Attitudes of primary care physicians to the management of asthma and their perception of its relationship to patients' work.

The results of a questionnaire on the attitude of family physicians and general practitioners to the management of asthma, and their perception of the relationship between working conditions and asthma are reported. Family physicians were three times more likely than general practitioners to treat asthmatic patients themselves, without referral to a specialist. However, there were no other major differences between these two groups regarding the weight they attributed to the occupational factor in asthma. Overall, both groups routinely asked patients about their job (78%) and exposure at work (75%), but at least in half the cases this issue was not followed-up to determine if occupation-related counselling or problem management were necessary. Differences in the primary care of asthmatics were also noted between physicians in Israel and America. In Israel, physicians tended to explain everything to the patients at the initial visit, and then leave them to cope on their own unless the episodes remained uncontrolled, whereas their American counterparts continued their educational activities in subsequent visits as well. We conclude that family medicine residency training in Israel, despite the inclusion of courses and lectures on occupational health in general and on respiratory diseases in particular, does not sufficiently emphasize this subject. Clinicians should be trained to take a more in-depth and active approach to this problem in order to avoid misdiagnosis and improve prevention.

Should nurses in Israeli primary care clinics be expected to manage streptococcal throat infections?

INTRODUCTION: Legal regulations in Israel allow nurses to perform only limited clinical procedures. OBJECTIVE: To determine the probability of streptococcal infection in adults with sore throat, as assessed clinically by standard nursing procedures. DESIGN: Using throat culture as the standard, the contribution of various clinical findings (fever, exudate, erythrocyte sedimentation rate (ESR), white blood count) to the determination of the diagnosis of streptococcal infection was assessed, using logistic regression analysis. SETTING: Israeli general practice. PATIENTS: 100 consecutive adult patients presenting with a red, sore throat. RESULTS: Six patients showed the full clinical picture of exudate, increased ESR and leukocytosis, with an 82% probability of streptococcal infection. Forty-nine patients showed none of these three findings, and only one of them (among the three patients with rhinitis) had a positive throat swab. Forty-five patients showed an intermediate clinical picture which did not provide a reliable basis for the diagnosis or exclusion of streptococcal infection. Fever alone did not significantly (P < 0.05) predict streptococcal infection. CONCLUSIONS: Nurses may safely discharge adult patients with a red, sore throat without antibiotic treatment only if they have no additional signs or symptoms. The few patients with all the clinical findings may be treated with antibiotics without a throat swab. All other patients should be referred for examination by a doctor.

The correlation between Chlamydia antigen, antibody, vaginal colonization and contraceptive method in young unmarried women.

In a group of 55 unmarried women, mean age 25 years, attending a family planning clinic and having minor gynecological complaints, the correlation between Chlamydia trachomatis (CT) antigen, CT antibodies, vaginal colonization by Candida or bacteria and the method of contraception was investigated. The correlation between CT antigen and CT antibodies (IgG) was significant in oral contraceptive users (p = 0.003), as was the correlation with vaginal colonization by Candida and potential pathologic bacteria. In the group using the natural family planning method, a statistically significant correlation was found between CT antigen, IgG (p = 0.002), IgA (p = 0.02) antibodies, and vaginal candidiasis (p = 0.002), but not with bacterial colonization (p = 0.90). The discrepancy between CT antigen and antibodies is discussed. Differences in the prevalence of Chlamydia trachomatis infection were found among groups using different birth control methods, indicating an association between Chlamydia infection and the contraceptive method used.