Screening for Chlamydia trachomatis in asymptomatic women attending family planning clinics. A cost-effectiveness analysis of three strategies

Because of increasing reports of multiple-antibiotic-resistant strains of Streptococcus pneumoniae and associated clinical failures, this study was performed to determine the prevalence of multiresistance among strains from nine Louisiana medical centers. Using a National Committee for Laboratory Standards broth microdilution method, 481 strains were tested. Of these, 70% were penicillin-susceptible (PS), 23% had intermediate minimum inhibitory concentration values to penicillin (I), and 7% were fully resistant to penicillin (PR). The isolation rates (15% to 40% for I strains and 0% to 33% for PR strains) at the various medical centers varied appreciably. The prevalence of penicillin resistance was highest among upper respiratory isolates, while cross-resistance to other antimicrobials varied. The least cross-resistance was noted among PS strains. However, strains with reduced penicillin susceptibility had high levels of cross-resistance. Among I strains, the prevalence of cross-resistance (%) was noted for amoxicillin/clavulanate (6%), cefuroxime (71%), cefaclor (91%), ceftriaxone (13%), cefotaxime (34%), erythromycin (67%), azithromycin (32%), and clarithromycin (32%). For PR strains, the prevalence of cross-resistance was 97% for amoxicillin/clavulanate, cefuroxime, and cefaclor; 67% for ceftriaxone and erythromycin; 89% for cefotaxime; and 69% for azithromycin and clarithromycin. These data emphasize the high prevalence of multiple-antimicrobial-resistance among strains of S pneumoniae with reduced penicillin susceptibility in this geographic area.     

Dietary risk factors for pre-eclampsia among women attending Harare Maternity Hospital, Zimbabwe

OBJECTIVE: To identify specific foods that predispose Zimbabwean women to a higher or lower risk of pre-eclampsia and/or eclampsia. DESIGN: A case control study was implemented. Participants were asked by questionnaire to recall the specific amounts of meats, poultry, fruits, fish, vegetables and dairy products they had consumed in the month prior to giving birth. SETTING: Harare Maternity Hospital, Harare, Zimbabwe between June of 1995 and April of 1996. SUBJECTS: 180 women clinically diagnosed with pre-eclampsia (144) or eclampsia (36), and 194 normotensive women without these conditions. MAIN OUTCOME MEASURES: Pre-eclampsia/eclampsia. RESULTS: There were few associations between consumption of specific food items and the occurrence of pre-eclampsia/eclampsia. Meat and fruit were the only foods found to be significantly associated with pre-eclampsia. Women who consumed 12 or more servings of meat per month were more likely to have pre-eclampsia/eclampsia when compared to women eating 11 servings of meat or less per month. While intake of bananas and mangos was unrelated to risk, women who consumed other fruits (i.e. apples, oranges, grapes, peaches, apricots, paw paw, and plums), were 1.7 (95% CI = 1.0 to 3.1) times more likely to develop pre-eclampsia/eclampsia as women who ate none of these fruits. However, women who consumed relatively large quantities of these fruits were not at a particularly high risk. Increased consumption of kapenta was modestly associated with a decrease in disease risk, but this finding was well within the limits of chance and no association was present with intake of other types of fish. CONCLUSIONS: Our findings suggest that variation in consumption of specific foods do not have a strong effect on the incidence of pre-eclampsia in this population. However, further research involving the use of a more comprehensive dietary measure, biochemical measurements of nutrients, pre-pregnancy assessment and ascertainment of dietary intake prior to the development of pre-eclampsia are needed.     

Linking psychologists and family physicians for collaborative practice.

