical school graduation and treated more colds. Those who gave antibiotics to an average of 16% of patients with colds were more likely pediatricians. Antibiotics are not effective or necessary for routine colds.

BACKGROUND. Streptococcus pneumoniae is one of the primary causes of illness and death among young children, and evidence suggests that the prevalence of anti-biotic-resistant S pneumoniae is increasing. The purpose [...]

BACKGROUND. The purpose of this study was to examine and compare the approaches of family physicians and obstetricians when evaluating and managing women with preterm contractions or labor. METHODS. A [...]

BACKGROUND. Primary care physicians frequently use antibiotics for nonindicated conditions and conditions for which antibiotics have not been shown to be effective. The intention of this study was to determine [...]

BACKGROUND. Clinicians often prescribe antibiotics to treat acute bronchitis despite scant evidence that this approach is effective at speeding symptom resolution. Because patients infected with bacteria but not treated with [...]

BACKGROUND. Increases in cesarean section frequency may be dependent on institutional or individual practitioner characteristics. The purpose of this study was to examine whether the diagnosis of fetal distress was influenced by time of day or institutional factors. METHODS. Chart review was performed on a random sample of women stratified by month of delivery at each institution (N=8647). All women who gave birth by elective cesarean section or whose labor was induced were excluded from analysis (n=2207), leaving a total population of 6440 for study. Women were stratified based on risk status, and comparisons were made between the time of delivery, maternal socioeconomic factors, and obstetric variables for those who had a cesarean section for fetal distress compared with women who gave birth vaginally. RESULTS. Large variations in rates of cesarean delivery for fetal distress were observed among the participating institutions (range 0.9% to 3.0% of all deliveries). Increased rates of cesarean delivery for fetal distress were observed in nonwhite women and those who had had a previous cesarean delivery. Also, a significant increase in rates of cesarean section for fetal distress was noted between the hours of 9:00 PM and 3:00 AM. When adjusted for risk status, previous cesarean delivery, race, use of pitocin augmentation, length of labor, and site, time of day was still a significant predictor (adjusted odds ratio=1.56, 95% confidence interval 1.06 to 2.29) for cesarean delivery for fetal distress. CONCLUSIONS. Cesarean delivery for the diagnosis of fetal distress appears to vary depending on institutional and other nonclinical factors. The observation that cesarean deliveries for fetal distress peak during nighttime hours raises the possibility that the interpretation of fetal monitor tracing is influenced by physician and patient fatigue or other clinical factors. KEY WORDS. Cesarean section; dystocia; fetal monitoring; fetal distress; pregnancy, high risk; labor stage, first., After rising markedly in recent decades, cesarean section rates in the United States appear to have reached a plateau.[1-3] Concerns about the increasing frequency of cesarean delivery have prompted several [...]

BACKGROUND. There is little information describing family physician researchers who work outside academic medical centers. This report describes the motivating factors and resources used by community residency faculty and nonfaculty [...]

Background. Symptomatic treatment is the only recommended therapy for the uncomplicated "common cold." The purpose of this study was to examine the use of antibiotics and other prescription medications for [...]

