Medical comorbidity of major depressive disorder in a primary medical practice

Article Abstract:

Major depression occurs in 6 to 9 percent of patients in primary care. In spite of this high frequency, only a minority of these patients are diagnosed correctly by their physicians, partly because in some cases the patients do not report mood or emotional symptoms. In addition, some diseases cause depression, as do many commonly prescribed drugs. The disorder is difficult to treat because of the relationship between the disease and the depression, and also because seriously ill patients are often unable to tolerate antidepressant medications. In order to determine the relationship between major depressive disorder (MDD) and physical illness, 618 clinic patients were tested. Forty-one (6.6 percent) were found to be suffering from MDD, a rate that is similar to those found in other studies. The depressed patients in this study were found to be sicker than nondepressed patients, although they were, on average, several years younger. Those who had been correctly diagnosed by their physicians had less severe physical illnesses, perhaps because depression was easier to notice when there was less ''contamination'' from medical disorders. Patients with MDD were far more likely to suffer from malignant tumors (10 percent) than the nondepressed group (1 percent), but there were differences in the prevalence of other medical conditions. Depressed patients were more likely to be diagnosed with ''unexplained'' symptoms, which were actually symptoms of depression that the physicians failed to diagnose correctly. The excess of medical illness among depressed patients could be a result of being sick, but with the exception of cancer, the diseases were present equally frequently among nondepressed patients. Symptoms may be more severe among depressed patients because of the interaction between psychological and physical symptoms. It is also possible that depression was caused by the medications that the patients were taking. However, nondepressed patients were equally likely to be taking these medications. The study raises complex questions about cause and effect in the relationship between mental and physical illness. (Consumer Summary produced by Reliance Medical Information, Inc.)

Psychological aspects, Depression, Mental, Depression (Mood disorder), Sick, Sick persons

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Wood-burning stoves and lower respiratory tract infection in American Indian children

Article Abstract:

Lower respiratory tract infections, such as bronchiolitis, pneumonia, and asthma, are a major source of illness and death in young children and are frequently precursors to chronic lung disease. Navajo and Hopi Indians, living on Arizona reservations, often use wood-burning stoves as a source of heat. A study was conducted to determine if wood-burning stoves are associated with an increased risk of lower respiratory tract infections in these children. Fifty-eight children, aged 2 weeks to 24 months, who had bronchiolitis or pneumonia were assessed. The results were compared with data from a matched control group of 58 healthy children. In the study group, 84 percent had wood-burning stoves in their home compared with 57 percent in the control group. In 36 percent of paired subjects, the study subject's family used the wood-burning stove as the primary heating source and the control subject's family did not. The mothers of significantly more study subjects than control subjects reported recent respiratory illness in other children in the home. Study children were also more likely to have a history of asthma. The rate of lower respiratory tract infections was also higher among children in homes with dirt floors and without running water. These results indicate that Southwestern American Indian children living in homes heated with wood-burning stoves have an increased risk of lower respiratory tract infections. (Consumer Summary produced by Reliance Medical Information, Inc.)

Infection, Environmental aspects, Diseases, Native Americans, Native North Americans, Respiratory system, Stoves, Wood, Wood stoves, Pediatric respiratory diseases, Respiratory organs

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The effect of full-time faculty hospitalists on the efficiency of care at a community teaching hospital

Article Abstract:

The use of hospitalists may improve the care of hospital patients and lead to shorter hospital stays and reduced health care costs. Hospitalists are physicians who work full-time in a hospital and care for the patients admitted to the hospital by the primary care physicians in the community. Researchers studied the effect of hospitalists for one year after a group of primary care physicians agreed to have their hospitalized patients cared for by hospitalists. Compared to the year before, when the primary care physicians cared for their own hospitalized patients, hospital stays, costs and re-admission rates were lower.

Care and treatment, Analysis, Evaluation, Medical care, Cost of, Health care costs, Hospital patients, Internists

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