This article describes a pilot, demonstration project that linked psychologists and family physicians to improve the care of patients with alcohol and other drug abuse problems. The project facilitated collaborative practice between family physicians and psychologists to enhance treatment of patients with alcohol and other drug abuse and other psychosocial problems in rural America. Ten pairs of psychologists and family physicians in rural Texas and Wyoming participated in the project. The training successfully established linkages between psychologists and family physicians for the care of a broad range of medical and psychological problems. This article discusses the linkage training, factors that facilitated and hindered collaboration, as well as implications for future training and collaborative health care practice. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Values, stress, and coping among practicing family physicians

A retrospective review of the medical records of blunt trauma patients with sternal fracture admitted to a level 1 trauma center from June 1990 to June 1993 was undertaken to determine the relationship between sternal fractures and clinically significant myocardial injury, and to assess the usefulness of cardiac evaluation and monitoring in these patients. Of 33 patients with sternal fracture, 31 were in motor vehicle crashes and 2 were pedestrians struck. All had Glasgow Coma Scale score = 15. No patient had a severe, life-threatening, associated injury (Abbreviated Injury Score of >3). No electrocardiogram or echocardiogram showed evidence of acute injury or ischemia. No arrhythmias requiring treatment were noted. No CPK-MB fraction was >5%. These results show that sternal fracture is not a marker for clinically significant myocardial injury. The management of sternal fracture patients should be directed toward the treatment of associated injuries.     

Quality of care among Jamaican private physicians offering family planning services

The National Family Planning Board is the agency of Government empowered to prepare, carry out and promote family planning programs in Jamaica. The Board has prioritized the expansion and sustainability of family planning services in large part through encouraging the participation of the private sector. To enhance the availability, acceptability and effectiveness of private physician family planning services, information was collected on the service practices of 90% of physicians, through face to face interviews. Bruce's framework was used to evaluate the findings of the study. The study indicated that: A wide variety of contraceptives are available - Basic equipment and adequate supplies are in place for the provision of services - Provider bias, inappropriate contraindicators and process and scheduling hurdles exist. The major recommendations relate to the: Revision of norms and guidelines for all contraceptives - Continuation of contraceptive technology updates for private physicians - Revision of legal/regulatory barriers which restrict access to some contraceptives for certain target groups.     

Work-related stress and depression among practicing emergency physicians: an international study

STUDY OBJECTIVE: To compare the levels of work-related stress and depression reported by practicing emergency physicians in three survey sites and to determine the effects of gender and marital status on the stress and depression experienced by these physicians. DESIGN: Cross-sectional mail surveys. SETTING AND PARTICIPANTS: Seven hundred sixty-four practicing emergency physicians from the United States, 91 fellows in full-time practice from Australasia, and 154 consultants and 47 senior registrars from the United Kingdom. INTERVENTION: Administration of questionnaires requesting demographic information and including an inventory to assess work-related stress and a scale to measure depressive symptomatology. MEASUREMENTS AND MAIN RESULTS: A 3 x 2 x 2 multivariate analysis of variance performed to compare scores on the stress inventory and depression scale simultaneously by survey site, gender, and marital status revealed significant differences in stress and depression by survey site and marital status. Univariate analyses of variance revealed significant differences in both stress and depression among the three survey sites and in depression by marital status. Adjusted means indicated that physicians from the United Kingdom reported higher levels of stress and depression than physicians from the United States and Australasia. Physicians from the United States and Australasia did not differ with respect to stress or depression. Physicians who were not married reported higher levels of depression than married physicians. No large mean differences, actual or adjusted, were found for any of the grouping factors. CONCLUSION: Statistical differences among practicing emergency physicians from the United States, Australasia, and the United Kingdom were observed, but the actual levels of work-related stress and depression were similar and did not appear severe. Marriage was associated with lower levels of depressive symptomatology.     

Factors predicting depression among Korean-American women in New York

A survey was administered to 262 women aged 35-55 years who had migrated to the U.S. within the last 10 years. The survey included measures of depression, acculturative stress, social support, self-esteem, education, income, age, and length of residence in the U.S. Hierarchical regression analyses in which demographic variables were introduced first indicated that age, education, and income were all significant predictors of depression, with age positively related to depression and education and income negatively related to depression. When acculturative stress, social support, and self-esteem were introduced on subsequent steps, only self-esteem explained significant additional variability in depression. Implications for prevention and treatment programs are discussed.     

