Biomedical subjects

Daniel E Ford

Publications and source records attributed to Daniel E Ford.

At least 19 recordsLinked to original sources

PubMed2003

Confronting depression and suicide in physicians: a consensus statement.

OBJECTIVE: To encourage treatment of depression and prevention of suicide in physicians by calling for a shift in professional attitudes and institutional policies to support physicians seeking help. PARTICIPANTS: An American Foundation for Suicide Prevention planning group invited 15 experts on the subject to evaluate the state of knowledge about physician depression and suicide and barriers to treatment. The group assembled for a workshop held October 6-7, 2002, in Philadelphia, Pa. EVIDENCE: The planning group worked with each participant on a preworkshop literature review in an assigned area. Abstracts of presentations and key publications were distributed to participants before the workshop. After workshop presentations, participants were assigned to 1 of 2 breakout groups: (1) physicians in their role as patients and (2) medical institutions and professional organizations. The groups identified areas that required further research, barriers to treatment, and recommendations for reform. CONSENSUS PROCESS: This consensus statement emerged from a plenary session during which each work group presented its recommendations. The consensus statement was circulated to and approved by all participants. CONCLUSIONS: The culture of medicine accords low priority to physician mental health despite evidence of untreated mood disorders and an increased burden of suicide. Barriers to physicians' seeking help are often punitive, including discrimination in medical licensing, hospital privileges, and professional advancement. This consensus statement recommends transforming professional attitudes and changing institutional policies to encourage physicians to seek help. As barriers are removed and physicians confront depression and suicidality in their peers, they are more likely to recognize and treat these conditions in patients, including colleagues and medical students.

Adult↗

PubMed2003

Outpatient prescriptions for atypical antipsychotics for African Americans, Hispanics, and whites in the United States.

BACKGROUND: New antipsychotic medications introduced during the past decade-clozapine (1990), risperidone (1994), olanzapine (1996), and quetiapine fumarate (1997)-offer a decrease in serious adverse effects compared with traditional antipsychotic medications, but at up to 10 times the cost. We examined whether ethnic minorities achieve access to these new advanced treatments. METHODS: Using national data on physician office and hospital outpatient department visits from the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey from 1992 through 2000, we selected all patient visits at which an antipsychotic medication (atypical or traditional) was prescribed or continued and the patient was aged between 18 and 69 years. We performed a series of cross-sectional logistic regression analyses to determine the association of ethnic group and receipt of an atypical antipsychotic prescription over time, adjusted for potential confounders such as age, diagnosis, and health insurance type. RESULTS: Antipsychotic medication was prescribed or continued in 5032 visits; 33% of overall visits involved an atypical antipsychotic prescription. During 1992 to 1994, the adjusted relative odds of receipt of an atypical antipsychotic prescription for African Americans was 0.50 (95% confidence interval [CI], 0.26-0.96) and for Hispanics was 0.43 (95% CI, 0.16-1.18) compared with whites. During 1995 to 1997, the odds of receipt of a prescription for atypical antipsychotics increased for African Americans (odds ratio [OR], 0.69; 95% CI, 0.54-0.85) and for Hispanics (OR, 0.84; 95% CI, 0.65-1.07) compared with whites; and during 1998 to 2000, the relative odds continued to increase for African Americans (OR, 0.88; 95% CI, 0.78-0.97) and for Hispanics (OR, 1.05; 95% CI, 0.92-1.16) compared with whites. For visits specified for psychotic disorders, receipt of atypical antipsychotics was still lower for African Americans by 1998 to 2000 (adjusted OR, 0.74; 95% CI, 0.61-0.89) compared with whites, while for Hispanics the relative odds was equivalent (adjusted OR, 1.05; 95% CI, 0.87-1.19). CONCLUSION: Early gaps between ethnic groups in receipt of atypical antipsychotic prescriptions decreased throughout the 1990s but persisted for African Americans with psychotic disorders.

Adolescent↗

PubMed2003

Life-sustaining treatments: what do physicians want and do they express their wishes to others?

