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91.
92.
Unemployment and emergency room visits predict poor treatment outcome in primary care panic disorder
BACKGROUND: To complement existing data on predictors of treatment response in groups of "pure" panic disorder patients studied in clinical trials or in poorly controlled naturalistic follow-up, we sought to elucidate predictors of treatment response over 1 year in a diagnostically heterogeneous and comorbidly ill group of primary care patients with panic disorder participating in a randomized effectiveness study. METHOD: Patients with DSM-IV panic disorder (N = 115), mostly without agoraphobia, were recruited from 3 primary care clinics in Seattle, Wash., and randomly assigned to an on-site collaborative care intervention (N = 57), in which psychiatrists provided education, 2 visits, follow-up phone calls, and paroxetine, or to usual care by their primary care physician (N = 58). Predictors of response at 3-month intervals over 1 year were determined using logistic regression analysis. RESULTS: Patients with consistent response over the year (response at the majority of available timepoints) were significantly (p <.05) more likely to be white, employed, in higher income strata, and in the intervention group and had less medical comorbidity and phobia severity, fewer recent hospitalizations and emergency room visits, and higher reported Medical Outcomes Study 36-Item Short Form physical and role functioning. The final regression model indicated that responders were more likely to be in the intervention group, be employed, and lack a recent emergency room visit. CONCLUSION: While some of the univariate findings partially replicate previous results linking greater illness severity with poorer response, univariate findings linking medical comorbidity and low socioeconomic status with poor response, as well as multivariate findings that unemployment and recent emergency room use are the most potent predictors of poor response, have not been previously reported. 相似文献
93.
Katon W Von Korff M Lin E Simon G Ludman E Bush T Walker E Ciechanowski P Rutter C 《General hospital psychiatry》2003,25(3):158-168
This paper describes the methodology of a population based study of primary care patients with diabetes mellitus enrolled in a health maintenance organization. The first goal was to determine the prevalence and impact of depression in patients with diabetes. The second goal was to randomize approximately 300 patients with diabetes and major depression and/or dysthymia in a trial to test the effectiveness of a collaborative care intervention in improving quality of care and health outcomes among patients with diabetes and depression. 相似文献
94.
Collaborative care management of late-life depression in the primary care setting: a randomized controlled trial 总被引:20,自引:0,他引:20
Unützer J Katon W Callahan CM Williams JW Hunkeler E Harpole L Hoffing M Della Penna RD Noël PH Lin EH Areán PA Hegel MT Tang L Belin TR Oishi S Langston C;IMPACT Investigators. Improving Mood-Promoting Access to Collaborative Treatment 《JAMA》2002,288(22):2836-2845
Context Few depressed older adults receive effective treatment in primary care settings. Objective To determine the effectiveness of the Improving MoodPromoting Access to Collaborative Treatment (IMPACT) collaborative care management program for late-life depression. Design Randomized controlled trial with recruitment from July 1999 to August 2001. Setting Eighteen primary care clinics from 8 health care organizations in 5 states. Participants A total of 1801 patients aged 60 years or older with major depression (17%), dysthymic disorder (30%), or both (53%). Intervention Patients were randomly assigned to the IMPACT intervention (n = 906) or to usual care (n = 895). Intervention patients had access for up to 12 months to a depression care manager who was supervised by a psychiatrist and a primary care expert and who offered education, care management, and support of antidepressant management by the patient's primary care physician or a brief psychotherapy for depresssion, Problem Solving Treatment in Primary Care. Main Outcome Measures Assessments at baseline and at 3, 6, and 12 months for depression, depression treatments, satisfaction with care, functional impairment, and quality of life. Results At 12 months, 45% of intervention patients had a 50% or greater reduction in depressive symptoms from baseline compared with 19% of usual care participants (odds ratio [OR], 3.45; 95% confidence interval [CI], 2.71-4.38; P<.001). Intervention patients also experienced greater rates of depression treatment (OR, 2.98; 95% CI, 2.34-3.79; P<.001), more satisfaction with depression care (OR, 3.38; 95% CI, 2.66-4.30; P<.001), lower depression severity (range, 0-4; between-group difference, -0.4; 95% CI, -0.46 to -0.33; P<.001), less functional impairment (range, 0-10; between-group difference, -0.91; 95% CI, -1.19 to -0.64; P<.001), and greater quality of life (range, 0-10; between-group difference, 0.56; 95% CI, 0.32-0.79; P<.001) than participants assigned to the usual care group. Conclusion The IMPACT collaborative care model appears to be feasible and significantly more effective than usual care for depression in a wide range of primary care practices. 相似文献
95.
