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A questionnaire was sent to directors of all family medicine-affiliated geriatric fellowship programs to characterize trends and changes since institution of ACGME accreditation of fellowships. The number of fellowships has more than doubled since 1986, but few fellows graduate from these programs. There is currently a surplus of fellowship positions; over half of all programs did not recruit a first-year fellow for the 1989 academic year. In 1986, most family medicine-affiliated programs had independent administration. Almost half of the programs are now jointly sponsored with an internal medicine department. These programs are over six times more likely to train internists than family physicians. Although there has been a growth in geriatric training programs over the past three years, the number of family physicians seeking such training remains negligible.

This study was conducted to determine the frequency of behavioral risk factor screening and counseling by family medicine residents. Patients seen for well-care visits reported that residents screened most often for smoking and alcohol abuse. Residents inquired about stress, sedentary life-style, poor nutritional habits, and obesity less often. Few patients were counseled to reduce risks, even when unhealthy behaviors had been identified. Residents provided counseling most often for obesity, smoking, and stress; sedentary life-style, poor nutritional habits, and alcohol abuse rarely received intervention. Chart documentation of screening reported by patients was done a majority of the time only for smoking and alcohol abuse. Counseling was usually not documented. Residents screened most often for those risk factors (smoking and alcohol) they considered the most important causes of chronic disease. No relationship was found, however, between resident attitudes and likelihood of counseling. Residents agreed they needed more training to counsel patients on reducing behavioral risks.

A random sample of 331 Enga mothers in Papua New Guinea perceived that an average of 5.96 live births (S.D. = 1.88) were needed to achieve their mean desired completed family size (DFS) of 4.65 children (S.D. = 1.32). The mean of the personal child mortality rates projected by the individual mothers. 194/1000, is very close to the rate of 198/1000 (224 deaths among 1134 live births) experienced by the women as a group and the 177/1000 documented in a 1972 prospective study in the area. This suggests that as a group preliterate women may possess an accurate estimate of prevailing child mortality rates. Considerable interest in family planning was shown. However for cultural or linguistic reasons, the majority (except in the case of the pill and tubal ligation) expressed no opinions about their readiness to use specific modern methods. The mean parity of 43 women seeking tubal ligation was 5.98 (S.D. = 1.81). An integrated maternal health and family planning program focusing on the health benefits to mother and child of the current 3-4-year birth interval seems indicated.

Continuity of relationship between physician and patient is a fundamental aspect of the health care provided by family physicians. Measurement of continuity has proved difficult, however. Commonly applied measures, usual provider of care (UPC), continuity of care (COC), and the modified continuity index (MCI), either ignore key aspects of continuity or provide misleading results. Consequently, a new measure of continuity, the modified, modified continuity index (MMCI), with a possible range of 0 to 1, was developed to overcome these problems. It was applied to a residency model practice, in which mean MMCI was found to be 0.59 (range 0.3 to 1.0). Mean COC was .41 and a mean MCI was .44. Thus, unlike COC and MCI, MMCI suggests fairly good continuity of care in this practice while still implying possible improvement. The MMCI should be useful for enhancing training and practice of family medicine.

Two hundred and fifty patients at a university hospital teaching clinic and 200 patients in a small private medical office were questioned about their expectations for confidentiality. It was found that in general, subjects in both groups had similar expectations of how physicians handle confidential information. This included physician behavior in situations such as discussing cases with other physicians for second opinions, submitting cases to medical journals, and discussing cases at parties or with spouses and friends. The similarity existed despite demographic differences between the two groups and despite marked differences in the two practice settings. A few differences between the groups were noted, however. University clinic patients were more likely than private office patients (54.5% vs 38.5%) to expect that cases are discussed at large physicians' meetings. Private office patients were more likely (77.8% vs 67%) to expect physicians to discuss cases with nurses. Men in both practice settings were more likely than women to believe that physicians commonly submit cases to medical journals (75.8% vs 59.9%), or discuss cases with nurses (81% vs 67%), non-medical friends (10.9% vs 4.4%), spouses (53% vs 36.4%), and at parties with physicians (56.4% vs 39.6%).

Research using high-risk pregnant women suggests that postprandial blood glucose levels at the high end of normal are associated with greater risk of adverse pregnancy outcomes than low-normal levels. The objective of this study was to determine the relationships between pregnancy complications and glucose levels in low-risk pregnant women. Based on 2-hour postprandial glucose testing at 27 to 33 weeks, 337 women with normal reproductive histories were divided into three groups: group A, glucose less than 5.6 mmol/L (100 mg/dL), group B, 5.6 to 6.6 mmol/L (100 to 119 mg/dL), and group C, 6.7 to 9.1 mmol/L (120 to 164 mg/dL). Women with glucose levels greater than or equal to 9.2 mmol/L (165 mg/dL) were excluded. The groups were compared to detect differences in rates of various maternal outcomes (preeclampsia, cesarean delivery, forceps delivery) and neonatal outcomes (macrosomia, Apgar scores, prematurity, fetal death, infant death, congenital anomalies). No significant differences were found. These data indicate that variations in maternal glucose tolerance (within the normal range) are not associated with adverse outcomes in normal pregnant women.

Previous research has identified five characteristics of medical schools that are related to the choice of family medicine as a specialty: (1) the amount of time devoted to required training in family medicine, (2) the timing of the required family medicine training, (3) the type of ownership of the school (public or private), (4) the geographic location of the school, and (5) the administrative structure of family medicine within the school. These five characteristics of U.S. medical schools during the mid-1980s, together with the school tuition levels, were examined with both univariate and multivariate analysis to observe their relationships to the percentage of U.S. medical graduates entering family medicine between July 1986 and December 1987. With univariate analysis, each characteristic was significantly related to the percentage of graduates entering family medicine. Using multivariate analysis, only the number of weeks required and the type of ownership of the school were significantly related to the percentage of graduates entering family medicine, with the higher percentages related to greater numbers of required weeks of family medicine training and to public ownership of the school.

This study was performed to evaluate the importance of obtaining postpartum Papanicolaou (Pap) smears routinely. Four hundred eighty-nine patients receiving pregnancy care had a normal prenatal Pap smear and a repeat Pap smear at their postpartum visit. Twenty-four (4.9 percent) had an abnormal postpartum Pap smear (95 percent confidence interval: 3.1-6.9 percent). Twenty-one (87.5 percent) of the abnormal smears showed squamous dysplasia; three (12.5 percent) showed squamous atypia. No specific risk factors were identified that predicted the occurrence of an abnormal postpartum Pap following a normal prenatal Pap except for age. Women more than 30 years of age were less likely to have an abnormal postpartum Pap smear (P = 0.008). The results of this study support the practice of performing Pap smears during prenatal care and again at postpartum examination, even when the prenatal Pap smear is normal.

A study was carried out to see if medical costs could be lowered by educating twenty six family practice residents and their patients. Four study conditions were were created: both resident and patient educated, resident only educated, patient only educated, and neither educated. Encounter data were collected before and after the resident education phase and a follow-up phone call was made to patients to obtain information on their current health. Cost measures included 1) physician's fee, 2) laboratory fees and 3) total ambulatory costs. Costs were lowered only in the both-educated group for laboratory costs. It was not sufficient to educate only residents, the group generally targeted for education about cost. This finding suggests that the most effective educational programs may involve patients as well as physicians.