Background. Personality disorders are believed to occur in approximately 10% of the adult population, yet they are rarely diagnosed in primary care settings. This study compares the functional status, health care utilization, and satisfaction with care for patients who were at high risk for a personality disorder with those who were at low risk. Methods. Patients at high risk for personality disorders were identified using a standardized psychometric instrument, the Structured Clinical Inventory for DSM-III Axis II (SCID-II). After assigning patients to risk categories, responses were compared on the Medical outcomes Study Short Form-36, the Beck Depression Inventory, the CAGE alcohol use questionnaire, and an adapted version of the RAND Patient Satisfaction Questionnaire Results. Patients who were at high risk for any personality disorder had lower functional status, higher risk for depression or alcohol abuse, and lower levels of satisfaction with care. These differences could not be explained by demographic or socioeconomic differences between high- and low-risk patients. Being at high risk for specific personality disorders, such as borderline, schizoid, and dependent disorders, was associated with higher degrees of functional impairment and greater risk for depression and alcohol abuse. Patients at high risk for other disorders, such as obsessive-compulsive, narcissitic, and schizotypal, consistently showed no appreciable degree of impairment as compared with patients at low risk for any personality disorder. Medical care utilization was no higher when personality disorders were examined in aggregate, but a marked increase in utilization was noted among patients at high risk for histrionic and dependent disorders. Conclusions. Among primary care patients, having a personality disorder is associated with lower functional status, lower satisfaction with health care, and higher risk for depression and alcohol abuse. Key words. Primary health care; personality disorders; patient satisfaction; psychopathology. ( J Fam Pract 1996; 42:54-60) Fifty percent to 70% of patients with a positive history of mental illness lasting at least 1 year seek care from primary care physicians, and primary care physicians provide nearly one half of all mental health services in the United States.[1-4] These physicians, however, frequently focus on the physical aspects of their patients and may underdiagnose or de-emphasize the importance of patients, psychological or psychiatric status in their evaluations.[5,6] Since emotional problems are often linked to medical complaints and utilization of medical resources,[7,8] focusing only on patients, physical conditions raises medical costs while decreasing the opportunity for prompt and effective intervention. Psychopathology in primary care patients is not benign. A World Health Organization study focusing on common mental disorders in primary care found that after controlling for physical disease severity, psychopathology was consistently associated with increased disability.[9] Moreover, although physical disease severity had an independent association with disabi, lity, its relation with disability was weaker than its relation with psychopathology.[9] Other evidence has shown that depressed individuals have been found to utilize health care service three times as [...]

Background. Controversy exists regarding the efficacy of routine neonatat circumcision of male infants. Little is known about parental or provider characteristics or the use of medical resources associated with this [...]

Background. Studies suggest that family physicians and other generalist physicians practice differently than specialtists. This study was performed to determine whether practice patterns and outcomes differ for women with low-risk [...]

Background. Participation of community-based primary care practitioners in practice-based research has been encouraged for several years. The purpose of this study was to examine characteristics related to community-based primary care [...]

Background. Previous research has suggested that cough associated with acute bronchitis is more likely to subside within 7 days when treated with albuterol than with an antibiotic. This study examines [...]

Background. The frequency of low birthweight decreases when women quit smoking in the first trimester of pregnancy. This analysis examines the cost-effectiveness of smoking-cessation programs during pregnancy for the prevention [...]

Background: There has been evidence that, in primary care practices, health screening tests are not ordered in random fashion but instead are coupled or bundled into distinct groups. This study was performed to determine if the Papanicolaou (Pap) smear serves as a marker for other health screening tests. Methods: The study consisted of a retrospective chart review of female patients over the age of 18 years at three' rural health clinics, followed by a prospective study of patients during a 3-month period in five rural family practice clinics. The study focused on whether a Pap smear was performed and whether a breast examination, mammogram, rectal examination or stool occult blood test, or serum cholesterol testing was performed. Results: In both the retrospective and prospective series, patients who received Pap smears were significantly more likely to receive breast examinations, mammograms, colorectal screening, and cholesterol tests. In addition, the coupling of other screening tests with the Pap smear appeared to increase with advancing patient age, with a decline after age 70 years. In patients who did not have Pap smears, only cholesterol testing increased as patients aged. Conclusion: Health screening tests in women are associated with the performance of a Pap smear. Providers may use the Pap smear as a marker of whether a woman has received screening for several other medical problems. Thus, the Pap smear can be considered a 'sentinel' test for health screening in women, and efforts to identify women at high risk and increase health promotion and disease prevention in this group should focus on women who have not received this test.

