bluuebunny/crossref_metadata_2025_split huggingface dataset:
Mental Health Problems in Primary Care: A Research Agenda
Authors: Klinkman Michael S. , Okkes Inge 
Published: May 2005

Purpose: The NAPCRG Task Force on Mental Health Problems was commissioned to explore critical research and policy issues in mental health and to develop a primary care research agenda for review and action by NAPCRG. This “White Paper” presents the key findings and recommendations of the Task Force. Methods: A comprehensive review of the primary care mental health literature, using MEDLINE searches with manual follow up, and personal communications with many active researchers in the field were performed by the authors; Task Force members participated in the editing and refinement of the White Paper in a series of email and face-to-face meetings. Summary and Conclusions: Although primary care researchers have made major contributions to our growing understanding of mental health problems as they exist in the “real world” of primary care, rapid changes in the U.S. health care environment threaten to undo the integration of mental and physical health that is at the heart of primary care. It will be necessary for the primary care leaders in this field to step forward to guide policy-makers, purchasers, and the public as primary care is reengineered for the next generation. Efforts to operationalize episode of care and comorbidity recording with EMR systems, particularly in cooperation with managed care corporations and/or primary care research networks, may represent the most effective strategy for promoting the integration of mental health services into primary care. The most promising area for research in the immediate future may be descriptive studies that capture and explore the clinical epidemiology of common mental health problems as they occur in routine practice.
The Relationship between Attendance at Religious Services and Cardiovascular Inflammatory Markers
Authors: King Dana E. , Mainous Arch G. , Steyer Terrence E. , Pearson William 
Published: May 2005

Objective: Previous studies have shown an association between attendance at religious services and health, particularly cardiovascular morbidity and mortality. Little research has focused on religious attendance and physiological markers of cardiovascular risk. The purpose of this study was to explore the relationship between religious attendance and inflammatory markers of cardiovascular risk. Method: Nationally representative sample of non-institutionalized United States adults aged 40 and over derived from the National Health and Nutrition Examination Survey III 1988–1994 ( n = 10,059). The main outcome measures were the inflammatory system markers C-reactive protein, fibrinogen, and white blood cell count. Results: 40.8 percent of the population attended religious services 40 or more times in the previous year while 22.4 percent attended services less than 40 times and 36.8 percent attended no religious services at all. Non-attenders of religious services were more likely than attenders to have elevated white blood cell counts ( p = .001), highly elevated C-reactive protein ( p = .02), and elevated fibronogen ( p = .05). After adjusting for demographic variables, health status, and BMI, the association between religious attendance and cardiovascular markers remained. Once current smoking was added to the model the independent effect of religious attendance dropped below conventional confidence limits. Conclusions: These findings suggest that people who have attended religious services in the previous year are less likely to have elevated levels of certain inflammatory markers, however, current smoking has significant shared variance with religious attendance.
Psychoneuroimmunological Aspects of Disease Progression among Women with Human Papilloma Virus-Associated Cervical Dysplasia and Human Immunodeficiency Virus Type 1 Co-Infection
Authors: Goodkin Karl , Antoni Michael H. , Helder Lynne , Sevin Bernd 
Published: May 2005

Objective: Psychosocial associations have been observed with level of cervical dysplasia or “pre-cancer” and invasive cervical cancer [related to human papillomavirus (HPV) infection]. Psychoneuroimmunological relationships have been observed in human immunodeficiency virus type 1 (HIV-1) infection, which is being described in an increasing number of women. Our objective was to review these relationships regarding effects that might be expected in HIV-1 and HPV co-infected women. Method: This review was based on a Medline literature search supplemented by a manual search of selected journals unrepresented in that database. Results: Relationships of psychosocial factors and level of cervical dysplasia were similarly observed with reference to immunological and health status in asymptomatic and early symptomatic HIV-1 infected homosexual men, suggesting that a potentiating effect may occur in HIV-1 and HPV co-infected women. Consistency of relationships across studies appeared to be enhanced by the use of a biopsychosocial model integrating the effects of life stressors, social support and coping style as well as psychiatric disorders. Conclusions: Research is indicated on the relationships between psychosocial factors, immunological status and clinical health status in this group of women. Because of the high prevalence of psychosocial risk factors for chronic psychological distress in these women and the known immunological and health status decrements occurring with progression of these two infections, a clinical screening program based on the biopsychosocial model is recommended as a means of secondary prevention. If effective in generating treatment referrals, such a program would likely improve quality of life and could aid in the determination of relationships with immunological and health status as well.
Health and Labor-Power: A Theoretical Investigation
Authors: Schatzkin Arthur 
Published: May 2005