OBJECTIVES: To assess whether older physicians have discussed their preferences for medical care at the end of life with their physicians, whether they have established an advance directive, and what life-sustaining treatment they wish in the event of incapacity to make these decisions for themselves. DESIGN: Mailed survey to a cohort of physicians. SETTING: Physicians who were medical students at the Johns Hopkins University in graduating classes from 1946 to 1964. PARTICIPANTS: Physicians who completed the advance directive questionnaire (mean age 68). MEASUREMENTS: Questionnaires were sent out to known surviving physicians of the Precursors Study, an on-going study that began in 1946, asking physicians about their preferences for life-sustaining treatments. RESULTS: Of 999 physicians who were sent the survey, 765 (77%) responded. Forty-six percent of the physicians felt that their own doctors were unaware of their treatment preferences or were not sure, and of these respondents, 59% had no intention of discussing their wishes with their doctors within the next year. In contrast, 89% thought their families were probably or definitely aware of their preferences. Sixty-four percent reported that they had established an advance directive. Compared with physicians without advance directives, physicians who established an advance directive were more likely to believe that their doctors (odds ratio (OR) = 3.42, 95% confidence interval (CI) = 2.49-4.69) or family members (OR = 9.58, 95% CI = 5.33-17.23) were aware of their preferences for end-of-life care and were more likely to refuse treatments than those without advance directives. CONCLUSION: This survey of physicians calls attention to the gap between preferences for medical care at the end of life and expressing wishes to others through discussion and advance directives, even among physicians.

Advance Directives↗

PubMed2003

The acceptability of treatment for depression among African-American, Hispanic, and white primary care patients.

BACKGROUND: Ethnic minority patients are less likely than white patients to receive guideline-concordant care for depression. It is uncertain whether racial and ethnic differences exist in patient beliefs, attitudes, and preferences for treatment. METHODS: A telephone survey was conducted of 829 adult patients (659 non-Hispanic whites, 97 African Americans, 73 Hispanics) recruited from primary care offices across the United States who reported 1 week or more of depressed mood or loss of interest within the past month and who met criteria for Major Depressive Episode in the past year. Within this cohort, we examined differences among African Americans, Hispanics, and whites in acceptability of antidepressant medication and acceptability of individual counseling. RESULTS: African Americans (adjusted OR, 0.30; 95% CI 0.19-0.48) and Hispanics (adjusted OR, 0.44; 95% CI, 0.26-0.76) had lower odds than white persons of finding antidepressant medications acceptable. African Americans had somewhat lower odds (adjusted OR, 0.63; 95% CI, 0.35-1.12), and Hispanics had higher odds (adjusted OR, 3.26; 95% CI, 1.08-9.89) of finding counseling acceptable than white persons. Some negative beliefs regarding treatment were more prevalent among ethnic minorities; however adjustment for these beliefs did not explain differences in acceptability of treatment for depression. CONCLUSIONS: African Americans are less likely than white persons to find antidepressant medication acceptable. Hispanics are less likely to find antidepressant medication acceptable, and more likely to find counseling acceptable than white persons. Racial and ethnic differences in beliefs about treatment modalities were found, but did not explain differences in the acceptability of depression treatment. Clinicians should consider patients' cultural and social context when negotiating treatment decisions for depression. Future research should identify other attitudinal barriers to depression care among ethnic minority patients.

Adolescent↗

PubMed2002

Marijuana use and cessation of tobacco smoking in adults from a community sample.

Tobacco smokers are more likely to use marijuana than those who do not smoke tobacco. Little is known about how marijuana use affects the probability of tobacco smoking cessation. This analysis was based on 431 adults less than 45 years of age who reported recent tobacco smoking in the 1981 baseline interview in the household-based Baltimore Epidemiologic Catchment Area study and were re-interviewed 13 years later. At baseline, 41% of the tobacco smokers reported ever use of marijuana, 27% reported use of marijuana in the previous 30 days, and 9% reported daily use of marijuana for 2 weeks or more in the last 30 days. Marijuana users in the past 30 days at baseline were more likely than nonusers to still be using tobacco at follow-up after adjusting for race, educational level and marital status (OR = 1.94, 95% CI = 1.03, 3.63). Daily use of marijuana at baseline was even more strongly related to continued tobacco smoking 13 years later. Difficulty in tobacco cessation might be considered one of the most important adverse effects of marijuana use. Clinicians working with patients who are trying to stop tobacco smoking may be aided by routinely assessing marijuana use history, particularly with the recent increase in co-smoking of marijuana and tobacco.

