CONCLUSION: Our small pilot survey indicates that patient knowledge of, and access to, acute primary care was very good. However a large number of patients with non-urgent conditions still didn't call before presenting to the ED. Almost all that did call were sent to the ED, even though 41% were then judged to be of lower sickness acuity by the ED triage nurses. These results suggest that our CMA and other patients need more education and/or incentives to access primary care alternatives to ED use. Our results also suggest that our triage nurses could benefit with further training on appropriate ED referral. We hypothesized that physically active PAD persons with no exertional leg symptoms would have better leg functioning than other leg pain groups. METHODS: Study participants were 454 men and women with PAD identified from three medical centers in Chicago. Participants were categorized into one of six mutually exclusive leg symptom groups: Group 1:No exertional leg pain/active (walked > 6 blocks in the last week) (13%); Group 2: No exertional leg pain/inactive ( < = 6 blocks walked last week) (6%); Group 3: Atypical exertional leg pain and walk through leg pain (8%); Group 4: Intermittent claudication (37%); Group 5: Atypical exertional leg pain/stop walking with leg pain (17%); Group 6: Leg pain on exertion and rest (19%). Functional measures included six-minute walk, four meter walking velocity, time for five chair rises, and standing balance. All statistical analyses were adjusted for multiple comparisons using Bonferroni method. RESULTS: Group 1 and Group 3 had significantly less severe PAD, as measured by the ankle brachial index, than the other groups. Compared to all other groups, Group 6 had the highest prevalence of lower extremity arthritis, disc disease, diabetes, and depression. In general, functional performance was poorest in Group 6 and best in Groups 1 and 3. Compared to Group 1, Group 6 had slower walking velocity (0.75 m/sec vs. 0.89 m/sec, p < 0.05), achieved shorter distance in the six-minute walk (972 feet vs. 1201 feet, p < 0.05), had slower time for rising from a seated position five times (14.2 sec vs. 11.3 sec, p < 0.05), and was less able to hold the tandem stand position for ten seconds (32% vs. 51%, p < 0.05). Compared to Group 1, Group 4 was more likely to stop during the six-minute walk (38% vs. 16%, p < 0.05) and walked fewer blocks in the last week (35.7 vs. 53.0, p < 0.05). Group 2 had slower walking velocity than Group 1 (1.02 vs. 1.22 meters/sec p < 0.01). CONCLUSION: Comorbid disease may contribute to the nature of leg symptoms reported by PAD patients. Clinicians can use the leg symptom categories defined above to gauge the degree of functional impairment associated with PAD. PURPOSE: Understanding the natural history of weight gain on a population basis may be a critical step towards developing effective clinical or public health interventions. While the marked rise in overweight and obesity prevalence in this country has been well documented by the serial cross sectional data of the US National Health and Nutrition Examination Survey (NHANES), longitudinal description of the trend is lacking. This study assesses the development of body mass of a cohort of young US adults and identifies predictors including age, gender and ethnic group that may have implications for targeted intervention. METHODS: The National Longitudinal Survey of Youth (NLSY79) is a nationally representative sample of over 12,000 persons aged 14 ± 22 years at baseline, with oversampling of minority ethnic groups. Body mass index (BMI = kg/m2) was calculated from self-reported height and weight data at 12 sample points over 17 years.`Overweight' and obese' were defined as BMI > 25 and > 30, respectively. Mean BMI was calculated by age group, gender and ethnicity. In this study, unadjusted data are used to describe trends in BMI, and to calculate incidence of overweight and obesity using survival analysis. RESULTS: BMI trends were strongly related to age, race and gender. Women's BMI increased steadily with age, with average BMI reaching``overweight'' status by age 26 in Black women, age 29 in Hispanic women and age 35 in all others. The average BMI of Black women was in the obese range before age 40. Ethnic differences in weight prevalence were evident by age 17. Survival analysis quantified the incidence rate of obesity as 2.5 times faster for Black women as for Non-Hispanic/Non-Black women (CI 2.2 ± 2.8) and 2.1 times faster for Hispanic women versus those who were Non-Hispanic/Non-Black (CI 1.8 ± 2.4). Male average BMI showed less dramatic age trends and a different ethnicity pattern: Hispanic men consistently had the highest mean BMI values. Hispanic men developed obesity 