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 34,133 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Primary care physicians have a vital role to play in identifying depression in their elderly patients. Diagnosis may be difficult, because symptoms are atypical and frequently include psychomotor agitation, somatic symptoms, and complaints of memory loss. Patients with medical illnesses, such as cancer, postmyocardial infarction, stroke, Parkinson's disease, and early Alzheimer's disease are particularly vulnerable to depression. Drugs that may cause depressive symptoms are digitalis at toxic levels, beta-blockers, centrally acting antihypertensives, immunosuppressants, and nonsteroidal anti-inflammatory agents. Cyclic antidepressants are the drugs of first choice. Selection depends on the patient's physical health and current medications and the side effect profile of the drug. Side effects are more pronounced in old age because of drug accumulation owing to slowed clearance. Troublesome side effects are anticholinergic effects, orthostatic hypotension, sedation, cardiotoxicity, and weight gain. The most useful antidepressants for geriatric patients are the secondary amines, desipramine and nortriptyline. The second-generation drug trazodone has the advantage of causing the least anticholinergic effects, but it is very sedating. Before treatment, the patient should have an electrocardiogram, liver function tests, tonometry, sitting and standing blood pressures, evaluation of urinary symptoms for outflow obstruction, review of current medications, and estimation of suicide risk. Cyclic antidepressants are contraindicated during recovery from myocardial infarction, in heart disease when there is severe impairment of myocardial performance, in seizure disorders, and in the presence of glaucoma or a large prostate. Drug interactions that may cause trouble can occur with epinephrine, MAO inhibitors, thyroid hormone, cimetidine, and centrally acting antihypertensives. Dosage should start low, increasing usually by 25 mg every 4 to 5 days until a therapeutic level is reached. Failure of a noradrenergic antidepressant after 4 to 5 weeks can be followed by a trial of a serotonergic drug. Drug serum level monitoring is useful for imipramine, desipramine, and nortriptyline. Monoamine oxidase inhibitors are effective in many elderly patients who are resistant to TCAs. Sympathomimetic drugs must be avoided with MAOIs. Elderly patients are at high risk of toxicity and drug interactions with lithium. Electroconvulsive therapy is useful for patients who do not respond to drug treatment, but medical complications, particularly cardiovascular, often occur in patients 75 or older. Many patients relapse after ECT. Psychotherapy together with pharmacotherapy may be the optimal treatment for elderly depressives. Older patients are more likely to become chronically depressed than younger patients. The risk of suicide in depressed elderly males is high, particularly in those with psychosocial problems, and depression rises with age.
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PMID:Management of depression in the elderly. 266 41

With reference to comparative data for New Zealand and the United Kingdom, the contribution of injuries to the Australian mortality mosaic is examined against the background of the three leading causes of death; namely, heart disease, cancer and cerebrovascular disease. The data are primarily adapted from 1980 age-, sex- and cause-specific mortality tabulations published by the World Health Organization. A core concept is premature mortality, which is operationalised as an age-adjusted rate of potential years of life lost between ages one and 65. Injuries universally rank first as a cause of male premature mortality, and are second to cancer in the female case. The 15-24 age group is the predominant source of these injury losses. Irrespective of sex, Australian and New Zealand premature injury mortality rates are similar, and are almost double the British rates. Three-quarters of the rate variation between Australia and the United Kingdom are accounted for by two causes of death; motor vehicle traffic accidents and suicide.
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PMID:Injuries and the Australian mortality mosaic: a comparison with the United Kingdom and New Zealand. 279 48

A retrospective cohort study was undertaken of the mortality of men exposed to carbon disulfide in the US rayon industry. The cohort consisted of 10,418 men employed between 1957 and 1979. Deaths to mid-1983 were ascertained by the Social Security Administration and the National Death Index. Total mortality in the group was slightly lower than that of the comparable US population. There was no significant difference in overall mortality between the 4,448 employees who had held jobs with the greatest potential for exposure to carbon disulfide and the 3,311 workers who had no exposure. However, there was an excess of deaths from arteriosclerotic heart disease among the potentially most heavily exposed (242 deaths observed, 195.6 expected). An excess of deaths from suicide (29 observed, 18.8 expected) was seen in only one of the four plants.
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PMID:Mortality in the US rayon industry. 318 86

