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PubMed1985

The efficiency of measles and pertussis notification in England and Wales.

This paper examines methods for estimating the efficiency of measles and pertussis notification with particular reference to England and Wales. Crude estimates are obtained from a comparison of annual numbers of births and notifications, and this approach is modified to include detailed age-specific data. Other sources of data, notably the Hospital In-Patient Enquiry, are used to give detailed estimates over time. These analyses provide evidence for a strong positive correlation between notification efficiency and incidence for both diseases and for a dramatic fall in the notification efficiency for pertussis between 1957 and 1976. This decrease is of particular interest insofar as it could explain in part the apparent fall in size of successive pertussis epidemics during that period. It is estimated that since 1976 the spotter practices of the Royal College of General Practitioners General Practice Research Unit have been approximately 1.5 times more efficient at reporting measles and 2.5 times more efficient at reporting pertussis than the national average for reporting to the Office of Population Censuses and Surveys. Finally it is noted that estimates of notification efficiency are positively correlated with the assumed level of vaccine efficacy, and that all these methods require assumptions concerning the proportion of vaccinations which are recorded, the proportion of vaccinations which are successful in immunizing the recipient, and the proportion of the population which ultimately contracts the infection. In general, measles notification in England and Wales is considerably better than that for pertussis, being of the order of 40-60% for the former and only 5-25% for the latter.

Child↗
PubMed2005

National trends in hospitalization of youth with intentional self-inflicted injuries.

OBJECTIVE: The authors examined national trends from 1990 to 2000 in the utilization of community hospital inpatient services by young people (5-20 years of age) with intentional self-inflicted injuries. METHOD: Discharge abstracts from a nationally representative sample of community hospitals were analyzed, with a focus on youth discharges (N=10,831) with a diagnosis of intentional self-inflicted injury (ICD-9-CM: E950-E959). Census data were used to derive national population-based rates of self-inflicted injuries requiring inpatient treatment. Overall population-based trends in hospitalizations for self-inflicted injury were calculated and stratified by gender and age. Among youths hospitalized with a self-inflicted injury, trends were also calculated for length of stay, inpatient costs, method of injury, and associated mental disorder diagnoses. RESULTS: The annual hospitalization rate of youths with self-inflicted injuries declined from 49.1 per 100,000 in 1990 to 44.9 per 100,000 in 2000, and the mean length of inpatient stay significantly declined from 3.6 days to 2.7 days. Among the hospitalized patients, there were increases in the rate of cutting (4.3% to 13.2%) and ingestion of acetaminophen (22.1% to 26.9%), antidepressants (10.0% to 14.0%), and opiates (2.3% to 3.3%) as a cause of injury, whereas there were decreases in the ingestion of salicylates (14.9% to 10.2%) and barbiturates (1.5% to 0.7%). There were significant increases in the proportion of subjects with primary mental disorder discharge diagnoses of depressive disorder (29.2% to 46.0%), bipolar disorder (1.3% to 8.2%), and substance use disorder (5.4% to 10.7%) and significant decreases in the rate of adjustment disorders (22.2% to 11.4%) and nonmental disorders (31.9% to 13.6%). After excluding cutting, which may be more closely related to self-mutilation than suicidal self-injury, the annual hospitalization rate of youths with self-inflicted injuries declined from 47.2 per 100,000 in 1990 to 39.4 per 100,000 in 2000. CONCLUSIONS: Over the decade of study, young people admitted to community hospitals with self-inflicted injuries tended to have more severe psychiatric diagnoses and to be treated during shorter inpatient stays. These trends suggest that the role of youth inpatient care has narrowed, becoming focused on those with severe psychiatric disorders.

Adolescent↗
PubMed2005

Suicide in the elderly in Kaniyambadi block, Tamil Nadu, South India.