Background: As the costs of childhood immunizations have increased over the past 10 years, patients have increasingly turned to public health departments for this service. This study compares reasons for delays in immunization among patients who obtained their immunizations at health departments and those who continued to utilize private physicians or clinics. Methods: A birth certificate survey of all children born between September 1, 1988, and August 31, 1989, in four urban census tracts and two rural counties in Kentucky was performed in late 199 1, when all children were over age 2 years. The percentage of patients whose immunizations had been delayed and the reasons for delay were noted. Results: Children who utilized public health departments or a combination of health departments and private sources for their immunizations were more likely to have experienced delays than those who obtained immunizations from private providers (56% vs 34%, P=.002). In particular, patients in the public provider group were more likely than those in the private provider group to have missed immunizations for invalid contraindications (34% vs 8%, P=.02), missed appointments (22% vs 9%, P=.02), or failure to receive immunizations when at the health department for another visit (23% vs 11%, P=.04). Conclusions: While a large number of patients in both the private and public provider groups experienced delays in immunizations, patients who received immunizations from public sources were more likely to experience delays related to missed opportunities. (Arch Pediatr Adolesc Med. 1994;148:4 70-473), Many children are not receiving immunizations in a timely manner, especially those who receive their health care from public medical facilities. The medical records of 494 children born in 1988 and 1989 were examined after the children had exceeded the age of two in order to identify delays in immunization. Patient's families were contacted to determine the reason for delays. Fifty-six percent of the children receiving care from a public provider experienced delays in being immunized, compared to 34% of those using private care facilities. Those using public providers were found to be more likely to have a delayed immunization due to missed opportunities, which include invalid contraindications, missed appointments and the lack of simultaneous administration of vaccines.

Background. This study examines referral patterns of family physicians who perform obstetrics to determine the effects of referral bias on family physician and obstetrician patient populations. Methods. A retrospective review [...]

Background. Evidence exists that maternal cigarette smoking is associated with preterm birth. Our purpose was to investigate the relation between maternal smoking cessation at different points during pregnancy and the [...]

Background. Practice associations between family physicians and nurse midwives have been suggested as a means of increase the availability of obstetric care in rural areas. No evidence exists, however, that [...]

Background. Family medicine has struggled to gain stature among academic medical disciplines. One factor has been the paucity of quality family medicine research. Methods. Two hundred eight full-time physician faculty members at family practice residency programs completed a survey that focused on demographics, training, experience, professional activities, and factors that motivated them to select academic careers. Bivariate and multivariate analyses were performed to determine if any of these factors was associated with increased time spent on research. Results. Faculty members who spent 10% or more of their professional time on research were more likely to be fellowship trained, employed in university training programs, have more academic experience, and to cite the opportunity to do research as a factor motivating them to enter academic medicine. However, when multivariate analysis was performed, the only significant factor that predicted that a faculty member would devote 10% or more time to research was having an interest in research when first seeking a position in academic medicine. Conclusions. The amount of time that family medicine faculty members dedicate to research is related to a strong interest in research when seeking their academic position. Fellowship training and an academic environment may have assisted faculty in performing research, but were not independent predictors of future involvement in research. Key words. Family practice; faculty; research; time factors; academic medical centers. (J Fam Pract 1993; 37:44-48), An academic discipline is defined by the scope of its clinical interests and measured by the output of its academic researchers. In becoming an academic discipline, family medicine has implicitly [...]

Preterm birth is second only to congenital diseases in causing morbidity and mortality in infants. To prevent preterm labor and delivery, a number of strategies have been developed. When choosing a strategy to prevent preterm birth, however, physicians must remember that preterm delivery arises from three separate conditions: iatrogenic preterm labor, premature rupture of membranes, and idiopathic preterm labor. Many of the programs that have been developed focus on patients who are at high risk for iatrogenic preterm birth and premature rupture of membranes, but do not include patients who are likely to experience idiopathic preterm labor. Since idiopathic preterm labor is the most common cause of preterm birth and is the most amenable to early intervention with tocolytic agents, more preterm labor education efforts should be included in prenatal care programs. In addition, further research is needed to delineate which features of preterm birth prevention programs are responsible for the beneficial effects that have been observed. Key words. Infant, premature; labor, premature. J Fam Pract 1992; 35:81-89., There is a great temptation to take the simple path, uncritically follow the precepts of leaders in the field, or succumb to the seduction of the uncontrolled studies.[1] Perhaps no [...]

