Wellbeing. Part 1--what is it?

This is the first in a series of articles which will explore the nondisease focused model of medicine--the notion of promoting wellness. The primary intention is to encourage the reader to reflect on their own wellbeing, and to gain some strategies to assist them in improving it where necessary. However, all the principles outlined here can also be used to help our patients in achieving similar outcomes.     

Cognitive-based measures screening for depression in the medically ill: the DMI-10 and the DMI-18

OBJECTIVE: We suggest that the identification of depression in the medically ill (DMI) might be improved by focussing on cognitive features. METHOD: We recruited 302 patients to complete our provisional cognitive-based measure. Subsets also completed one of two comparator screening measures, either the Hospital and Anxiety Depression Scale (HADS) or the Beck Depression Inventory for Primary Care (BDI-PC). One hundred and sixty patients were then assessed by a psychiatrist who estimated whether they were 'clinically depressed' and who also administered a standardized interview for depression (the CIDI). RESULTS: Analyses identified items discriminating clinically depressed and non-depressed individuals, allowing development of brief (10-item) and extended (18-item) measures. The two new measures were compared with the HADS and the BDI-PC in discriminating depressed and non-depressed medically ill patients. CONCLUSION: A cognitive construct-based approach to assessing depression in the medically ill appears strongly supported. We provide brief (DMI-10) and extended (DMI-18) measures that appear to have utility as screening instruments. Consideration of the discriminating items may also assist clinical decision making.     

Six years' experience of prophylactic oral vitamin K

AIMS: The ability of oral vitamin K to eliminate all risk of vitamin K deficiency bleeding during the first three months of life was studied. METHODS: Babies (n=182,000) in the north of England judged well enough to be offered milk within 12 hours of birth were given 1 mg of phytomenadione (vitamin K(1)) suspended in a medium chain triglyceride oil by mouth at delivery between 1993 and 1998. The parents of those who were breastfed were given a further three doses to give to the baby once every two weeks after discharge. RESULTS: Four breastfed babies developed late vitamin K deficiency bleeding. In two, staff failed to follow policy guidelines, and in two there was undiagnosed alpha(1) antitrypsin deficiency. Audit suggested that 93% of breastfed babies had all four doses, as advised. CONCLUSIONS: An oral product that parents can administer themselves would be popular if licensed, but the total dose offered may need to be more than in this study if babies with undiagnosed liver disease are to be protected.     

Coincidence of Congenital Malformation and Embryonic Tumours of Childhood

Examination of the records of cases of neuroblastoma, nephroblastoma, hepatoblastoma, and teratoma has not revealed a significant association between neoplasia and malformation. An increase in ''local'' abnormalities in sacrococcygeal teratomata might be explained by local growth effects. The significance of the definition of malformation, the validity of comparisons between ''general incidence'' figures for malformations, and those obtained in tumour-bearing patients is considered.     

5-Hydroxytryptamine levels and platelet aggregation responses in subjects with acute migraine headache

Blood 5-hydroxytryptamine levels were reduced during migraine attacks in patients who had not taken any drugs but the aggregation responses to 5-hydroxytryptamine of the blood platelets from these patients were similar to responses of platelets from migrainous subjects between attacks. This confirms earlier findings that a permanent difference exists in the behaviour of platelets from migrainous subjects. Blood 5-hydroxytryptamine levels were reduced during migraine attacks in patients who had taken ergotamine. The aggregation responses of platelets taken from migrainous patients on ergotamine both during and between attacks were inhibited, which is in agreement with results previously found for aggregation responses following the in vitro pre-incubation of control platelets with ergotamine. Blood 5-hydroxytryptamine levels were maintained during migraine attacks in patients who had taken analgesics and there was no reduction in the aggregation responses of their platelets.