Adolescent↗

PubMed2002

Sports ability in young men and the incidence of cardiovascular disease.

PURPOSE: For physical activity to reduce the risk of cardiovascular disease, it must be sustained throughout life. We sought to determine the relation between the ability of young adults in different sports and their continued physical activity in midlife, and subsequent cardiovascular disease. SUBJECTS AND METHODS: Baseline self-reported ability in tennis, golf, football, baseball, and basketball was assessed in a cohort study involving 1019 male medical students (median age, 22 years). Physical activity and sports participation were assessed 22 years later. The incidence of cardiovascular disease was assessed during a median follow-up of 40 years, using annual questionnaires, medical records, and death certificates. RESULTS: Subjects with high ability in tennis as young adults had the highest participation in the sport in midlife (median age, 48 years). In the midlife questionnaire administered in 1978, 33% reported playing tennis within the past week and 51% within the past year. Tennis was the only sport in which a higher ability during medical school was associated with a lower risk of cardiovascular disease. After adjustment for father's occupation, parental incidence of cardiovascular disease, serum cholesterol level, cigarette smoking, body mass index, and hypertension during follow-up, the relative hazard of developing cardiovascular disease was 0.56 (95% confidence interval [CI]: 0.35 to 0.89) in the high-ability group and 0.67 (95% CI: 0.47 to 0.96) in the low-ability group, compared with the no-ability group. CONCLUSION: Our results support the association between sustained activity in aerobic sports and a lower risk of cardiovascular disease. Sustainability of activity should be considered when developing physical education programs for young adults.

Adult↗

PubMed2002

Anger in young men and subsequent premature cardiovascular disease: the precursors study.

BACKGROUND: Anger can trigger myocardial ischemia and may be an independent risk factor for coronary heart disease, but its effect on early compared with late onset of disease is unclear. METHODS: We performed a prospective study of 1055 men followed up for 32 to 48 years to examine the risk of premature and total cardiovascular disease (CVD) associated with anger responses to stress during early adult life. Highest level of anger was defined as a self-report of all 3 possible anger reactions to stress (expressed or concealed anger, gripe sessions, and irritability) on a checklist questionnaire administered in medical school. Premature disease was defined as events before age 55 years. RESULTS: During a median follow-up period of 36 years, 205 men developed CVD (cumulative incidence at 76 years, 34.5%), of whom 77 men developed premature disease (cumulative incidence before 55 years, 7.9%). The highest level of anger was associated with an increased risk of premature CVD (adjusted relative risk, 3.1; 95% confidence interval, 1.1-8.6), including premature coronary heart disease (relative risk, 3.5; 95% confidence interval, 1.1-11.8) and premature myocardial infarction (relative risk, 6.4; 95% confidence interval, 1.8-22.3), compared with lower levels of anger. When CVD events after age 55 years were included, there was no longer a statistically significant association between anger and CVD. CONCLUSION: High level of anger in response to stress in young men is associated with an increased risk of subsequent premature CVD, particularly myocardial infarction.

Adult↗

PubMed2002

Coffee intake and risk of hypertension: the Johns Hopkins precursors study.

BACKGROUND: Whether the increase in blood pressure with coffee drinking seen in clinical trials persists over time and translates into an increased incidence of hypertension is not known. METHODS: We assessed coffee intake in a cohort of 1017 white male former medical students (mean age, 26 years) in graduating classes from 1948 to 1964 up to 11 times over a median follow-up of 33 years. Blood pressure and incidence of hypertension were determined annually by self-report, demonstrated to be accurate in this cohort. RESULTS: Consumption of 1 cup of coffee a day raised systolic blood pressure by 0.19 mm Hg (95% confidence interval, 0.02-0.35) and diastolic pressure by 0.27 mm Hg (95% confidence interval, 0.15-0.39) after adjustment for parental incidence of hypertension and time-dependent body mass index, cigarette smoking, alcohol drinking, and physical activity in analyses using generalized estimating equations. Compared with nondrinkers at baseline, coffee drinkers had a greater incidence of hypertension during follow-up (18.8% vs. 28.3%; P =.03). Relative risk (95% confidence interval) of hypertension associated with drinking 5 or more cups a day was 1.35 (0.87-2.08) for baseline intake and 1.60 (1.06-2.40) for intake over follow-up. After adjustment for the variables listed above, however, these associations were not statistically significant. CONCLUSION: Over many years of follow-up, coffee drinking is associated with small increases in blood pressure, but appears to play a small role in the development of hypertension.

