In vivo binding of [11C]SKF 75670 and [11C]SKF 82957 in rat brain: two dopamine D-1 receptor agonist ligands.

The high affinity benzazepine D1 agonists SKF 75670 and SKF 82957 labeled with C-11 were evaluated in vivo in rats as potential radioligands for imaging dopamine D1 receptors with positron emission tomography (PET). Their in vivo pharmacological profile revealed selective binding for both tracers in rat brain regions rich in D1 receptors such as the caudate-putamen. The more lipophilic [11C]SKF 82957 (6-chloro-[11C]SKF 75670) showed a higher brain uptake (more than 2-fold up to 30 min), higher specific uptake in the striatum and higher signal-to-noise ratio (striatum-to-cerebellum = 3.2 +/- 0.4 for [11C]SKF 75670 and 9.7 +/- 2.5 for [11C]SKF 82957 at 60 min post-injection) as compared to [11C]SKF 75670. Both radiotracers exhibited high specificity and selectivity for D1 receptors, since only D1 competitors but not the D2 antagonist sulpiride or the 5-HT2 antagonist ritanserin reduced significantly their binding the striatum with [11C]SKF 75670 or the striatum and olfactory tubercles with [11C]SKF 82957. Previous reports have shown that only D1 agonists can recognize the functional high-affinity state from the low-affinity state of D1 receptors. [11C]SKF 75670 and especially [11C]SKF 82957 are D1 agonist radioligands that can potentially be used to study in vivo the functional high-affinity state of D1 receptors using PET.

Reported practices, attitudes, and confidence levels of primary care physicians regarding patients who abuse alcohol and other drugs.

The American Medical Association recommends that physicians screen all patients for alcohol and other drug abuse so that substance-abusing patients can be referred for appropriate treatment. A 1991 survey of primary care physicians in Baltimore and Cumberland revealed that only 41% routinely screened their patients for alcohol problems and only 20% screened for other drug problems. These levels, as well as the levels at which Maryland physicians counsel, refer, and otherwise treat substance-abusing patients, are well below levels recommended by the AMA. The role that attitudes, confidence, and education play in determining physicians' practice patterns in regard to substance abuse is explored.

Helping patients stop smoking.

As more patients seek treatment for nicotine addiction, physicians must become adept at counseling patients on how to quit. Several simple behavioral modification techniques are available to help patients stop smoking, and these techniques can be incorporated into any busy practice. Any patient encounter can be used to inform patients of the dangers of smoking and to tell them to quit. Patients can be offered nicotine replacement therapy, although the long-term benefit is still unknown. Helping patients to quit is a rewarding process.

Physician estimates of substance abuse in Baltimore and Cumberland: 1991.

By identifying and counseling substance abusers within their own practices, primary care physicians can play a major role in reducing levels of substance abuse. How proficient area physicians are in identifying substance abuse is examined by comparing physician estimates of substance abuse in their patient populations with local and national statistics.

Self-reported referral patterns in practices of family/general practitioners, internists, and obstetricians/gynecologists.

A profile of referrals can help to define the characteristics of a physician's practice. Self-reported referral patterns in the practices of Family/General Practitioners (FP/GP), Internists (IM), and Obstetricians/Gynecologists (OB/GYN) in Maryland were assessed with a questionnaire mailed to an area sample of 1,715 physicians. A 65% response rate was obtained after three mailings (weighted N = 1,487). Self-reported referrals received per month averaged 16% of patients seen (six percent FP/GP, 13% OB/GYN, 23% IM), and were more frequent among self-employed, younger, metropolitan and female physicians who spent less time in patient care. Self-reported referrals made per month averaged ten percent (10% FP/GP), 11% IM, and eight percent OB/GYN), and were higher for physicians in metropolitan areas. The correlation between percentage referrals received and percentage referrals made was r = .19 (r = .03 FP/GP, r = .21 IM, r = .25 OB/GYN). Self-reported practice referral patterns are similar to referrals reported in prior studies, and can be used to consider specialty differences in referral behavior of physicians.

Health promotion: physicians' beliefs, attitudes, and practices.

There is a paucity of research describing the health-promotion beliefs, attitudes, and practices of physicians. Self-reported data from a survey of 1,040 primary care physicians showed that a majority of physicians (97 percent) believed they should modify patients' behaviors to minimize risk factors and rated a variety of health behaviors as important in promoting health. While most physicians gathered information about risk factors and believed they were prepared to counsel patients, only a small percentage (3-18 percent) reported being very successful in helping patients achieve behavioral change. However, given appropriate support, physicians reported that they could be up to six times more successful in influencing behavioral change. This study indicated that physicians have strong beliefs and interests in health promotion, are interested in continuing education about health promotion topics, and desire a variety of new skills to help patients modify their health behaviors.

Physicians' beliefs about the importance of 25 health promoting behaviors.

A mail survey of 1,040 primary care physicians in Maryland examined their beliefs about the importance of 25 behaviors for promoting the health of the average person. Physician consensus existed across specialties in rating most health behaviors as very important and few as very unimportant. Eliminating smoking was most important and taking vitamin supplements least important.