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Biomedical subjects

D B Kamerow

Publications and source records attributed to D B Kamerow.

32 records · Page 2Linked to original sources
PubMed1989

Epidemiologic study of sleep disturbances and psychiatric disorders. An opportunity for prevention?

As part of the National Institute of Mental Health Epidemiologic Catchment Area study, 7954 respondents were questioned at baseline and 1 year later about sleep complaints and psychiatric symptoms using the Diagnostic Interview Schedule. Of this community sample, 10.2% and 3.2% noted insomnia and hypersomnia, respectively, at the first interview. Forty percent of those with insomnia and 46.5% of those with hypersomnia had a psychiatric disorder compared with 16.4% of those with no sleep complaints. The risk of developing new major depression was much higher in those who had insomnia at both interviews compared with those without insomnia (odds ratio, 39.8; 95% confidence interval, 19.8 to 80.0). The risk of developing new major depression was much less for those who had insomnia that had resolved by the second visit (odds ratio, 1.6; 95% confidence interval, 0.5 to 5.3). Further research is needed to determine if early recognition and treatment of sleep disturbances can prevent future psychiatric disorders.

Adolescent↗
PubMed1989

Prescribing of psychotropics in elderly nursing home patients.

This study examined the prescribing of psychotropic drugs for patients 65 years of age and older in nursing homes using data from the 1984 National Nursing Home Survey pretest. The most frequently used antipsychotic, anxiolytic, antidepressant, and sedative/hypnotic medications were respectively: haloperidol, hydroxyzine, doxepin, and temazepam. Results indicate that more than one-fifth of the patients having orders for psychotropic medications did not have a documented mental disorder. More than one-fourth of the study patients had orders for more than one psychotropic medication. Nursing home patients who received psychotropics had concurrent orders for an average of 3.3 nonpsychotropic medications, many of which could increase the possibility of drug interactions and potential side effects.

Aged↗
PubMed1988

Anxiety and depression in the medical setting: an overview.

Many physicians fail to correctly diagnose, treat, or refer their patients with anxiety and depression. These are common and costly disorders, but many barriers often prevent effective care for them in medical settings. Greater knowledge about these disorders and closer working relationships with mental health specialists should lead to decreased morbidity and mortality.

Anxiety Disorders↗
PubMed1988

Psychotropic drug prescriptions for nursing home residents.

Previous work has indicated that psychotropic medications may be misused in nursing homes. Utilizing data from the National Nursing Home Study Pretest, this analysis examined the frequency, indications, and appropriateness of psychotropic drug prescriptions for a random group of 526 US nursing home residents. One third of the sample residents were receiving a psychotropic medication, and 8 percent were receiving more than one. Twenty-one percent of those without a listed mental disorder diagnosis received psychotropic medications, almost one third of which were antipsychotic medications. With no corresponding notation of a related symptom or diagnosis in the chart, 30 percent of 212 psychotropic prescriptions were judged inappropriate by a three-physician panel. Although more research should be done, these results suggest the need for better and more careful charting in nursing homes as well as better training for primary care physicians in the proper prescribing of psychotropic drugs.

Data Collection↗
PubMed1987

Lead poisoning in automobile radiator mechanics.

Exposure to lead occurs during automobile radiator repair when soldered joints are heated, but this relatively common hazard has received little public recognition. We therefore studied lead exposure among automobile radiator mechanics in the Boston area. Twenty-seven shops were surveyed, and most were found to be small and poorly ventilated. Seventy-five workers were interviewed and tested for blood lead and free erythrocyte protoporphyrin levels. Fifty-six of the 75 actually repaired radiators, and they had a mean blood lead level of 37.1 micrograms per deciliter (range, 16 to 73). Thirty-nine percent of these mechanics had levels higher than 40 micrograms per deciliter; hematologic, neurologic, and renal effects are known to develop at or above this blood lead level. Multiple regression analysis showed that the number of radiator repair work stations (an index of exposure) was the variable most significantly associated with increased blood lead levels. We conclude that excessive exposure to lead occurs frequently among radiator repair workers and should be prevented by improved ventilation, engineering controls, and the use of respirators (if indicated) while working.

Adult↗
PubMed1987

The effectiveness of mental health consultation and referral in ambulatory primary care: a research lacuna.

This article reviews the research literature on referral to and consultation with mental health specialists for patients in ambulatory medical settings. Very few controlled trials measuring the efficacy of such liaison could be located. They were mainly from the British literature, usually involved psychologists, and (with the exception of one study) tested only the model of referral to the mental health specialist for treatment. More research needs to be done in this important area. Methodologic issues and topics for further study are discussed.

Ambulatory Care Facilities↗
PubMed1986

Alcohol abuse, other drug abuse, and mental disorders in medical practice. Prevalence, costs, recognition, and treatment.

