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Biomedical subjects

David Melzer

Publications and source records attributed to David Melzer.

28 records · Page 2Linked to original sources
PubMed2004

Trends in service use and treatment for mental disorders in adults throughout Great Britain.

BACKGROUND: Trends in health treatments and outcomes in the general population may be used to monitor achievement of health targets. AIMS: To investigate changes in mental health services and treatment in Britain over a 7-year period. METHOD: National surveys of psychiatric morbidity were completed in 1993 and 2000 in households throughout Great Britain. Standardised interviews were used to establish psychiatric case status and service and treatment utilisation in adults aged 16-64 years. RESULTS: Use of psychotropic medication doubled in those designated as psychiatric cases. In the non-case-status population antidepressant use rose from 0.16% in 1993 (95% CI 0.07-0.25) to 2.02% in 2000 (95% CI 1.69-2.35). However, the overall prevalence of neurotic and psychotic disorder hardly changed from 1993 to 2000. Use of specialised 'talking treatments'did not increase significantly, except in the non-case group. CONCLUSIONS: Treatment with psychotropic medication alone is unlikely to improve the overall mental health of the nation. A policy based almost exclusively on treatment of identified cases should be augmented by preventive approaches.

Adolescent↗
PubMed2003

Prevalence and distribution of hip and knee joint replacements and hip implants in older Americans by the end of life.

BACKGROUND AND AIMS: Hip and knee replacements have become increasingly common in the older population but the prevalence of these procedures and the potential impact on functioning towards the end of life have not been previously described. The aim of this study was to estimate the rates and distribution of hip and knee joint replacements and hip implants (surgical pins, screws, rods, plates, etc.) in people aged 65 and over who died in the US in 1993, and to measure mobility outcomes during their last year of life. METHODS: Data were drawn from the 1993 National Mortality Followback Survey; 7684 deaths in people aged 65 years or over were included. From these data full informant interviews were available for 6586 (86%). Three hundred and forty-four decedents had hip joint replacements, 357 had hip implants, and 102 had knee joint replacements. Replicate methods were used to obtain weighted estimates for all decedents in the 1993 US base population. RESULTS: Of female and male decedents, 15.5% (95% CI: 14.3-16.7) and 6.1% (95% CI: 3.9-8.2), respectively, had received the studied devices. About 80% of these had been implanted more than a year before death. There were large differences in the risks of receiving a hip joint replacement or a hip implant depending on gender, education and race. About 60% of recipients either had no difficulty in getting around their own homes during the last year of life or had difficulty lasting less than 6 months. CONCLUSIONS: Implanted hip and knee devices were common in older people who died in the US in 1993. Large sociodemographic differences in those who received vs those who did not were present at the end of life. While difficulty in walking is the main indication for joint replacements, a majority of those receiving replacements experienced less than 6 months of mobility difficulties in their own homes during the last year of their lives.

Activities of Daily Living↗
PubMed2003

Social inequalities and the common mental disorders: a systematic review of the evidence.

BACKGROUND: Of two large-scale government-commissioned studies of common mental disorders in the UK, one found occupational social class to be the strongest marker of risk while the other showed no clear relationship. This study reviews the published evidence on the links between conventional markers of social position and the common mental disorders in developed countries. METHODS: Inclusion criteria covered general population based studies with broad social class variation; samples of 3,000 or more adults of working age; identification of mental illness by validated instruments; social position identified by explicit standard markers; fieldwork undertaken since 1980; published output on key areas of interest. Incompatible study methods and concepts made statistical pooling of results invalid. RESULTS: Of nine studies, eight provide evidence of an association between one or more markers of less privileged social position and higher prevalence of common mental disorders. For some individual indicators in particular studies, no clear trend was evident, but no study showed a contrary trend for any indicator. The more consistent associations were with unemployment, less education and low income or material standard of living. Occupational social class was the least consistent marker. CONCLUSIONS: Common mental disorders are significantly more frequent in socially disadvantaged populations. More precise indicators of education, employment and material circumstances are better markers of increased rates than occupational social class.

Humans↗
PubMed2003

Social position and the common mental disorders with disability: estimates from the National Psychiatric Survey of Great Britain.

BACKGROUND: Published studies linking the common mental disorders with social disadvantage lack basic comparability. This project aimed to estimate effect sizes and independence of social position markers as risk factors for common mental disorders. Disorders with disability were examined to identify groups with high clinical and policy priority. METHODS: Data from the 1993 household survey of psychiatric morbidity in Great Britain were analysed using logistic regression models, using traditional and more specific markers of social position. RESULTS: Of those with a common mental disorder, 22 % reported difficulty doing at least one activity of daily living, linked to their mental symptoms. In comprehensive statistical analyses, having two or more physical illnesses was associated with an odds ratio of 6.42 (95 % CI 4.34-9.51) for common mental disorder with disability, while odds ratios of 3 or more were present for being economically inactive or having had two or more recent adverse life events. Occupational social class was not an independent marker of raised rates of disorder. Similar patterns of result were present for common mental disorders irrespective of disability, although odds ratios were smaller. CONCLUSIONS: Several specific markers of less privileged status are independently associated with raised rates of common mental disorders, with or without disability. There may be scope to target specific high-risk groups within comprehensive programmes to reduce mental health inequalities.

