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Biomedical subjects

L G Kessler

Publications and source records attributed to L G Kessler.

At least 55 records · Page 3Linked to original sources
PubMed1987

Mental health services use by elderly adults in a primary care setting.

This study examined the use of general health, mental health, and other medical specialty services by elderly persons 65 and older with mental disorders and compares them with adults 45 to 64 and 18 to 44. Data were collected at the Bunker Hill Health Center (BHHC), a Boston neighborhood health center providing a broad range of ambulatory medical and specialty mental health services. Results show that the 5-year rate of mental disorder diagnoses for elderly individuals is not significantly different from persons 45 to 64, although it is higher than the rate for young adults 18 to 44. Not only were elderly adults less likely to see a mental health specialist, but when they did, their use of mental health specialty services was usually lower.

Adult↗
PubMed1987

Psychiatric diagnoses of medical service users: evidence from the Epidemiologic Catchment Area Program.

Based on data from the five sites of the National Institute of Mental Health-sponsored Epidemiologic Catchment Area (ECA) Program, this paper examines the prevalence of psychiatric disorder among recent medical service users versus nonusers, with a particular focus on affective disorders, substance abuse/dependence, and phobias. The rate of current Diagnostic Interview Schedule (DIS) disorders among medical users in all five ECA sites is 21.7 per cent (slightly higher than general population rates) versus 16.7 per cent among nonusers; there is generally no difference between users and nonusers with past DIS diagnoses. Affective disorders were among the most common mental disorders of medical service users, especially among females, with little variation between sites: females: users: 6.9 per cent to 9.3 per cent, nonusers: 3.4 per cent to 6.4 per cent, and males: users: 3.3 per cent to 6.5 per cent, nonusers: 1.2 per cent to 4.1 per cent. Rates of phobias among persons using medical services are also higher than among nonusers. Substance abuse disorders are at least as common among persons who use medical services (8 per cent to 14 per cent of male users) as among those who do not (9 per cent to 11 per cent of male nonusers). The high rates of affective disorders among women and of substance abuse among male medical service users underscore the need to increase the ability of general medical practitioners to recognize and manage or refer these conditions.

Catchment Area, Health↗
PubMed1986

Falling rates of lung cancer in men in the United States.

Lung-cancer incidence and mortality rates in the United States were calculated for the years 1973 to 1983. The historically increasing age-adjusted rates for white men levelled off in the late 1970s and fell between 1982 and 1983. These falls were seen for white men only. Both the incidence and mortality rates for women continued to rise with no hint of a reduction.

Adult↗
PubMed1986

Estimating the probability and level of ambulatory mental health services use.

Analysis of the National Medical Care Utilization and Expenditure Survey for persons with positive out-of-pocket expenses for one or more ambulatory mental health visits indicates that demand for such visits is responsive to price, and considerably more so than demand for health visits. Income, education, and insurance coverage interact in predicting demand, and price elasticity varies across income groups.

Age Factors↗
PubMed1985

Psychiatric disorders in primary care. Results of a follow-up study.

Despite extensive documentation of high rates of psychiatric morbidity among primary care patients, there have been, to our knowledge, no US studies following up these patients over time. We analyzed data based on two administrations of the Schedule for Affective Disorders and Schizophrenia-Life-time version (SADS-L) six months apart to 166 attenders at a primary care clinic in Marshfield, Wis. In the short span between interviews, 35% of the study group exhibited at least one Research Diagnostic Criteria disorder, and almost two thirds of these individuals had significant changes in diagnostic status based on SADS-L data. Diagnosis of these transient and episodic cases by the primary care physicians was under 10%, demonstrating the need for careful evaluation of the psychiatric status of primary care patients.

Adult↗
PubMed1985

A comparative description of mitochondrial DNA differentiation in selected avian and other vertebrate genera.

