Is your depressed patient bipolar?

Accurate diagnosis of mood disorders is critical for treatment to be effective. Distinguishing between major depression and bipolar disorders, especially the depressed phase of a bipolar disorder, is essential, because they differ substantially in their genetics, clinical course, outcomes, prognosis, and treatment. In current practice, bipolar disorders, especially bipolar II disorder, are underdiagnosed. Misdiagnosing bipolar disorders deprives patients of timely and potentially lifesaving treatment, particularly considering the development of newer and possibly more effective medications for both depressive features and the maintenance treatment (prevention of recurrence/relapse). This article focuses specifically on how to recognize the identifying features suggestive of a bipolar disorder in patients who present with depressive symptoms or who have previously been diagnosed with major depression or dysthymia. This task is not especially time-consuming, and the interested primary care or family physician can easily perform this assessment. Tools to assist the physician in daily practice with the evaluation and recognition of bipolar disorders and bipolar depression are presented and discussed.     

Is your patient sick--or hungry?

With millions of Americans struggling to recover from job loss and recession, it's critical to include hunger and poverty in the medical history and physical assessment.     

Is greater patient choice consistent with equity? The case of the English NHS

There are substantial inequities within the current National Health Service (NHS), with people in lower socioeconomic groups (SEGs) using a wide range of services less relative to their needs than people in higher SEGs. These inequities are likely to arise due to factors on both the demand and the supply side of the system. On the demand side, they could arise from differences in patients' beliefs, knowledge, costs, resources and capabilities. On the supply side, professional beliefs and attitudes, and risk selection or cream-skimming by providers may result in inequities. This paper discusses whether these factors are at play within the English NHS and analyses whether current policy to extend patient choice of provider is likely to reduce or increase these inequities. It shows that extending patient choice may leave unchanged inequity due to differences in health beliefs (because choice does not affect these directly), increase inequity due to unequal resources (because patients may have to travel further), and decrease inequity due to unequal capabilities (because the poor will have access to a new and, for them a more effective, source of leverage over health service professionals). On the supply side, there will be little change. The paper then discusses policy options for dealing with factors that contribute to greater inequity on the demand side. It proposes a package of supported choice whereby individuals from lower SEGs would receive assistance in making choices, including an identified key worker to act as patient care adviser and help with transport costs. The paper concludes that policies for extending patient choice can enhance equity--so long as they are properly designed.     

Is the job satisfaction of primary care team members associated with patient satisfaction?

BACKGROUND Previous research has shown a correlation between physician job satisfaction and patient satisfaction with quality of care, but the connection between job satisfaction of other primary care team members and patient satisfaction is yet unclear. OBJECTIVE To evaluate whether there is an association between patient satisfaction and job satisfaction of the members of patient care teams. DESIGN The study was based on data from the European Practice Assessment and used an observational design. SETTING 676 primary care practices in Germany. PARTICIPANTS 47?168 patients, 676 general practitioners (practice principals), 305 physician colleagues (trainees and permanently employed physicians) and 3011 non-physician practice members (nurses, secretaries). MAIN OUTCOME MEASURES Patient evaluation was measured using the 23-item EUROPEP questionnaire. Job satisfaction was measured using the 10-item Warr-Cook-Wall job satisfaction scale and further items relating to practice structure. Bivariate correlations were applied in which factors of patient satisfaction and practice structure were compared with physicians and non-physicians satisfaction. RESULTS Patient satisfaction correlates positively with the general job satisfaction of the non-physician (r=0.25, p<0.01) and no significant correlation was found for the general job satisfaction of practice principals and physician colleagues. Patients' satisfaction with the practice organisation correlates positively with the general job satisfaction of the non-physicians (r=0.30, p<0.01) and their view of practice structure (r=0.29, p<0.01). CONCLUSIONS The correlation between non-physician team member satisfaction and patient satisfaction was higher than the correlation between satisfaction of physicians and patients. Patients seem to be sensitive to aspects of practice structure.     

Is the standardised term ‘Black African’ useful in demographic and health research in the United Kingdom?

Objective. The main objective of this paper is to review the literature on the term ‘Black African’ with respect to a number of themes: its use in the census and official data collections; the acceptability of a colour-based term; the heterogeneity concealed within the ‘Black African’ collectivity; the invisibility of distinct populations; the concealment of disparities in health, health care, and determinants; the capture of ‘Black Africans’ in other countries; and a set of possible alternatives for classifying this population.

Design. Structured searches were undertaken on a wide range of government and other grey literature sources and on two biomedical databases (Medline and EMBASE), using combinations of search terms for the collectivity and specific national origin groups.

Results. Analyses of the data show that the term ‘Black African’ conceals substantial heterogeneity with respect to national origins, religion, and language. It includes many who have come to the UK since the 1960s from former colonies but also sizeable groups arriving as refugees and asylum seekers from a wide range of African countries. Moreover, its boundaries are fuzzy, especially with regard to those originating in Horn of Africa countries. Marked variations are found in the (albeit limited) available disaggregated data on health and the determinants of inequalities.

Conclusions. Given the substantial increase in the size of the group, the extent to which such heterogeneity can continue to be tolerated in a single term must be questioned. The ‘Black African’ collectivity merits categorisation that addresses this issue and the proposed regional subdivisions in the Scotland 2006 Census Test currently offer the best solution.