Background . In recent years the 12-item General Health Questionnaire (GHQ-12) has been extensively used as a short screening instrument, producing results that are comparable to longer versions of GHQ. Methods The validity GHQ-12 was compared with GHQ-28 in World Organization study psychological disorders general health care. Results presented for 5438 patients interviewed 15 centres using primary care version Composite International Diagnostic Instrument, or CIDI-PC. were uniformly good,...

Patients with depression and poorly controlled diabetes, coronary heart disease, or both have an increased risk of adverse outcomes high health care costs. We conducted a study to determine whether coordinated management multiple conditions improves disease control in these patients.

Abstract An important quality of meta‐analytic models for research synthesis is their ability to account both within‐ and between‐study variability. Currently available approaches studies diagnostic test accuracy work primarily within a fixed‐effects framework. In this paper we describe hierarchical regression model meta‐analysis reporting estimates sensitivity specificity. The allows more between‐ within‐study variability than fixed‐effect approaches, by allowing stringency vary across...

OBJECTIVE—We assessed whether diabetes self-care, medication adherence, and use of preventive services were associated with depressive illness. RESEARCH DESIGN AND METHODS—In a large health maintenance organization, 4,463 patients completed questionnaire assessing monitoring, depression. Automated diagnostic, laboratory, pharmacy data used to assess glycemic control, services. RESULTS—This predominantly type 2 diabetic population had mean HbA1c level 7.8 ± 1.6%. Three-quarters the received...

Background: The relationships among breast density, age, and use of hormone replacement therapy (HRT) in cancer detection have not been fully evaluated. Objective: To determine how HRT individually combination affect the accuracy screening mammography. Design: Prospective cohort study. Setting: 7 population-based mammography registries North Carolina; New Mexico; Hampshire; Vermont; Colorado; Seattle, Washington; San Francisco, California. Participants: 329 495 women 40 to 89 years age who...

To examine whether depressive symptoms in older adults contribute to increased cost of general medical services.A 4-year prospective cohort study.Four primary care clinics a large staff-model health maintenance organization (HMO) Seattle, Wash.A total 5012 Medicare enrollees than 65 years were invited participate the study; 2558 subjects (51%) successfully enrolled. Non-participants somewhat and had higher level chronic illness.Depressive as measured by Center for Epidemiological Studies...

A sociological model for the mental health consequences of social organization is distinguished from a sociomedical etiology particular disorders. Both models use stress to explain associations between placement and disorder. These are not interchangeable, despite apparent similarities, but researchers frequently apply questions. Discrepancies illustrated with survey data collected community sample adults. We demonstrate that gender differences in impact disorder-specific do indicate general...

OBJECTIVE—We assessed whether patients with comorbid minor and major depression type 2 diabetes had a higher mortality rate over 3-year period compared alone. RESEARCH DESIGN AND METHODS—In large health maintenance organization (HMO), 4,154 were surveyed followed for up to 3 years. Patients initially filled out written questionnaire, HMO-automated diagnostic, laboratory, pharmacy data Washington State collected assess complications deaths. Cox proportional hazards regression models used...

This paper describes characteristics of opioid use episodes for noncancer pain and defines thresholds de facto long-term therapy.CONSORT (CONsortium to Study Opioid Risks Trends) includes adult members 2 health plans serving over 1% the US population. beginning in years 1997 2005 were classified as acute, episodic, long-term/lower dose, or long-term/higher dose.On basis evaluation likelihood continuing, therapy was defined by lasting longer than 90 days with 10+ prescriptions 120+ supply...

Objective: To test the effectiveness of two programmes to improve treatment acute depression in primary care. Design: Randomised trial. Setting: Primary care clinics Seattle. Patients: 613 patients starting antidepressant treatment. Intervention: Patients were randomly assigned continued usual or one interventions: feedback only and plus management. Feedback comprised algorithm based recommendations doctors on basis data from computerised records pharmacy visits. management included...

Abstract Objective To report trends and characteristics of long‐term opioid use for non‐cancer pain. Methods CONSORT (CONsortium to Study Opioid Risks Trends) includes adult enrollees two health plans serving over 1 per cent the US population. Using automated data, we constructed episodes between 1997 2005. We estimated age–sex standardized rates beginning in each year (incident) on‐going (prevalent), change annualized (PCA) 9‐year period. Long‐term were defined as > 90 days with 120+...