Levels of mitochondrial DNA (mtDNA) sequence divergence between species within each of several avian (Anas, Aythya, Dendroica, Melospiza, and Zonotrichia) and nonavian (Lepomis and Hyla) vertebrate genera were compared. An analysis of digestion profiles generated by 13-18 restriction endonucleases indicates little overlap in magnitude of mtDNA divergence for the avian versus nonavian taxa examined. In 55 interspecific comparisons among the avian congeners, the fraction of identical fragment lengths (F) ranged from 0.26 to 0.96 (F = 0.46), and, given certain assumptions, these translate into estimates of nucleotide sequence divergence (p) ranging from 0.007 to 0.088; in 46 comparisons among the fish and amphibian congeners, F values ranged from 0.00 to 0.36 (F = 0.09), yielding estimates of P greater than 0.070. The small mtDNA distances among avian congeners are associated with protein-electrophoretic distances (D values) less than approximately 0.2, while the mtDNA distances among assayed fish and amphibian congeners are associated with D values usually greater than 0.4. Since the conservative pattern of protein differentiation previously reported for many avian versus nonavian taxa now appears to be paralleled by a conservative pattern of mtDNA divergence, it seems increasingly likely that many avian species have shared more recent common ancestors than have their nonavian taxonomic counterparts. However, estimates of avian divergence times derived from mtDNA- and protein-calibrated clocks cannot readily be reconciled with some published dates based on limited fossil remains. If the earlier paleontological interpretations are valid, then protein and mtDNA evolution must be somewhat decelerated in birds. The empirical and conceptual issues raised by these findings are highly analogous to those in the long-standing debate about rates of molecular evolution and times of separation of ancestral hominids from African apes.

Animals↗
PubMed1985

Factors influencing the diagnosis of mental disorder among primary care patients.

Understanding the role primary care physicians play in the recognition and management of mental disorder among their patients is a research topic that has assumed considerable importance because of the high prevalence combined with low recognition of mental morbidity in primary care settings. Patient characteristics that influence diagnostic patterns have been one important focus of this research. This paper presents data from a study in two primary care departments in a large comprehensive health care clinic in central Wisconsin. During a 3-month period, 1,452 attenders at these clinics were assessed using a brief psychiatric screening scale, and special study forms were completed by the primary care clinicians. Consistent with previous research, reason for visit, psychiatric symptoms, and prior knowledge of the patient are significant predictors of physician diagnosis of mental disorder. Additionally, pattern of physician practice, as represented by differences between the two types of clinics, was a strong predictor of both diagnosis and treatment. The lack of significant effects of sex and previous medical utilization is contrary to previous research. Key words: mental disorders; diagnosis; primary care.

Adult↗
PubMed1984

The usefulness of screening for mental illness.

The study assessed the effect of screening for mental disorder by means of the General Health Questionnaire (GHQ) on the rate of detection of mental disorder by fourteen physicians in a primary-care clinic. After completing the GHQ, patients were randomised into control (722 patients) and experimental (730 patients) groups. GHQ results of the experimental group were made available to the physicians; those of the control group were not. Sociodemographic factors influenced the physicians' rate of diagnosis of mental disorders (rates were lower for men, students, and patients with at least a partial college education than in subjects who had a low income, less than 7 years of school, or were widowed) but there was no difference between control and experimental groups (16.8% vs 16.0%). Among patients with a prior diagnosis of a mental disorder, twice as many were found to have mental disorders by the physicians as by the GHQ (70% vs 33%).

Adult↗
PubMed1984

The design of the Epidemiologic Catchment Area surveys. The control and measurement of error.

Several methods are used to minimize and measure error in the NIMH Epidemiologic Catchment Area program. Sampling methods involve the inclusion of group quarters such as prisons, nursing homes, and mental hospitals in the sample frame and the use of probability sampling throughout. Interviewing, methods include use of identical diagnostic interview protocols, centralized training of interview supervisors, standard instructions to interviewers, and reinterview of a subsample by clinicians. In the area of completion, the methods include a 75% to 80% respondent completion rate, a 95% or greater completion rate for individual questions, use of informant interviews where necessary, and statistical adjustments to correct for low completion rates in some subgroups. Analytic methods include use of a computerized diagnostic algorithm, common estimation formulas on identically formatted data files, and estimation of exact variances that take account of the multistage sample design.