BACKGROUND: Inefficient civil registration systems, non-report of deaths, variable standards in certifying death and the legal and social consequences of suicide are major obstacles in investigating suicide in the developing world. Very high rates of suicide have been recorded in the region in the general population and among younger people. OBJECTIVE: This paper describes the suicide rate among the elderly in Kaniyambadi block, Tamil Nadu, South India for the years 1994-2002 using verbal autopsies. METHOD: The setting for the study was a comprehensive community health program in a development block in rural South India. The main outcome measure was death by suicide diagnosed by a detailed verbal autopsy and census, birth and death data to identify the population base. RESULTS: The average annual suicide rate was 189 per 100,000 for people over 55 years of age. The ratio of male to female suicides was 1: 0.66. The age-specific suicide rate for men and women increased with age. Hanging (52%) and poisoning with organo-phosphorus compounds (39%) were the commonest methods employed for committing suicide. Significantly more women chose drowning or burning than men who preferred poisoning or hanging (chi2 19.75; df 1; p < 0.001). CONCLUSIONS: The suicide rate documented in this study among the elderly is very high. The reasons for the high suicide rate observed in older people are not known. There is a need to develop innovative strategies to reduce deaths by suicide.

Age Distribution↗
PubMed1992

Geographic and socioeconomic variation in the onset of decline of coronary heart disease mortality in white women.

BACKGROUND: Regional, metropolitan, and socioeconomic factors related to the onset of decline of coronary heart disease (CHD) mortality among White women are reported. Such studies are important for planning population-level interventions. METHODS: Mortality data for 1962 to 1978 were used, to estimate the year of onset of decline. Ecological analyses of socioeconomic data from the US census were used to emphasize structural and organizational aspects of changes in disease, rather than as a substitute for an individual-level design. RESULTS: Onset of decline of CHD mortality among White women was estimated to have occurred by 1962 in 53% of 507 state economic areas (SEAs), ranging from 79% in the Northeast to 39% in the South. Metropolitan areas experienced earlier onset of decline than did nonmetropolitan areas. Average income, education, and occupational levels were highest in early onset areas and declined across onset categories. CONCLUSIONS: The results provide additional evidence for previously observed geographic and social patterns of CHD decline. Emphasis on structural economic factors determining the shape of the CHD epidemic curve does not detract from the medical importance of risk factors, but underscores the importance of community development to public health improvements. The results are consistent with the idea that the course of the CHD epidemic in the United States has been strongly influenced by socioeconomic development.

Adult↗
PubMed2004

Population need and geographical access to general practitioners in rural New Zealand.

AIMS: To use a geographical information system (GIS) approach to demonstrate the extent to which different areas in New Zealand vary in their geographical access to GPs, and to analyse the extent to which spatial access varies in relation to different population groups. METHODS: Three methods; population/GP ratios, least cost path analysis (LCPA), and an allocation method (which considered the capacity constraint of GPs) were used to demonstrate differences in geographic accessibility to GPs. Travel time, and distance to the closest GP, was calculated for every census enumeration district in New Zealand (n=38336)--thus enabling population-based accessibility statistics to be calculated and aggregated to the territorial local authority level. These calculations include the average travel time if everybody visited a GP once and the population more than 30 minutes from a GP. The composition of this population is analysed according to three criteria of need: the level of deprivation (NZDep2001), ethnicity (%Maori), and age (% <5 years, and %65 years and over). RESULTS: There are significant regional variations in geographical accessibility in New Zealand, and these differences are dependent upon the method to calculate accessibility. Ratio measures give a different picture of GP access than the other two indicators, reflecting the fact that TAs with similar ratios often have wide variations in travel times as well as the size and proportion of the population living more than 30 minutes from the closest GP. TAs with larger numbers and a higher proportion of their populations living in such areas tend to be more deprived and have a higher proportion of Maori, especially in the North Island. There appears to be no significant trend by age. CONCLUSION: Given the health and service consequences of poor access, the results suggest that more attention needs to be paid to extending the spatial information base in primary care, in order to achieve more effective planning of services for disadvantaged populations.

