Identifying patients with familial hypercholesterolaemia in primary care: an informatics-based approach in one primary care centre.

BACKGROUND: Familial hypercholesterolaemia (FH) is associated with highly raised low-density lipoprotein-cholesterol and causes early-onset cardiovascular disease. Its autosomal dominant inheritance allows family cascade screening to be performed once an index case has been identified. However, the vast majority of people with FH in the United Kingdom have not been identified, and there is no national screening programme. OBJECTIVE: To assess the utility of combined computer- and notes-based searches in identifying index cases of FH in primary care, and to uncover the degree of case overlap with secondary care. METHODS: Four computer searches were conducted in one South London practice with a registered population of 12,100 patients. Selected notes were reviewed by a general practitioner and consultant lipidologist to give a Dutch score for the probability of FH. RESULTS: 402/12,100 (3.3%) patients had a Dutch score high enough to require a notes review. Twelve cases of definite FH were found, of whom two were unknown to the practice. Eight probable cases were found, seven of whom were previously unknown. 2/12 (17%) definite cases and 4/8 (50%) probable cases were unknown to a secondary care lipid clinic. 216/402 (54%) patients scored as possible cases. After specialist review 47/216 (21.8%) patients would merit recalling for a detailed family history and xanthoma examination. CONCLUSIONS: There are both diagnosed and undiagnosed cases of FH in primary care not known to secondary care. Significant potential exists to identify new cases of FH in primary care who could act as new index cases for a family screening programme.

Public agency collaboration: implementation of the behavioral risk factor survey in adjacent Texas communities.

This article describes a collaborative community survey project between two public agencies serving adjacent urban communities. The main purpose of the collaboration was to establish comparable baseline health risk data for each community. To meet this goal, the agencies jointly administered the Centers for Disease Control and Prevention Behavioral Risk Factor Surveillance System questionnaire in their communities. The collaborative process was manageable and conserved both time and resources. This assessment project exemplifies a collaboration that both public and private healthcare entities can model to help ensure the health of the communities they serve.

Yoruba traditional healers in psychiatry. II. Management of psychiatric disorders.

The methods of management of mental disorders employed by twenty Yoruba traditional healers were studied. Paranormal and pharmacological therapeutic agents were given prominence; psychological treatments were not employed to any great extent. The different types of medication employed could be differentiated into two groups, one in which pharmacological influences may be most important, and one in which paranormal influences may be more relevant (from the healers' points of view). Other forms of treatment that could be classified as paranormal are also described. One hundred and sixty-three plants were named by the healers as being used; of these only forty-eight were named by a quarter or more of the healers and only nine by half or more of the healers. The root bark of Rauwolffia vomitoria was employed by all healers. Animals and other agents employed were also identified.