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Query: UMLS:C0011570 (depression)
 172,036 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

In a pilot study, 55 low-income Latina patients with breast or cervical cancer and comorbid depression were randomly assigned to receive collaborative care as part of the Multifaceted Oncology Depression Program or usual care. Relative to patients in the usual care condition, patients receiving collaborative care were more likely to show>or=50% improvement in depressive symptoms as measured by the Personal Health Questionnaire (OR=4.51, 95% CI=1.07-18.93). Patients in the collaborative care program were also more likely to show improvement in emotional well-being (increase of 2.15) as measured by the Functional Assessment of Cancer Therapy Scale than were those receiving usual care (decrease of 0.50) (group difference=2.65, 95% CI: 0.18-5.12). Despite health system, provider, and patient barriers to care, these initial results suggest that patients in public sector oncology clinics can benefit from onsite depression treatment.
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PMID:Can collaborative care address the needs of low-income Latinas with comorbid depression and cancer? Results from a randomized pilot study. 1588 43

Nurse-managed centers (NMCs) provide viable options for primary healthcare and contribute substantially to filling access gaps for vulnerable populations. The purposes of this paper are to (a) describe a pilot application and adaptation of eight Health Plan Employer Data and Information Set (HEDIS) measures to six NMCs, (b) report the findings from the quality assessments, and (c) compare findings to national HEDIS data. The eight quality assessment areas are asthma, cervical cancer screening, childhood immunizations, depression, diabetes, hypertension, mammography screening, and smoking cessation. The NMCs achieved or exceeded HEDIS 50th percentile levels in a number of important clinical areas, but did not attain the 50th percentile level in others. Thus, HEDIS measures are relevant for the assessment of care quality and provide useful data for quality improvement in NMCs.
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PMID:Measuring quality in nurse-managed centers using HEDIS measures. 1641 87

For the most part, lesbians and bisexual women face the same health issues as heterosexual women, but they often have difficulty accessing appropriate care. Physicians can improve care for lesbians and bisexual women by acknowledging the potential barriers to care (e.g., hesitancy of physicians to inquire about sexual orientation and of patients to disclose their sexual behavior) and working to create a therapeutic physician-patient relationship. Taking an inclusive and nonjudgmental history and being aware of the range of health-related behaviors and medicolegal issues pertinent to these patients enables physicians to perform relevant screening tests and make appropriate referrals. Some recommendations, such as those for screening for cervical cancer and intimate partner violence, should not be altered for lesbians and bisexual women. Considerations unique to lesbians and bisexual women concern fertility and medico-legal issues to protect familial relationships during life changes and illness. The risks of suicidal ideation, self-harm, and depression may be higher in lesbians and bisexual women, especially those who are not open about their sexual orientation, are not in satisfying relationships, or lack social support. Because of increased rates of nulliparity, the risks of conditions such as breast and ovarian cancers also may be higher. The comparative rates of alcohol and drug use are controversial. Smoking and obesity rates are higher in lesbians and bisexual women, but there is no evidence of an increased risk of cardiovascular disease.
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PMID:Primary care for lesbians and bisexual women. 1688 26

Using the Health Plan Employer Data and Information Set (HEDIS), the National Committee for Quality Assurance partners with more than 90% of the nation's managed care organizations to collect, audit, and report performance on a range of standardized healthcare quality measures. Many HEDIS measures have been useful in promoting population health, such as rate of beta-blocker use after myocardial infarction or rate of cervical cancer screening. Other measures, such as those for Antidepressant Medication Management (AMM), have been less successful. Several trends are occurring within behavioral health management that attempt to improve depression treatment outcomes, including the implementation of performance-based initiatives using the HEDIS AMM measures and the 9-item Patient Health Questionnaire. Ultimately, linking quality measures to clinical strategies is critical for achieving successful depression treatment outcomes.
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PMID:HEDIS antidepressant medication management measures and performance-based measures: an opportunity for improvement in depression care. 1804 69

The psychologic and psychosexual sequelae of cervical screening and disease are well recognized but most research has focused on women with cervical intraepithelial neoplasia (CIN) or women with early (stage IB) to advanced cervical cancer. There has been little work looking at women with microinvasive cancer as a unique clinical identity. Many of these women have a similar diagnostic, treatment, and follow-up pathway to those with high-grade CIN. This could result in unrecognized and ongoing health concerns. We report on a questionnaire-based case-control study, comparing the concerns of women with microinvasive cervical cancer with those of women with high-grade CIN. Women with microinvasive cancer and controls with CIN2/3 diagnosed between 2000 and 2006, from a geographically defined population, were recruited and invited to complete a postal questionnaire consisting of the Hospital Anxiety and Depression Scale (HADS) and the Process Outcome Specific Measure (POSM). Twenty-eight women diagnosed with microinvasive cancer were identified and 18 participated (response rate 64%). Fifty-eight controls were matched by age and year of treatment with 26 responding (45%). About 18% of women with microinvasive cancer had a HADS depression score of 8 or more, compared to 12% of those with CIN (P = not significant). The HADS anxiety score of 8 or more occurred in 35% of each group. There were no significant differences in terms of POSM results for sexual activity, fertility, and developing cervical cancer in the future between cases and controls. We did not find a difference between women with a previous diagnosis of microinvasive cancer and those with high-grade CIN, in terms of ongoing concerns during their follow-up. We did not identify any additional concerns for women with microinvasive cancer in the care provided in the colposcopy service.
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PMID:The impact of microinvasive cancer of the cervix on women during follow-up. 1821 62