Acute bronchitis is an inflammation of the membranes of the bronchial tubes, through which air moves from the windpipe to the lungs. However, bronchitis is not easily treated, partly because of disagreement about what type of organism causes the condition. Despite evidence that the causative agent is probably viral in origin, more than 90 percent of physicians treat bronchitis with antibiotics. There is evidence that pulmonary function test results of patients with bronchitis resemble those of patients with asthma, and that patients with a history of bronchitis are more likely to develop asthma in the future. In the present study, the treatment of bronchitis with albuterol, a bronchodilator frequently used in the treatment of asthma, is compared with erythromycin, one of the more commonly used antibiotics. Patients with bronchitis were identified and assigned to one of two treatment groups. The 17 patients in the albuterol group took one teaspoonful of liquid albuterol concentrate, 2 milligrams per 5 milliliters, every six hours for seven days. The remaining 17 patients took one teaspoonful of liquid erythromycin concentrate, 400 milligrams per 5 milliliters, every six hours for seven days. During the treatment period, patients kept a symptom diary. Seven days later, 41 percent of the patients taking albuterol were still coughing, compared with 88 percent of the patient taking erythromycin. The former group also had earlier relief of symptoms than the latter group. These results were not influenced by the smoking behavior of the patients. It is concluded that albuterol taken by mouth may be more effective than antibiotic therapy in the treatment of acute bronchitis. (Consumer Summary produced by Reliance Medical Information, Inc.), Background. Based on observations that pulmonary function tests of patients with acute bronchitis resemble those of patients with asthma, it was hypothesized that a bronchodilator may be an effective form of treatment for patients with acute bronchitis. Methods. Albuterol was compared with erythromycin in a prospective, randomized, double-blinded fashion. Participants were patients who presented to family physicians with a history of having a productive cough of less than 30 days&apos; duration, no history or evidence of pneumonia, and no other pulmonary or cardiac disease. Patients completed a 7-day symptom diary and returned to their physician after 1 week of therapy for reexamination. Results. Patients treated with albuterol were less likely to be coughing after 7 days of treatment than patients treated with erythromycin (41% vs 88%, P < .05). This was true for both smokers and nonsmokers and in patients with purulent-appearing sputum. Trends toward an earlier improvement in cough and an improved feeling of well-being also were observed in the albuterol group. No differences between groups were found as to the length of time before patients returned to work, the length of time until patients resumed normal activities, or the overall improvement in patient well-being. Minor side effects were equal in both groups. Conclusions. Oral albuterol may be more effective than commonly used antibiotics in relieving the symptoms of acute bronchitis. Key words. Bronchitis; albuterol; erythromycin; comparative study. J Fam Pract 1991; 33:476-480., Acute bronchitis is one of the most common illnesses seen in ambulatory practice, [1-3] yet there is no clear effective treatment. Despite the opinion that acute bronchitis is a viral-mediated [...]

Family physicians are increasingly deciding to stop including obstetrics in their practices, for many reasons, such as malpractice costs and the demanding schedule involved in delivering babies. This has had a great impact on rural hospitals, where the lack of competition means that as family practitioners give up obstetrics, there may be no one willing to take over. Birth records for a three-year period were reviewed in a hospital where a maternity center was established. There was a 35.8 percent increase in births at the hospital in the three years following establishment of the maternity center. Family physicians performed 64 percent of all deliveries. The number of patients who were delivered without prenatal care has steadily fallen since the center opened as well. Several problems were addressed by the opening of the maternity center. First, relief was offered to the obstetricians on the medical staff, who were feeling overwhelmed by the number of deliveries they were performing. By establishing the maternity center, the number of births increased at the hospital while the number of births per obstetrician decreased, since family physicians were employed in the maternity center for this purpose. The planning of the center, and its impact upon the hospital and family physicians working there are discussed. (Consumer Summary produced by Reliance Medical Information, Inc.)

Seventy, to 80% of women using subdermal contraceptive implants (Norplant) have reported side effects, such as uterine bleeding, headache, mastalgia, and local pain at the site of insertion. This is [...]

Are the Right Patients Being Tested? * OBJECTIVE Our goal was to determine whether adult patients with type 2 diabetes who had gross proteinuria or were already taking angiotensin-blocking drugs [...]

