Numeric terminology of erythrocyte blood group antigens

BACKGROUND: Depression in late life is a significant health problem in the United States. This study examined the relationship between depression and alcohol, cigarette use, family history, and sociodemographic factors in older adult primary care patients. METHODS: As part of a larger clinical trial, 2,732 patients in 24 primary care offices were recruited to complete a self-administered health screening survey. Depression was assessed using Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised (DSM-III-R) criteria for lifetime and current depression. RESULTS: A total of 17.8% of females and 9.4% of males age 60 and over met DSM-III-R criteria for lifetime depression; 10.6% of the females and 5.7% of the males met current depression criteria. Depression was significantly and positively correlated with female gender and family history of mental health problems and negatively correlated with social contact. CONCLUSIONS: Older adults, especially women, should be considered at elevated risk for depression when a family history of mental health problems and self-report of inadequate social connection can be established.     

Consequences of major and minor depression in later life: a study of disability, well-being and service utilization

BACKGROUND: The consequences of major depression for disability, impaired well-being and service utilization have been studied primarily in younger adults. In all age groups the consequences of minor depression are virtually unknown. In later life, the increased co-morbidity with physical illness may modify the consequences of depression, warranting special study of the elderly. With rising numbers of elderly people, excess service utilization by depressed elderly represents an increasingly important issue. METHODS: Based on a large, random community-based sample of older inhabitants of the Netherlands (55-85 years), the associations of major and minor depression with various indicators of disability, well-being and service utilization were assessed, controlling for potential confounding factors. Depression was diagnosed using a two-stage screening design. Diagnosis took place in all subjects with high depressive symptom levels and a random sample of those with low depressive symptom levels. The study sample consists of all participants to diagnostic interviews (N = 646). RESULTS: As in younger adults, associations of both major and minor depression with disability and well-being remained significant after controlling for chronic disease and functional limitations. Adequate treatment is often not administered, even in subjects with major depression. As the vast majority of those depressed were recently seen by their general practitioners, treatment could have been provided in most cases. Bivariate analyses show that major and minor depression are associated with an excess use of non-mental health services, underscoring the importance of recognition. In multivariate analyses the evidence of excess service utilization was less compelling. CONCLUSIONS: Both major and minor depression are consequential for well-being and disability, supporting efforts to improve the recognition and treatment in primary care. However, controlled trials are necessary to assess the impact this may have on service utilization.     

Sex differences in the sensitivity of two self-report depression scales in older depressed inpatients.

Both the Geriatric Depression Scale (J. A. Yesavage et al; see record 1984-02939-001) and the Beck Depression Inventory were less effective in identifying depressed men than women in a sample of 191 geriatric psychiatric inpatients with major unipolar depression. From one quarter to one half of the men were missed cases, depending on the cutoff score used. Separate cutoff scores for older men and women on depression screening instruments may be appropriate. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A bilingual telephone-enabled speech recognition application for screening depression symptoms.

Are computerized and face-to-face screening methods equivalent at detecting depression symptoms in English and Spanish speakers? This study integrates state-of-the-art speech recognition and telephone technologies to conduct voice-interactive screening. Computerized or face-to-face forms of the Center for Epidemiological Studies Depression Scale (CES-D) were administered to 82 English and 84 Spanish speakers. The results indicate that the 2 CES-D methods demonstrate similar psychometric properties. The findings also suggest that computerized screening could increase avenues for the detection of depression in non-English-speaking primary care populations. Thus, automated interviewing can place mental health practitioners at the forefront of identification of depression in the general population. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The treatment of depression in older adults in the primary care setting: An evidence-based review.

