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

Calcium channel blockers seem to be particularly suitable for elderly hypertensive patients since these agents do not cause salt and fluid retention, postural hypotension, sedation, depression, or biochemical abnormalities. Moreover, their use is compatible with several common diseases of old age, such as diabetes, obstructive lung disease, and peripheral vascular disease. We recently conducted a study in 21 patients (average age, 79 +/- 2 years) who completed an eight-week trial with 20-mg nifedipine tablets taken twice daily. Mean blood pressure decreased from 191 +/- 2/96 +/- 2 mm Hg to 151 +/- 4/80 +/- 3 mm Hg. In 15 patients (71 percent), blood pressure decreased to less than or equal to 160/90 mm Hg; in four additional patients (19 percent), diastolic blood pressure decreased by 15 to 25 percent. Thus, there was a sustained lowering of blood pressure in 90 percent of the participants receiving nifedipine monotherapy. A review of recent studies in elderly hypertensive patients revealed similarly favorable results with calcium channel blockers given alone or in combination with other agents. The accumulating data suggest that these compounds may offer a useful new approach to the treatment of hypertension in old age. However, in these studies, the number of patients and the duration of follow-up need to be extended to confirm the favorable impression obtained thus far.
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PMID:Calcium channel blockers in the management of hypertension in the elderly. 354 97

We report the total clinical experience for one family medicine resident who documented every patient encounter during his three years of residency training, and compare experience with model practice patients with that in other training sites. There were 7,671 encounters with 4,449 patients, for 17,660 problem contacts and 679 procedures. Encounter and problem activity for model practice patients constituted one fifth of the total experience. Model practice patients were older than patients, and were seen more often in the office than in the hospital. Most clinical experience with acute infections, depression, and obesity was gained with model practice patients. Most experience with pneumonia, normal delivery, myocardial infarction, and chronic lung disease was acquired with other patients, and most procedures were performed on them. Personal patients of the resident within the model practice provided the greatest experience with continuity of care. These data support the value of the model practice as an important supplement to traditional hospital-based patient populations for training family physicians.
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PMID:Clinical experience during family medicine residency training. 360 11

A case-control study was performed to test whether or not respiratory disease in coal miners presented a risk for suicide. While coal miners in general do not experience elevated rates of suicide, coal miners with respiratory disease have been found to have high rates of psychiatric disability, especially depressive reactions. Further, depression has been related to suicide. To test the hypothesis, 50 suicide deaths from four National Institute for Occupational Safety and Health cohorts of coal miners were matched by age at death to two series of controls, a noncancer, nonaccident control series, and a cancer control series. Using odds ratios (tested by chi-square) the risks of obstructive lung disease and coal workers pneumoconiosis were evaluated together with the risks of years of underground mining, cigarette smoking at the time of cohort creation, and ever having smoked cigarettes. Neither respiratory disease was found to pose a statistically elevated risk of suicide in this sample of U.S. white male coal miners.
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PMID:Respiratory disease and suicide among U.S. coal miners: is there a relationship? 387 Sep 26

Sleep and sleep loss have remarkable effects on breathing. Although sleep causes ventilatory disturbances of greater severity and variety than does sleep deprivation, the effects of sleep and sleep loss on respiration are similar. For example, both impair ventilatory drive and arousal responses to a variety of stimuli. Although the mechanism of impaired ventilation after sleep loss is not entirely understood, there is evidence to suggest that both respiratory muscle fatigue and central nervous system depression play a role. Patients who suffer from both disturbed sleep and lung disease are particularly vulnerable to the adverse effects of sleep disruption on breathing. Since sleep restoration returns many respiratory parameters to normal in sleep-deprived individuals, perhaps we should include rest in our treatment of certain patients with respiratory disease.
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PMID:Sleep, sleep loss, and breathing. 390 14

The authors assessed the prevalence and demography of depressive symptoms, their association with specific chronic diseases, and their influence on health service use in a large sample of elderly men seen in a primary care setting. Twenty-four percent of respondents reported clinically significant depressive symptoms; the prevalence of major depressive disorders was estimated at 10%, but only 1% reported receiving mental health treatment by a specialist. Self-reported marital separation or divorce and physical disability affecting employment were strongly associated with high depression scores, whereas the normative stresses of aging (widowhood, retirement, social isolation) were not. Only chronic lung disease was differentially associated with high depression scores, and this effect was weak. The authors discuss the implications of these findings for the design of comprehensive health services for the elderly with chronic disease.
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PMID:Symptomatic depression in elderly medical outpatients. I. Prevalence, demography, and health service utilization. 395 8

The pathophysiological basis of pulmonary atelectasis is reviewed and risk factors that enhance lung collapse are discussed. Management strategies to reduce or eliminate risk factors and to prevent collapse are discussed and the rational bases of these strategies are identified. Instability of lung alveoli is a consequence of surface tension and regional differences in alveolar size. The inherent tendency of alveoli to collapse is enhanced by the following risk factors; low lung volume, high closing volume, oxygen therapy, a rapid shallow ventilatory pattern, chronic lung disease, smoking, obesity, postoperative pain following abdominal or thoracic surgery, narcotic induced ventilatory depression, and neurological, neuromuscular, muscular and musculoskeletal diseases associated with mechanical impairment of respiratory function. The primary goal of perioperative respiratory management is prevention of atelectasis. Appropriate management strategies include physiotherapy and delay of elective surgery if substantial improvement in respiratory status can be achieved by specific treatments such as antibiotics, bronchodilators, steroids, and reduction of tobacco use and caloric intake. In selected cases, elective postoperative controlled ventilation may be indicated.
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PMID:Pulmonary atelectasis after anaesthesia: pathophysiology and management. 611 89

