Educational status and health.

Some of the problems with the traditional measures of socioeconomic status include (1) the loss of information resulting from combining different factors that have varying associations with health problems; (2) the reverse causal pathway that exists from health and illness to income and occupation; and (3) a number of particular problems with deriving socioeconomic status from census tract information. In contrast there are clear advantages to using educational status as the primary socioeconomic index. A wide variety of literature is reviewed pointing to a strong positive relationship between years of schooling and health. Three models that attempt to account for this association are described. It is suggested that the educational status of patients should be part of their data base.

The spectrum of otitis media in family practice.

Individual and family factors which relate to acute purulent otitis media were investigated in a family practice population. In a practice with more than 11,000 patients, 442 persons had 527 episodes of otitis media during a one-year period. More than 20 percent of the cases occurred in patients of age 15 years and over, but the case rate per year for this group was 11 cases per 1,000 as opposed to 109.7 cases per 1,000 for patients under the age of 15 years. Twenty percent of young children had two or more episodes during the year as compared with five percent for adults. Females had more multiple episodes than did males. The incidence of multiple cases in families is greater than would be expected if cases were distributed randomly (P less than 0.05). However, significantly fewer families with three or more children reported cases of otitis media as compared with smaller families (P less than 0.05).

Practice profiles in evaluating the clinical experience of family medicine trainees.

A practice profile is a compilation of information allowing definition and evaluation of any of several parameters of health-care delivery. Prerequisites for development of profiles presented in this report include: suitable classification of health problems; patient demographic data; identification of individual and groups of health-care providers; and definition of the practice or study population. Details are given for two profiles: the assigned patient and the diagnostic workload profiles. Single profiles are purely descriptive but, when evaluated by appropriate peer comparison, may form the basis for a more dynamic process--that of improvement and change. Possible applications of practice profiles are discussed.

An integrated medical record and data system for primary care. Part 8: the individual patient's medical record.

This is the last in a series of eight articles describing an integrated system of recording medical data as developed and used by the Family Medicine Program at the University of Rochester-Highland Hospital. Compatability of manual and automated systems has been described. The total system allows the practicing family physician to assess morbidity patterns within his/her practice more effectively, to record and monitor patient care, to perform audit, and to conduct research in primary care.

An integrated medical record and data system for primary care. Part 7: the encounter form: problems and prospects for a universal type.

The importance of an encounter form for recording ambulatory patient information is stressed. Certain problems surrounding appropriate definition of the minimum basic data set (MBDS) are discussed as is the potential development of a uniform encounter form which would cover diagnostic information as well as items necessary for insurance companies and internal practice management.

An integrated medical record and data system for primary care. Part 5: Implications of filing family folders by area of residence.

A discussion of the advantages of filing family folders by geographic location is presented in addition to several methods for determination of socioeconomic status. Advantages of current filing techniques at the University of Rochester-Highland Hospital Family Medicine Program are detailed. Examples are given of the use of such information to estimate health-care utilization as determined by factors of distance from practice, socioeconomic status, natural barriers, and family size.

An integrated medical record and data system for primary care. Part 4: Family information.

The gathering of family information has numerous advantages in a family practice setting. Methods are described which not only allow description of family structure but permit identification of each individual family member and his/her relationship to the family as a unit. The value of filing individual medical records in family folders is detailed. A functional definition of family is established and certain health-related characteristics are given. Included is comparison of family size and socioeconomic status (SES) of a family practice with census information on the total county population. Health-seeking behavior of two-person families (couples or single-parent plus child) related to SES is presented as one of many applications of recorded family information, potential for future research into the effects of family structure on morbidity is discussed.

An integrated medical record and data system for primary care. Part 3: the diagnostic index manual and computer methods and applications.

Manual and computer versions of the diagnostic of the index-E-Book are described. Methods for establisment and maintenance of both indexes are given and the relative merits of each are delineated. Uses of diagnostic indexes are presented which are appropriate to solo and group practices. The role of the diagnostic index in curriculum development within a family practice training setting is also illustrated.

Effect of long-term calcitonin therapy on the clinical course of osteogenesis imperfecta.

10 children with osteogenesis imperfecta, 4 with "tarda" and 6 with "congenita" varieties of the disease, were treated with salmon calcitonin (SCT) for intervals ranging from 14 to 35 months. Responses to SCT therapy in patients with osteogenesis imperfecta tarda were characterized by an apparent decreased fracture incidence in three, a fall in either alkaline or acid phosphatase, and a rate of increase in forearm bone mass which was greater than that observed in an untreated "tarda" population. The chemical response SCT therapy varied in children with osteogenesis imperfecta congenita, only one demonstrating a decrease in both acid phosphatase and urinary hydroxyproline. Three others responded with a rise in acid phosphatase, two of whom also demonstrated a fall in urinary hydroxyproline; in two other "congenita" patients urinary hydroxyproline was actually higher after SCT treatment and acid phosphatase relatively unchanged. Alkaline phosphatase was normal in all "congenita" patients before and following the SCT treatment interval. These varied biochemical responses were associated with temporary increments in bone mass early in the treatment course, although in bone mass early in the treatment course, although one "congenita" patient with the largest calciuric response to SCT and an increase in hydroxyproline excretion demonstrated progressive increments in skeletal mineral content during a 14-month treatment interval. In both "tarda" and "congenita" subjects, parathyroid hormone was unchanged by chronic SCT treatment; SCT-antibodies were detectable although biological responsivity to SCT persisted.

Calcifediol in chronic renal insufficiency. Skeletal response.

Quantitative histology of thin, nondecalcified sections was performed on sequential bone biopsy specimens from five patients undergoing long-term hemodialysis and treated with calcifediol (25-hydroxycholecalciferol) for periods of three to nine months. With increase of intestinal absorption of calcium and decline of circulating immunoreactive parathyroid hormone and alkaline phosphatase, the bones of each patient exhibited striking histological improvement. The group as a whole showed statistically significant decreases in osteoclast number and in the percentages of osteoid surface covered by active osteoblasts. Marrow fibrosis was either eliminated or strikingly decreased in each patient. Osteoid volume significantly declined in four of five patients. In patients with osteitis fibrosa as the predominant histological lesion, calcifediol therapy resulted in decreased calcification front activity. Increased activity was the result when osteomalacia predominated.

Effects of diabetes mellitus on bone mass in juvenile and adult-onset diabetes.

To assess the influence of diabetes mellitus on bone metabolism, we measured skeletal mass in the forearms of 35 patients with juvenile diabetes on insulin and 101 stable patients with adult-onset diabetes, on diet alone, insulin, or oral hypoglycemic agents. There was a significant loss of bone mass in both juvenile and adult-onset diabetes (P less than 0.01) as compared to controls matched for age and sex. The decrease was already present in patients with diabetes of less than five years' duration. Bone loss and duration of the diabetes did not correlate; the greatest decrease in bone mass was observed in the patients receiving oral agents. These data are consistent with the hypothesis that the loss of skeletal tissue in diabetes reflects the underlying disease since it occurs early and is not related to severity as evidenced by the need for insulin, to duration, or to treatment with insulin or diet alone.