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Biomedical subjects

J L Coulehan

Publications and source records attributed to J L Coulehan.

At least 19 recordsLinked to original sources
PubMed1991

Strategies for evaluating treatments for major depression in primary care patients.

Primary care physicians are being urged to provide patients experiencing a major depression treatments validated with psychiatric patients. The propriety of transferring clinical technologies from one care-giving sector to another is questionable, however, as it has little scientific support. We suggest that clinical trials be initiated so as to expand the available knowledge base. This paper analyzes the methodologic issues involved in pursuing such experimental research and urges that it be conducted despite the possible need for initial design compromises.

Adult↗
PubMed1991

The treatment act: an analysis of the clinical art in chiropractic.

This paper discusses the nature of healing as it applies to the clinical art of chiropractic. General concepts of the phenomenology of illness and healing are developed and then applied specifically toward chiropractic care. The role of metaphor in medicine and chiropractic is discussed; chiropractic may make better use of root metaphor than does the practice of medicine. Finally, the paper discusses certain implications of the clinical art of chiropractic as they relate to teaching and research within the chiropractic profession.

Back Pain↗
PubMed1990

Wood-burning stoves and lower respiratory tract infection in American Indian children.

Some studies suggest that home use of wood-burning stoves is an independent risk factor for lower respiratory tract infection in young children. To test this hypothesis in a population with a high prevalence of wood-burning stove use, we studied Navajo children with diagnosed pneumonia or bronchiolitis. We matched each case (less than or equal to 24 months of age) with a child of identical sex and age who was seen for well-child care or a minor health problem, and we interviewed an adult caretaker about family history and environmental exposures. Analyzing 58 case-control pairs, we found that home wood-burning stove use, recent respiratory illness exposure, family history of asthma, dirt floors, and lack of running water in the home increased the risk of lower respiratory tract infection. On multiple logistic regression analysis, however, only wood-burning stove use and respiratory illness exposure were independently associated with higher risk.

Bronchiolitis↗
PubMed1990

Depressive symptomatology and medical co-morbidity in a primary care clinic.

Most primary care patients exhibiting significant depressive symptomatology fail to meet DSM-III criteria for a major depressive disorder (MDD). Yet, such patients have substantial morbidity and dysfunction attributable to their affective syndrome. Since surprisingly little is known about this group's clinical characteristics, we studied 618 general medicine patients aged eighteen to sixty-four years. In this population, fifty-seven (9.2%) scored quite high when screened on the Center for Epidemiological Studies Depression Scale (greater than or equal to 27) while not meeting MDD criteria on the Diagnostic Interview Schedule. Membership in the "depression symptoms only" (DSO) group was predicted by a logistic regression model including female gender, more severe medical illness, higher likelihood of operative procedures, and less frequent cardiovascular diagnoses. Our findings suggest that the DSO state is associated with substantial "medical" morbidity. Prospective studies of subclinical depression in the primary care setting are urged to clarify etiologic and treatment concerns.

Adjustment Disorders↗
PubMed1990

Determinants of blood pressure in Navajo adolescents.

Hypertension is becoming more common among Navajo people, especially among young men. In a group of 580 Navajo adolescents, we looked for factors associated with variations in blood pressure level. Using our criteria, 11.1% of adolescent males and 1.6% of females had an elevated screening blood pressure. In males, blood pressure was a function of age only, and not significantly related either to obesity (body mass index) or measures of acculturation and personal adjustment. In females, blood pressure was not related to age, but was associated with body mass index. Systolic pressure in females was also associated with poor personal adjustment. Level of acculturation (by our index) had no bearing on blood pressure level in this population.

Acculturation↗
PubMed1990

Medical comorbidity of major depressive disorder in a primary medical practice.

Despite much speculation about the relationship between depression and medical comorbidity in primary care settings, few investigators have examined this issue empirically. Using a two-stage screening procedure, we assessed 618 patients aged 18 to 64 years in an academic general medicine clinic. Forty-one patients (6.6%) suffered from a current episode of major depressive disorder (MDD). We compared this group with a 20% random sample of nondepressed patients. While patients with MDD were younger (mean age, 41.1 vs 47.2 years), they were assessed by the Duke University Severity of Illness Scale as having more severe medical illness. Patients with MDD were more likely to have malignant tumors and "ill-defined conditions" than nondepressed patients. The 18 patients with MDD (44%) who were correctly diagnosed by their physicians had less severe medical illness than those whose depression was clinically undetected. A logistic regression model predicting MDD group membership included female gender, younger age, higher Duke University Severity of Illness Scale score, and more frequent inactive ill-defined diagnoses. These findings are consistent with assertions: (1) patients with MDD have more physical illness than nondepressed patients and/or (2) somatic symptoms and disability caused by MDD add to the burden of physical illness.

Adult↗
PubMed1989

Treating depression in primary care practice. An application of decision analysis.

Decision analysis approaches complex treatment issues by considering alternative strategies in an explicit and logical manner, and examining their outcomes in the face of varied assumptions. Significant data gaps impede full application of this framework to the treatment of depressed primary care patients. Nevertheless, decision analysis already can be useful in emphasizing needed clinical information in treating these patients and highlighting future directions for research.

Curriculum↗
PubMed1989

Acute myocardial infarction and sudden death in Sioux Indians.

While some Indian tribes have low rates of acute myocardial infarction, Northern Plains Indians, including the Sioux, have rates of morbidity and mortality from acute myocardial infarction higher than those reported for the United States population in general. In a review of diagnosed cases of acute myocardial infarction over a 3-year period in 2 hospitals serving predominantly Sioux Indians, 8% of cases were found misclassified, and 22% failed to meet rigorous diagnostic criteria, although the patients did indeed have ischemic heart disease. Patients had high frequencies of complications and risk factors and a fatality rate of 16% within a month of admission. Sudden deaths likely due to ischemic heart disease but in persons not diagnosed as having acute myocardial infarction by chart review occurred 3 times more frequently than deaths occurring within a month of clinical diagnosis.

Adult↗
PubMed1988

Symptom patterns of depression in ambulatory medical and psychiatric patients.

The failure of primary care physicians to recognize depressive disorders in medical patients has been attributed to the differing clinical syndromes presented by these persons in comparison with psychiatric patients. Earlier British studies have found intersector difference in the prevalence and severity of somatic, affective, and cognitive symptoms. Our investigation with American patients did not replicate these findings. The need for further research along these lines is discussed, as are the implications for assessing depression in generalist and specialist practices.

Adult↗
PubMed1988

More frequent diagnosis of acute myocardial infarction among Navajo Indians.

In an earlier study, we failed to confirm a clinical impression that the incidence of acute myocardial infarction (AMI) was increasing in Navajo men. Extending our data collection an additional three years, through 1986, we observed that the attack rate in men more than doubled and there was a gradual increase among women. Most Navajos who sustain AMI are hypertensive (51 per cent), diabetic (50 per cent) or both (31 per cent), but few smoke cigarettes.

Adult↗