ISSN:0033-3174    

出版商:OVID    

年代:1998

数据来源: OVID

ISSN:0033-3174    

出版商:OVID    

年代:1998

数据来源: OVID

ISSN:0033-3174    

出版商:OVID    

年代:1998

数据来源: OVID

ISSN:0033-3174    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

ObjectiveThis report estimates the treatment costs, cost-offset effects, and cost-effectiveness of Collaborative Care of depressive illness in primary care.Study DesignTreatment costs, cost-offset effects, and cost-effectiveness were assessed in two randomized, controlled trials. In the first randomized trial (N = 217), consulting psychiatrists provided enhanced management of pharmacotherapy and brief psychoeducational interventions to enhance adherence. In the second randomized trial (N = 153), Collaborative Care was implemented through brief cognitive-behavioral therapy and enhanced patient education. Consulting psychologists provided brief psychotherapy supplemented by educational materials and enhanced pharmacotherapy management.ResultsCollaborative Care increased the costs of treating depression largely because of the extra visits required to provide the interventions. There was a modest cost offset due to reduced use of specialty mental health services among Collaborative Care patients, but costs of ambulatory medical care services did not differ significantly between the intervention and control groups. Among patients with major depression there was a modest increase in cost-effectiveness. The cost per patient successfully treated was lower for Collaborative Care than for Usual Care patients. For patients with minor depression, Collaborative Care was more costly and not more cost-effective than Usual Care.ConclusionsCollaborative Care increased depression treatment costs and improved the cost-effectiveness of treatment for patients with major depression. A cost offset in specialty mental health costs, but not medical care costs, was observed. Collaborative Care may provide a means of increasing the value of treatment services for major depression.

ISSN:0033-3174    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

ObjectiveWomen have consistently been shown to report greater numbers of physical symptoms. Our aim in this study was to assess gender differences for specific symptoms and to assess how much of these differences were attributable to psychiatric comorbidity.MethodData from the PRIME-MD 1000 study (1000 patients from four primary care sites evaluated with the Primary Care Evaluation of Mental Disorders interview) were analyzed to determine gender differences in the reporting of 13 common physical symptoms. The effect of gender on symptom reporting was assessed by multivariate analysis, adjusting for depressive and anxiety disorders as well as age, race, education, and medical comorbidity.ResultsAll symptoms except one were reported more commonly by women, with the adjusted odds ratios (typically in the 1.5-2.5 range) showing statistically significant differences for 10 of 13 symptoms. Somatoform (ie, physically unexplained) symptoms were also more frequent in women. Although depressive and anxiety disorders were the strongest correlate of symptom reporting, gender had an independent effect that persisted even after adjusting for psychiatric comorbidity. Gender was the most important demographic factor associated with symptom reporting, followed by education.ConclusionsMost physical symptoms are typically reported at least 50% more often by women than by men. Although mental disorders are also more prevalent in women, gender influences symptom reporting in patients whether or not there is psychiatric comorbidity.

ISSN:0033-3174    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

ObjectivePast organ donation research has studied attitudes toward donation, predictors of signing donor cards, and distinguishing characteristics of donors vs. nondonors. The current study is the first to examine predictors of family members's satisfaction with the decision to consent or refuse donation of a dying loved one's organs or tissue.MethodThis study surveyed 225 family members who had been approached to donate the organs or tissue of a dying loved one. Participants were surveyed about demographic characteristics, medical/hospital factors, previous knowledge of transplantation, the request process, religion, and characteristics of the deceased and of the recipient. Discriminant analyses were conducted to characterize four specific groups: a) donors who would donate again; b) donors who would not donate again; c) nondonors who would now donate; and d) nondonors who still would not donate.ResultsThree significant discriminant functions emerged, discriminating donors from nondonors, those who were satisfied with their decision from those who were not, and people who would now donate from those who would not. Donation was predicted by formal education, being married, volunteerism, signing donor cards, and having personal conversations about donation. Subsequent satisfaction was predicted by comfort and confidence during the decision-making process, familiarity with medical center, and understanding of brain death. A willingness to now donate was predicted by personal discussions about donation.ConclusionsPeople should be encouraged not only to sign donor cards, but to have discussions with family about wishes. Individuals should be encouraged to seek the help of family and friends during the decision, and be aware of the need of social support from family and friends during and after the decision.

ISSN:0033-3174    

出版商:OVID    

年代:1998

数据来源: OVID

ISSN:0033-3174    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

ObjectiveThe purpose of this investigation is to test whether related bone marrow donors experience more distress from marrow donation than volunteer unrelated donors.MethodParticipants in the study were 77 related and unrelated marrow donors who agreed to complete 11 pre- and 8 postdonation self report questionnaires. Related and unrelated donors were recruited from the Bone Marrow Transplant Programs at the Brigham and Women's Hospital and the Massachusetts General Hospital in Boston, MA. Additional unrelated donors were recruited from the American Red Cross-Carolinas and the Heart of America Bone Marrow Donor Registry in Kansas City, MO.ResultsThe 41 unrelated and 36 related marrow donors who participated in this prospective study had similar demographic backgrounds and predonation questionnaire results, although related donors endorsed more items on the Beck Depression Inventory, both before and after marrow harvesting. After marrow donation, related donors reported significantly more pain than unrelated donors (p = .0001).ConclusionsIt is unlikely that intraoperative events alone could account for the increased pain experienced by related donors. Related donors were more likely to experience moderate to severe physical pain after marrow donation than unrelated donors, on the basis of logistic regression analysis (odds ratio = 7.63; 95% confidence interval 2.74, 23.01).

ISSN:0033-3174    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

ObjectiveSeveral authors have suggested that patients adjust more poorly to breast cancer if they are heavily invested in body image as a source of their sense of self-worth. This prospective study examined this possibility, looking at two aspects of concern about body image as predictors of several indices of adjustment over the first postoperative year.MethodsAt diagnosis (and again a year later) 66 women with early stage breast cancer reported how much they valued a) a sense of body integrity (or intactness) and b) a good physical appearance. The day before surgery, a week afterward, and at 3-month, 6-month, and 12-month follow-ups, they reported on their mood. At presurgery and at follow-ups they also rated their attractiveness and sexual desirability and reported on frequency of sexual interaction. At follow-ups they also indicated how much their illness and treatment were interfering with social and recreational activities.ResultsInitial investment in appearance was related to distress across the postsurgical year. In contrast, investment in appearance made women more resilient against deterioration in their perceptions of attractiveness. Concern about body integrity did not strongly predict emotional distress, but it related to adverse impact on social and recreational activities in the follow-up period, to deterioration in feelings of sexual desirability, and to feelings of alienation from the self (feeling "not like yourself anymore").ConclusionsBody image is often thought of in terms of physical appearance, but there is also a body image pertaining to integrity, wholeness, and normal functioning. People who are greatly concerned about either aspect of their body image are vulnerable to poorer psychosocial adjustment when confronting treatment for breast cancer. The poorer adjustment takes a different form, however, depending on the nature of the patient's body-image concern.

ISSN:0033-3174    

出版商:OVID    

年代:1998

数据来源: OVID