96.
97.
RM Subramaniam J Sherriff K Holmes MC Chan B Shadbolt 《Journal of Medical Imaging and Radiation Oncology》2006,50(5):442-446
This study was conducted to establish clinicians’ perspectives of a set of radiology curriculum topics for medical student teaching, which were held to be important by radiologists. A questionnaire was sent to clinicians in all specialties. Forty‐six clinicians (51.1%) out of 90 returned the questionnaires. All curriculum topics were scored above an average of 4 (agree). The five highest ranking curriculum topics in order of importance were: developing a system for viewing chest radiographs (5.59), developing a system for viewing abdominal radiographs (5.56), developing a system for viewing bone and joint radiographs (5.33), distinguishing normal structures from abnormal in chest and abdominal radiographs (5.33) and identifying gross bone or joint abnormalities in skeletal radiographs (5.22). Correlative analysis between speciality groups showed surgical and medical specialities were significantly different in their responses of two learning outcomes: basic knowledge about the contrast media benefits and risks (P= 0.01) and ability to select the most appropriate and the most cost‐effective methods of radiological investigations for clinical situations (P= 0.03). Acute specialities were not significantly different from the other two groups for these two learning outcomes. There was no statistically significant difference for other learning outcomes between the three speciality groups. 相似文献
98.
Induction of oxidative DNA base damage in human skin cells by UV and near visible radiation 总被引:11,自引:2,他引:11
The premutagenic oxidative DNA base damage, 7,8-dihydro-8-oxoguanine, is
induced in human skin fibroblasts by monochromatic radiation ranging from a
UVB wavelength (312 nm) up to wavelengths in the near visible (434 nm). The
oxidative damage is not generated by absorption of radiation in DNA but
rather by activation of photosensitizers generating genotoxic singlet
oxygen species. The spectrum for the yield of the oxidative damage in
confluent, non-growing, primary skin fibroblasts shows that it is UVA
(above 334 nm) and near visible radiations which cause almost all of this
guanine oxidation by natural sunlight in the fibroblast model. We estimate
that the total amount of oxidation of guanine induced by sunlight in
fibroblasts in the epidermis of the skin equals or exceeds the amount of
the major type of direct DNA damage, cyclobutane pyrimidine dimers. In
rapidly dividing lymphoblastoid cells, no oxidative guanine damage was
induced. However, in melanoma cells almost as much damage as in non-growing
fibroblasts (1.1 per 10(4) guanine bases after 1200 kJ/m2 UVA) was found.
We conclude that oxidative DNA base damage can probably contribute to the
induction of both non-melanoma and melanoma skin cancer by sunlight.
相似文献
99.
Immunological and functional protein S, protein C and antithrombin III levels and anticoagulant responses to activated protein C were measured in 24 patients with stroke in childhood. No hereditary deficiencies were found. The protein S levels in healthy controls of younger age did not differ from the adult levels. For optimal screening of protein S deficiency, measurements using functional as well as immunological assays are recommended. Appropriate criteria for the diagnosis of the deficiencies must be carefully applied if unnecessary anxiety and inappropriate treatment of children are to be avoided. 相似文献
100.
GJ Fuchs P Tienboon S Linpisarn S Nimsakul P Leelapat S Tovanabutra V Tubtong M DeWier RM Suskind 《Archives of disease in childhood》1996,74(3):224-227
Abnormal growth is a common feature of thalassaemia major in children. In an attempt to determine whether it has a nutritional cause, 12 children aged 1 to 3 years with thalassaemia major were studied under metabolic ward conditions. Nutritional status was assessed by anthropometry and biochemistry before and after an intensive nutrition regimen. Five children had wasting or stunting on admission. As a result of the nutrition intervention, mean weight for height improved significantly. The mean height increase of 0.4 cm after one month was not significant. Plasma zinc, depressed in half the children on admission, improved, as did alpha tocopherol, while copper decreased. Plasma insulin-like growth factor-I also increased commensurate with improved growth. Fat absorption was normal in all children. Undernutrition is an important cause of associated growth disturbances in children with thalassaemia major. Malnutrition was primarily caused by inadequate nutrient intake, as indicated by the capacity to gain weight appropriately when provided with nutrition support, and by the absence of intestinal malabsorption. While long term studies are required to determine if nutritional support will prevent stunting, these results underscore its central role in preventing nutritional deficiencies and in promoting normal growth in thalassaemic children. 相似文献