The objective of this study was to conduct an evidence-based review of treatments for depression in older adults in the primary care setting. A literature search was conducted using PsycINFO and Medline to identify relevant, English language studies published from January 1994 to April 2004 with samples aged 55 and older. Studies were required to be randomized controlled trials that compared psychosocial interventions conducted within the primary care setting with "usual care" conditions. Eight studies with older adult samples met inclusion criteria and were included in the review. Two treatment models were evident: Geriatric Evaluation Management (GEM) clinics and an approach labeled integrated health care models. Support was found for each model, with improvement in depressive symptoms and better outcomes than usual care; however, findings varied by depression severity, and interventions were difficult to compare. Further efforts to improve research and clinical care of depression in the primary care setting for older adults are needed. The authors recommend the use of interdisciplinary teams and more implementation of psychosocial treatments shown to be effective for older adults. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

To screen or not to screen: symptoms identifying primary care medical patients in need of screening for depression

OBJECTIVE: It is estimated that 5 percent to 10 percent of primary care patients meet criteria for Major Depressive Disorder with an additional 10 percent to 30 percent experiencing significant subclinical depression. However, only 18 percent to 50 percent of depressed primary care patients are so diagnosed by their primary care physicians and even fewer receive professional mental health care. The current study proposes a quick and efficient means to assist physicians in determining for which patients the resource intensive process of thoroughly screening for depression should be engaged. METHOD: The present study examined responses of 358 consecutively reporting patients to a mid-west university-based primary care clinic on the Beck Depression Inventory. RESULTS: Among individuals reporting high levels of depressive symptomatology, five questions from the Beck Depression Inventory were endorsed by 90 percent or greater of the participants. Analyses by gender indicated that while the same five items were endorsed by males and females, three additional items were frequently endorsed by males. CONCLUSIONS: These findings suggest that a means for efficiently identifying individuals who warrant screening for depression may be readily available to primary care physicians. Surprisingly, this screening was found to emphasize psychological rather than vegetative symptoms. Thus, attending to these symptoms and/or complaints during the course of an office visit may serve as an indicator that a thorough screening for depression, or possibly referral, is warranted.     

Social support: some pragmatic implications for health care professionals

BACKGROUND: Depression affects a significant proportion of the expanding elderly population in the UK. Reports of a poorer prognosis for older than for younger adult patients have been challenged by recent papers. METHOD: The casenotes of 56 adults (mean age 47.8 years) and 54 elderly (mean age 72.9 years) patients with primary depression were assessed one year after receiving hospital treatment. Outcome measures were compared with earlier reported findings and factors possibly influencing outcome were explored. RESULTS: The pattern of outcome in both age groups was broadly similar, thus: adults v. elderly: recovered 44.6% v. 44.4%; relapsed and recovered 23.2% v. 24%; residual symptoms 19.6% v. 13% and chronic depression 7.1% v. 5.5%. In the adults there were two natural deaths and one suicide. In the elderly there were two cases of dementia and five natural deaths, which was double the expected death rate. Predictors of poor outcome were melancholic depression in adults and longer duration of illness at intake and an increasing number of previous episodes of affective disorder in the elderly. CONCLUSION: The outcome of treated depressive illnesses appears similar in elderly and adult patients. Associated physical ill health did not adversely affect outcome in the elderly group.     

A longitudinal analysis of anxiety and depressive symptoms.

The authors modeled depressive and anxiety symptom data from 1,391 participants in a longitudinal study of middle-aged and older Swedish twins (M age?=?60.9 years, SD?=?13.3). Although anxiety and depression were highly correlated, a model with distinct Anxiety and Depression factors fit the data better than models with Positive and Negative Affect factors or a single Mental Health factor. Lack of well-being was associated with anxiety rather than depression. Over two 3-year intervals, anxiety symptoms led to depressive symptoms, but the relationship was not reciprocal. Anxiety symptoms were more stable than depression. These findings provide additional support for the idea that anxiety symptoms may reflect a personality trait such as neuroticism more than do depressive symptoms and suggest that low positive affect may not be as specific to depression among older adults as in younger people. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Detecting depression in elderly medical inpatients.

Prevalence rates for depression indicate that elderly medical patients are a population at high risk. Studies of middle-aged adults show that detection of depression in medical patients by primary health care providers is poor and that screening instruments can improve detection, although little is known about geriatric patients. The present study used Research Diagnostic Criteria to assess the base rate of detection by nonpsychiatric physicians in a random sample of 150 elderly medical inpatients. In addition, the psychometric properties of three slightly different self-report screening instruments were evaluated. Results indicated that detection by house staff was extremely low (8.7%). All three instruments were much more sensitive, were equally specific, and yielded greater predictive power than the procedures used by hospital staff. All three instruments were especially sensitive to major depression. Of the scales, the Beck Depression Inventory (BDI), the BDI Psychological subscale, and the Geriatric Depression Scale had the best reliability and validity and were the most efficient. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Model stability of the 15-item Geriatric Depression Scale across cognitive impairment and severe depression.