In this historical materialist analysis of health and medical care, health is defined as a component of labor-power (capacity to work). Investment in health, including provision of medical services, represents part of the cost of maintaining the labor force. The primary determinant of the level of health and medical care under capitalism is the tendency toward maximization of the rate of exploitation. The absolute level of health and medical care tends to decline as unemployment rises and individual workers become more “replaceable.” Health differentials by socioeconomic status are similarly explained by the easier replacement of lesser-skilled workers. Medical care services in the context of the capitalist system constitute a drain on surplus-value. In periods of economic decline, attempts are made to conserve surplus-value through reductions in medical services (“social wages”). Institutional and ideological racism yields additional surplus-value savings and weakens public resistance to medical care retrenchment. The profits of health-related industries are shown to be merely partially recouped surplus-value losses. The social epidemiology of capitalism has been characterized as social murder. “Public health” measures appropriate to this systemic pathology are suggested.
Resolution of Depressive Symptoms in Medical Inpatients after Discharge
Authors: Pomerantz Andrew S. , De Nesnera Alexander , West Alan N. 
Published: May 2005

Objective: Most studies to date demonstrate a high prevalence of depressive symptoms and depressive disorders in general medical inpatients. In order to determine whether these symptoms represent a self limited epiphenomenon of medical illness or evidence of psychiatric comorbidity, assessment of the natural history of such symptoms in this population is necessary. In this study we focused on resolution versus persistence of depressive symptoms in hospitalized medical patients following medical, but not psychiatric, treatment. Method: Every second admission to the acute care medical ward of a VA teaching hospital was assessed for inclusion in the study. Fifty-seven were screened, fifty participated initially, forty-two remained in the study for the one-week post-discharge follow-up, and thirty-three remained at the one-month follow-up. Depressive symptomatology was measured with the Beck Depression Inventory at each time point. Subjects whose scores at follow-ups were above threshold were considered to have persistent symptoms and those whose scores fell below threshold were considered to have resolved. No patients were treated with antidepressants prior to or during the study. Results: With a conventionally accepted threshold score (14) on the BDI as representing clinically significant depression, roughly half of those patients identified as depressed at the time of admission were nondepressed at both follow-ups. The BDI predicted persistence of depression with a sensitivity of .64 and specificity of .74 at one week and .71 and .73 at one month. Raising the threshold score to 20 raised the sensitivity to 1.00 and the specificity to .95 at one week and 1.00 and .93 at one month. Conclusions: Depressive symptoms seen in acutely-ill medical patients can be expected to resolve without potentially-hazardous antidepressant treatment in a significant number of patients. Persistence of depressive symptoms may be better predicted by raising the threshold on commonly used self-report scales.
A Paradigm of Educational Change: Major Factors in Renewal and Change
Authors: Simonds Richard S. 
Published: May 2005

The rate and direction of educational change are major concerns throughout the literature on educational change. The lack of a broad-based, comprehensive model has further been identified. The purpose of this paper has been to integrate a variety of models and paradigms of educational change into one comprehensive model/paradigm. To do this the literature of management information systems, system analysis and synthesis, management science, and the behavioral sciences was reviewed and a search for compatible data elements was made. From this search and comparison came the generic paradigm presented in this paper. The paradigm is basically a “linking model,” with influence to be seen from a variety of other disciplines, as mentioned above. Components of this paradigm which make it somewhat unique are: community involvement, “temporary systems,” force-field analysis, forcing function, professional education, and computer managed and client assisted change. These concepts have existed independently in the literature, and are brought together in this paradigm as a holistic approach toward change. The significance of and need for a system approach to educational change is emphasized in this paradigm, and the computer-based change process is inherent in managing change.
A Review of the Differences between Somatizing and Psychologizing Patients in Primary Care
Authors: Garcia-Campayo J. , Sanz-Carrillo C. 
Published: May 2005

Objective: This article reviews all published studies on somatizing and psychologizing patients in primary care, according to Bridges and Goldberg's criteria [1]. Method: A review of the Medline base from 1985 to 1998 was carried out. Results: Somatization is a concept valid, reliable, and stable over time. There are no differences between somatizers and psychologizers in sociodemographics, social problems or past medical and psychiatric history. The main clinical and diagnostic difference is a predominance of depressive symptoms and disorders in psychologizers. Finally, the most remarkable differences between somatizers and psychologizers are found in personality traits, such as attribution of somatic symptoms. However, some traits considered important in the outcome of somatizers, such as hypochondriasis or locus of control, show no differences between both groups of patients. Conclusion: Contrary to what was expected, the comparison between these two groups of patients give few clues for the etiology and treatment of somatization. Follow-up studies should be the main source of data to answer these questions.
The Clinical Applications of Mini-Mental State Examination in Geropsychiatric Inpatients
Authors: Yang Cheng-Hung , Hwang Jen-Ping , Tsai Shih-Jen , Liu Chin-Ming 
Published: May 2005

