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Biomedical subjects

J M Hickner

Publications and source records attributed to J M Hickner.

At least 19 recordsLinked to original sources
PubMed1998

Do gastrointestinal symptoms accompanying sore throat predict streptococcal pharyngitis? An UPRNet study. Upper Peninsula Research Network.

BACKGROUND: The purpose of this study was to determine whether gastrointestinal (GI) symptoms are more common in streptococcal than nonstreptococcal pharyngitis, and, if so, whether these symptoms are useful diagnostic predictors. METHODS: Patients aged 4 and older presenting consecutively to one of three family practice clinics and one emergency department with the chief complaint of sore throat were invited to participate in the study. A nurse administered a brief symptom checklist; after documenting clinical signs, the clinician assessed and treated the patient. All patients were screened for group A streptococcus using the Abbott Test Pack Plus. Patients were enrolled from January 1996 through March 1996. Significant associations of signs and symptoms with streptococcal pharyngitis were determined by chi square, likelihood ratios were calculated, and logistic regression was used to compare diagnostic prediction models with and without GI symptoms. RESULTS: Six hundred fifty-seven consecutive patients with the presenting complaint of sore throat were enrolled in the study. The mean age of the patients enrolled was 19 years; the median age was 14. Thirty-two percent of the children (ages 4 to 18), 23% of the adults (ages 19 to 74), and 29% of all patients had streptococcal pharyngitis. Symptom frequencies for streptococcal and nonstreptococcal pharyngitis, respectively, were: nausea (39% vs 31%, P = .14); vomiting (14% vs 7%, P = .004); abdominal pain (27% vs 26%, P = .621); and any GI symptom (47% vs 41%, P = .45). When included in a predictive model with other significant predictors of streptococcal pharyngitis including age, palatal petechiae, absence of cough, and anterior cervical adenopathy, the addition of nausea or vomiting added slight predictive power to the models, but abdominal pain and "any GI symptom" did not. CONCLUSIONS: Nausea and vomiting are somewhat more common in streptococcal than in nonstreptococcal pharyngitis, but appear to have limited usefulness as clinical predictors of streptococcal pharyngitis.

Adolescent↗
PubMed1998

How concerned are elderly patients without coronary heart disease about hypercholesterolemia and heart disease? An UPRNet study. Upper Peninsula Research Network.

BACKGROUND: There has been much controversy in the medical literature regarding the benefit of treating elevated cholesterol levels in asymptomatic elderly people (65 years of age and older) to prevent coronary heart disease (CHD). Little has been published about the attitudes and beliefs of elderly patients regarding the importance of cholesterol levels to their health. This study seeks to describe the importance that elderly persons place on cholesterol in regard to heart disease, how worried they are about it, and what behavior changes they are making to control their own cholesterol levels. METHODS: We used a cross-sectional questionnaire to study elderly primary care patients in a rural setting with no personal history of coronary heart disease. RESULTS: Six hundred eighty patient questionnaires were analyzed. Ninety-six percent of respondents believed high cholesterol to be at least moderately important for heart disease; 67% believed it to be very important. Fifty-nine percent were at least slightly worried about their own cholesterol level. Seventy-four percent said they had had their cholesterol checked within the past 2 years, and 66% had discussed their cholesterol level with their physician within the past 2 years. Sixty-six percent were trying to keep their cholesterol level down by dieting (42%), exercising (39%), or taking prescription medicine (15%). CONCLUSIONS: Elderly patients who responded to this questionnaire are aware that hypercholesterolemia is a risk factor for CHD, and many eat a low-fat diet, exercise, or take prescription medication to lower their cholesterol. Physicians should be aware that many elderly patients without an established diagnosis of CHD are concerned about their cholesterol level. Physicians should be prepared to discuss with their elderly patients the potential advantages and disadvantages of the treatment of asymptomatic hypercholesterolemia.

Age Factors↗
PubMed1997

Smoking cessation interventions in rural family practices: an UPRNet study.