The 15-item Geriatric Depression Scale (GDS) is used in a wide variety of clinical and research settings. The study's purpose was to further establish the validity of the 15-item GDS by exploring the underlying factor structure in a healthy, nondemented sample of older adults and then analyzing whether this factor structure remained stable across a sample of demented individuals and a sample of individuals with a history of depression 6 months after discharge from an inpatient psychiatric setting. A 2-factor model fit the data best in the exploratory analyses. The 2 factors, Life Satisfaction and General Depressive Affect, found in the nondemented sample (r = .39) remained stable across cognitive impairment (r = .12) but merged into a 1-factor model in the psychiatric sample (r = .93). The results indicate that nondepressed older adults with poor life satisfaction may be identified as depressed on screening instruments such as the 15-item GDS. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Depression

Depression occurs in up to 45% of medically hospitalized older patients. The diagnosis of depression in this population is particularly difficult. Assessing for depression is made easier by the use of scales for screening and is best accomplished using the inclusive approach. These depressions can be divided into two groups: "reactive" depression and major depression. Depression is treatable using a variety of modalities that include psychotherapy, pharmacotherapy, and electroconvulsive therapy.     

Identifying comorbid depression in elderly medical patients: Use of the Extracted Hamilton Depression Rating Scale.

The high prevalence and low rate of detection of comorbid depression in primary care is now well documented. Older adults with multiple medical problems represent a population at higher risk for underrecognition. The Extracted Hamilton Depression Rating Scale (XHDRS) was evaluated as a screening instrument for depression diagnosed according to Research Diagnostic Criteria in a sample of 150 geriatric medical and surgical inpatients. Scale reliability and validity were evaluated, and its sensitivity, specificity, and predictive power were calculated at multiple cutoff points. Results indicated good internal consistency, interrater reliability, concurrent validity, convergent validity, and discriminant validity. Additionally, use of the XHDRS offered greatly improved case identification when compared with use of conventional screening procedures. The XHDRS also showed improved specificity and positive predictive power when compared with several widely used self-report symptom scales. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Angiocardiographic digital still images compressed via irreversible methods: concepts and experiments

OBJECTIVE: Primary care occupies a strategic positive in the evaluation, treatment, and prevention of the mental disturbances of later life. This article highlights four themes that are crucial to understanding mental disturbances among older adults: 1) subsyndromal depression, 2) coexisting depression and anxiety, 3) comorbidity of depression and chronic medical conditions, and 4) risk factors for cognitive impairment. METHOD: The literature was selectively reviewed for each theme to ask the central question, "What can primary care physicians learn about mental disturbances of their older patients from epidemiologic and community studies?" RESULTS: The primary care setting itself is an important venue for an examination of aging issues and mental health. Workers in the "middle ground of psychiatric epidemiology"--primary health care--have not yet reached a full appreciation for the value of research in the primary care setting for enhancing our understanding of the mental disturbances of late life, and how these intersect with other salient factors. CONCLUSIONS: Primary care physicians and others who work in primary care should advocate for further mental health integration and research in primary care. Research is needed that will lead to new ways of maximizing the health and quality of life of older adults and their families.     

Predisposition to the fragile X syndrome in Jews of Tunisian descent is due to the absence of AGG interruptions on a rare Mediterranean haplotype

Lesbians may engage in behavior that places their health at risk and may delay health care and screening more than do their heterosexual counterparts. This article examines influences on lesbians' health risk factors and health-seeking behaviors. A statewide, self-administered survey of members of a lesbian community organization was performed. Univariate and bivariate analyses were calculated, and linear regression was used to examine models of health risks and health-seeking behavior. Of 324 respondents, 90% had disclosed sexual orientation to at least one provider, 22% reported seeking care without symptoms (preventive care), and 23% reported waiting until symptoms are at their worst or never seeking care. Young age, belief in the importance of lung cancer, difficulty of getting health care when needed, reliance on the partner for health support, and fewer male partners were all associated with greater health risk for lesbians. Difficulty obtaining health care, difficulty communicating with the primary care provider, discomfort in discussing depression, and degree of comfort in discussing menopause were all associated with a delay in seeking health care. Sensitive communication with lesbians and further identification of lesbians' specific barriers to care may improve health-seeking behavior and provide more opportunities for screening and risk factor counseling in this population.     