Aged↗
PubMed2002

Survey on maternal mortality in Swaziland using the sisterhood method.

Monitoring and evaluating maternal mortality in African countries is impossible without specific and reliable data and indicators. This study of maternal mortality using the 'Sisterhood Method' was undertaken in Swaziland. The crude data on 'sisterhood mortality' were obtained from the 1993-94 Multi-Purpose Household Survey carried out by the Central Statistics Office and Ministry of Health of Swaziland. A total fertility rate of 6.36, as given in the 1986 Swaziland census, was used in estimating these indicators. Prior to this study, the maternal mortality rate (MMR) in Swaziland (based only on health facility data) was considered to lie within the range of 107-125 maternal deaths per 100 000 live births. Use of the 'Sisterhood Method' allowed a more precise estimate of maternal mortality for the general population of Swaziland. The study revealed the estimated MMR to be 229 and the life-time risk of maternal death to be 1 in 69. These values were most probably stable throughout the 6- to 7-year period before the survey.

Adult↗
PubMed1988

Mortality differentials in Canada, 1951-1971: French, British, and Indians.

Mortality differentials reflect in part the social and economic conditions of groups in society. In this paper, the relationship between ethnic origin and mortality is investigated from the point of view of convergence and minority group status hypotheses. Multivariate methods are used to study differences among the French, the British and Native Indian (includes Metis and Eskimos) populations of Canada over three census periods from 1951 to 1971. A significant downward trend in the death rates of all three subpopulations is noted, but substantial differences persist, as the pace of mortality decline over time varies across the three ethnic groups. In the twenty-year interval between 1951 and 1971, Native Indians have experienced spectacular reductions in their overall death rates, but in comparative terms, their mortality levels still exceed those of the French (who show intermediate levels) and the British ethnic groups. The multivariate analysis provides strong support for the minority status effect, which is taken to suggest that the roots of inequalities in survival probabilities are partly a result of social and economic disparities. The convergence thesis received some support: over time the general pattern is one of declining mortality with some narrowing of the differences. An examination of four broad causes of death (neoplasms, cardiovascular, accidents-violence, and "other") suggests that Native Indians are characteristic of populations undergoing epidemiologic and demographic transitions. Their elevated risk of accidents-violence reflects social disruption in the process of modernization. Causes of death of the French and British populations are characterized by higher risks of cancer and cardiovascular diseases, typical of advanced societies.

Accidents↗
PubMed1982

Population regionals--a perspective in geographic space of India.

"This paper is concerned with the issue of delimiting population [regions] in India on the basis of selected and basic population variables." Types of regions are defined in two ways: by measuring 16 population variables at the district level and by measuring selected blocks of variables at the state/union territory level. "A defined method of score assessment has been employed which displays characteristic and clear grouping of districts in each [case]." Data are from the 1971 census.

Asia↗
PubMed2002

GIS-based support tool system for decision-making regarding local forest protection: illustrations from Orissa, India.

A support tool system comprising risk and priority analyses was illustrated in a geographical information system environment and also tested with data from two forest protection areas for comparison of the system output. The system is recommended as a management monitoring tool for areas where village forest protection at a local level is taking place. The geographical area in the eastern part of India is subject to scarcity of forest resources and is representative in the context of widespread occurrence of local forest protection. Data used were topography, hectares protected, population census, distance to forest and other villages, degree of forest regeneration, presence of plantations, age of protection, surrounding forest resources, and population mix. Methods used were digitizing information for the systems' different layers, analyses of satellite information, field work, gathering of local information, and the application of five risk/priority analyses: erosion, ecological and institutional sustainability, conflict, and degree of dependency. Questions asked were how the different analyses should be interpreted and how the system could be kept updated. The results show that the system needs resource-demanding and field assistance to be kept dynamic. The system is also dependent on the interpretations of the analyses. The limits or levels of assistance for forest management depend on the resources available. The system illustrates how a tool can be utilized for decisions regarding input of resources. It can further be very useful in defining and comparing different areas in order to detect areas in need of assistance and the type of help needed.