A Reconceptualization of Acute Viral Respiratory Infections BACKGROUND * Considerable overlap exists in patient presentations and physical findings in viral upper respiratory tract infections (URIs) and acute bronchitis. Our goal [...]

Hypokalemia is a condition of extreme potassium depletion in the blood which may be accompanied by symptoms of muscular weakness or paralysis, nerve spasms, and a decrease in blood pressure. It is often a secondary complication resulting from the use of diuretics, which are prescribed for the control of blood pressure. No completely satisfactory treatment has yet been found to alleviate these symptoms. One method to control hypokalemia has been the use of a salt substitute in the diet. Ten patients who were taking a potassium product to control diuretic-induced hypokalemia and who had stable high blood pressure were evaluated. These patients switched from their normal medication to a potassium salt substitute for a two-week period. The blood concentrations of potassium in these patients were monitored every two weeks, and it was found that the salt substitute was effective in increasing potassium levels. A follow-up questionnaire was completed by the patients at the end of the trial period. The results indicated that the potassium salt supplement method was effective and also inexpensive. Very few side effects were reported for the use of the potassium salts and those that were recorded were not significant. However, the patients disliked the taste of the potassium salt and eight out of 10 individuals chose to return to their prescription potassium supplement. In conclusion, this method was found to be safe, economical and effective but patient resistance was an obstacle to successful use., To evaluate the safety, effectiveness, and patient acceptance of salt substitutes for use as a potassium replacement, a series of 10 patients who had controlled hypertension and who were taking a prescription potassium replacement product for diuretic-induced hypokalemia agreed to switch from their usual potassium product to the salt substitute for 6 weeks. Serum potassium values were monitored every 2 weeks while patients took the salt substitute. It was found that the salt substitute was very effective at maintaining patients&apos; serum potassium in the normal range. A questionnaire completed at the end of the 6-week period showed that only three patients experienced any side effects from the salt substitute, none of which was severe enough to warrant discontinuation of the product. The questionnaire also revealed, however, that patients did not care for the salt substitute, and at the end of the study, eight out of the 10 subjects chose to return to their prescription potassium product despite a marked cost advantage in favor of the salt substitute. While this study shows that salt substitutes are an effective, safe, and economical alternative to prescription potassium products, poor patient acceptance of this agent is discouraging., Hypokalemia secondary to diuretic use for hypertension is common. Nearly one third of all patients who are placed on thiazide diuretics will become hypokalemic, albeit usually only to a mild [...]

The initial portion of the tape presents a review of breech positions and epidemiology of breech presentations as well as noting the contraindications for breech delivery. Included in this portion [...]

The debate about three-year medical school curricula has resurfaced recently, driven by rising education debt burden and a predicted physician shortage. In this Perspective, the authors call for an evidence-based discussion of the merits and challenges of three-year curricula. They examine published evidence that suggests that three-year curricula are viable, including studies on three-year curricula in (1) U.S. medical schools in the 1970s and 1980s, (2) two Canadian medical schools with more than four decades of experience with such curricula, and (3) accelerated family medicine and internal medicine programs. They also briefly describe the new three-year programs that are being implemented at eight U.S. medical schools, including their own. Finally, they offer suggestions regarding how to enhance the discussion between the proponents of and those with concerns about three-year curricula.

Which Antibiotics Work Best? BACKGROUND. Recurrent infection after an episode of otitis media is common in pediatric patients. If a patient experienced primary treatment failure in a preceding episode, physicians [...]

Study Guide for Williams Obstetrics is intended to accompany the popular obstetrics reference by the same name. The guide comprises over 2000 multiple-choice questions that appear to be carefully constructed [...]

This pocket reference for obstetrics was developed from a guide for interns prepared by the first author during a leave of absence forced by her own complicated pregnancy. The text [...]