2.0 times faster (CI 1.7 ± 2.3) and Black men developed obesity 1.8 times faster than Non-Black/Non-Hispanic men (CI 1.6 ± 2.0). CONCLUSION: This large longitudinal survey shows marked differences in the rate of weight accumulation for different ethnic groups, evident at a very young age. This pattern persisted through young adulthood with excess weight, on average, increasing gradually with age. To alter the trajectory of obesity in this country, interventions should target young adults, and focus on those of minority ethnic groups. have been shown to be as effective as antidepressant medications for treating patients with major depression. The success of these methods may be related in part to the use of specific counseling techniques. These analyses assess the extent to which primary care clinicians and mental health specialists use CBT techniques to treat primary care patients with major depression. METHODS: Cross-sectional descriptive evaluation of counseling received by 567 patients meeting criteria for 1-year major depressive disorder based on a structured diagnostic interview. The 567 enrolled participants are from a consecutive sample of patients attending one of nine participating primary care practices in California (3 based in a single academically-affiliated VA medical center and 6 in independent medical centers from 1 region of Kaiser Permanente). Participants completed an interviewer-administered survey of health perceptions and utilization patterns. Patients reported the frequency of visits to medical and mental health providers and the extent to which their providers used four different CBT techniques. These included helping the patient reduce negative thinking, encouraging enjoyable activities, assisting with problemsolving, and helping the patient feel better about their life as it is. RESULTS: Patients reported an average of 3.2 visits (median=1.0, range 0 ± 144, 61.3% with no visits) to medical providers in which they discussed their personal or emotional problems and 4.5 (median=0, range 0 ± 96, 60.7% with no visits) visits to mental health specialists. Of those patients with at least one visit to a medical provider during the past six months, between 42.1% and 57.6% per therapeutic technique reported that their medical providers had used it. The range was 78.9% to 84.9% per therapeutic technique for patients visiting mental health specialists. The most prevalent therapeutic technique was encouragement of more enjoyable activities. 59.3% and 85.5% of patients reported receiving counseling that included at least two of the four therapeutic techniques from medical and mental health providers, respectively. CONCLUSION: Although the mental health specialists used therapeutic counseling techniques more often than did the primary care clinicians in these practices, primary care clinicians used them more often than we expected given the competing demands of generalist practice. This optimistic result suggests that further evaluation of the efficacy and effectiveness of primary care clinician therapeutic counseling in improving outcomes is warranted. Little is known about the predictors of alternative medicine use in the veteran population. This study investigates whether veterans' sociodemographic characteristics, selfreported health status, health-related beliefs, and satisfaction with their VA health care providers, are related to their use of alternative medicine. METHODS: Participants included patients attending 7 VA general internal medicine clinics participating in the VA Ambulatory Care Quality Improvement Project (ACQUIP), a multicenter randomized controlled trial to test the effectiveness of an information feedback system on improving health status and satisfaction outcomes. This analysis is based on a random subsample of 1034 patients who also received the ACQUIP Health Beliefs Scale. This scale assessed patients' attitudes towards conventional medicine and adherence to health-conscious lifestyles. Patients' satisfaction with their provider was measured with the 12-item humanistic component of the Seattle Outpatient Satisfaction Questionnaire. Self-reported health status was measured with the mental, physical, and pain subscales of the SF-36. Additional data included patients' age, gender, ethnicity, level of education, and income. Alternative medicine use was determined with a questionnaire assessing the use of the following: biofeedback/relaxation, chiropractic, acupuncture, massage, herbs, homeopathy, naturopathy, spiritual healing, folk remedies, and other. Multiple logistic regression techniques were used to evaluate the association between alternative medicine use within the past year (yes or no), sociodemographic characteristics, health beliefs, and patient satisfaction. RESULTS: 495 patients returned the Health Beliefs Scale (48% response) and were included in this analysis. 