Conservation of Natural Resources↗
PubMed1995

Patterns of care survey results: treatment planning for carcinoma of the prostate.

PURPOSE: Treatment planning has been defined differently at various institutions to encompass tasks ranging from the initial evaluation of the patient to the delivery of the treatment as well as a more narrow view, focused primarily on isodose computation. To evaluate the impact of much of the new treatment-planning technology that has become available, it is necessary to define and develop recommended guidelines for the treatment-planning process. METHODS AND MATERIALS: The 1989 Patterns of Care Study (PCS) included questionnaires to access treatment planning practices currently in use for the entire census of oncology facilities in the United States. These questionnaires were developed by a consensus committee consisting of both physicists and radiation oncologists whose charge was to formulate a description of current treatment-planning practices. The description was based on the committee's experience and knowledge of the treatment-planning process considered to be widely available and in general use, as well as a review of the literature. From the description of the treatment-planning process, a set of guidelines for treatment planning was developed for prostate as well as each of the other disease sites included in the PCS. Data from the study defined the general structure, methodology, process, and tools used by each institution involved in the Patterns of Care Survey Study. National averages for all of the variables were calculated with weighted averages, with the weights reflecting the sample design and number of patients in the different types of facilities. The data were stratified according to academic, hospital, or free-standing facility and were compared with the Consensus Guidelines for Treatment Planning of the Prostate. DISCUSSION: Based on the consensus statement, the treatment-planning process was separated into the following categories: (a) Treatment-Planning Workup, (b) Treatment Plan Implementation, (c) Treatment Delivery, (d) Treatment Verification, and (e) Quality Assurance. The results from the survey were summarized for each category and compared with the consensus statement. CONCLUSIONS: Although there is an increasing trend toward using computed tomography (CT) information to acquire individualized patient data, volume definition and localization are often completed in the simulator without the direct use of CT information (47%). As more sophisticated beam arrangements and blocking are used, one needs to look at the full three-dimensional (3D) volume to ensure that there are no marginal misses due to blocking and beam arrangement. Improved and more widespread use of immobilization devices is also required with conformal treatments and reduced margins. The results of the survey helped to identify and establish the standard of practice for treatment planning of the prostate as well as to provide documentation for better defining a complete description of the treatment planning process. Well-documented guidelines will provide more consistent treatment of patients, which should have an impact on outcome.

Clinical Protocols↗
PubMed2005

Playground safety and access in Boston neighborhoods.

BACKGROUND: Youth physical activity is partly influenced by access to playgrounds and recreational opportunities. Playgrounds in disadvantaged areas may be less safe. METHODS: Investigators assessed safety at 154 playgrounds in Boston between July 2000 and July 2001. Playgrounds were geocoded and safety scores assigned to census block groups (CBGs). For each of Boston's 591 CBGs, investigators calculated the total number youth and proportions of black residents, adults without a high school degree, and youth living in poverty. Investigators assigned each CBG a safety score, and calculated distance from the CBG centroid to the nearest playground and nearest "safe" playground (top safety quartile). Statistical analyses were completed using SAS PROC GENMOD by October 2002. RESULTS: In bivariate analysis, playground safety was inversely associated with total CBG youth population (p =0.001) and proportions of black residents (p <0.001), youth in poverty (p =0.003) and residents with no high school degree (p <0.002). The proportion of black residents in the CBG was inversely associated with safety (p =0.013), independent of CBG educational attainment and numbers of youth. The average distance was 417 meters to the nearest playground and 1133 meters to the nearest "safe" playground. Distance to the nearest playground was inversely associated with the proportion of residents with no high school degree (p <0.0001) after controlling for numbers of youth and proportion of black residents. CBGs with more youth had greater distances to the safest playgrounds (p =0.04). CONCLUSIONS: In Boston, playground safety and access to playgrounds varied according to indicators of small-area socioeconomic and racial/ethnic composition.

