Faculty Bibliography

This study aims to assess the nature and prevalence of somatization and related psychiatric symptoms among residents in Daytop Village, a drug-free residential therapeutic community (TC). Three hundred and twenty two residents at Daytop were surveyed, and when compared with a normal, non-patient reference group, residents at Daytop exhibited higher levels of somatization, depression, and anxiety as measured with the Brief Symptom Inventory. Multiple linear regression analysis showed that being widowed or divorced, having marijuana/hallucinogens as greatest drug problem, and the importance of a religious figure in entering Daytop were associated with higher levels of somatization. A length of stay of 3-6 months and acceptance of Daytop program philosophy was inversely correlated with somatization scores. These findings are discussed with particular attention focused on the role of somatization among TC residents. (Am J Addict 2003;12:60-70)

OBJECTIVE: To estimate the proportion of outpatient visits that could be managed at a primary-care level, by World Health Organization (WHO) clinical staging. DESIGN: Prospective, descriptive study. Six medical doctors in a tertiary hospital HIV ambulatory clinic recorded clinical diagnoses, WHO clinical staging and their recommendation regarding the appropriate level of care for each outpatient seen. SETTING AND STUDY POPULATION: All HIV-infected patients attending a public-sector, urban, South African, referral and teaching hospital HIV outpatient clinic between September and November 1992. PARTICIPANTS: There were 238 visits by 148 patients during the study period. RESULTS: Of 238 visits, 165 (69.3%) were deemed suitable for treatment at the primary-care level. After allowing for contradictory responses, at least 141 visits (59.2%) could be appropriately treated at the primary-care level. Although all six doctors assessed more than half of their visits as suitable for primary care, there were significant differences among them. In total, 83 visits (34.8%) needed a medical specialist, and 45 (18.9%) required tertiary-care facilities. Of all the visits, 58 (24.9%), 51 (21.9%), 60 (25.8%) and 64 (27.4%) were classified as WHO stages 1, 2, 3 and 4, respectively. For these stages, 55 (94.8%), 38 (74.5%), 42 (70.0%) and 26 (40.5%) visits, respectively, were suitable for treatment at a primary-care facility. CONCLUSIONS: Many of the outpatient visits to this outpatient specialist clinic could have been safely cared for at a primary-care level. As the severity of the disease increases, there is a decrease in the proportion of patients that can be treated at a primary-care level