Validating the concept of abuse: women's perceptions of defining behaviors and the effects of emotional abuse on health indicators.

OBJECTIVES: To validate the construct of abuse in 2 ways: first, to examine female patients' perceptions of abusive behaviors that are typically used in standardized abuse scales; and second, to determine health status symptom and medical utilization differences between women who report emotional abuse and women who are not abused. DESIGN: Cross-sectional interviews and medical record reviews. MAIN OUTCOME MEASURES: Modified directions to the Conflict Tactics Scale were used to identify women's perceptions of abusive behaviors. Personal history of abuse was determined by self-report. Health status was measured using the Medical Outcomes Study Short-Form Health Survey-36 and medical services utilization was determined from medical records. The Wahler Physical Symptom Inventory was used to measure symptom experience. SETTING: Patients were interviewed in either a rural primary care practice or an urban medical university practice. PATIENTS: Four hundred seven women older than 18 years were interviewed. Half were from an urban and half from a rural setting. Sixty-four percent of the sample was black. RESULTS: Women saw more behaviors as abusive than are typically identified by the Conflict Tactics Scale and abused women identified more abusive behaviors than nonabused women. Significant health status differences were found between women who reported emotional abuse with no concurrent physical or sexual abuse and nonabused women on 7 of the 8 dimensions of the Short-Form Health Survey health status scales and on 25% of measured symptoms. CONCLUSIONS: These findings reflect the idea that women consider many behaviors to be abusive and that abused women perceive more behaviors as abusive than do nonabused women. Given that significant health status differences are shown between emotionally abused and nonabused women, emotional abuse can be viewed as a critical variable in patient health behavior.

'White coat' hypertension in children.

BACKGROUND: Research with ambulatory blood pressure monitoring (ABPM) clearly demonstrates the importance of identifying "white coat" hypertension before making the diagnosis of hypertension. While the existence of white coat hypertension has been documented in adults, it is unknown whether this phenomenon is present during childhood. Therefore, the purposes of this study were to determine whether white coat hypertension exists in children with a positive family history of essential hypertension; and if it exists, to compare 24-hour ambulatory blood pressure patterns among normotensive, white coat hypertensive, and hypertensive children. METHODS: One hundred fifty-nine children (aged 5 to 15 years) participated in the study. Based on office systolic and diastolic measurements and 24-hour ABPM, subjects were placed into one of three groups: normotensive, white coat hypertensive, and hypertensive. RESULTS: Forty-four percent of 34 subjects with systolic blood pressures greater than or equal to 95th percentile were reclassified as white coat hypertensive; 56% remained hypertensive. Group comparisons of 24-hour ABPM patterns showed significant differences between groups. Also, the ABPM patterns of white coat hypertensive patients were significantly different from those of normotensive patients. CONCLUSIONS: This study documented the existence of white coat hypertension in children and showed that white coat hypertensive children were significantly different from normotensive and hypertensive children on most comparisons of 24-hour ABPM data. Also, when age and sex were controlled, heavier children had a more significant chance of having elevated systolic blood pressure than normal-weight children, regardless of their race, height, or body mass index.

Ambulatory blood pressure monitoring in hypertension.

Compared with blood pressure measurements in the office setting, ambulatory blood pressure monitoring offers a more accurate and reliable method of diagnosing and managing hypertension. Indications for ambulatory blood pressure monitoring include borderline hypertension, a discrepancy between home and office blood pressure measurements, persistent blood pressure elevation in the office with no end-organ damage, episodic elevations of blood pressure or suggestive symptoms, hypertension resistant to treatment, episodic angina not related to exercise, end-organ damage but normal office blood pressure readings, and evaluation of the efficacy of antihypertensive agents. Several cases are presented for review.

Comparison of dietary intake of urban and rural elderly patients in family practice centers.

To compare dietary intake of urban and rural patients, we interviewed 50 patients over age 64 at each of two family practice centers, one urban and one rural, using the 24-hour dietary recall method for nutrient comparison. A deficiency of calcium was evident in the intake of both elderly populations, but other specific deficiencies were evident in the rural group. We discuss the need for dietary evaluation and intervention in the elderly, with emphasis on the rural population, and offer specific strategies for application by primary care physicians.

A decentralized clerkship: strategies for standardizing content and instruction.

Course decentralization in a required family medicine clerkship occurred because additional teaching and clinical resources were needed to meet the educational goals and objectives of an entire class of medical students. The decentralized teaching effort, which consisted of a variety of practice models, had the potential for an inconsistent exposure to the required educational content of the clerkship. Course monitoring and evaluation also was difficult because of the logistics of the various teaching sites. In order to minimize inconsistent content exposure, efforts to standardize course requirements occurred through criterion-based faculty and teaching site selection, initial faculty development, and provision of appropriate library resources. Continuous standardization consisted of required periodic faculty development, frequent evaluation of faculty and teaching sites, and comparative studies of student performance. Standardization of some of the students' patient care experience resulted from the use of predetermined list of required clinical encounters. A computer assisted evaluation of students' patient experience log defined the actual student patient care population at various teaching sites and compared this to course requirements. Deficits in patient care experiences were addressed by providing either the appropriate patient encounters or alternative experiences through print, audiovisual, or teaching sessions.

Tick toxicosis in North America.

This is a case presentation and review of an uncommon disorder, tick toxicosis. The history, epidemiology, pathophysiology, and treatment are discussed. This disorder was mentioned in diaries from the early 1800s and has been reported in 18 states and the District of Columbia. A review of 70 cases reveals that the typical patient is a female child who develops leg weakness, irritability, or clumsiness. The exact site at which the toxin induces the paralysis is unknown. Removal of the tick usually reverses the paralysis within hours. Confusing tick toxicosis with other disorders may occur, and death has resulted. This article will remind physicians to consider tick toxicosis when seeing patients with acute ataxia or ascending paralysis and to, perhaps, prevent death from an easily treatable disorder.