Adult↗

PubMed2002

Marijuana smoking and head and neck cancer.

A recent epidemiological study showed that marijuana smoking was associated with an increased risk of head and neck cancer. Among high school students and young adults, the prevalence of marijuana use was on the rise in the 1990s, with a simultaneous decline in the perception that marijuana use is harmful. It will be a major public health challenge to make people aware of the harmful effects of marijuana smoking, when some people view it as the illicit drug with the least risk. The carcinogenicity of delta9-tetrahydrocannabinol (THC) is not clear, but according to laboratory studies, it appears to have antitumor properties such as apoptosis as well as tumor-promoting properties such as limiting immune function and increasing reactive oxygen species. Marijuana tar contains similar carcinogens to tar from tobacco cigarettes, but each marijuana cigarette maybe more harmful than a tobacco cigarette since more tar is inhaled and retained when smoking marijuana. More molecular alterations have been observed in bronchial mucosa specimens of marijuana smokers compared to nonsmokers. Field cancerization may be occurring on the bronchial epithelium due to marijuana smoking exposure. Several case studies were suggestive of an association of marijuana smoking with head and neck cancers and oral lesions. However, in a cohort study with 8 years of follow-up, marijuana use was not associated with increased risks of all cancers or smoking-related cancers. Further epidemiological studies are necessary to confirm the association of marijuana smoking with head and neck cancers and to examine marijuana smoking as a risk factor for lung cancer. It will also be of interest to examine potential field cancerization of the upper aerodigestive tract by marijuana and to explore marijuana as a risk factor for oral premalignant lesions.

Case-Control Studies↗

PubMed2002

Burden of illness.

The burden of affective disorders includes costs and the pain and suffering of affected individuls. Burden can be perceived from social and private perspectives. Although no ideal measure of burden exists, ample evidence documents the extensive cost and other negative impacts of affective disorders. Affective disorders are associated with disruptive family relations, higher health care costs for comorbid conditions, elevated rates of suicide, and lower productivity. Reserch should focus on improving measures of burden in general and on quantifying burden from the standpoint of diverse population groups.

Cost of Illness↗

PubMed2002

Practice-based interventions.

Current evidence indicates there remains a large gap in the provision of depression care, particularly in primary care. Several studies have demonstrated that interventions based on the chronic disease management model can improve patient outcomes. Challenges include designing more robust interventions that can move easily into a wide variety of primary care organizations. More research is needed to develop programs to improve outcomes for children with depression and adults with bipolar disorders.

Adult↗

PubMed2002

Urinary incontinence and psychological distress in community-dwelling older adults.

OBJECTIVES: To examine the relationship between urinary incontinence (UI) and psychological distress in older adults. We hypothesized that persons with UI associated with condition-specific functional loss would be most likely to report psychological distress. DESIGN: A population-based longitudinal survey. SETTING: Continuing participants in a study of community-dwelling adults who were initially living in East Baltimore in 1981. PARTICIPANTS: Persons aged 50 and older (n=781) at follow-up interviews conducted between 1993 and 1996 for whom complete data were available. MEASUREMENTS: Participants were classified as incontinent if they reported any uncontrolled urine loss within the 12 months preceding the 13-year follow-up interview. Condition-specific functional loss secondary to UI was further assessed based on a series of questions relating directly to participants' inability to engage in certain activities due to their UI. Psychological distress was assessed using the General Health Questionnaire (GHQ) at interviews in 1981 and at the 13-year follow-up. RESULTS: Persons with UI were more likely to experience psychological distress as measured by the GHQ than were persons without UI (unadjusted odds ratio (OR)=1.74, 95% confidence interval (CI)=1.13-2.68). Persons with condition-specific functional loss secondary to UI were substantially more likely to have psychological distress as measured by the GHQ than were persons without UI (unadjusted OR=4.02, 95% CI=1.86-8.70). In multivariate models that controlled for potentially influential characteristics such as age, gender, ethnicity, and chronic medical conditions the association between condition-specific functional loss secondary to UI and psychological distress remained statistically significant. Among people with UI, persons with persistently elevated GHQ scores were much more likely to report condition-specific functional impairment from UI (adjusted OR=6.55, 95% CI=1.94-22.12). CONCLUSION: Individuals with UI, especially when incontinence was associated with condition-specific functional loss, were more likely to have psychological distress than were other older adults. Our findings support a general conceptual model that condition-specific functional impairment mediates the relationship between a chronic medical condition and psychological distress.