Treatment with opioid analgesics often causes adverse reactions that may make continuous use of such drugs difficult. We investigated the efficacy and safety of controlled-release oxycodone in the treatment of gynecologic cancer pain. The patients included 14 with cervical cancer, 6 with corpus cancer, and 17 with ovarian cancer. Treatment with controlled-release oxycodone was started at 5 mg/dose when pain control using nonsteroidal anti-inflammatory drugs became ineffective. The dose was titrated to the optimal level over a mean duration of 2.34 +/- 1.13 days, and the initially optimal dose was 18.92 +/- 5.23 mg/day. Although no patients experienced confusion, vomiting, or respiratory depression, 17 patients experienced adverse events, including constipation in 14 patients and nausea in 9 patients. The incidence of nausea was low in patients receiving oxycodone and prochlorperazine. In the present study, patients with moderate to severe pain caused by gynecologic cancer could successfully be treated with controlled-release oxycodone.
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PMID:Analgesic efficacy of controlled-release oxycodone in patients with uterine or ovarian cancer. 1822 51

Certain high-risk types of human papillomaviruses (HPVs), which are sexually transmitted persistent, and currently epidemic in the United States, are important etiologic agents in cervical cancer, constituting an acute health threat to women. Consequently, adherence to recommended Papanicolaou (Pap) screening and colposcopy regimens is crucial for early diagnosis and treatment which enhance survival dramatically. This article reviews research and theory on major psychosocial factors relevant to the transmission, onset, and course of this infection. The review focuses on cognitive-affective variables and processes (e.g. monitoring-blunting, anxiety, depression) that underlie--and potentially undermine--adherence to relevant health-protective behaviors. Identification of these processes should facilitate interventions to help women, particularly from low-income, inner city populations who are at highest risk, to adhere to essential follow-up regimens.
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PMID:From human papillomavirus (HPV) to cervical cancer: psychosocial processes in infection, detection, and control. 1842 67

Marriages in which a child under the age of 18 years is involved occur worldwide, but are mainly seen in South Asia, Africa, and Latin America. A human rights violation, child marriage directly impacts girls' education, health, psychologic well-being, and the health of their offspring. It increases the risk for depression, sexually transmitted infection, cervical cancer, malaria, obstetric fistulas, and maternal mortality. Their offspring are at an increased risk for premature birth and, subsequently, neonatal or infant death. The tradition, driven by poverty, is perpetuated to ensure girls' financial futures and to reinforce social ties. One of the most effective methods of reducing child marriage and its health consequences is mandating that girls stay in school.
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PMID:Child marriage: a silent health and human rights issue. 1939 95

Orthostatic hypotension (OH) is regarded as a decrease primarily in systolic blood pressure on changing position from supine to erect. Based on clinical criteria, it is characterized by a decrease in systolic pressure of 20 mmHg and diastolic pressure of 10 mmHg within 1 to 3 minutes of standing after being supine. It is most prevalent in, although not limited to, the elderly population and is characterized by a variety of problems, including diminished cognition and disturbed emotion along with gate problems, falls, and brain and cardiovascular difficulties. Although often seen as an age-related condition, occurrence of OH is also associated with a number of autonomic nervous system neurodegenerative disorders. Medications may play a direct role in the risk of triggering OH; these drugs include, but are not limited to, agents used in the treatment of hypertension, myocardial ischemia, psychosis and schizophrenia, depression, Alzheimer and Parkinson disease as well as a vaccine approved for the prevention of cervical cancer. Most of these agents increase the risk for triggering OH through varying vasodilative mechanisms or through sympathetic nervous system interruption; for other drugs, no mechanism of action has been identified. These factors should be considered when diagnosing OH and when prescribing remedies for both patients with OH and those without OH; medication's contributions to the severity and/or risk of developing OH could limit their use. However, their effects could be attenuated or even eliminated by modifying drug dosages.
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PMID:Etiology and risk factors for developing orthostatic hypotension. 1943 76

This study evaluated the psychological impact caused by genital warts and whether this altered over time. Eighty-four patients with genital warts and a group of 28 appropriately matched volunteers from the local general population were recruited. The patients were divided into three groups of 28 according to the Health Protection Agency classification codes for genital warts. A comprehensive health questionnaire was completed by all participants. Patients with first attack genital warts experienced significantly more distress, anxiety and depression and were less satisfied with their lives than all the other groups. They also reported less satisfaction with the practical support they received. The recurrent episode genital warts group experienced significantly high levels of emotional distress and the re-registered group reported significantly less emotional and practical support according to their needs. While the first attack genital warts group experienced the most psychological effects, it is clear that those effects did not disappear as an individual came to terms with their diagnosis. The choice of vaccine to prevent cervical cancer will not prevent clinical warts occurring and therefore will not help prevent the psychological morbidity associated with this condition.
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PMID:The psychological impact caused by genital warts: has the Department of Health's choice of vaccination missed the opportunity to prevent such morbidity? 1981 14


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