Screening for depression prevention: Identifying adolescent girls at high risk for future depression.

This study investigated a broad array of putative risk factors for the onset of major depression and examined their screening properties in a longitudinal study of 479 adolescent girls. Results indicated that the most potent predictors of major depression onset included subthreshold depressive symptoms, poor school and family functioning, low parental support, bulimic symptoms, and delinquency. Classification tree analysis revealed interactions between 4 of these predictors, suggesting qualitatively different pathways to major depression. Girls with the combination of elevated depressive symptoms and poor school functioning represented the highest risk group, with a 40% incidence of major depression during the ensuing 4-year period. Results suggest that selected and indicated prevention programs should target these high-risk populations and seek to reduce these risk factors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Aging women and depression.

Practicing psychologists will increasingly have the opportunity to include older women with depression among their clients. Research on depression in older women is summarized, including rates of disorder, age of onset, symptom profiles, suicidal behavior, risk factors for depression such as physical health and social inequalities, and protective factors such as spirituality. The empirical literature about treatment of depression in older adults is presented, with special attention to psychotherapeutic approaches. Ways in which information can help mold effective service provision are enumerated. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Screening older adults for depression in primary care settings.

Primary care is a logical environment for depression recognition in older adults. Most older adults are diagnosed and treated for depression by primary care providers. Recognition systems for depression in this setting are particularly needed because the prevalence of depression in older primary care patients may range from 7% to 36%, depending on the instrument and diagnostic criteria used. Implementing systematic detection systems in primary care settings has proven difficult. In one study, only one third of all physicians surveyed used any formal screening tool. Though a number of barriers to recognition of depression have been identified, the authors focus their discussion in this article on two, time and patient factors, and review two screening instruments, the Geriatric Depression Scale--Short Form and the Center for Epidemiologic Studies Depression Scale, that may be able to address these factors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Screening calcaneal ultrasound and risk factors for osteoporosis among lesbians and heterosexual women

We compared calcaneal ultrasound measurements (speed of sound [SOS], broadband ultrasound attenuation [BUA], and stiffness index [SI]) of lesbian and heterosexual women to examine the medical and lifestyle risk factors for osteoporosis in each group. This was an exploratory, community-based, cross-sectional study. Subjects were mailed food frequency, health, and physical activity questionnaires. Weight, height, and calcaneal ultrasound measurements were taken at one office visit. In communities in southern and eastern Maine, 71 lesbians and 77 heterosexual women between the ages of 30 and 50 with regular menses and in good general health were the subjects. Statistical analysis used t-tests and chi-square tests to evaluate differences between study groups. Linear regression models were used to evaluate risk factors for low calcaneal ultrasound measurements. There were no differences between the lesbian and heterosexual women in age, body mass index (BMI), exercise, calcium intake, alcohol use, or calcaneal ultrasound measurements. There was a positive association between BUA and both BMI and alcohol consumption (p < 0.01). Antidepressant use significantly reduced SOS and SI (p < 0.05). There were no differences in calcaneal ultrasound measurements between lesbian and heterosexual women. BMI was strongly and positively associated with BUA. Antidepressant use in both populations was associated with a significant reduction in calcaneal bone mass. Studies are needed to define the relationship of depression and its treatment to bone mineral density and the future risk of osteoporosis.     

Depressive symptoms and risk factors for HIV acquisition among black women attending urban health centers in Baltimore

Blacks comprise 55% of all AIDS cases among women, and have 9 times the risk of white women of mortality from AIDS. Thus, prevention of HIV infection is critical among black women. Programs to prevent HIV infection have focused upon the adoption of behavioral strategies such as limiting the number of sexual partners, avoiding intercourse with i.v. drug users, and using condoms. However, such programs are dependent upon the ability of the woman to assume responsibility for her health and successfully adopt behavior changes. Generally overlooked in the development of health education interventions are those factors, such as depressive symptoms, which may make it very difficult for an individual to adopt healthy behaviors. In the present study, an analysis was conducted of the association between depressive symptoms and risk factors for the acquisition of HIV infection among black women using two urban health centers. Those women with higher levels of depressive symptoms were significantly more likely than other women to report more risk factors for HIV acquisition. The implications of these findings for the development of preventive interventions are discussed.     