The Geriatric Depression Scale and the Beck Depression Inventory as screening instruments in an older adult outpatient population.

Compared older adult outpatients with major depression (n?=?25) and healthy control Ss (n?=?25) using the Geriatric Depression Scale (GDS) and the Beck Depression Inventory (BDI). Both measures were sensitive in detecting clinical depression. Ss were, however, more likely to endorse multiple response on BDI items, suggesting that the GDS is simpler for older adults to complete. Viewed within the context of previous relevant research that used these instruments to compare older adults, the results yield additional evidence of cross-study consistency in the functional efficiency of both measures. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Changes in NMDAR2 subunit mRNA levels during pentobarbital tolerance/withdrawal in the rat brain: an in situ hybridization study

BACKGROUND: Urban academic medical centers provide care for large populations of vulnerable older adults. These patients often suffer a disproportionate share of chronic illnesses, disabilities, and social stressors that may increase health care costs. OBJECTIVE: To describe the distribution and content of total healthcare costs accrued over a 4-year period by a community of older adults cared for in an urban academic healthcare system and to describe high-cost patients and utilization patterns. DESIGN: A cohort study. SETTING: A tax-supported public healthcare system consisting of a 450-bed hospital and seven community-based ambulatory care centers. PATIENTS: 12,581 patients aged 60 years and older who had at least two ambulatory visits and/or one hospitalization within the healthcare system from 1993 through 1995. MEASUREMENTS: Patient demographic and clinical characteristics, hospital and ambulatory utilization rates, and all healthcare costs accrued from 1993 through 1996 were determined. Costs were estimated from the perspective of the healthcare system using cost to charge ratios. MAIN RESULTS: The mean patient age was 70 years, 60% were women, 44% were Black, and 83% were covered by Medicare and/or Medicaid. Nearly 25% of patients were obese, 15.8% had a history of smoking, and 15.5% had evidence of malnutrition. The mean number of ambulatory visits per year was 4.3 (+/-7.2), and 38.1% of patients had been hospitalized one or more times. Within the 4-year window, 24.1% of patients had missed five or more appointments with their primary care physicians, 32.7% of patients had five or more unscheduled clinic visits, and 12.5% had five or more emergency room visits. Total health care costs for 4 years for this cohort of older adults was $125.2 million dollars, with per capita annual mean costs of $3893. Expenditures associated with hospitalizations accounted for 63.6% of healthcare costs. Total inpatient and outpatient costs for the 38% of patients hospitalized at least once accounted for 85.3% of all health care expenditures. Patients who died in the hospital did not accrue significantly greater costs than patients who died out of the hospital. Simulations of a random 5% adverse selection of high-cost patients among two capitated systems resulted in cost shifts of $11.1 million. Recorded smoking history, obesity, and low serum albumin were significantly associated with excess costs. CONCLUSIONS: Healthcare costs are concentrated in a significant minority of older adults. Costs accrued in conjunction with hospital stays dominate healthcare expenditures for this cohort of older adults. However, most older adults (83%) have one or fewer hospital episodes in a 4-year period. Although patients who died accrued greater healthcare costs, these costs were not higher when the death occurred in the hospital. Self-care behaviors are an important target for interventions to reduce costs.     

Experience with a Swedish version of the Geriatric Depression Scale in primary care centres

OBJECTIVE: The purpose of this study was to use a Swedish version of the Geriatric Depression Scale (GDS-20) for diagnosis of depression in the elderly in primary care. DESIGN: Elderly consecutive patients visiting two primary care centres (> or = 65 years of age; N = 1189) were rated by educated nurses using the GDS-20. SETTING: All elderly patients attending two primary care centres in an urban-based community in the south of Sweden. PATIENTS: Of the 1189 patients interviewed, 1002 were rated using the GDS-20. MEASURES: The GDS-20, and in 26 patients also the Geriatric Mental State Schedule--Depression Scale (GMSS-DS). RESULTS: Of 1002 rated patients, 93 had scores of 5 or above on the GDS-20. Further analysis showed that 158 (13.3%) suffered from affective disorders. CONCLUSION: Depression in the elderly is underdiagnosed in primary care centres. A screening instrument such as the GDS-20 is of value in identifying the patients.     