OBJECTIVE To prospectively examine the association of depression with risks for advanced macrovascular and microvascular complications among patients type 2 diabetes. RESEARCH DESIGN AND METHODS A longitudinal cohort 4,623 primary care diabetes was enrolled in 2000–2002 followed through 2005–2007. Advanced included blindness, end-stage renal disease, amputations, failure deaths. myocardial infarction, stroke, cardiovascular procedures, Medical record review, ICD-9 diagnostic procedural...

Can asking one question accurately assess suicide risk? If the is item 9 on Patient Health Questionnaire (PHQ-9), answer may be yes. Researchers in a large integrated health system examined outcomes for more than 84,000 outpatients who completed PHQ-9 at every visit depression between 2007 and 2011. Patients reported thoughts of death or self-harm “more half days” “nearly day” experienced markedly increased risk subsequent attempt death. For this high-risk group, additional assessment...

<h3>Background</h3> Early childhood maltreatment has been associated with adverse adult health outcomes, but little is known about the magnitude of care use and costs that accompany maltreatment. We examined differences in annual women without histories sexual, emotional, or physical abuse neglect. <h3>Methods</h3> A random sample 1225 members a maintenance organization completed 22-page questionnaire inquiring into experiences as measured by Childhood Trauma Questionnaire. Health data were...

The US Preventive Services Task Force (USPSTF) is updating its 2008 colorectal cancer (CRC) screening recommendations.

Depression co-occurring with diabetes mellitus is associated higher health services costs, suggesting that more effective depression treatment might reduce use of other medical services.To evaluate the incremental cost and cost-effectiveness a systematic program among outpatients diabetes.Randomized controlled trial comparing care as usual.Primary clinics group-model prepaid plan.A 2-stage screening process identified 329 adults current depressive disorder.Specialized nurses delivered...

Decision aids are evidence-based sources of health information that can help patients make informed treatment decisions. However, little is known about how decision affect care use when they implemented outside randomized controlled clinical trials. We conducted an observational study to examine the associations between introducing for hip and knee osteoarthritis rates joint replacement surgery costs in a large system Washington State. Consistent with prior trials, our introduction was...

<h3>Importance</h3> The US Preventive Services Task Force (USPSTF) is updating its 2016 colorectal cancer screening recommendations. <h3>Objective</h3> To provide updated model-based estimates of the benefits, burden, and harms strategies to identify that may an efficient balance life-years gained (LYG) from colonoscopy burden inform USPSTF. <h3>Design, Setting, Participants</h3> Comparative modeling study using 3 microsimulation models in a hypothetical cohort 40-year-old individuals at...

Background & AimsA blood-based colorectal cancer (CRC) screening test may increase participation. However, blood tests be less effective than current guideline-endorsed options. The Centers for Medicare Medicaid Services (CMS) covers with sensitivity of at least 74% detection CRC and specificity 90%. In this study, we investigate whether a that meets these criteria is cost-effective.MethodsThree microsimulation models (MISCAN-Colon, CRC-SPIN, SimCRC) were used to estimate the effectiveness...

The authors evaluated the incremental cost-effectiveness of stepped collaborative care for patients with persistent depressive symptoms after usual primary management.Primary initiating antidepressant treatment completed a standardized telephone assessment 6-8 weeks initial prescription. Those major depression or significant subthreshold were randomly assigned to continued care. included systematic patient education, an visit consulting psychiatrist, 2-4 months shared by psychiatrist and...

Background: Despite high rates of relapse and recurrence, few primary care patients with recurrent or chronic depression are receiving continuation maintenancephase treatment.We hypothesized that a prevention intervention would improve adherence to antidepressant medication outcomes in high-risk compared usual care.Methods: Three hundred eighty-six major dysthymia who had largely recovered after 8 weeks treatment by their physicians were randomized program (n=194) (n=192).Patients the group...

ContextInitiation of hormone replacement therapy (HRT) has been shown to increase breast density. Evidence exists that increased density decreases mammographic sensitivity. The effects on discontinuing and continuing HRT have not studied systematically.ObjectiveTo examine the initiation, discontinuation, continued use in postmenopausal women.Design, Setting, ParticipantsObservational cohort study 5212 naturally women aged 40 96 years enrolled a large health maintenance organization western...