We studied 20 men (ages 46 to 69, mean 45 years) with chronic obstructive pulmonary disease (FEV1 of 0.55 to 2.1 L), to determine the relative importance of pulmonary impairment vs other occult physical or psychologic factors in the genesis of sexual dysfunction. Seven subjects had ceased sexual activity concomitant with worsening of their pulmonary symptoms; six because of erectile impotence and one due to dyspnea. Frequency of intercourse for the remaining 13 was 16 percent of prelung disease levels, and libido was decreased to 25 percent of premorbid levels. Nocturnal penile tumescence monitoring disclosed that six subjects had organogenic erectile impotence (OEI). None of the subjects showed signs of peripheral vascular disease as assessed by Doppler examination of peripheral pulses (including penile). The mean bulbocavernosus reflex latency (BCRL) for the OEI group (N = 5) was 40.2 msec, while that for the group with full nocturnal erections (N = 10) was 34.5 msec (P less than 0.005). Four subjects had occult diabetes mellitus evident on oral glucose tolerance tests, and one had evidence of an androgen deficit. The correlation coefficient for rank by sexual dysfunction vs pulmonary impairment and age was 0.66 (P less than 0.005) and 0.24 P greater than 0.05), respectively. Subjects with OEI tended to have the worst pulmonary function test results and the highest T-scores on the hypochondriasis, depression, and hysteria scales of the Minnesota Multiphasic Personality Inventory. Data suggest that sexual dysfunction worsens as lung disease worsens and that chronic obstructive pulmonary disease may be associated with male impotence in the absence of other commonly known causes.
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PMID:Sexual dysfunction and erectile impotence in chronic obstructive pulmonary disease. 680 73

An investigation on the occurrence and role of acute-phase reactants in experimental inhalation lung disease (ILD) was undertaken. Using an experimental model of ILD in which rabbits are exposed to aerosols of appropriate fungal spores, haptoglobin analysis was compared with depressions in arterial oxygen tension (PaO2) with time following challenge. Haptoglobin values of rabbits exposed to single 30-min aerosol challenges of Aspergillus terreus, demonstrated a significant (two- to three fold) increase 24-48 hr after challenge. Haptoglobin elevation was found to be a more reliable and consistent indicator of pulmonary inflammation than depression of PaO2. In an effort to determine the role of haptoglobin in this response, acute phase reactant levels were elevated either actively or passively. When rabbits with augmented haptoglobin levels were exposed to aerosol challenges with A. terreus, the typical depressions in PaO2 at 1-4 hr postchallenge were not observed. This indicated the plasma containing elevated acute-phase reactants may be involved in limiting the pulmonary response that normally occurs following challenge. Haptoglobin was not found to bind to A. terreus spores in vitro.
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PMID:Acute-phase reactants in experimental inhalation lung disease. 732 66

We surveyed 1,000 randomly selected state-licensed pesticide appliers to improve our understanding of pesticide use and its potential health effects. Participants were stratified by pesticide class (herbicides, insecticides, fungicides, fumigants) to determine potential differences in health characteristics among different pesticide groups. A subset of 60 applicators, divided by pesticide class used, were studied for exposure-related cholinesterase (ChE) depression. ChE depression in excess of 20% was most frequent in fumigant applicators who did enclosed-space application, in addition to other pesticide application procedures (p < .05). Survey data demonstrated that the prevalence of all common chronic diseases considered together was significantly increased (p = .015) in fumigant appliers, compared with all other pesticide use groups. The frequency of chronic lung disease was also significantly increased in the fumigant applier group (p = .027). Curiously, two cases of a rare hematopoietic neoplasm--hairy cell leukemia--were identified in our study group (annual incidence 0.67/100,000 in Minnesota). Whether there is an association between this unique tumor and agricultural work is uncertain, and further study is needed in this regard.
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PMID:Survey of health and use characterization of pesticide appliers in Minnesota. 794 64

Quality-of-life (QOL) in patients with respiratory illness is a topic of increasing interest to clinicians and researchers. In a multicentre trial, which studies the long-term effects of three medication regimens (beta-agonist plus either placebo, anticholinergic agent or corticosteroid, all by inhalation) in patients with chronic nonspecific lung disease ((CNSLD): asthma and chronic obstructive pulmonary disease (COPD)), quality-of-life was included as an additional outcome measure. We wanted to provide a baseline assessment of quality-of-life in 274 adult patients with a mild to moderate degree of CNSLD. Quality-of-life was measured using a set of six standardized tests: Anxiety, Depression and Sleep Disorders, Optimism and Stigma, and Activities of Daily Living were assessed via scales with adequate validity and reliability, as established in previous work in Dutch patients with CNSLD. We found that quality-of-life was mildly impaired in these patients. Although differences with a reference group were present throughout, these were not significant, probably due to selection of relatively young, clinically stable, and highly motivated patients for our study. Quality-of-life scores showed higher correlation coefficients (0.20 < r < 0.38) to symptom scores than did results of pulmonary function tests (r < 0.015). In logistic regression models, absence from work and hospitalizations due to CNSLD were partly determined by quality-of-life scores.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Quality-of-life in a long-term multicentre trial in chronic nonspecific lung disease: assessment at baseline. The Dutch CNSLD Study Group. 811 42


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