Adolescent↗
PubMed1996

Risk of aspirin-associated major upper-gastrointestinal bleeding with enteric-coated or buffered product.

BACKGROUND: Aspirin products are known to cause irritation and injury to the gastric mucosa. The belief that enteric-coated and buffered varieties are less likely to occasion major upper-gastrointestinal bleeding (UGIB) than plain aspirin was tested in data from a multicentre case-control study. METHODS: 550 incident cases of UGIB admitted to hospital with melaena or haematemesis and confirmed by endoscopy, and 1202 controls identified from population census lists, were interviewed about use of aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs) during the 7 days before the onset of bleeding (cases) or interview (controls). Relative risks of UGIB for each type of aspirin used regularly (at least every other day) were calculated overall, and according to dose, by multiple logistic regression, with control for age, sex, marital status, date, education, cigarette smoking, alcohol use, and use of NSAIDs. FINDINGS: The relative risks of UGIB for plain, enteric-coated, and buffered aspirin at average daily doses of 325 mg or less were 2.6, 2.7, and 3.1, respectively. At doses greater than 325 mg, the relative risk was 5.8 for plain and 7.0 for buffered aspirin; there were insufficient data to evaluate enteric-coated aspirin at this dose level. There were no important differences in risk attributable to the three aspirin forms according to bleeding site (gastric vs duodenal), or when users of NSAIDs were excluded. INTERPRETATION: Use of low doses of enteric-coated or buffered aspirin carries a three-fold increase in the risk of major UGIB. The assumption that these formulations are less harmful than plain aspirin may be mistaken.

Adolescent↗
PubMed2003

Cross-type recidivism among child maltreatment victims and perpetrators.

OBJECTIVE: This study investigated the extent to which child maltreatment victims and perpetrators were reported for different types of maltreatment over time (cross-type recidivism). Second, this study examined whether certain individual, community or child welfare service variables were associated with a tendency for the first recidivism event to be the same as the initial report among cases involving sexual abuse, physical abuse and neglect. METHOD: Statewide administrative data on child abuse reporting at the child and perpetrator levels were linked to data on child welfare services and census information to examine cross-type recidivism prospectively for 4.5 years. Analyses include descriptive and logistic regression techniques. RESULTS: There was substantial cross-type recidivism at both the child and perpetrator levels, with neglect being the most common recidivism type. Among neglect cases, "lack of supervision" was the most frequent subtype at time of re-report regardless of the initial subtype of neglect reported. Predictors of remaining within-type varied by the type of maltreatment initially reported and by perpetrator compared to child-level analyses. For example, among physical abuse cases, older child victims were more likely to remain within-type, while the opposite was true for neglect. CONCLUSIONS: Cross-type recidivism is common among re-reported cases of maltreatment. Non-neglect cases that re-reported to child welfare agencies are likely to return for neglect. Child welfare risk assessment, service provision, and research on children and families with a recidivism event should be focused neglect and on broad areas of need and risk rather than rely on typologies based on the index event. Researchers attempting to model recurrent maltreatment should consider recurrence at the child and perpetrator levels separately.

Child↗
PubMed2005

[Quantitative assessment of the risk of lung cancer and pleural mesothelioma among automobile mechanics].

