Largest Diagnostic Category Research Articles

Primary Pediatric Care in One Community

Primary pediatric practice in one community was studied by using a household interview survey, a pediatrician mail questionnaire, and an ambulatory care survey of nine practices reporting on all visits over a four-week period. The results for the study year 1975 are compared with those for 1971 and 1967. Pediatricians provided an ever-increasing proportion of ambulatory care. Of all the children who had a regular physician in 1967, only 47% had a pediatrician; by 1975, this proportion had increased to 74%. Well-child care continues to be the largest diagnostic category (30%), followed by treatment for upper respiratory tract infections (24%), otitis media (14%), and lower respiratory tract infections (6%). Variations by practice and patient characteristics are examined. If the observed changes indicate a nationwide trend, a larger number of pediatricians will be needed to cover their growing share in primary care for children. Working in multiple settings and delegating part of the work load to nurse practioners have helped to meet the growing demand.

Total hip replacement. First year's experience.

Developed techniques of total prosthetic replacement of diseased hip joints have led to a study of 92 patients (110 hips) who underwent total hip replacement of the Charnley type during the one-year period from October 1969 to October 1970. The majority of patients were over 60 years of age and degenerative joint disease was the largest diagnostic category. The major complications encountered were dislocation of prosthetic components (seven patients) and thromboembolic disease (three patients). No harmful effects from the use of polymethylacrylate to cement the prostheses into bone have yet been recognized. Study of the prosthetic components, technique of this procedure, and method of treatment has initiated several potentially serious questions which can only be answered by continued, long-term study.

Neurologic disease on an adolescent service.

Neurologic diseases or neurologic complications of medical diseases accounted for 17% of all admissions to an adolescent service over a 2½-year period. The largest diagnostic categories were trauma, convulsive disorders, infectious and parainfectious illness, and drug ingestion or abuse. Of all the patients admitted, 62% were suffering acute and potentially fully reversible illnesses, 23% suffered from chronically handicapping conditions, and 15% had progressive and potentially or probably fatal diseases. These illnesses account for a significant proportion of the morbidity and mortality of the adolescent years. In addition, many of these conditions superimpose chronic disabilities upon attempts at full adult adjustment. The effect of these illnesses on the patient's life adjustment calls for a multidisciplinary approach to treatment, with the full availability of a wide range of ancillary personnel.

The epidemiology of mental illness in an English city

A register of adult patients from Salford, England (population 150,000) who came into any form of special psychiatric care was maintained from 1959 to 1963. — Those seeking psychiatric care for the first time in their lives were classed as inceptions (1,945 cases). — Inception rates were calculated for the population at risk. The effects of sex, age, marital state and social class were considered for all cases and for those in specific diagnostic categories. — Considering all categories of mental illness, women had higher rates than men, but only up to the 60's. Both sexes showed an early peak in the 30's then a decline, followed by a rise beginning in the 60's and climbing steeply at older ages. The married had lower rates of inceptions than did the single, widowed or divorced. Persons in the unskilled manual labourer class had higher rates than other occupational categories. — Schizophrenia, as expected, had higher rates among the young, among men, among the single, and among the unskilled. — Depressive psychosis was nearly twice as common in women as in men. Although the married had the lowest rates of depressive psychosis among marital categories, the differences were not as marked as for schizophrenia, nor were the differences in rates for the social classes remarkable. Nothing to suggest the existence of involutional melancholia was found in the inception rates. Attention is drawn to the bimodal age curve for depressive psychosis, and its possible implications for the definition of the syndrome and its causes. — Psychoneurosis was the largest diagnostic category up to 40 years in both sexes, and then declined in numbers. Women, and especially single women, had higher rates than men. No social class variation in psychoneurosis was discovered. — Epidemiological features of psychopathy, addictive disorders, senile psychosis, organic disorders and epilepsy are also presented. — Comparisons are made with Lundby, Sweden and New Haven, Connecticut. The Salford rates fall between these two. — The age distributions of inceptions of schizophrenia and psychoneurosis are compared with that of Huntington's chorea. The resemblance is great, and these data therefore provoke serious consideration of the existence of genetic susceptibility to schizophrenia and psychoneurosis, although there are good reasons for seeking multiple causes including social causes.

An Electrophoretic Study of Serum Protein-bound Carbohydrate in Dysproteinemia

Abstract The glycoprotein hexose in the sera of patients having an electrophoretically homogeneous globulin fraction was studied by paper electrophoresis. The largest diagnostic category was multiple myeloma, but also included were cases of macroglobulinemia, primary systemic amyloidosis, lymphoma, collagen vascular disease, liver disease, and other conditions. The hexose contents of the pathologic globulin fractions were compared; only in the macroglobulins was this value of diagnostic significance, consistently averaging more than 3 times that in normal gamma globulin. In myeloma globulins there was a relationship between the hexose content and the electrophoretic mobility, with only an occasional value approaching the macroglobulin range in the faster electrophoretic mobilities. It is shown that paper electrophoresis and the PAS staining technic, in conjunction with protein staining on a duplicate sample of serum, constitute a useful screening test for detection of increased concentration of macroglobulin in serum in a large percentage of cases of "hypergammaglobulinemia." Gel electrophoresis, immunologic typing, and ultracentrifugation studies then can be used for further elucidation of the type of abnormality present.