124 patients (25%) reported the use of at least one alternative medicine therapy in the past year, with the most common modalities including herbs (13.5%), chiropractic (7%), and massage (6%). In multivariate analyses adjusted for sociodemographic characteristics and selfreported health status, the following were associated with alternative medicine use: more education (OR 1.5; 95% CI 1.3 ± 1.9); better physical health (OR 1.044; 95% CI 1.009 ± 1.081); and more pain (OR 1.022; 95% CI 1.005 ± 1.039). After adjustment for sociodemographic factors and subjective health status, alternative medicine use was associated with the following health-related attitudes and behaviors: believing more in the value of non-medical treatments (OR 1.4; 95% CI 1.1 ± 1.9); adhering to health-conscious lifestyles (OR 1.7; 95% CI 1.3 ± 2.2); and actively seeking health information from non-medical sources (OR 1.6; 95% CI 1.3 ± 2.1). In adjusted analyses, there were no significant associations between alternative medicine use and attitudes towards conventional medicine or patient satisfaction. CONCLUSION: A quarter of VA general internal medicine patients in this study reported the use of alternative medicine in the past year. Patients who used alternative medicine had more education, and reported better physical health but more pain. Alternative medicine users also believed more in the value of non-medical treatments, reported adherence to health-conscious lifestyles, and reported obtaining more health information from non-medical sources. Similar to previous studies, negative attitudes towards conventional medicine and lower levels of patients' satisfaction with their VA providers did not appear to influence use of alternative medical modalities. Procedures Ð Using established criteria, potentially inappropriate medications were identified in the hospital formulary and assessed by the central pharmacy database for frequency of use. The hospital admissions database was used to identify the total number of elders hospitalized in the previous year. The two databases were merged, sorting by patient age, non-intensive care unit location, and our defined inappropriate medications. A medical error rate was calculated by dividing the total of inappropriate medications dispensed by 100 patient-days. Patient days were calculated by length-of-stay data also obtained from the hospital admissions database. The study was repeated in the subsequent 6-months to assess for secular trends and the stability of the error rate. RESULTS: A total of 11,797 doses of inappropriate medications were dispensed to 15,011 patients aged 70 and over during a 12-month period. The most common of these prescribed medications were meperidine (3,652 doses), amitriptyline (1,736 doses) , and diazepam (1,644 doses) . The medical error rate was 0.12 per day, or 12 errors per 100 patient days. Findings for the subsequent 6 months were similar. CONCLUSION: The results of our study are troubling though not surprising. Academic teaching hospitals often require all patient orders to be written by resident physicians, with variable levels of senior supervision. Educational interventions targeted at internal medicine residents have the potential to reduce the medical error rate in elderly hospitalized patients. References of key articles were also reviewed for related studies. Studies were included if they enrolled postmenopausal women and reported deep venous thrombosis (DVT), pulmonary embolism (PE), or VTE as either part of a predetermined outcome or as a reportable adverse event related to HRT. Another Medline search from January 1991 to June 2000 identified studies addressing SERMs and VTE risk. Ten HRT studies (two randomized controlled trials, seven case-control studies, and one cohort study) and five SERM randomized controlled trials met inclusion criteria. Two investigators abstracted data on participants, intervention, VTE rates, and confounders. We used the Bayesian data analysis framework for the meta-analysis of HRT studies. The SERMs were not included in the meta-analysis. RESULTS: HRT was associated with an increased risk of VTE in current users (RR=2.34; 95% Cl, 1.83 ± 2.94). Five studies showed a significant increase in VTE with HRT. The highest VTE risk was reported with the first year of URT use (OR =2.9 to 6.7). Two of the SERM randomized controlled trials reported an increased risk of VTE (RR= 1.91 to 3. 1). CONCLUSION: Postmenopausal HRT is associated with an increased risk of VTE. SERMs may be similarly associated with VTE risk. These findings are pertinent to clinicians and patients considering HRT.