BACKGROUND: Primary care physicians are urged to offer smoking cessation counseling to their patients. Many studies have sought to determine which smoking interventions are most effective in medical office settings. As a result, routine identification of smokers, brief counseling, referral to smoking cessation programs, and nicotine replacement therapy are advocated. The context of patient visits during which smoking cessation advice is given, however, has received little attention. The objective of this study was to determine if patients' reasons for visits and self-reported readiness to quit smoking are associated with likelihood and type of smoking cessation intervention offered by family physicians. METHODS: The study was conducted in the Upper Peninsula Research Network (UPRNet), a voluntary association of family physicians in 15 medical clinics located in rural areas of northern Michigan. Practice coordinators administered a 1-page exit questionnaire to every other adult patient seen by a participating physician immediately after the office visit. Clinicians were blinded to the specific purpose of the questionnaire. During the study, 2317 questionnaires were administered, yielding information on 455 smokers. RESULTS: The overall rate of physicians' providing any smoking cessation intervention at any type of visit was 47%. There was a significant association between frequency of smoking cessation intervention and reasons for visits (chi 2 = 10.46, P = .01). There was a statistically significant difference between stages of readiness to quit and frequency of smoking cessation intervention offered (chi 2 = 26.5, P < .001). Clinicians offered smoking cessation interventions to smokers in the precontemplative stage significantly less often than to smokers in the contemplation, preparation, or action stages. CONCLUSIONS: UPRNet practitioners vary the frequency of smoking cessation interventions according to patients' reasons for the medical visit and their readiness to quit smoking.

Acute Disease↗
PubMed1995

Effect of distance and travel time on rural women's compliance with screening mammography: an UPRNet study. Upper Peninsula Research Network.

BACKGROUND: The purpose of this study was to determine whether the distance and time required for rural women to travel for a mammogram is associated with their compliance with screening mammography recommendations. METHODS: Women who were > or = 40 years old and visiting family physician offices for any reason were given a questionnaire regarding their frequency of mammography during the past 4 years, the distance and travel time from their homes to the nearest mammography unit, their attitudes and knowledge about mammography, and demographics. The study was conducted in the 12 family practices of the Upper Peninsula Research Network (UPRNet), a Michigan rural family practice research network. RESULTS: Eighty-eight percent (N = 416) of the women in the study had previously had mammography, but 41% were not compliant with American Cancer Society guidelines regarding mammography screening. After controlling for confounding, none of the measures of travel time or distance were associated with mammography compliance. CONCLUSIONS: In this rural population, mammography compliance is not affected by distance, travel time, or transportation. A population-based study in a more remote area is needed to further explore geographic barriers to mammography compliance among rural women.

Adult↗
PubMed1993

Prevalence and severity of urinary incontinence in ambulatory adults: an UPRNet study.

BACKGROUND: Although urinary incontinence (UI) is a common and costly problem, its prevalence and severity in ambulatory patients is not well established. The main objectives of this study were to define the prevalence and severity of urinary incontinence in adult men and women who came to a primary care office for health care, to determine if these patients had ever told a health care provider about this problem, and to determine if they would be interested in treatment if it were available and effective. METHODS: Men and women aged 20 years and over who came to family physicians' offices seeking health care for any reason during an 11-week period were the subjects of a survey by an anonymous questionnaire. Five family practice offices in UPRNet (the Upper Peninsula Research Network), a research network in Michigan, participated. We defined "current urinary incontinence" as any degree of incontinence in the past 12 months. RESULTS: Of the 2830 study participants, 33% had current urinary incontinence (95% confidence interval [CI] 31% to 35%). Incontinence was experienced by 11% of the men and 43% of the women. Urinary incontinence constituting a social or hygienic problem was reported by 5% of the men and 23% of the women (17% overall). Of those with current UI, 72% had not told a health care provider. Of the patients who had not told a physician, 37% said they would seek care if they knew tests and effective treatment were available. CONCLUSIONS: Urinary incontinence is a common problem among those seen in primary care settings, and its presence is often not known to the health care provider.

