Infectious diseases--from AIDS to the common cold--send 129 million patients to doctors in the United States each year, but the frequency of such visits appears to have leveled off after increasing throughout the 1980s, according to new federal figures.

In recent years, infectious diseases have accounted for nearly one in five visits to the doctor, the figures show. Except in the very young and the very old, the rate is higher among female patients than males. Children under 5 go to the doctor for diagnosis and care of infectious diseases more often by far than any other age group.

Upper respiratory infections, which show symptoms such as sore throats and runny noses, account for the largest percentage of doctor visits by patients with infectious disease. Ranking next in frequency are ear infections; lower respiratory infections, including influenza; and skin infections.

Previous studies found that the death rate from infectious diseases rose 58 percent between 1980 and 1992 and that infectious diseases accounted for an increasing proportion of hospitalized patients. The new study focuses on care of nonhospitalized patients, or outpatients.

The reasons for the increase in infectious disease-related doctor visits during the 1980s and the slight decrease since 1990 are not fully clear, researchers said. Among the factors contributing to the increase during the 1980s were the emergence of HIV, the virus that causes AIDS; the resurgence of tuberculosis; and a rise in bacteria resistant to antibiotics.

The causes of the more recent decline in doctor visits are even more complex. Possible factors range from improved antiviral drugs to the effects of managed care, which seeks to limit unnecessary doctor visits as well as hospitalizations.

Trends in sexually transmitted diseases are especially complicated. Doctor visits for gonorrhea have declined steadily since 1980 as a result of improved screening and treatment. Visits for syphilis rose during the 1980s and declined during the 1990s. Availability of antiviral drugs called protease inhibitors has recently improved the outlook for patients with HIV, reducing the need for doctor visits.

The findings, based on Centers for Disease Control and Prevention data for outpatient care from 1980 through 1996, were reported last week in the Archives of Internal Medicine.

--Don Colburn



The prevalence of alcohol abuse among a group of first-year pediatric residents is disturbingly high, according to a new study conducted by researchers at Harvard Medical School.

John R. Knight of Boston's Children's Hospital and his colleagues surveyed 115 residents during three consecutive years beginning in 1996 to determine the extent of alcohol-related problems among residents at a large urban pediatric residency training program that was not identified. Two-thirds of those surveyed were women.

To assess the prevalence and severity of problem drinking, Knight and his colleagues distributed a questionnaire called the Michigan Alcoholism Screening Test (MAST), which the authors say is a reliable predictor of alcoholism among adults.

Three-quarters of residents surveyed completed the 25-item questionnaire, which was returned anonymously. Overall, 22 percent of the group had scores that were suggestive of alcoholism. Thirty-five percent of the group admitted to having "blackouts," while an equal number said they had experienced a serious consequence from heavy drinking. Eleven percent said they drank before noon. None of the trainees admitted to having alcohol-related problems at work and only one physician had sought help for drinking.

Previous studies have indicated that between 10 and 20 percent of residents had scores on the MAST that indicated alcoholism, a statistic consistent with the general population.

It's not clear, the authors wrote, why their survey revealed a greater problem, although it may reflect the characteristics of a single training program. The results are disturbing and warrant further study, they concluded.

"Faculty must . . . model responsible use of alcohol (in social settings) and complete abstinence while professionally involved in the hospital," they wrote. "It was not so long [ago] that 'liver rounds' were a regular and popular feature of medical education and training."

While social drinking should not be discouraged, they added, "events should never be centered around heavy drinking and no individuals should return to professional duty after drinking."

The study was published in the November issue of the Archives of Pediatric and Adolescent Medicine.

--Sandra G. Boodman



The wives of men who have heart disease are not wising up to their own risks, researchers said.

These "women may be at increased risk . . . because of their shared lifestyle," said Lynn Macken, a registered nurse at Regional West Medical Center in Scottsbluff, Neb.

She told a meeting of the American Heart Association in Atlanta this month that wives often share risk factors with husbands--smoking, lack of exercise, an unhealthy diet and being overweight.

A study of 177 men recovering from a heart attack or bypass surgery and their wives showed that the wives could even be at greater risk than their husbands. The men had an average cholesterol level of 212, while the women had an average level of 226, Macken's study found. Anything over 200 is considered high. The couples were slightly overweight on average.

And the stress of caring for an ill husband could make the women's situation even worse, Macken said.