The functioning and well-being of depressed patients. Results from the Medical Outcomes Study

We describe the functioning and well-being of patients with depression, relative to patients with chronic medical conditions or no chronic conditions. Data are from 11,242 outpatients in three health care provision systems in three US sites. Patients with either current depressive disorder or depressive symptoms in the absence of disorder tended to have worse physical, social, and role functioning, worse perceived current health, and greater bodily pain than did patients with no chronic conditions. The poor functioning uniquely associated with depressive symptoms, with or without depressive disorder, was comparable with or worse than that uniquely associated with eight major chronic medical conditions. For example, the unique association of days in bed with depressive symptoms was significantly greater than the comparable association with hypertension, diabetes, and arthritis. Depression and chronic medical conditions had unique and additive effects on patient functioning.     

Nurses' Logs as an Evaluation Tool for School-Based Violence Prevention Programs

ABSTRACT: Programs for preventing violence among youth should be evaluated to determine if they are effective. Nurses' logs appear to be a useful tool for evaluating school-based violence prevention programs. The logs provide a record of students' visits to the school nurse that can be used to determine if a violence prevention program is associated with a reduction in fighting—and other injury-related nurse visits. This method has many strengths: it is simple and inexpensive, it does not interrupt the school routine, it permits school-level rather than student-level data collection, it provides a ready "baseline," and it allows continuous data collection. However, potential limitations do exist. For example, the method may provide insufficient information and may be affected by factors unrelated to the intervention. School officials can increase the usefulness of the logs by encouraging standardization and providing training in their use.     

Is endometrial infection with Candida albicans a cause of recurrent vaginal thrush?

OBJECTIVE--It was hypothesised that the endometrium might act as a reservoir for candida, thus infecting the vagina as the endometrium is shed during menstruation. DESIGN--A prospective study of women with recurrent vulvo-vaginal candidiasis. The endometrium was sampled and cultured for candida species. SETTING--Central London STD clinic. SUBJECTS--26 women were enrolled, of whom 20 completed the study. RESULTS--One patient had a positive endometrial culture for candida species, the isolate being Candida krusei. CONCLUSIONS--The endometrium is not a common resevoir for candida species and therefore, infection at this site is an unlikely cause of recurrent vaginal candidiasis.     

Sarcoidosis and primary biliary cirrhosis

Summary An unusual case of a woman with primary biliary cirrhosis and cutaneous sarcoidosis is described. The factors that allow a specific diagnosis of each condition are presented and the literature pertaining to such complex and unusual cases is presented.This work was supported in part by a grant from the Gastroenterology Medical Research Foundation of Southwestern Pennsylvania.     

Without Parental Consent: Conducting Research With Homeless Adolescents

ISSUES AND PURPOSE. To identify the ethical and legal implications of conducting research with homeless adolescents and to discuss guidelines for conducting research without parental consent.
CONCLUSIONS. Ethical principles of capacity, risk, postponement, and truthful disclosure within the context of the rights of minors to consent to healthcare treatment form the basis of the argument for allowing adolescents to consent to participate in research without parental consent when there is minimal risk or when such consent could place them at increased risk for harm.
PRACTICE IMPLICATIONS. Adolescents who are the target population for clinical research or who are intended recipients of nursing care should be involved in setting priorities, purposes, and protocols. Parents and other adults from their communities should be included in developing strategies to protect their confidentiality and privacy while helping them achieve autonomy in making informed health-related decisions.     

Neridronate prevents bone loss in patients receiving androgen deprivation therapy for prostate cancer.

Today, androgen deprivation therapy is a cornerstone of treatment for advanced prostate cancer, although it presents important complications such as osteoporosis. Neridronate, a relatively new bisphosphonate, is able to prevent bone loss in patients with prostate cancer during androgen ablation. INTRODUCTION: Androgen-deprivation therapy (ADT) is a cornerstone of treatment for advanced prostate cancer. This therapy has iatrogenic complications, such as osteoporosis. The aim of our study was to evaluate the efficacy of neridronate, a relatively new bisphosphonate, to prevent bone loss during androgen ablation. MATERIALS AND METHODS: Forty-eight osteoporotic patients with prostate cancer, treated with 3-month depot triptorelina, were enrolled and randomly assigned to two different treatment groups: group A (n = 24) was treated with a daily calcium and cholecalciferol supplement (500 mg of elemental calcium and 400 IU cholecalciferol), and group B (n = 24) received in addition to the same daily calcium and cholecalciferol supplement, 25 mg of neridronate given intramuscularly every month. All patients also received bicalutamide for 4 weeks. Lumbar and femoral BMD was evaluated by DXA at baseline and after 1 year of therapy; moreover, deoxypyridinoline (DPD) and bone alkaline phosphatase (BALP) were determined at the beginning, midway through, and at the end of the study. RESULTS: After 6 and 12 months, whereas patients treated only with calcium and cholecalciferol (group A) showed a marked bone loss, with increased levels of DPD and BALP compared with baseline values, patients treated also with neridronate (group B) had substantially unchanged levels of these markers. After 1 year of treatment, lumbar and total hip BMD decreased significantly in patients treated only with calcium and cholecalciferol (group A), whereas it did not change significantly at any skeletal site in patients treated also with neridronate (group B). No relevant side effects were recorded during our study. CONCLUSIONS: Neridronate is an effective treatment in preventing bone loss in the hip and lumbar spine in men receiving ADT for prostate cancer.     

Reductions in depressed mood and denial coping during cognitive behavioral stress management with hiv-positive gay men treated with haart

Background: Stress management interventions for HIV-positive persons have been designed to enhance coping skills and encourage health-promoting behaviors with the hope of decreasing distress and slowing disease progression.Purpose: We examined the efficacy of a cognitive behavioral stress management (CBSM) intervention in combination with medication adherence training (MAT) in 130 gay and bisexual men living with HIV infection.Methods: Participants were randomized to either a 10-week CBSM+MAT intervention (n = 76) or a MAT-only condition (n = 54). Measures of self-reported adherence, active cognitive coping (i.e., acceptance and positive reinterpretation), avoidant coping (i.e., denial and behavioral disengagement), and depressed mood were examined over the 10-week intervention period.Results: Men in CBSM+MAT reported reductions in depressed mood and denial coping during the 10-week intervention period, but no changes in active cognitive coping or self-reported adherence were observed. Using path analysis, greater reliance on denial coping at baseline was associated with decreased depressed mood at 10 weeks. We also determined that CBSM+MAT may decrease depressed mood by reducing reliance on denial coping over the 10-week intervention period.Conclusions: Although denial may be an effective means of distress reduction in the short term, reliance on this coping strategy may result in a decreased capacity to effectively manage a variety of disease-related stressors in the long term. CBSM+MAT addresses this potentially detrimental pattern by teaching stress reduction skills that may decrease depressed mood via reduced reliance on denial coping. This research was supported by National Institute of Mental Health Grants P01 MH49548 and T32 MH18917.