Objectives. Antibiotic resistance is a significant global problem, but the trends in prevalence and impact of antibiotic resistance in hospitalizations in the United States are unclear. We evaluated the trends in hospitalizations associated with antibiotic-resistant infections in U.S. hospitals from 1997 to 2006.Methods. We analyzed the National Hospital Discharge Survey (NHDS) during 1997–2006 (unweighted n=3.3 million hospitalizations; weighted n=370.3 million hospitalizations) and examined trends in prevalence of hospitalizations with antibiotic-resistant infections, length of stay, and discharge status.Results. The number of infection-related hospitalizations with antibiotic resistance increased 359% during the 10-year period, from 37,005 in 1997 to 169,985 in 2006. The steepest rise was seen among individuals <18 years of age. The mean age of individuals with infection-related hospitalizations that had antibiotic-resistant infections decreased substantially, from 65.7 years (standard error [SE] = 2.01) in 1997 to 44.2 years (SE = 1.47) in 2006. As the proportion of patients with antibiotic-resistant infections who did not have insurance increased, the length of stay for those hospitalizations had a corresponding decrease (r=0.91, p<0.01).Conclusions. Antibiotic-resistant infections are becoming increasingly commonplace in hospitalizations in the U.S., with a steady upward trend between 1997 and 2006. Antibiotic-resistant infections are increasingly being seen in younger patients and those without health insurance.

We conducted a survey to assess clinical pharmacists' recommendation of antibiotics for upper respiratory infections (URIs) and acute bronchitis. A random sample of 752 members of the American College of Clinical Pharmacy were mailed a multiple‐choice survey that presented four examples consistent with clinical symptoms of the two disorders. Respondents were asked what treatment they would recommend for each example. The response rate was 59%. Pharmacists recommended antibiotics for the treatment of both URIs and acute bronchitis significantly more if patients' symptoms included discolored discharge or sputum as opposed to clear discharge. Those who were board certified were less likely than nonboard‐certified pharmacists to recommend antibiotics for URIs with discolored discharge. Pharmacists who specialized in either ambulatory care or infectious disease were less likely than those in other specialties to recommend antibiotics for acute bronchitis with discolored sputum. Clinical pharmacists are similar to patients and physicians in their belief that antibiotics are appropriate for URIs and acute bronchitis with discolored discharge. Considering the role that pharmacists play as clinical consultants to physicians, greater efforts should be made to educate them regarding appropriate prescription of antibiotics.

Objective: Previous work in an academic setting has found that scoring in the higher ranges for selected personality disorders on an objective assessment tool was associated with increases in psychiatric co-morbidities, decreased satisfaction with health care, and diminished health related functional status. This study examines how often patients in primary care practices exhibit traits consistent with these selected disorders and what impact this has on their health related functional status and use of health care resources.Methods: Thirteen family practices agreed to distribute questionnaires to 50 consecutive patients in the spring of 1997. Questionnaires contained instruments that assess risk for personality disorders, health related functional status, health resource use, demographics, and depression. The relationships between four specific personality disorders (borderline, dependent, schizoid and schizotypal) and other assessed variables were explored.Results: Of the 250 patients returning completed survey instruments, 80 (32%) scored in the high range for traits consistent with one of the four target personality disorders. Patients in the high risk group also were noted to have more outpatient, emergency, and inpatient visits in the previous six months. Those in the high risk group also had significantly lower scores on seven of eight measures of health related functional status.Conclusions: Patients who have several traits for borderline, dependent, schizoid, and schizotypal personality disorders are common in primary care practices. These patients utilize services at higher rates than others and are more likely to screen in the positive range for depressive symptoms and have overall lower health related functional status.

To explore the potential use of a risk score based on clinical risk factors related to cesarean delivery.

Objective: To evaluate the influence of socioeconomic factors and provider characteristics on the use of intrapartum epidural anesthesia.

To examine factors associated with the performance of episiotomy.

To evaluate whether preterm-birth prevention educational programs are effective at reducing neonatal mortality, low birth weight (LBW), and preterm delivery.

To evaluate whether preterm-birth prevention educational programs are effective at reducing neonatal mortality, low birth weight (LBW), and preterm delivery.

Reports on a case of a woman with unexplainable neurologic symptoms. Use of a pesticide for her cat; Women as allergic to organophosphate in the pesticide.