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Biomedical subjects

S Shapiro

Publications and source records attributed to S Shapiro.

730 records · Page 41Linked to original sources
PubMedDate not supplied

Detection and management of mental health problems of older patients by primary care providers.

Evidence is accruing that older individuals receive little attention for mental health problems and that any attention that is given is most often within the primary care setting. A randomized clinical trial was carried out at a primary care clinic of The Johns Hopkins University, Baltimore, testing the ability of feedback of the results of a screening instrument (the General Health Questionnaire) to increase awareness in clinicians of the emotional and psychological problems of their patients. This report contrasts those aged 65 years and older with younger patients. Detection and management of mental morbidity were lower for older individuals, but the feedback intervention increased the likelihood of attention to these problems. This was not true for younger patients. Detection was significantly higher for older patients when screening data were made available, as was management, although the latter difference was not statistically significant. There was evidence as well that the intervention moved clinicians to greater congruence with their older patients in the perception that current mental health problems existed. These findings have important implications for primary care.

Adult↗
PubMedDate not supplied

Myocardial infarction and cigarette smoking in women younger than 50 years of age.

The modifying influence of individual risk factors on the relation between myocardial infarction (MI) and cigarette smoking was evaluated in a case-control study of women younger than 50 years of age. Data from 555 women who survived first MIs were compared with those of 1,864 hospital controls of similar ages. The risk of MI increased with the number of cigarettes smoked, both in the presence and absence of factors that predispose to an infarction. In particular, the association was apparent at all ages, at all levels of total serum cholesterol and high-density lipoprotein cholesterol, and in the presence and absence of oral contraceptive use, hypertension, diabetes mellitus, blood group A, tendency to type A behavior, and family history of MI. The relative increase in risk was generally greater the lower the underlying predisposition to MI. There was clear evidence, however, that recent oral contraceptive use substantially augmented the increased risk for smokers, and hypercholesterolemia may have had the same effect.

Adult↗
PubMedDate not supplied

Epidemiology and health service resource allocation policy for alcohol, drug abuse, and mental disorders.

Data from the NIMH Epidemiologic Catchment Area (ECA) Study in Baltimore, Md., are used to illustrate the association between alcohol, drug abuse, and mental disorder diagnoses with health service use. A probability sample of 3,481 adult (age 18 and over) residents of a geographically defined Baltimore City population of 175,000 was found to have a 23.4 per 100 population, 6-month prevalence of 13 specific alcohol, drug, and mental disorders. Of this population, 7.1 percent sought outpatient mental health treatment from both general medical physicians and mental health specialists in a 6-month period. The presence of a mental disorder diagnosis increased the average number of visits to all health providers from 1.91 to 4.06 during the same 6-month period. Although the presence of a mental disorder diagnosis clearly increased the probability of using both general medical and mental health services, only 15.6 percent of the persons with a mental disorder sought any mental health treatment during this 6-month timeframe--leaving 84 percent of those with mental disorders not seeking any outpatient treatment during the same period. The addition of a measure of high symptomatology (a score of 4 or more on the General Health Questionnaire) increased the percentage of persons with mental disorder using services to 30.5 percent. When a measure of disability was added to the diagnosis and the high symptom level score, 54.7 percent of the population could be predicted to use some mental health service. These data demonstrate the necessity of having additional patient assessment measures with a diagnosis to predict probable service use. However, even in the most comprehensive multidimensional model, more research is required to explore the phenomena of presumed unmet need--the 45 percent of those with a diagnosis, disability, and high symptoms who do not use services. Hence, epidemiologists who wish to participate in setting policy for resource allocation must join with their colleagues in economics, sociology, and health services research to identify all factors in addition to disease states that either predispose population groups to use services or represent additional resource allocation needs.

Adult↗
PubMedDate not supplied

Brain biopsy in Indiana AIDS patients.

The neuropathologic findings of brain biopsies in a series of Indiana AIDS patients were reviewed. All subjects displayed focal lesions on radiographic studies. The three most common diagnoses were toxoplasmosis, progressive multifocal leukoencephalopathy and primary central nervous symptoms (CNS) lymphoma. These findings were consistent with previous studies elsewhere. Biopsy appears to affect the course of treatment only if CNS lymphoma is discovered. Because the value of currently available therapy for this disease in AIDS patients is controversial, there is no clear consensus regarding the indications for biopsy in this population.

AIDS Dementia Complex↗