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Ethics, Medical↗
Biomedical subjects
James Barrett
Publications and source records attributed to James Barrett.
Predictors of nonresponse to treatment in primary care patients with dysthymia.
Dysthymia is one of the most prevalent problems in primary care, especially in the elderly. In this study, we evaluated the demographic and clinical predictors of nonresponse to treatment in primary care patients with dysthymia. The study sample consisted of 338 primary care patients meeting DSMIII-R criteria for dysthymia from 4 diverse geographic sites in a randomized controlled 11-week trial of paroxetine, problem-solving therapy or placebo. Patients who attended at least 4 treatment sessions were used in the analysis. A score of less than 7 on the Hamilton was defined as a positive response to treatment. By Week 11, 52.2% of patients had a positive response to treatment. Patients with lower levels of education (odds ratio 0.44, 95% CI 0.23, 0.86), higher scores on the personality dimension of neuroticism (odds ratio 0.58, 95% CI 0.36, 0.92) and those with more severe medical illness (odds ratio 0.97, 95% CI 0.95, 0.99) were less likely to recover with either active or placebo treatments. Elderly women (>60 years of age; odds ratio 0.19, 95% CI 0.05, 0.66) were also less likely to respond to all treatments; however, females had a significantly higher response to placebo treatment compared to males. The factors associated with lack of response to treatment included lower-levels of education, high neuroticism, more severe medical illness and being an older female. This analysis is based on patients agreeing to participate in a randomized controlled trial, limiting representativeness of the sample, however, the demographic and clinical characteristics are common in elderly depressed primary care patients, and may signal the need for increased mental health specialty consultation.
Aged↗
Correlates of remission in primary care patients treated for minor depression.
As minor depression is perhaps the most common form of mood disorder seen in primary care, we sought to explore the effects of both pharmacologic and psychosocial interventions for primary care patients with this condition. Three hundred and eighteen primary care patients meeting criteria for minor depression (defined as endorsing 3 or 4 of the nine DSM-IV symptoms of major depression, at least one of which was either depressed mood or anhedonia, for a period of at least four weeks, and scoring > or = 10 on the Hamilton Rating Scale for Depression) from 4 diverse geographic sites were enrolled in a randomized controlled 11 week trial of paroxetine, problem-solving therapy or placebo. Patients who attended at least 4 treatment sessions and who received a Hamilton score by an independent rater at either 6 or 11 weeks were used in the analysis (77% of enrolled patients). A score of < or = 6 on the Hamilton was defined as a positive response to treatment. Fifty four percent of patients met our criteria for remission (HRS-D < or = 6) by week 11, with no difference among treatments. Patients who were women, younger, of European descent, homemakers or retired persons (as opposed to unemployed) and who had lower baseline severity of depression were more likely to remit across all treatment conditions. Although explicitly addressed in the data analysis, differences in outcomes across the four sites of the investigations limit our confidence in the generalizabilty of our findings. In addition, patients with lower levels of educational attainment had a higher dropout rate, suggesting further caution about the generalizability of the findings. Defining remission in this categorical way, we found no differences among the interventions studied, but did find that outcome was related to demographic and clinical characteristics of the patients. While it is difficult to know why female patients were more likely to remit, this may be a function of the association in our subject populations between male gender and the likelihood (approximately .46) of being a patient in the VA system. The remaining variables associated with higher probability of remission appear to reflect social advantage and lower severity or complexity of illness.
Adult↗
Privacy for defecation and fecal incontinence in older adults.
INTRODUCTION: Privacy during defecation is important to individuals and society at large and it has not been studied in older people with fecal incontinence. METHODS: One hundred twenty adults aged 65 years and with fecal incontinence who were either living in their own homes or in a nursing home or receiving care in an acute or rehabilitation elderly care ward were surveyed with a questionnaire that included questions on privacy during defecation. RESULTS: Privacy while defecating was often least achieved in the patients with fecal incontinence living in nursing homes (NH) (n=7, 23%) but usually was achieved in those living at home (H) (n=28, 93%) and by some being cared for in rehabilitation wards (R) (n=16, 53%) or in acute wards (AC) (n=15, 50%; P<.001). Very few participants with fecal incontinence were aware of leakage (NH: n=3, 10%; R: n=9, 30%; AC: n=9, 30%; H: n=15, 50%), able to clean themselves (NH: n=0, 0%; R: n=2, 7%; AC: n=5, 17%; H: n=24, 80%) or had access to patient information leaflets about fecal incontinence (NH: n=3, 10%; R: n=4, 13%; AC: n=1, 3%; H: n=16, 53%). CONCLUSION: Older people, especially those who are dependent, lack privacy during bowel movements. They are usually unaware of being incontinent of stool and are unable to clean themselves afterwards. Access to information about fecal incontinence is poor.
Activities of Daily Living↗
Incontinence and falls in older people: is there a link?
Incontinence, falling and cognitive impairment have been recognised as 'geriatric syndromes' for many years (Reuben, 1991). They often result from the accumulated effect of impairments in multiple domains (organ systems) (Tinetti et al, 1988). The relationship between cognitive impairment and incontinence has been extensively written about (McGrother et al, 1990), but the relationship between falls and urinary incontinence (UI) has hardly been studied.
Accidental Falls↗