The authors evaluated the impact of a continuing education program on the AIDS-related competencies of primary care physicians in Los Angeles County. In the fall of 1984, telephone interviews were conducted with a random sample of general internists and family and general practitioners. Interviews were completed with 635 physicians, or 63% of the original sample. Less than 30% demonstrated adequate knowledge or practices necessary to deal with patients' AIDS-related symptoms and concerns. These physicians were randomly assigned to one of three treatment groups receiving materials presenting similar content about AIDS in printed, audiocassette or videocassette formats. Follow-up interviews with 81% of the study group revealed significant increases in competence but this was unrelated to the use of the educational materials. Several descriptors of physicians and their practices were significant predictors of competence as assessed on pre- and post-test interviews.

Acquired Immunodeficiency Syndrome↗

PubMedDate not supplied

A model for predicting the counseling practices of physicians.

The authors present a conceptual model of the determinants of the counseling practices of physicians and an empirical test of the model. Seventy-six per cent of a 50% random sample of physicians in a western county medical society completed a questionnaire (n = 151). This instrument measures the aggressiveness, the indications and techniques used by physicians in counseling patients about smoking, exercise, weight control and alcohol use. The independent variables assessed by this instrument are motivations, perceived skills and barriers, medical specialty, and personal health habits. Significant associations were found between the counseling practices reported and physicians' personal health habits, attitudes and specialties. Non-surgeons counseled more patients, counseled more intensively, and used a greater variety of techniques than surgeons and obstetrician-gynecologists. In general, physicians who had poor health habits did not fully counsel patients about those habits; however, physicians attempting to improve poor habits counseled patients significantly more often than physicians who were not trying to change their own behavior. Health maintenance efforts among physicians may have a multiplier effect.

Alcohol Drinking↗

PubMedDate not supplied

Academic general internists' work roles and motivations for learning.

As part of an assessment of interests and needs for continuing medical education among academic general internists, a 20 per cent random sample of the 1985 physician membership of SREPCIM was asked to describe how they divided their time among basic work activities (patient care, teaching, housestaff supervision, administration, and research), how they perceived the importance of specific skills related to those basic activities, and how interested they were in participating in a faculty development program in order to improve those skills. Although respondents reported a great diversity of work roles, attitudes, and values, there was a strong and consistent tendency to value and want to improve upon only those skills related to basic activities in which physicians were already spending more time. Also, physicians who spent more time in direct patient care were significantly less likely to value classroom teaching or research, less likely to be doing teaching or research, and less motivated to improve their skills in those activities. Likewise, faculty who spent more time doing research were less interested in improving their patient care skills. The implications of these findings for meeting current and future manpower needs of divisions of general internal medicine are discussed.

Academic Medical Centers↗

PubMedDate not supplied

Sexual practices: are physicians addressing the issues?

The literature suggests that prior to 1981, the only groups concerned with sexual history taking were urologists, psychiatrists, and gynecologists. The appearance of AIDS, however, has made competency in this area of interviewing essential for all primary care physicians. The teaching of sexual history taking presents a challenge to educators, since it involves all three educational domains--cognitive, affective, and skills. The authors have developed an approach to teaching sexual history taking to providers in small groups utilizing videotapes that model the content and sequence of questions and confront learners about the fears and the emotional concerns they may have in obtaining these data.

Acquired Immunodeficiency Syndrome↗

PubMedDate not supplied

Psychiatric diagnostic predispositions to alcoholism.

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Adult↗

PubMedDate not supplied

Nurse practitioners in rural California and AIDS.

A random sample of nurse practitioners located in the 26 rural counties of California were surveyed to assess their experience with HIV-positive patients. Of those selected, 70.5% participated; of those interviewed, 65.5% had seen a patient with HIV infection in the past 12 months. Of those providing primary care, 85% had seen HIV-positive patients. Their specific practice activities ranged from simply assessing to making all critical decisions with regard to therapeutic regimes in consultation with AIDS experts. Their most frequent activities involved education and/or counseling and the provision of psychosocial support.

California↗

PubMedDate not supplied

The relative effectiveness of different approaches to the surveillance of infections among hospitalized patients.

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Hospitalization↗

PubMedDate not supplied

Inverse relationship of urinary cyclic GMP to blood pressure reactivity in the CARDIA study: vasodilatory regulation of sympathetic vasoconstriction. Coronary Artery Risk Development in Young Adults.

OBJECTIVE: To determine whether urinary cyclic GMP (cGMP), which mediates the actions of the vasodilators nitric oxide and atrial natriuretic factor, is inversely related to blood pressure (BP) reactivity. In previous work, we found that urinary cGMP was inversely related to diastolic BP, but cGMP levels were higher among individuals presumed to have increased adrenergic activity, increased reactivity, and increased risk of hypertension (blacks, individuals with a family history of hypertension). METHOD: We measured 24-hour urinary cGMP levels in a substudy of 529 individuals in the Coronary Artery Risk Development in Young Adults (CARDIA) study; the sample was 23 to 35 years of age and approximately balanced for race (black/white) and gender. BP reactivity to stressors (video game, star-tracing, cold pressor) was tested 3 years earlier. Baseline BP was included as a covariate in all analyses. RESULTS: Diastolic BP reactivity to cold pressor was inversely related to cGMP excretion (p < .05); the relationship was strongest among black women with a family history of hypertension (partial r = -.33, p < .01). Systolic BP reactivity to star-tracing was also inversely related to cGMP (p < .01); the relationship for both star-tracing and video game stressors was strongest among black men (partial r values = -.25 and -.24, respectively; p values < .01). CONCLUSIONS: The results indicate that vasodilatory activity may impact the BP response to stress through modulation of adrenergic activation, particularly among blacks.

Adolescent↗