Age Factors↗

PubMed2002

Internet support groups for depression: a 1-year prospective cohort study.

OBJECTIVE: This study described the characteristics of users of Internet-based depression support groups and assessed whether use predicts change in depression symptoms and social support. METHOD: Users (N=103) of these groups were recruited into the study cohort and followed prospectively. Demographic characteristics, support group use, depression care, score on the Medical Outcomes Study Social Support Survey, and score on the Center for Epidemiologic Studies Depression Scale (CES-D Scale) were assessed by Internet survey at baseline, 6 months, and 12 months. RESULTS: Users' demographic characteristics included median age of 40 years, 78.6% women, and 56.3% unmarried. Most (86.4%) were currently depressed (CES-D Scale score >22). Over 50% of participants heavily used the support group (5 or more hours in 2 weeks), and 37.9% preferred online communication to face-to-face counseling. Social support scores were low, compared with those from other studies of primary care patients with depression. The overall follow-up rate was 81.6% at 6 or 12 months. During follow-up, 72.6% of responders still participated in the online group; 81.0% were still receiving face-to-face depression care. Heavy users of the Internet groups were more likely to have resolution of depression (CES-D Scale score < or =22) during follow-up than less frequent users, after adjustment for age, gender, employment, and baseline CES-D Scale score with logistic regression. Social support scores did not change during follow-up. CONCLUSIONS: Users had high depression severity scores, were socially isolated, and perceived considerable benefit from the group. Internet depression support groups warrant continued research regarding supplementation of face-to-face depression care.

Adolescent↗

PubMed2002

Receipt of preventive medical services at psychiatric visits by patients with severe mental illness.

The authors used data from the National Ambulatory Medical Care Survey from 1992 to 1999 on 3,198 office visits to explore the extent to which psychiatrists provide clinical preventive medical services to patients with severe mental illness. Preventive services were provided during 11 percent of the visits. A multivariate analysis showed that preventive services were more likely to have been provided for patients with a chronic medical condition, for patients who were also seen by a nurse or other health provider during the visit, in rural areas, and during longer visits. Preventive services were less likely to have been provided during visits to health maintenance organizations and visits that took place later in the study period.

Adolescent↗

PubMed2002

Do family physicians and internists differ in knowledge, attitudes, and self-reported approaches for depression?

OBJECTIVES: The purpose of this investigation was to assess the relationship of primary care specialty training with self-assessed skill, knowledge, attitudes, and behavior toward depression recognition and management. METHOD: A baseline self-report questionnaire was administered to 184 internists and 138 family physicians participating in a multisite depression intervention study. RESULTS: There were no marked differences in knowledge of internists and family physicians regarding depression, in attitudes about the effectiveness of specific therapies, or in barriers to providing optimum treatment for depression. However, compared to internists, family physicians rated themselves as more skilled in the management of depression. When considering management of patients with moderate to severe depression, family physicians were more likely to report that they prescribed a selective serotonin-reuptake inhibitor (relative odds (RO) = 3.51, 95 percent Confidence interval (CI) [2.19, 5.60] and to personally counsel patients (RO = 1.97, 95 percent CI [1.16, 3.38]) more than half the patients, but were less likely to refer to a specialist in mental health (RO = 0.52, 95 percent CI [0.33, 0.82]) than were internists. Additional potentially influential characteristics did not wholly account for the reported differences in practice according to specialty. Physicians of both specialties expressed considerable uncertainty in their knowledge of psychotherapy and in their evaluation of the effectiveness of other strategies for the prevention of recurrence of depression. CONCLUSION: Strategies to improve mental health care should account for the orientation of primary care physicians to mental health issues.