BACKGROUND: A quantitative assessment of the risk of lung cancer and pleural mesothelioma among mechanics exposed to dust released from automobile asbestos-containing parts was performed. METHODS: The population of automobile mechanics in France, according to profession and industrial sectors codes, was estimated from the data of the 1999 census. Risks were computed for a total male population of 242,360 automobile mechanics aged 16 to 60 years. Exposure to asbestos among these workers comes from maintenance tasks involving asbestos-containing parts produced before 1997 (date of the asbestos ban in France). Airborne asbestos concentration data available from the literature were highly variable. No data reporting the distribution of time spent for such tasks over a typical week of work were available. Therefore, different weekly exposure profiles were simulated, based on data from the 1994 SUMER survey. Risk models were those used for assessing asbestos health effects by all national and international agencies. Exposure scenarios mixed different levels of exposure, periods of time, proportions of exposed workers and dates of the "natural" disappearance of the automobile fleet built before asbestos was banned in brakes and other parts. The most realistic scenario hypothesizes that all automobile mechanics were exposed to asbestos, that the exposure levels ranged from 0.06 and 0.25 fibers/liter per week for the period before 1997, and between 0.01 and 0.06 fibers/liter per week afterwards until 2010. RESULTS: According to this scenario, the number of lifelong cancer deaths (lung and pleura) induced by asbestos exposure in this population is estimated at 602 "unavoidable" cases, due to exposure experienced before 2003; 43 other cases will occur if asbestos is not removed from existing automobiles.

Adolescent↗
PubMed2003

Neighborhood context and self-rated health in older Mexican Americans.

PURPOSE: To determine whether neighborhood characteristics are associated with self-rated health in older Mexican Americans. METHODS: Epidemiologic data on 3050 older Mexican Americans residing in the southwestern United States during 1993 and 1994 were merged with 1990 US Census data. All subjects were matched to one of 210 census tracts (neighborhoods). Multilevel ordinal logit models were used to examine relationships between self-rated health and individual- and neighborhood-level variables. RESULTS: After adjusting for individual characteristics, older Mexican Americans were more likely to rate their health poorer if they lived in neighborhoods that were economically disadvantaged, less populated by other Hispanics, or located within 50 miles of the US-Mexico border. In addition, residence in a border community moderated the relationship between self-rated health and neighborhood economic disadvantage. The effect of neighborhood economic disadvantage on poorer self-rated health was two to three times stronger for subjects living near the border region than subjects living further away from the border. CONCLUSIONS: This study demonstrates the importance of considering several dimensions of neighborhood context, especially for Mexican Americans. Residence in a border community and neighborhood economic disadvantage were important predictors of poorer self-rated health status. In addition, older Mexican Americans experience a health benefit from living in neighborhoods populated with other Hispanics.

Aged↗
PubMed2004

Colorectal neoplasia screening with virtual colonoscopy: when, at what cost, and with what national impact?

BACKGROUND & AIMS: When optimized, virtual colonoscopy may be highly sensitive for colorectal neoplasia. We evaluated the effectiveness and cost-effectiveness of virtual colonoscopy screening (VC) vs. colonoscopy screening (COLO) and the potential impact at the national level. METHODS: Using a Markov model, we estimated the clinical and economic consequences of VC and COLO from ages 50 to 80 years. Using census data, we made projections to the national level. RESULTS: In the best case considered (95%, 94%, and 87% sensitivity for colorectal cancer [CRC], polyps > or =10 mm, and polyps <10 mm), VC was nearly as effective as COLO. However, if test costs were equal, total cost per person was 15% greater for VC than COLO, making COLO dominant. When test cost for VC was < or =60% of test cost for COLO, the small benefit of COLO vs. VC cost >200,000 US dollars/incremental life-year. The greater the likelihood of being referred for colonoscopy after VC, the greater the advantage of COLO. With 75% screening adherence in the United States, VC and COLO could decrease CRC incidence by 46%-54%, with COLO requiring 6.9 million colonoscopies/yr, and VC, 3.2 million colonoscopies/yr, plus 5.4 million virtual colonoscopies/yr with VC. CONCLUSIONS: Even if screening test sensitivities were similar, COLO is likely to be preferred over VC unless virtual colonoscopy costs significantly less than colonoscopy. VC may be most appropriate in persons unlikely to need colonoscopy, such as those at low CRC risk. If VC were substituted for COLO, the demand on resources would shift from endoscopic to radiologic services, but would not diminish.