Association of symptoms of depression with diagnostic test charges among older adults

BACKGROUND: Previous studies have documented greater use of health services by depressed persons and have postulated that health care costs could be reduced overall through better recognition and treatment of depression. OBJECTIVE: To determine whether a greater burden of medical illness contributes to excess charges for diagnostic tests among older adults with symptoms of depression. DESIGN: Prospective cohort study. SETTING: A primary care group practice at an academic institution. PATIENTS: 3767 patients 60 years of age and older who completed testing on the Centers for Epidemiologic Studies Depression Scale (CES-D) during routine office visits. MEASUREMENTS: Charges for all inpatient and ambulatory diagnostic testing for 2 years, including clinical pathology, diagnostic imaging, and special procedures; number of visits to the ambulatory care center or emergency department; and number of hospitalizations. The Ambulatory Care Group case-mix approach, which is based on ambulatory diagnoses, was used as a measure of health status and expected resource consumption. RESULTS: Patients with symptoms of depression (CES-D scores > or = 16) were significantly younger (66.6 compared with 68.1 years; P < 0.001), more likely to be white (50.5% compared with 33.9%; P = 0.001), and more likely to be female (75.8% compared with 67.6%; P = 0.001) than were those without these symptoms (CES-D scores < 16). They also had more nonpsychiatric comorbid conditions, had more visits to the ambulatory care center (9.2 compared with 7.8; P < 0.001), were more likely to use the emergency department (52.3% compared with 40%; P = 0.001), were more likely to be hospitalized (22.4% compared with 17%; P = 0.002), and had greater median total diagnostic test charges for a period of 1 year ($583 compared with $387; P < 0.001). The difference in charges, most of which were clinical pathology charges (54.2%), persisted into the second year. Ambulatory Care Group assignment was independently associated with diagnostic test charges. The CES-D summary score was not independently associated with diagnostic test charges when controlling for Ambulatory Care Group assignment. CONCLUSIONS: Patients with symptoms of depression accrue greater average diagnostic test charges. However, these data suggest that such patients also have a greater burden of comorbid nonpsychiatric illness. Efforts to improve outcome and decrease cost for patients who have late-life depression must target interventions to improve the care of psychiatric and medical illness concurrently.     

Asian blepharoplasty with a short-pulsed contact Nd-Yag laser: limited-incision resectable laser double fold with internal medial and lateral functional epicanthoplasty

PURPOSE: To determine how often primary care physicians screen adolescents for important risk factors and to determine how rates of screening vary by physicians' specialty and practice setting, patients' age, and type of risk factor. METHODS: A stratified random sample of 343 California physicians who are Board certified in pediatrics, family practice, or internal medicine, and physicians in these specialties who specialized in adolescent medicine were surveyed about their screening practices using a mailed questionnaire. Subjects were asked the percentage of routine comprehensive physical examination during which they personally queried or screened each age group of adolescents (11-14 years old and 15-18 years old) for each of the following risk factors: high blood pressure, alcohol use, cigarette use, sexual activity, and drug use. RESULTS: The frequency with which primary care physicians reported actually screening younger and older adolescents for the various risks were approximately: 93% and 96% for high blood pressure, 70% and 84% for alcohol use, 74% and 82% for drug use, 67% and 83% for sexual activity, and 76% and 86% for smoking, respectively. For all risk factors, providers screened older adolescents more frequently than younger adolescents (p < 0.01). Finally, screening rates varied by specialty (p < 0.01) but not by practice setting. CONCLUSIONS: This study found that California physicians frequently screen adolescents for a variety of risk factors. However, the reported rates may not be consistent with published guidelines. Interventions may need to be developed which focus on improving primary care physicians' adolescent-specific screening practices.