OBJECTIVE: To examine the effect of gender on the relationship between obesity measures and lipids/lipoproteins.DESIGN: Cross-sectional, matched observational study of adult men and women.SUBJECTS: 225 spousal pairs from Cincinnati, Ohio (age range, 28-66 years; mean +/- SD (yr), 44.0 +/- 6.7 (men), 42.1 +/- 5.9 (women)).MEASUREMENTS: Body mass measures, lipids, lipoproteins, apolipoproteins, physical activity levels, cigarette use and dietary variables.RESULTS: Correlations between the lipids/lipoproteins and body mass index (BMI) were stronger in women than in men for cholesterol (r = 0.24 vs 0.10), LDL-c (r = 0.27 vs 0.12), triglycerides (TG) (r = 0.48 vs 0.23) and the ratio cholesterol/HDL-c (r = 0.47 vs 0.28). Utilizing statistical regression models which included potentially confounding environmental factors, BMI and WHR both contributed significant information to describe cholesterol, HDL-c, TG and cholesterol/HDL-c values in women, whereas WHR alone provided information for these lipids/lipoproteins in men.CONCLUSION: The association between BMI and lipids/lipoproteins appears to be stronger in women than in men. In women, in contrast to men, BMI and WHR, measures which are easily attainable in the clinical setting, provide separate, independent information in the explanation of these lipid/lipoprotein levels.

The question of who should treat acne patients--primary care physicians or dermatologists--is debatable. To determine physicians' attitudes toward, and referral patterns in, acne management, the authors conducted two studies. According to results of the first study, primary care physicians were less likely than dermatologists to feel referral was necessary for acne management. Primary care physicians felt that they should treat most patients with less severe (comedonal and papulopustular) acne and were neutral about referral of patients with nodulocystic acne. Dermatologists were neutral about referral of patients with less severe acne and recommended referral for most patients with nodulocystic acne. Results of the second study showed that almost all patients with less severe acne and most patients with nodulocystic acne were managed by primary care physicians. The authors feel that primary care physicians can and should handle most cases of acne without referral.

A review of the charts of 79 patients with urticaria was conducted in a residency-based family practice center. All patients seen with urticaria in 7 years who were identified by the practice-data retrieval system were included in the review. The annual incidence of urticaria was 0.27 percent. Female patients predominated (76 percent), and 70 percent of the cases lasted less than 6 weeks. A personal history of atopy was more common in acute urticaria than in urticaria lasting longer than 6 weeks (P less than .05). No causes were identified in 54 percent of the cases. Association with zomepirac and symptomatic dermographism were each noted in three cases. Diagnostic tests were performed in 17 percent of cases, and consultation or referral occurred in 15 percent. Treatment usually included antihistamines (89 percent). The coded diagnosis was judged by the chart reviewers to be incorrect or inadequately supported in 28 of the 108 charts (26 percent) coded urticaria. In 25 charts coded for other skin disorders, three cases (12 percent) of urticaria were noted by the chart reviewers. Coding errors involving digit transposition were noted in three of 1,044 cases. Diagnostic error, incorrect coding by nonphysicians or by physicians not familiar with the coding system, or even clerical error may be a significant problem in this type of study.

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A course in medical history-taking for first-year medical students is described. Examples of course objectives are given, illustrating a simplified, organized approach to history-taking suitable for first-year students. Course evaluation data show that first-year students are able to acquire history-taking skills and that they consider such a course involving patient contact appropriate to this level of training.

Urticaria is caused by physical factors in almost 12 percent of cases. These factors include pressure. Dermographism is the appearance of whealing and erythema within minutes where skin has been exposed to pressure or mechanical irritation. Symptomatic dermographism is present when "normal" pressures, such as those encountered in the activities of daily living, cause urticaria. Individuals with symptomatic dermographism can be shown to have a lower pressure threshold for the production of dermographism than normal individuals. A case of symptomatic dermographism is presented, and the differential diagnosis is discussed.