Study Reveals Family Physicians' Patterns for Diagnosis of Depression

(49th Annual Scientific Assembly of the American Academy of Family Physicians) Although most family physicians do not make extensive use of formal diagnostic criteria in the diagnosis of depression, family practice recognition patterns and management practices for depression appear to be reasonable, according to the results of a national survey. The 622 survey respondents reported their recognition and management approach for the last patient seen with newly recognized major depression, dysthymia or minor depression. Of a median of 100 patients seen per week, the respondents reported that they saw an average of four new or returning patients with major depression. The prevalence of depression reported by the family physicians was similar to that in the general population. Only 23 percent used five or more formal diagnostic criteria in the assessment of depression. Other diagnoses were made because a presenting complaint was associated with depression, because the patient introduced the subject, or because of specific symptoms and overall impression. Patterns of management were similar for the three diagnoses. Overall, 81 percent of patients received a prescription for anti-depressant medication alone or in combination with counseling (71 percent). The median time between initial appointment and follow-up was four weeks. The physicians reported that barriers to optimal care included not having enough time for adequate history or for counseling.—ALLEN J. DIETRICH, M.D., Dartmouth Medical School, Hanover, N.H.

Adhesive Patch Is Effective for Control of Stress Urinary Incontinence

(American Academy of Family Physicians) Results of a study of 34 women who were 31 to 78 years old with mild to moderate stress urinary incontinence show that a urethral occlusion patch designed to seal the urethral opening significantly reduced urine leakage. The 21-week study included a one-week qualifying period, a four-week control period, a 12-week intervention period and a four-week, post-use control period. With use of the patch, overall leakage was reduced by 60 percent (01.1 g to 0.44 g of urine per hour). Perception of dryness, recorded by the women in voiding diaries, improved 67 percent (from 13.3 to 4.3 leakage episodes per week). Peri-urethral cytology, urinalysis, urine culture and vaginal cultures showed that the patch did not increase infections. Fifty-eight percent of the women reported that the patch was very comfortable, 38 percent reported that it was comfortable and 3 percent thought it was not comfortable. Most of the women (97 percent) were able to use the patch correctly after receiving only written instructions.—BARBARA BEST NORTH, PH.D., M.D., Hornbrook, Calif.

Study Evaluates Patient Population to Determine Pap Test Intervals

(American Academy of Family Physicians) The U.S. Preventive Services Task Force recommends that women who are sexually active receive Papanicolaou tests at least once every three years. More frequent screening is left to the discretion of physicians. The anticipated atypical Pap smear rate based on patient characteristics may be the simplest objective measure of a select group's risk for cervical cancer and can help determine if more frequent screening is necessary, according to results of a study conducted to determine the most appropriate screening interval between Pap smears for the female population in a primary care clinic on a military base. An evaluation was made of the prevalence of cervical cancer risk factors and rate of atypical Pap smears in the clinic's female population. Three hundred and sixty women were evaluated (median age: 25 years). The median number of lifetime sexual partners was seven, and 71 percent of the women had more than five (compared with 39 percent in the general population). The women in the study had roughly twice the rate of sexually transmitted diseases, compared with national statistics (33 percent versus 18 percent). A review of the cytology records of the study population determined that the rate of atypical Pap smears was 25.6 percent, nearly twice that of the national rates. The investigator suggests comparing the atypical Pap smear rate with the local institutional reference rate or laboratory reference rate specific to the location of the clinic and adjusting the interval of Pap smears accordingly.—HEIDI P. TERRIO, M.D., M.P.H., Madigan Army Medical Center, Tacoma, Wash.

A Brief Screening Battery Is Sensitive in Diagnosis of Alzheimer's Disease

(American Academy of Family Physicians) A brief neurocognitive screening battery consisting of four tests (enhanced cued memory, temporal orientation, verbal fluency, clock drawing) is very sensitive in distinguishing between patients with probable Alzheimer's disease and normal healthy subjects, according to an evaluation of the validity of the four tests used together in 60 patients who had been referred to a memory disorders clinic and diagnosed with probable Alzheimer's disease. The tests were also given to 60 community-dwelling volunteers of comparable age, sex and education. Mean time required to administer the four tests was seven minutes, 42 seconds. All four of the tests in the screening battery distinguished between the subjects with probable Alzheimer's disease and the normal subjects. The battery had a sensitivity of 100 percent and a specificity of 100 percent. The investigator in this study believes that this screening battery is appropriate for a primary care setting, because it is brief, accurate and requires little training.—PAUL R. SOLOMON, PH.D., Williams College, Williamstown, Mass.

At-Risk Athletes Should Be Screened for Exercise-Induced Asthma

(American Academy of Family Physicians) Consideration should be given to objective screening of at-risk athletes for exercise-induced asthma. This was the conclusion of a study to determine the incidence of undiagnosed exercise-induced asthma in youth hockey players and to determine whether undiagnosed exercise-induced asthma impairs competitive performance. Each of 210 players aged five to 13 years was questioned about a history of exercise-induced asthma, allergies, asthma and recent (within one hour) use of an inhaler. The players were categorized by age, skill level and team position. Peak flow measurements before and after eight minutes of continuous skating drills were recorded for each player. Overall, there was an 11.9 percent incidence of exercise-induced asthma (similar to that in the general population). In players with a history of asthma, 29.2 percent tested positive for exercise-induced asthma, compared with 9.7 percent of players without a history of asthma. Players with a history of allergies had a 23.5 percent incidence of exercise-induced asthma, compared with a 40.0 percent incidence in the players with allergies who reported a history of exercise-induced asthma. Although the difference was not statistically significant, the incidence of exercise-induced asthma was lower in more highly skilled players. The investigators point out that evidence of exercise-induced asthma did not predict a player's chances of participating at a more skilled level. They recommend obtaining a history to determine the risk for exercise-induced asthma in children presenting for sports physicals.—STEPHANIE J. ASHBAUGH, M.D., and IDA RUBINO, M.D., Southfield, Mich.