Mode-specific effects among three treatments for depression.

In the NIMH Treatment of Depression Collaborative Research Program (TDCRP), 250 depressed outpatients were randomly assigned to interpersonal psychotherapy, cognitive–behavioral therapy, imipramine plus clinical management, or pill placebo plus clinical management treatments. Although all treatments demonstrated significant symptom reduction with few differences in general outcomes, an important question concerned possible effects specific to each treatment. The therapies differ in rationale and procedures, suggesting that mode-specific effects may differ among treatments, each of which was precisely specified, applied appropriately, and shown to be discriminable. Outcome measures were selected for presumed sensitivity to the different treatments. Findings provided only scattered and relatively insubstantial support for mode-specific differences. None of the therapies produced consistent effects on measures related to its theoretical origins. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Childhood sexual abuse and sexual risk behavior among men and women attending a sexually transmitted disease clinic.

Childhood sexual abuse (CSA) is associated with a wide range of negative outcomes. The authors investigated the relation between CSA and sexual risk behavior in 827 patients recruited from a sexually transmitted disease (STD) clinic. Overall, CSA was reported by 53% of women and 49% of men and was associated with greater sexual risk behavior, including more sexual partners, unprotected sex, and sex trading. Alcohol use for men and drug use for women mediated the relation between CSA and the number of sexual partners in the past 3 months; intimate partner violence mediated the relation between CSA and the number of episodes of unprotected sex in the past 3 months for women. These results document the prevalence of CSA among patients seeking care for an STD and can be used to tailor sexual risk reduction programs for individuals who were sexually abused. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Electroconvulsive therapy: a guide for family physicians

Electroconvulsive therapy, which works by creating a generalized seizure, is used most frequently to treat medication-resistant depression. Other indications for electroconvulsive therapy includes severe depression with suicidal ideation, acute mania and severe psychiatric illness with food and fluid refusal. Electroconvulsive therapy may be administered as an inpatient or outpatient procedure. Treatments are usually administered three times a week for six to 12 treatments. Before this therapy is used, a thorough medical and anesthetic history should be obtained, and a complete physical examination, an electrocardiogram and appropriate laboratory studies should be performed to rule out anemia, electrolyte imbalances, and cardiopulmonary and neurologic risk factors. Heart rate and rhythm, oxygenation, blood pressure and, often, the electroencephalogram are monitored continuously while the patient is anesthetized with a short-acting hypnotic agent and a muscle depolarizing agent. After electroconvulsive therapy, antidepressant or lithium therapy significantly reduces the symptom relapse rate.     

Convergence among multiple methods of measuring positivity and negativity in the family environment: Relation to depression in mothers and their children.

The present study addressed the following questions: (a) To what extent do different methods of measuring the family environment converge onto a single latent construct? (b) How are the constructs of positive and of negative family environment related? (c) Do the associations among various methods of measuring the family environment differ as a function of children's gender or of risk? and (d) How are the latent constructs of family environment related to depression in mothers and their children? Participants were 240 children (mean age = 11.86 years, SD = 0.57) and their mothers, who varied with regard to their history of depression. Family environment was measured with self-report questionnaires completed separately by mothers and by children, observations of mother-child interactions, and a 5-min speech sample of each mother talking about her child. Confirmatory factor analyses revealed that different methods for assessment of the family environment converged and that the constructs of positive and of negative family environments were significantly related to each other and to depression in both mothers and their children. These findings may help inform future intervention efforts by highlighting specific parenting dimensions that are strongly associated with maternal and with child depression. (PsycINFO Database Record (c) 2010 APA, all rights reserved)