Aged↗
PubMed2003

Cancer incidence among male Swedish veterinarians and other workers of the veterinary industry: a record-linkage study.

OBJECTIVE: To investigate the risk of cancer among veterinarians in a large record-linkage study from Sweden. METHODS: We used the nationwide, Swedish Cancer Environment Registry III, which links the Cancer Register data for 1971-1989 to the national population censuses from 1960 and 1970, to compare the incidence of cancer among male veterinarians to that of the remaining part of the active population using multivariable Poisson regression models and standardized incidence ratios. One thousand one hundred and seventy eight men classified as veterinarians or workers in the veterinary industry at either census were identified. RESULTS: Veterinarians in the veterinary industry experienced increased risk of esophageal (relative risk (RR) 3.78, 95% confidence interval (CI) 1.42-10.09), colon (RR: 2.36, 95% CI: 1.42-3.91), pancreatic (RR: 2.10, 95% CI: 0.94-4.68) and brain (RR: 2.51, 95% CI: 1.04-6.03) cancers as well as melanoma of the skin (RR: 2.77, 95% CI: 1.24-6.17). Similar excess risks were observed when veterinarians were compared with individuals of similar socioeconomic status. CONCLUSION: The increased risks of esophageal, colon, pancreatic and brain cancers as well as melanoma observed among veterinarians did not seem to be explained by the high socio-economic status of this occupational group. Therefore, it is possible that some of these results reflect the carcinogenicity of occupational exposures, including animal viruses, solar or ionizing radiations and anesthetics.

Adult↗
PubMed2001

Enabling the diagnosis of occult psychiatric illness in the emergency department: a randomized, controlled trial of the computerized, self-administered PRIME-MD diagnostic system.

STUDY OBJECTIVE: Undiagnosed mental illness is highly prevalent and produces needless morbidity. Emergency department patients with vague or longstanding complaints are at risk for occult mental illness, but are seldom diagnosed. We conducted this study to determine whether a previously validated, self-administered, computerized psychiatric interview (Primary Care Evaluation of Mental Disorders [PRIME-MD]) could increase the detection of occult psychiatric illness in the ED. METHODS: This was a randomized, controlled trial of consecutive patients enrolled during convenient times at a university teaching hospital ED with an annual census of 38,000. ED house staff and attending physicians participated. Patients were those with nonspecific complaints potentially associated with occult psychiatric illness (eg, long-standing headache, abdominal or back pain). Exclusion criteria were known psychiatric illness, complaint, or medication; and straightforward reason for the ED visit. Consenting subjects completed the PRIME-MD questionnaire in the waiting room, and were randomly assigned to either the "report" (report results given to physician) or "no-report" groups. PRIME-MD results were clipped to the front of the chart of report group patients. There was no other intervention. The main outcome measures were the percentage of all patients and percentage of patients with a PRIME-MD diagnosis who received a psychiatric diagnosis, consultation, or referral from the emergency physician. RESULTS: A total of 339 (5.1%) of all patients were approached; 230 consented to participate in the study, and 218 completed the PRIME-MD session and were randomly assigned to study groups. Ninety-two patients in the report group and 98 cases in the no-report group were analyzed. Patients were omitted for the following reasons: left without being seen (8), mistakenly enrolled (10), or unretrievable medical records (10). Seventy-nine (42%) patients received a psychiatric diagnosis from PRIME-MD and 9 (5%) from the physician. The frequencies of physician psychiatric diagnosis and referral did not differ between groups (diagnosis: report 9%, no report 9%, Delta 0%, 95% confidence interval [CI] -13, 14; referral: report 9%, no report 7%, Delta 2%, 95% CI -11, 16). CONCLUSION: ED patients willingly completed the PRIME-MD questionnaire (in a median time of 7 minutes), which frequently diagnosed psychiatric conditions. Despite this, physicians rarely diagnosed or treated these conditions regardless of whether they were provided with the PRIME-MD diagnoses.

Adult↗