Objective: This study investigated the association between Mini-Mental State Examination (MMSE) scores and diagnosis, computerized tomographic scans or electroencephalogram findings in geropsychiatric inpatients (age 65). Method: We analyzed the MMSE records of patients sixty-five and older who had been hospitalized in our psychiatric ward during a nine-year period. Case data were collected by review of chart records. Results: In these patients, MMSE scores were significantly different among the seven diagnostic groups included. Demented patients had the lowest MMSE scores. Patients who had abnormal findings on computerized tomographic scans or electroencephalogram had lower MMSE than patients with normal findings. Conclusion: Our findings suggest that the MMSE is a useful screening instrument for organicity in the geropsychiatric inpatients. However, because of the lower average MMSE score in geropsychiatric inpatients, the optimal cut-off point of MMSE for dementia should be lower than those used in other populations.
Wernicke's Disease and Schizophrenia: A Case Report and Review of the Literature
Authors: Casanova Manuel F. 
Published: May 2005

Objectives: A review of the neuropathology literature in schizophrenia suggests that some patients with this disease exhibit periventricular gliosis at postmortem examination. Several researchers have speculated that this finding is the remnant of either a prior viral infection or a gestational intraventricular hemorrhage. The present article uses a case report to hypothesize and discuss an alternate possibility to the putative gliosis, namely Wernicke's disease. Method: Based on the pathological findings of our patient and a review of the literature, the author summarizes several reasons why Wernicke's disease may occur, and still be unnoticed, in some schizophrenic patients. Results: Inefficient self-care and homelessness predisposes some patients with schizophrenia to poor dietary habits and malnutrition. Similarly, the high prevalence of concurrent alcoholism in patients with schizophrenia may propitiate thiamine deficiency. The resulting brain insult may be compounded by disturbances of carbohydrate metabolism which may be peculiar to the schizophrenic process itself, or acquired, as in coincidental diabetes. Conclusions: Since symptoms accrued to Wernicke's may often be subtle and obscured by other schizophreniform manifestations, clinicians should lower their threshold for suspecting this potentially fatal complication. The diagnostic possibility of Wernicke's should be especially entertained in schizophrenic patients who are alcoholics and/or diabetics.
Psychiatric Consultations in Medical Outpatients with Abdominal Pain: Patient and Physician Effects
Authors: Meeuwesen Ludwien , Huyse Frits J. , Meiland Franka J. M. , Koopmans Gerrit T. , Donker Ab J. M. 
Published: May 2005

Objective: The purpose of the study was to assess the effect of a psychiatric consultation intervention in terms of changes in 1) the patients' psychological symptoms, and 2) satisfaction of general practitioners (GPs) concerning their cooperation with the internists. Method: In a randomized controlled design, the effect of a psychiatric consultation intervention in medical outpatients with abdominal pain ( n = 106) has been assessed. The goal of the intervention was 1) a holistic approach toward the patients' symptoms, and 2) the improvement of the cooperation between primary and secondary medical health services. The intervention was designed at the health care provider level; the psychiatrist did not see or examine the patient. The 106 patients were subdivided in an index group ( N = 49) and a control group ( N = 57). The major outcome measures were the psychological status of the patient and degree of satisfaction of the GPs about the cooperation with the medical specialists. Results: At six months follow-up, there was a significantly greater decline in depressive symptoms assessed by SCL-90 in the patient index group compared with the control group. The GPs of the index group were significantly more satisfied with the cooperation and communication with the internists compared with the control group. Conclusions: An experimental psychiatric consultation intervention did effect the patients' well-being to a certain degree, and especially the GPs were affected in terms of satisfaction. The relevance of improving the communication between health care providers in the management of somatizing patients is discussed.
The Patient-Doctor Relationship and Metabolic Control in Patients with Type 1 (Insulin-Dependent) Diabetes Mellitus
Authors: Viinamäki Heimo , Niskanen Leo , Korhonen Timo , Tähkä Veikko 
Published: May 2005