Adult↗

PubMed2002

Anxiety disorders and disability secondary to urinary incontinence among adults over age 50.

OBJECTIVE: No previous research has investigated whether there is an association between anxiety disorders and urinary incontinence. We hypothesized that anxiety disorders would be associated with increased urinary incontinence related disability. METHOD: Continuing participants who were aged 50 years and older in a longitudinal study of community-dwelling adults who were initially living in East Baltimore in 1981 (n = 787). Participants were classified as incontinent if any uncontrolled urine loss within the 12 months prior to the interview was reported. Urinary incontinence related functional loss was further assessed based on a series of questions relating directly to participants' inability to engage in certain activities due to their urinary incontinence. Anxiety disorders were assessed with standardized interviews. RESULTS: Persons meeting criteria for an anxiety disorder were no more likely to have urinary incontinence than were persons without anxiety disorders (unadjusted odds ratio (OR) = 1.36,95 percent confidence interval (CI) [0.96, 1.93]). Among people with urinary incontinence (n = 159), persons meeting criteria for anxiety disorders in 1981 and in 1994 were much more likely to report urinary incontinence relatedfunctional impairment in 1994(adjusted OR = 6.51, 95 percent CI [1.42, 29.86]). CONCLUSIONS: Individuals with changes in day-to-day routines or activities secondary to urinary incontinence were more likely to meet criteria for an anxiety disorder than were other older adults. Further studies must tease out the temporal relationship and whether early detection of urinary incontinence and associated anxiety improves quality of life and functioning.

Aged↗

PubMedDate not supplied

Characteristics of primary care visits for individuals with severe mental illness in a national sample.

Individuals with severe mental illness (SMI) are at risk for inadequate general medical and preventive care, but little is known about their visits for primary care. We performed a cross-sectional analysis of primary care physician visits from the National Ambulatory Medical Care Survey (NAMCS) 1993-1998 and compared visit characteristics for patients with and without SMI. SMI was defined from ICD-9 diagnoses and medications. Primary care visits for patients with SMI were more likely to be return visits, were longer, and were more likely to have scheduled follow-up than for patients without SMI. Obesity, diabetes, and smoking were reported approximately twice as frequently in visits for patients with SMI compared to patients without SMI. The percent of visits with preventive counseling and counseling targeted at chronic medical conditions was similar for both groups. Likely appropriate to their complex needs, patients with SMI using primary care tend to have more return visits, longer time with the physician and are more often scheduled for follow-up care; their preventive counseling appears similar to non-SMI visits.

Adolescent↗

PubMedDate not supplied

Managed care organizational complexity and access to high-quality mental health services: perspective of U.S. primary care physicians.

This analysis addresses the relationship between perceived access to high-quality specialty mental health and medical services and 2 aspects of managed care organizational complexity at the practice level: 1) gatekeeper requirements for specialty services, and 2) managing multiple contracts. Cross-sectional analysis of a national telephone survey of 7,197 primary care physicians (PCPs) was performed. Access was defined as high-quality specialty services being always or almost always available to the PCP's patients when medically necessary. PCPs rated access to high-quality outpatient specialty mental health services as much lower than that of specialty medical services (28%; 95% confidence interval [CI], 27-29 versus 81%; 95% CI, 80-82). After adjustment for physician, practice, and managed care factors (multiple logistic regression analysis), perceived access to high-quality outpatient mental health services was lowest for practices with the largest number of managed care contracts and when a physician's practice was a "mixed model" with regard to the gatekeeper function. Perceived access to high-quality specialty medical services was not as strongly associated with these practice characteristics. PCPs who interact with a large number of managed care plans and different administrative models may have the most difficulty in obtaining high-quality mental health services for their patients.

Attitude↗