Potentially modifiable factors associated with disability among people with diabetes.

Objective: This article seeks to identify potentially modifiable factors associated with disability among people with diabetes.

Study Design And Setting: Among people with diabetes (N = 4357) in a large health maintenance organization, disease severity, psychologic and behavioral risk factors for disability were assessed. Disability was evaluated by the WHO Disability Assessment Scale (WHO-DAS-II), the SF-36 Social Functioning scale, and days of reduced household work.

Who benefits from more structured depression treatment?

Objective: This article uses data from two studies that have demonstrated the overall effectiveness of Collaborative Care interventions to evaluate factors associated with poor outcomes overall (general prognostic factors) and factors associated with greater or lesser effects of treatment (differential treatment effects).

Methods: Adult primary care patients initiating antidepressant treatment for major depression were randomized to usual care or to Collaborative Care, a structured depression treatment program that included planned, proactive and coordinated care with a health care team and informed, activated patients (n = 156, mean age = 43, 85% white). Response to treatment was defined as a 50% or greater reduction in depression at four months.

Relationship of depression and diabetes self-care, medication adherence, and preventive care.

Objective: We assessed whether diabetes self-care, medication adherence, and use of preventive services were associated with depressive illness.

Research Design And Methods: In a large health maintenance organization, 4,463 patients with diabetes completed a questionnaire assessing self-care, diabetes monitoring, and depression. Automated diagnostic, laboratory, and pharmacy data were used to assess glycemic control, medication adherence, and preventive services.

Use of a respiratory clinical score among different providers.

Respiratory assessment of children with asthma or bronchiolitis is problematic because both the components of the assessment and their relative importance vary among care providers. Use of a systematic standard assessment process and clinical score may reduce interobserver variation. Our objective was to determine observer agreement among physicians (MD), nurses (RN), and respiratory therapists (RT), using a standard respiratory clinical score.

Effect of breast augmentation on the accuracy of mammography and cancer characteristics.

Context: Breast augmentation is not associated with an increased risk of breast cancer; however, implants may interfere with the detection of breast cancer thereby delaying cancer diagnosis in women with augmentation.

Objective: To determine whether mammography accuracy and tumor characteristics are different for women with and without augmentation.

Design, Setting, And Participants: A prospective cohort of 137 women with augmentation and 685 women without augmentation diagnosed with breast cancer between January 1, 1995, and October 15, 2002, matched (1:5) by age, race/ethnicity, previous mammography screening, and mammography registry, and 10 533 women with augmentation and 974 915 women without augmentation and without breast cancer among 7 mammography registries in Denver, Colo; Lebanon, NH; Albuquerque, NM; Chapel Hill, NC; San Francisco, Calif; Seattle, Wash; and Burlington, Vt.

Clinical and sociodemographic factors associated with colon surveillance among patients with a history of colorectal cancer.

Background: Substantial variability in the use of colon surveillance among colorectal cancer survivors has been reported. This study sought to examine trends in the use of colon surveillance among patients who have had colorectal cancer and to investigate factors associated with utilization.

Methods: Health maintenance organization enrollees with a diagnosis of local or regional colon or rectal cancer between January 1993 and December 1999 were studied.

Effect on disability outcomes of a depression relapse prevention program.

Objective: This report evaluates the effects of a depression relapse prevention program on disability outcomes among patients treated for depression at high risk for relapse.

Materials And Methods: Primary care patients initiating antidepressant treatment for depression were assessed 6 to 8 weeks after the initial prescription. Patients responding to initial treatment but at high risk for relapse were randomized to usual care or a relapse prevention intervention (N= 386).

Thoracoscopic approach for spine deformities.

Background: We reviewed our experience using anterior thoracoscopic procedures in the correction of severe idiopathic scoliosis and kyphotic deformities to evaluate the feasibility and effectiveness of such procedures.

Study Design: Twenty-four patients who underwent thoracoscopic surgical correction of the spine between March 1995 and December 2001 were retrospectively reviewed. A team consisting of one orthopaedic surgeon and one thoracic surgeon performed anterior thoracoscopic soft tissue release, disc excision, and bone grafting followed on the same day with posterior instrumentation and correction of deformity.

Enhancing adherence to prevent depression relapse in primary care.

We performed a randomized trial to prevent depression relapse in primary care by evaluating intervention effects on medication attitudes and self-management of depression. Three hundred and eighty six primary care patients at high risk for recurrent depression were randomized to receive a 12-month intervention. Interviews at baseline, 3, 6, 9, and 12-months assessed attitudes about medication, confidence in managing side effects, and depression self-management.

Behavioural factors associated with symptom outcomes in a primary care-based depression prevention intervention trial.

Background: A randomized trial of a primary care-based intervention to prevent depression relapse resulted in improved adherence to long-term antidepressant medication and depression outcomes. We evaluated the effects of this intervention on behavioural processes and identified process predictors of improved depressive symptoms.

Method: Patients at high risk for depression recurrence or relapse following successful acute phase treatment (N=386) were randomly assigned to receive a low intensity 12-month intervention or continued usual care.

Estimating the accuracy of psychological scales using longitudinal data.

