The use of acute and preventative medical services by a general population: relationship to alcohol consumption.

AIMS: To investigate the hypothesis that increasing alcohol consumption is accompanied by increasing use of acute, but decreasing use of preventative, medical services among the general population. DESIGN AND PARTICIPANTS: Health and life-style survey of 41,000 randomly-sampled adults in SE England who self-completed a validated questionnaire covering socio-demographics, alcohol and tobacco usage and use of acute (A&E department and general practitioner) and preventative (dental, optician, mammography and cervical cytology) services: the response rate was 60%. MEASUREMENTS: Comparative use of acute and preventative health care services by patients with varying consumption of alcoholic beverages. This was estimated by the odds ratio for service use, after correcting for the following confounding variables; age, social class, ethnic group, employment status, whether lives with children or with other adults, whether is a career, limiting long-term illness, depression status, smoking habit and use of private health insurance. FINDINGS: There was increased use of accident and emergency services by the harmful and intermediate drinking groups compared with the safe drinking group. Male abstainers attended their A&E departments more frequently than 'safe limit' drinkers. With respect to preventative services, both male and female abstainers and harmful drinkers used dental services less than safe limit drinkers. For females, mammography and cervical cytology services were less frequently used by abstainers and by harmful drinkers. CONCLUSIONS: This study supports the generally held view that heavy alcohol consumers are disproportionate users of acute medical services but they are relative under-users of preventative medical care services. Alcohol abstainers are also over-users of acute services, but under-users of preventative services. These latter observations are relevant to the claims that moderate alcohol consumers have lower apparent morbidity and mortality rates compared to abstainers.

A study of microscopical and chemical tests for the rapid diagnosis of urinary tract infections in general practice.

Aids to the rapid diagnosis of urinary tract infection were assessed by the examination of 325 consecutive urine samples taken in the normal course of work in a general practice. Of these samples 103 produced a pure growth of at least 10(5) organisms per ml. The appearance and smell of each sample was noted and it was then tested by simple low-power microscopy of a drop of urine and by a dipstick which measured leucocyte esterase and nitrite, together with protein, blood and pH. In addition, pus cell counts per mm3 were performed on 272 of the samples using a cytometer chamber. This method is too time-consuming for routine use in the surgery. Neither a cloudy appearance nor haematuria were sufficiently specific to be of much use in the diagnosis of urinary tract infection. In the prediction of a 'positive' culture the sensitivity and specificity of the other tests were as follows: drop method microscopy 95% and 76%, respectively; cytometer count 95% and 81%; leucocyte-esterase estimation 89% and 68%; and nitrite 57% and 96%. These figures may underestimate the true values of the tests in the diagnosis of urinary tract infection because infection may be present in some cases producing growths of less than 10(5) organisms per ml. It is concluded that the most useful aid to the diagnosis of urinary tract infection is low-power microscopy of a drop of urine.

The bacteriology of a rural general practice: a retrospective six-year study.

The organisms cultured and their antibiotic sensitivities, together with clinical details, were obtained from all the available bacteriology requestlresult forms from a rural practice over a six-year period. The 3022 bacteriology specimens analysed yielded 997 potential pathogens. The main infections studied were those of the urinary tract, the upper respiratory tract and the skin and soft tissue. In spite of the fact that trimethoprim alone had never been used in the practice, 29% of urinary tract pathogens were resistant to this drug. Ninety-six per cent of isolates of Haemophilus influenzae were sensitive to ampicillin. The overall results suggest that most infectious disease in rural general practice can be managed with a limited and inexpensive antibiotic regimen. Such a regimen is described.

Clinical presentation of diseases of the large bowel. A detailed study of 642 patients.

This paper presents in detail the symptomatology and findings on examination of 642 patients suffering from a variety of lower gastrointestinal disorders, such as colonic and rectal cancer, diverticular disease, Crohn's disease, and ulcerative colitis. Location of precise sites of abdominal pain and tenderness was shown to carry a high level of diagnostic discrimination between the various disorders. Some surprising features emerged: almost half of patients with lower gastrointestinal tract disease complained of symptoms referable to the upper gastrointestinal tract, such as nausea/vomiting or anorexia. It is suggested that the provision on demand of such data to junior staff may benefit both diagnostic ability and decision making. As an incidental finding, just under 40% of patients with large bowel cancer had undergone previous (unrelated) abdominal surgery. The significance of this is unclear.

Clinical presentation of acute abdomen: study of 600 patients.

This paper presents the clinical features of 600 patients suffering from abdominal pain of acute onset and admitted to either the General Infirmary or St. James's Hospital, Leeds. The survey was initially retrospective, but later put on a prospective basis. Roughly two-thirds of these 600 patients presented a "typical" picture of the disease with which they presented, while the remaining third presented one or more atypical features. Since other prospective studies have indicated that the diagnostic accuracy of a group of clinicians in respect of the acute abdomen is roughly 65% it is tentatively suggested (a) that clinical diagnosis contains a large element of "pattern-matching," and (b) that such a policy can be expected to be ineffective in roughly one-third of all cases of acute abdominal pain.