Activities of Daily Living↗
PubMed2003

The predictive validity for mortality of the index of mobility-related limitation--results from the EPESE study.

BACKGROUND: self-reported disability reflects physical, environmental and attitudinal factors. We have previously reported the empirical identification of three simple tests to provide an index of (ambulatory) mobility-related physiological limitations (MOBLI). Evidence of the MOBLI 's responsiveness over time has been presented. Evidence of the predictive validity of the index is needed. OBJECTIVE: we aimed to measure the predictive validity for future mortality of the MOBLI and of self-reported mobility disability in a longitudinal cohort study. METHODS: data are from the sixth annual interview for two sites in the Established Populations for Epidemiologic Studies of the Elderly study. Included were 3,040 people, with information about self-reported walking difficulties, walking speed, time to complete five chair stands and peak expiratory flow. Age- and sex-adjusted death rates over a 4-year follow-up were computed, and proportional hazards regression models were used in the analysis. RESULTS: the MOBLI score is associated with subsequent mortality over 4 years, with evidence of a 'dose-response' relationship. The predictive value for mortality of the MOBLI score is similar to that of self-reported mobility disability in the studied population. CONCLUSIONS: the 'objective' MOBLI index has predictive validity as a continuous or dichotomised measure of the physiological component of mobility limitation in older populations. Given its empirical basis and face validity, predictive validity and responsiveness to change, MOBLI should be considered for local validation and use in epidemiological comparisons of older populations across countries or over longer periods of time.

Activities of Daily Living↗
PubMed2003

Responsiveness of the index of mobility limitation: comparison with gait speed alone in the longitudinal aging study amsterdam.

BACKGROUND: Interpreting self-reported disability differences between diverse older populations is complicated by differences in attitudes and environment. We have previously reported on the index of mobility-related limitation tests (MOBLI), and shown that it predicts mortality over 4 years. In this article, we examine whether the index is responsive to changes in self-reported mobility disability. METHODS: Data on gait speed, time to complete 5 chair stands, and peak expiratory flow rate, with self-reported difficulty walking for 5 minutes, were available from the baseline and two 3-year follow-ups in the Longitudinal Aging Study Amsterdam. Analysis used data on changes in the index (or walking speed alone) and corresponding change over 3 years in self-reported difficulty or inability with a medium-distance walk. RESULTS: During all follow-ups, groups reporting deterioration in functioning had relatively larger changes in gait speed and MOBLI score than did the "no deterioration" groups. In comparative analyses of responsiveness, the MOBLI score had a larger responsiveness index, higher odds ratios, and larger receiving operating characteristic area than gait speed alone. CONCLUSIONS: The MOBLI index of mobility-related physical limitation tests is responsive to changes in self-reported mobility disability over two 3-year periods, and performs better than gait speed alone. This property is strongly supportive of its validity for epidemiological comparison of older populations across countries or over longer periods of time.

Aged↗
PubMed2003

Pharmacogenetics and public policy: expert views in Europe and North America.

The new genetics is stimulating the development of genetic testing of patients to help choose the best drug, adjust doses and avoid side effects. Proponents say that this personalized medicine will revolutionize drug development and healthcare. In a series of group meetings, 48 leading experts from regulatory agencies, industry, academia and consumer interests gave their opinions on the public policy priorities. Most believed that pharmacogenetics would have a clear impact on care within 15 years and that a public policy response was needed. The establishment of a good clinical evidence base should be a priority, together with addressing the needs of drug response gene minorities. A total of 72% also believed that postmarketing surveillance systems should be collecting DNA from patients experiencing moderate or severe adverse events.

Europe↗
PubMed2002

Performance tests and disability: developing an objective index of mobility-related limitation in older populations.

BACKGROUND: Disability reflects physiological limitations, social and environmental barriers, and "sickness" behavior. Being able to measure these influences separately would greatly assist interpretation of disability comparisons over time or between populations. This study aimed to identify an index of mobility-related limitations composed of physiological measures that are most closely associated with reported mobility disability in elders. METHODS: Data from the Third National Health and Nutrition Examination Survey (NHANES III) were used. Participants aged 60 and older were included in this analysis. Participants included 6596 respondents who were interviewed in their homes, and 5724 (87%) of these attended a further examination. Domains of measurements included body measurements, bone densitometry, physical examination, spirometry, fundus photography, and physical performance measures. Multivariate models were developed on a random half subsample of the data and were validated on the other half. Receiver operating characteristic (ROC) areas and logit rank slopes were used to evaluate sets of measures. RESULTS: In weighted logistic regression models, six and five measures were significantly associated with difficulty and inability in walking a quarter of a mile, respectively. These mainly included measures of lower extremity and lung function. A relatively minimal loss of sensitivity and specificity occurred from using more economical models, employing a subset of the identified measures. CONCLUSIONS: Subsets of measures associated with reported mobility disability could provide objective indices of mobility-related limitation for comparing populations or long-term population health monitoring.

Aged↗