This article presents a method for estimating the accuracy of psychological screening scales using receiver operating characteristic curves and associated statistics. Screening scales are typically semicontinuous within a known range with distributions that are nearly symmetric when the target condition is present and highly skewed when the condition is absent. We model screening scale outcomes using truncated normal distributions that accommodate these different distributional shapes and use subject-specific random effects to adjust for multiple assessments within individuals.

Improving primary care treatment of depression among patients with diabetes mellitus: the design of the pathways study.

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.

Illness representation, coping and outcome in irritable bowel syndrome (IBS).

OBJECTIVE: Irritable bowel syndrome has no observable symptom markers and there is little that the medical profession can do to help sufferers. Psychotherapy, antidepressants and drugs aimed at the most problematic symptoms have been shown to have limited efficacy. In an attempt to help understand the illness better, and to suggest alternative forms of intervention, the study tested whether outcome might be influenced by patients' representation of their illness and by their coping strategies.

Individual and combined effects of age, breast density, and hormone replacement therapy use on the accuracy of screening mammography.

Background: The relationships among breast density, age, and use of hormone replacement therapy (HRT) in breast cancer detection have not been fully evaluated.

Objective: To determine how breast density, age, and use of HRT individually and in combination affect the accuracy of screening mammography.

Design: Prospective cohort study.

Cost-effectiveness of a program to prevent depression relapse in primary care.

Objective: Evaluate the incremental cost-effectiveness of a depression relapse prevention program in primary care.

Materials And Methods: Primary care patients initiating antidepressant treatment completed a standardized telephone assessment 6-8 weeks later. Those recovered from the current episode but at high risk for relapse (based on history of recurrent depression or dysthymia) were offered randomization to usual care or a relapse prevention intervention.

A measure for assessing patient perception of provider support for self-management of bipolar disorder.

Objectives: Health care providers have an important role in acknowledging and supporting patients' self-management of chronic illnesses such as bipolar disorder. This report describes the development and evaluation of a brief measure for assessing patient perception of providers' support for self-management of bipolar disorder.

Methods: A 10-item measure was developed combining generic items from an existing measure of providers' autonomy supportive versus controlling style with items specific to the self-management of bipolar disorder.

Screening mammography: clinical image quality and the risk of interval breast cancer.

Objective: We evaluated the association between clinical image quality and breast cancer occurrence within 24 months of a negative mammogram.

Materials And Methods: We identified women with breast cancer who were younger than 40 years old and older and screened from January 1, 1988, through December 31, 1993. We retrospectively assigned Breast Imaging Reporting and Data System (BI-RADS) assessments to their screening mammogram.

Inhibitory effects during object name retrieval: The effect of interval between prime and target on picture naming responses.

Three picture naming experiments are reported which examine the relationship between the apparent inhibition of a response on one trial, and naming latency on the subsequent trial. The design of each experiment involves the presentation of prime and target pairs, either presented in succession (Lag 1 condition), or separated by two intervening unrelated trials (Lag 3 condition). A control condition is also included.

Binge drinking among female Veterans Affairs patients: prevalence and associated risks.

This study evaluated the prevalence and associated risks of binge drinking, defined as having > or = 4 drinks on an occasion in the past year, in a female patient population. Of 1,259 female Veterans Affairs patients surveyed, 780 reported drinking alcohol in the past year, and 305 (24% of respondents, 39% of drinkers) reported binge drinking in the past year; 84 (11% of drinkers) had done so monthly or more often. Age-adjusted logistic regression analyses indicated that women who reported past-year binge drinking monthly or more often reported significantly increased odds of morning drinking (odds ratio [OR] = 40.

Cost-effectiveness of a collaborative care program for primary care patients with persistent depression.

Objective: The authors evaluated the incremental cost-effectiveness of stepped collaborative care for patients with persistent depressive symptoms after usual primary care management.

Method: Primary care patients initiating antidepressant treatment completed a standardized telephone assessment 6-8 weeks after the initial prescription. Those with persistent major depression or significant subthreshold depressive symptoms were randomly assigned to continued usual care or collaborative care.

A hierarchical regression approach to meta-analysis of diagnostic test accuracy evaluations.

An important quality of meta-analytic models for research synthesis is their ability to account for both within- and between-study variability. Currently available meta-analytic approaches for studies of diagnostic test accuracy work primarily within a fixed-effects framework. In this paper we describe a hierarchical regression model for meta-analysis of studies reporting estimates of test sensitivity and specificity.

Inhibitory effects during object name retrieval: the effect of interval between prime and target on picture naming responses.

Three picture naming experiments are reported which examine the relationship between the apparent inhibition of a response on one trial, and naming latency on the subsequent trial. The design of each experiment involves the presentation of prime and target pairs, either presented in succession (Lag 1 condition), or separated by two intervening unrelated trials (Lag 3 condition). A control condition is also included.

Effect of training with the american college of radiology breast imaging reporting and data system lexicon on mammographic interpretation skills in developing countries.

Rationale And Objectives: The authors evaluated the effect of training in the American College of Radiology (ACR) Breast Imaging Reporting and Data System (BI-RADS) lexicon on the interpretive skills of radiologists evaluating screening mammograms in Ukraine.

Materials And Methods: As part of a program to improve breast cancer detection and treatment in Ukraine, a series of training sessions was given to a group of radiologists across Ukraine to improve their interpretive skills in screening mammography. The training sessions focused on the use of the lexicon and assessment categories developed by the ACR BI-RADS committee.