Widespread Illness Research Articles

Underdiagnosis of alcoholism by residents in an ambulatory medical practice.

Alcoholism is a widespread illness which in its early stages can be treated effectively. It is important, therefore, that medical residents be able to diagnose alcoholism prior to end-stage disease and organ damage. To assess the ability of residents to diagnose alcoholism, a survey was conducted of 95 patients from the ambulatory care internal medicine practice of the Johns Hopkins Hospital. The patients' alcohol consumption was measured by a self-report questionnaire, and the patients answered an alcoholism questionnaire, the responses to which have been shown to correlate with alcoholism. The questionnaire contains four questions, one each on cutting down on alcohol consumption, annoyance at criticism of alcohol consumption, guilty feelings about alcohol consumption, and use of alcohol early in the day. The answers to the questionnaire were compared with the residents' diagnoses of alcoholism on the medical record. Alcoholism was diagnosed by the residents in only 11 of the 20 patients (55 percent) who had given three or more yes answers on the alcoholism questionnaire and in only 14 of the 31 patients (45 percent) who had given two or more yes answers. (Yes answers indicate that patients suffer from alcoholism.) The residents' diagnosis of alcoholism correlated with signs of physical damage or dependence. These results demonstrate a moderate underdiagnosis of alcoholism by residents in the ambulatory care setting and suggest that diagnosing alcoholism in early stages of the disease should be made a part of the training curriculum.

497 A NOSOCOMIAL OUTBREAK OF FATAL ADENOVIRUS TYPE 7

The CHHC has experienced, to our knowledge, the first major outbreak of adenovirus type 7 disease in a children's hospital. At least 61 hospital employees and 7 patients were involved. Patients experienced a biphasic course which consisted of croup, diarrhea, fever, exudative pharyngitis, and/or conjunctivitis which preceded an acute respiratory decompensation by 1 wk. Those patients acquiring disease were individuals with compromised airways and underlying pulmonary pathology. Mortality from overwhelming viral pneumonia was 4/6 (67%). All fatal cases grew the organism from multiple sites including lung. Widespread illness appeared among hospital employees beginning 7 days after admission of the index case. History, NP and rectal viral cultures, and serology were obtained on 336/363 (94%) of staff working during the outbreak. Conjunctivitis was reported by 61 employees (16%), which was associated with corneal infiltrates in 5 (8%). 92/336 (27%) reported diarrhea and 221/336 (66%) reported URI symptoms. Control of viral transmission was achieved only when strict isolation precautions and cohorting of infected patients was combined with extensive screening of staff, and the temporary closure of the hospital to all new admissions. While adenovirus is a frequent community pathogen, this outbreak demonstrates that nosocomial type 7 infections in patients with pulmonary compromise frequently can be fatal.

COMMUNITY CONTROL OF THE ACUTE INFECTIONS

CONTROL of the communicable diseases is a community health problem because however much laboratory or hospital or health department may contribute, community diseases are the result of community habits and customs, and these will be changed by the community only on convincing evidence that their cost in deaths and illness is too high. The most expensive habit is that which considers a minor infection such as a common cold a trivial affair to be ignored or endured but not to be taken seriously as the great opportunity of preventing widespread illness. The beginning of many of the most deadly infections are entangled with the common cold; either because of the difficulty in making the distinction early enough as in diphtheria, or because the cold is the opportunity of many associated respiratory infections to get started as in pneumonia, or because it is the means of spreading in the community virulent infections of carriers as in scarlet fever and others of the respiratory group. An expensive habit of physicians is to attempt to treat serious infections under unfavora-ble conditions in homes instead of at once sending patients to special hospitals. Their best efforts are often nullified by lack of the supervision and nursing care which are only possible in the hospital. Surgeons insist on adequate