Millions of Americans suffer and die of alcohol abuse, other drug abuse, and mental disorders that go undiagnosed and untreated. Studies showing that up to 19% of the US adult population have these disorders also have found that only one fifth of those affected have sought help for them in the previous six months. Many of these persons have disorders that are treatable with modern medications and therapy. Because more than half of all persons with these disorders obtain all of their care from the general medical sector, a great potential exists in primary care for prevention, detection, treatment, and referral of these patients. Primary care physicians, however, have not been very successful at diagnosing and treating substance abuse and mental disorders because of inadequate training, patients' attitudes, and the constraints of the health care system. Recommendations to improve this situation include continued research, improved physician education, and increased emphasis on care of these disorders by organized medicine. Although tobacco use is also a major health problem, data relating to nicotine addiction were not included in this report.

Alcoholism↗
PubMed1986

Research on mental disorders in primary care settings: rationale, topics, and support.

Mental disorders in primary care settings are common, costly, frequently unrecognized and not optimally treated. Much research needs to be done in this area, documenting the prevalence and need for treatment of primary care patients with mental disorders; improving the understanding of these problems as they present themselves in primary care settings; and testing interventions to improve recognition and treatment. The National Institute of Mental Health is interested in supporting such research. Grant mechanisms and useful references are detailed.

Health Services Needs and Demand↗
PubMedDate not supplied

Primary care physicians' use of office resources in the provision of preventive care.

OBJECTIVES: To assess (1) the extent to which office resources (eg, chart aids, educational materials, office staff) are used by primary care physicians in the provision of preventive care; (2) the characteristics of physicians associated with this use; and (3) the relationship of office resource use to reported preventive service provision. DESIGN: Survey. SUBJECTS: Randomly selected active members of the American Academy of Family Physicians, Kansas City, Mo, American Academy of Pediatrics, Elk Grove Village, III, American College of Obstetricians and Gynecologists, Washington, DC, and American College of Physicians, Philadelphia, Pa. MALE OUTCOME MEASURES: Use rates for each of 14 types of office resources, and scores for total office resource use, total preventive service provision, and counseling, screening, and immunization provision. RESULTS: Most types of office resources were used by less than 50% of the physicians. Physicians in small private practices reported less use of resources than those in other settings. The chart flow sheet was the resource that was most strongly and consistently related to preventive service provision. For all organizations, the total resource use score was significantly correlated with scores for total preventive service provision, and counseling and immunization provision. For most organizations, the total resource use score was more highly related to total preventive service provision than was the age or sex of the physician, the percentage of patients uninsured or with Medicaid coverage, or community size. CONCLUSIONS: The use of office resources is an important factor in the provision of preventive care. Intervention efforts to improve office resource use may benefit from targeting by resource type, practice setting, physician specialty, and other physician and practice characteristics.

Adult↗
PubMedDate not supplied

Who talks to physicians about mental health and substance abuse problems?

This is an analysis of data from the NIMH-sponsored Epidemiologic Catchment Area community-based study, investigating who reported discussing mental health or substance abuse problems with nonpsychiatric physicians. Data were from 7,092 respondents in four sites, all of whom had received care only in the nonpsychiatric sector in the previous six months. A multiple logistic model found that those individuals who had psychiatric disorders, and female, middle-aged, and Hispanic respondents, were more likely to have discussed emotional or mental health problems with their physicians. Respondents with alcohol abuse and substance abuse disorders did not report any more discussion of mental health problems than did respondents without alcohol or substance abuse disorders. Only 36% of the respondents who said they had discussed mental health problems were found to have psychiatric disorders by the Diagnostic Interview Survey (DIS), but many of those without disorders reported more anxiety symptoms. An analysis was done to predict which respondents with DIS-defined psychiatric disorders did not report discussing mental health problems with their nonpsychiatric physicians. Those less than 35 years of age, those older than 65 years of age, males, and those with only one recent visit to a provider were statistically at high risk for not discussing their psychiatric problems.

Catchment Area, Health↗
PubMedDate not supplied

Screening for psychiatric and substance abuse disorders in clinical practice.

Psychiatric disorders, particularly depression and alcohol abuse, represent a large burden of illness to the society. Many individuals with these disorders receive all of their care from health care providers who are not mental health specialists. There is evidence that non-psychiatric physicians frequently do not recognize these disorders in their patients. Screening questionnaires have been introduced to improve detection of these patients. Several studies have found that these screening questionnaires can increase detection rates, but no important impact on patient outcomes has been demonstrated. This review article outlines several reasons why it has been difficult to discern improvement in patient outcomes: inadequate study design, insufficient physician education, interdependence of psychiatric and medical conditions, and vague treatment guidelines. Practical use of the current psychiatric screening questionnaires and key areas for further investigation are considered.

Alcoholism↗