Catchment Area, Health↗
PubMed1984

Utilization of health and mental health services. Three Epidemiologic Catchment Area sites.

Utilization of health and mental health services by non-institutionalized persons aged 18 years and older is examined based on interviews with probability samples of 3,000 to 3,500 persons in each of three sites of the National Institute of Mental Health Epidemiologic Catchment Area (ECA) program: New Haven, Conn, Baltimore, and St Louis. In all three ECAs, 6% to 7% of the adults made a visit during the prior six months for mental health reasons; proportions were considerably higher among persons with recent DSM-III disorders covered by the Diagnostic Interview Schedule (DIS) or severe cognitive impairment. Between 24% and 38% of all ambulatory visits by persons with DIS disorders were to mental health specialists. In seeking mental health services, men were more likely to turn to the specialty sector than to the generalist; women used both sectors about equally. The aged infrequently received care from mental health specialists. Visits for mental health reasons varied considerably depending on specific types of DIS disorder.

Adolescent↗
PubMed1984

Site-specific cleavage of DNA at 8- and 10-base-pair sequences.

A method is described for cutting DNA at specific sites that are 8 and 10 base pairs long. The DNA is first treated with a specific methylase, either the restriction-modification enzyme M. Taq I, which converts the 4-base sequence T-C-G-A to T-C-G-mA, or the similar enzyme M. Cla I, which converts the 6-base sequence A-T-C-G-A-T to A-T-C-G-mA-T. The DNA is then cleaved with Dpn I, a restriction endonuclease that recognizes the sequence G-mA-T-C. Dpn I is unique in that it cuts only DNA that is methylated at adenine in both strands of its recognition sequence. In DNAs that are not otherwise methylated at adenine in both strands of the sequence G-A-T-C, cleavage by Dpn I occurs only at the following sequences: in the case of M. Taq I methylation, 5' T-C-G-mA - T-C-G-mA 3' 3' mA-G-C - T-mA-G-C - T 5'; in the case of M. Cla I methylation, 5' A - T-C-G-mA - T-C-G-mA-T 3' 3' T-mA-G-C - T-mA-G-C - T-A 5'. Specific cutting and cloning at these methylase/Dpn I-generated sites is shown experimentally. Further, we describe how the above technique can be extended to generate Dpn I cleavage sites of up to 12 base pairs. In DNA that contains equal amounts of each base distributed at random, 8- and 10-base-pair recognition sequences occur, on the average, approximately once every 65,000 and 1,000,000 base pairs, respectively. Potential applications, including the development of cloning vectors and a rapid method for chromosome walking, are discussed.

Base Composition↗
PubMed1984

Treated incidence of mental disorders in a prepaid group practice setting.

We followed a cohort of 7,666 individuals enrolled continuously for five years in a prepaid group practice in Columbia, Maryland. Incidence rates of all diagnosed mental disorders were estimated at approximately 3.7 per cent, lower for adolescents and children (about 3 per cent), higher for adult males aged 20-49 (4.3 per cent), and highest for adult females (5.8 per cent). Diagnoses are primarily for acute mental disorders and show a tendency to recur at fairly high rates.

Adolescent↗
PubMed1983

Mental health training of primary care residents: a review of recent literature (1974-1981).

As the mental health role of primary care physicians has been formally recognized in recent years, educational efforts have also been directed toward the development of mental health attitudes, knowledge, and skills. To assess gains in the latter area, recent literature (1974-81) on mental health training for primary care residents was reviewed. Although shifts from the pre-1975 literature in the training objectives, content, teaching methods and setting were observed, further needs were noted. These include more systematic instruction in the diagnosis and management of mental disorder, evaluation of such training and more extensive collaboration among primary care, psychiatric, and behavioral science disciplines in the teaching of mental health content to primary care physicians.

Adult↗