Adult↗
PubMed1991

Training for rural practice in Australia 1990.

There is a shortage of general practitioners in rural Australia. Several recent State and federal government reports have highlighted the difficulties of rural practice. One of the reasons commonly cited for the shortage of country doctors is the lack of appropriate training in Australia's medical schools and the Family Medicine Programme. This survey of the heads of departments of community medicine/general practice of Australia's 10 medical schools and of the State directors of the Family Medicine Programme documents the present efforts to train doctors for rural general practice. A 100% response was achieved. The responses indicate much interest and effort from the Family Medicine Programme in developing rural training schemes. Though the community medicine/general practice departments demonstrate considerable interest and innovation, they are hampered by lack of resources and negative attitudes of some specialist colleagues. Overall, the main impediments are: lack of "affirmative action" admissions policies to recruit rural students; insufficient curricular time for teaching the principles of general practice; students' lack of confidence in the procedural aspects of rural practice; lack of appropriate training posts in anaesthetics; lack of appropriate general practice training posts at regional hospitals; and lack of financial resources. Some suggestions are given to improve training for rural practice in Australia.

Attitude of Health Personnel↗
PubMed1991

Prevalence and prediction of chlamydial cervical infection in a rural area: an UPRNet project.

BACKGROUND: Though many studies have described the prevalence of genital Chlamydia trachomatis infections in urban and suburban populations, no data on a rural general practice population have been published. Knowledge of the prevalence of infection is necessary to develop screening strategies. METHODS: The Upper Peninsula Research Network (UPRNet) is a rural primary care research group composed of five family practice offices. Cervical cultures for C trachomatis were taken on all women under the age of 36 years who presented to UPRNet physicians for a pelvic examination for any reason between August 15 and November 10, 1989. Demographic and clinical variables were analyzed for correlation with infection, and the best predictors of infection were identified by logistic regression. Previously published screening protocols were then tested on our data to develop the best predictive model for our rural population. RESULTS: C trachomatis was cultured from 25 (4.7%, 95% CI 2.9% to 6.5%) of 530 consecutive women. Infection was significantly more common among younger and single women, women with a new sex partner, and women with mucopurulent cervical discharge or increased cervical friability. No symptoms were predictive of an increased risk of infection. Based on the clinical presentation alone, the physicians correctly predicted only 28% of the infections. Using a modified Rosenthal protocol, we would have identified 80% of the infections while testing only 31% of the women. The protocols of Magder and Handsfield and their respective colleagues performed reasonably well, too. Other published screening protocols were less useful. CONCLUSIONS: The prevalence of C trachomatis cervical infection in our rural primary care office population is relatively low. In rural primary care we recommend testing all high-risk women using a modification of Rosenthal's protocol instead of relying on symptoms or clinical suspicion.

Adolescent↗
PubMed1991

Incidental blood pressure elevations: a MIRNET project.

BACKGROUND: A prospective study was undertaken to determine the prevalence of hypertension in office patients with an incidental diastolic blood pressure greater than or equal to 90 mm Hg. METHODS: During routine screening of 14,890 patients, 174 patients with elevated diastolic blood pressures but no previous diagnosis of hypertension were identified over a 3-month period. Only 115 (64%) returned as requested for two subsequent blood pressure readings. RESULTS: Sixty percent of those returning fit the definition for hypertension using the criteria of the Joint National Committee on Detection, Evaluation, and Treatment of Hypertension. Sixty-nine percent (43/62) of the men and 49% (26/53) of the women were hypertensive. Women under 40 years old were less likely to be hypertensive, but age did not predict hypertension in men. Among those patients with a diastolic pressure reading below 105 mm Hg, progressively higher diastolic readings on the first visit did not predict a higher probability of hypertension. Among those patients with a diastolic pressure reading above 105 mm Hg, however, 90% (9/10) were hypertensive. CONCLUSIONS: Physicians should take incidental elevation of diastolic pressure seriously because of the high prevalence of confirmed hypertension in this group of patients.

Adult↗