Objective: Our hypothesis was that patient-doctor relationship experienced positively by the patient is associated with adequate compliance behavior and thus to the long-term metabolic control of diabetes. Method: Cross-sectional study of 100 consecutive adult patients with Type 1 diabetes treated in a diabetes out-patient department. From a questionnaire, four scores (direct estimate of physician, satisfaction with the place of treatment, self-esteem score, security with the patient-doctor relationship) determining the patient-doctor relationship were formed. In score 3 (self-esteem score) the impact of the patient-doctor relationship to the patients' self-esteem was indirectly estimated. The anonymous data taken from diabetes register including information about treatment of diabetes, metabolic control and end-organ complications were returned together with the questionnaire. On the basis of GHbA1c diabetic patients were divided into two groups: with adequate metabolic control (GHbA1c ⩽ 8.0%) or with poor/moderate control (GHbA1c > 8.0%). Results: In univariate analyses the score 3 associated with metabolic control ( p < 0.001). In logistic regression analyses the nephropathy ( t = 2.80, p < 0.05) and score 3 ( t = 3.98, p < 0.001) were associated with metabolic control. Conclusion: Patient's positively-experienced patient-doctor relationship was associated with good metabolic control of diabetes.
Long-Term Glue Sniffing: Report of Six Cases
Authors: Shu Li-Ren , Tsai Shih-Jen 
Published: May 2005

Objective: Glue is cheap and readily available, and is frequently misused, especially by adolescents. Long-term effects of regular use, in terms of the psychiatric symptoms and cognitive function, have rarely been reported, however. Method: We retrospectively reviewed the psychiatric symptoms and the results of cognitive tests for six long-term glue sniffers admitted to a psychiatric ward. Results: Our results suggest that long-term abuse of these adhesive products is often associated with violent behavior and/or self-mutilation. Functional deterioration, characterized by impairment of intelligence, was noted for most of the patients, with some developing psychosis. Conclusions: Chronic glue sniffing may cause functional deterioration, and even psychosis. The associated violent behaviors in long-term glue sniffers also warrant caution.
Cross-Sectional Psychometric Assessment of the Functional Status Questionnaire: Use with Geriatric versus Nongeriatric Ambulatory Medical Patients
Authors: Yarnold Paul R. , Stille F. Conrad , Martin Gary J. 
Published: May 2005

Objective: The Beth Israel/UCLA Functional Status Questionnaire (FSQ) is a multidimensional self-report instrument used for assessing the physical, social, and psychological status of children and adults. This study assessed the appropriateness of the FSQ for use with geriatric (at least 65 years of age) ambulatory medical patients. Method: Concurrent cohort convenience samples of forty geriatric and eighty-five nongeriatric ambulatory patients were drawn from a general internal medicine clinic. Patients completed the FSQ while waiting to see their physician. Analyses were conducted in order to: 1) address the magnitude and pattern of missing responses that are generated when the FSQ is administered to small groups; 2) assess whether, as was intended, each of the different FSQ subscales is unidimensional; 3) evaluate the magnitude and pattern of variances and covariances of items constituting FSQ subscales; 4) compare profiles of FSQ scores between geriatric versus nongeriatric samples; and 5) investigate whether FSQ subscales correlate with different self-report outcome measures in a convergent or divergent manner. Results: For both samples, FSQ subscales were internally consistent and moderately variable. Cross-sectional comparisons revealed both convergent and divergent relationships between FSQ subscales and measures of social support and satisfaction with health. Conclusions: The FSQ appears to be appropriate for use with geriatric ambulatory medical patients. Findings highlighted the positive influence of intermediate activities of daily life—involving moderate levels of physical activity—on satisfaction with health, and the negative effect of depression on physical activity.
Yoruba Disease Classifications for Planning in Health Care
Authors: Brieger William R. , Ramakrishna Jayashree , Adeniyi Joshua D. 
Published: May 2005

An understanding of local concepts of illness and disease that underlie disease classification systems is essential for designing culturally relevant training programs in primary health care. Prior to training personnel in primary health care in Idere, Nigeria, residents were interviewed revealing that two main groups of disease exist. Generally, arun is serious, chronic and contagious, while aisan represents temporary indispositions. When given seventeen conditions to classify, respondents clearly demarked five as arun and five as aisan while the remainder fell in a grey area in between. Ironically, malaria which is a dangerous disease to young children, was classified as aisan. The disease classification system is being used as a general point of departure for discussion during training. Concerning training on the specific diseases, appropriate ideas are reinforced while others are modified all within the context of the local classification system.
Developing an Instructional Workstation
Authors: Doss David , Rhodes Dent M. 
Published: May 2005

A computer-based instructional workstation (IWS) is a means to: 1) integrate computer, video, and optical data storage technology into a single instructional system, 2) enable students to learn how to manage information and resolve problems by using the new technology available to them, and 3) help preservice and inservice teachers learn how to use these forms of technology to teach subject matter and information management skills. This workstation is a “problem-centered, information management” instructional system, suitable for individuals or small groups. It combines a microcomputer; video tape, video disc, and CD-ROM players; a video camera; and a printer with productivity, educational, and custom-designed software. An instructional workstation enables teachers and media specialists to focus on educational intents, processes and outcomes without the restrictions of discrete technologies. The system is flexible enough to provide multiple options in task selection, information presentation, and performance evaluation.