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STUDY OBJECTIVE--The relation between a history of disorders suggestive of acute otitis media, symptoms, and findings of an examination of the tympanic membrane and doctors' certainty of diagnosis. Also, to examine differences in prescribing habits for acute otitis media among doctors from different countries. DESIGN--Questionnaires were completed by participating doctors for a maximum of 15 consecutive patients presenting with presumed acute otitis media. SETTING--General practices in Australia, Belgium, Great Britain, Israel, The Netherlands, New Zealand, Canada, Switzerland, and the United States. PATIENTS--3660 Children divided into the three age groups 0-12 months, 13-30 months, and greater than or equal to 31 months. MAIN OUTCOME MEASURES--General practitioners' responses to questions on their diagnostic certainty and resolution of patients' symptoms after two months. RESULTS--The diagnostic certainty in patients aged 0-12 months was 58.0%. This increased to 66.0% in those aged 13-30 months and 73.3% in those aged greater than or equal to 31 months. In all age groups diagnostic certainty was positively associated with the finding of a tympanic membrane that was discharging pus or bulging. Redness of the membrane and pain were also associated with certainty in patients aged 13-30 months, and a history of decreased hearing or recent upper respiratory infection was positively associated in patients aged greater than or equal to 31 months. The proportion of patients prescribed antibiotics varied greatly among the countries, from 31.2% in The Netherlands to 98.2% in both Australia and New Zealand, as did the duration of treatment. Patients who did not take antibiotics had a higher rate of recovery than those who did; the rate of recovery did not differ between different types of antibiotic. CONCLUSIONS--Doctors' certainty of diagnosis of acute otitis media was linked to patient's age. Improved criteria or techniques for diagnosing acute otitis media, especially in very young children, need to be developed. Antibiotic treatment did not improve the rate of recovery of patients in this study.

All electrocardiograms (ECGs) from a primary care setting during a one-year period were analyzed. A total of 370 ECG tracings were recorded during 2.1 percent of patient visits. Of these tracings 62.4 percent were interpreted as normal. Only 15 different ECG diagnoses were needed to interpret 96.5 percent of the ECG tracings (97.2 percent of total diagnoses). These data can facilitate design of ECG curricula for family medicine training programs.

Three documents that considerably facilitate primary care research have been produced in recent years. They are an international glossary of primary care health terms, an international classification of primary care health problems, and a primary care process classification. To describe the full spectrum of primary health care, however, additional classifications are needed that detail the reasons for encounters and indicate health status. Work on these several classifications is in progress and a set of primary care classifications has been proposed as a basis for the 10th revision of the International Classification of Diseases.

The red blood cell (RBC) content of urine specimens was determined both by direct counts by a hemocytometer and by the number of RBCs per high-power field (HPF) in the sediment by routine urine analysis. The sensitivity of a finding of 1 to 3 and 2 to 4 RBCs/HPF in detecting greater than or equal to 2,000 RBCs/ml unspun urine was 63% (73/116) and 54% (63/116), respectively. There was a wide range of values of RBCs/ml determined by direct counts for each degree of microscopic hematuria as defined by the HPF method. We conclude that examination of the urinary sediment by the HPF method is not sufficiently sensitive to be used as a screening test for the detection of microhematuria in asymptomatic subjects.

Seasonal effects on mood and other components of functional status have been demonstrated in large segments of the general population but have received little attention in primary care patients. In the present study on adult members of a communal settlement (kibbutz) in Israel, seasonality and functional status were measured in both the winter and summer seasons in the same patients. Patients under age 65 had better overall health ratings than those 65 and over in both winter and summer. Overall health ratings were better in summer for those under 65 but were unchanged in the older group. Summer and winter seasonality scores were more constant in the younger group than in the older patients. We conclude that both age and seasonality need to be considered when measuring functional status in primary care patients.

Trauma to the back from the force of chronic stress is thought to be an etiologic factor in isthmic spondylolisthesis (SLL). The relationship of first degree spondylolisthesis to low back pain (LBP) is controversial. We compare the prevalence of SLL in helicopter pilots who are subject to strong vibrational forces, with other airforce personnel. Helicopter pilots had more than a four times higher prevalence of SLL (4.5%) than did cadets (1.0%) and transport pilots (0.9%). Low back pain was more frequent in pilots with SLL than in those without this lesion but in no case was the pain disabling or the defect progressive. We conclude that SLL may be induced by vibrational forces and although SLL is associated with LBP, the pain was little clinical significance.