The United States has the highest incidence of firearm-related deaths among the Western industrialized nations. Firearms are the second leading cause of injury death. In 1982, the National Center for Health Statistics showed that firearms killed more than 33,000 individuals: 1,756 unintentionally, 16,573 by suicide, 13,841 by homicide, 376 by legal action, and 540 of undetermined intent. In terms of the total number of years of life lost, trauma in general contributed more years than heart disease and cancer combined for the year 1975. The southern regions of the United States tend to have higher firearm-related death rates than other regions of the country. Data collected within Arkansas are consistent with this trend. Handguns are the most frequently used firearms in fatal injuries. Unfortunately, data on nonfatal injuries are lacking. The emotional and economic costs of firearm-related death and injury are staggering. The estimated daily cost of hospitalization is $2100, and the average length of hospitalization is 10 days. The emotional impact of a gun-related injury or death will be felt immediately by 950,000 people per year. The economic loss resulting from "premature" deaths due to firearms is estimated to be nearly $4 billion annually. Unfortunately, the firearm is so ingrained in the American experience that one must conclude gunshot injuries and fatalities are simply part of the cost of living in America today.
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PMID:Gunshot wounds. Incidence, cost, and concepts of prevention. 330 55

Disopyramide is an oral antiarrhythmic drug which reduces conduction velocity, prolongs duration of action potential and the effective refractory period, and exerts vagolytic properties. The drug is usually well absorbed orally. The principal use of the drug is to suppress ventricular extrasystoles with usual oral dosage of 100 to 200 mg every 6 h, until blood levels of 2 to 4 micrograms/mL are attained. The use of the drug for suicide is uncommon as it is a prescription drug. Two cases of fatal disopyramide intoxication seen at the Los Angeles County Medical Examiner's Office will be discussed followed by a review of the literature of fatal suicidal disopyramide overdose. Case 1 was a 31-year-old male pharmacist with known history of depression and no history of heart disease. His decomposed remains were found with a suicide note and with several disopyramide tablets. At autopsy the blood level for disopyramide was 146 micrograms/mL. Case 2 is a 40-year-old male with history of alcoholism and prior suicidal attempts who regularly took disopyramide to control ventricular arrhythmias. He apparently ingested 36 100-mg tablets of disopyramide before his final collapse. At autopsy his blood level of disopyramide was 63 micrograms/mL.
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PMID:Fatal disopyramide intoxication from suicidal/accidental overdose. 332 13

Standardized proportional mortality ratios (PMR) were computed for a population of highway workers. Hazards of highway maintenance work include exposure to solvents, herbicides, asphalt and welding fumes, diesel and auto exhaust, asbestos, abrasive dusts, hazardous material spills, and moving motor vehicles. Underlying cause of death was obtained for 1,570 workers who separated from the California Department of Transportation between 1970 and 1983, and who died in California between 1970 and 1983 (inclusive). Among 1,260 white males, the major findings were statistically significant excesses of cancers of digestive organs (PMR = 128), skin (PMR = 218), lymphopoietic cancer (PMR = 157), benign neoplasms (PMR = 343), motor vehicle accidents (PMR = 141), and suicide (PMR = 154). Black males (N = 66) experienced nonsignificant excesses of cancer of the digestive organs (PMR = 191) and arteriosclerotic heart disease (PMR = 143). Among 168 white females, deaths from lung cancer (PMR = 189) and suicide (PMR = 215) were elevated. White male retirees, a subgroup with 5 or more years of service, experienced excess mortality due to cancers of the colon (PMR = 245), skin (PMR = 738), brain (PMR = 556), and lymphosarcomas and reticulosarcomas (PMR = 514). Deaths from external causes (PMR = 135) and cirrhosis of the liver (PMR = 229) were elevated among white males with a last job in landscape maintenance. White males whose last job was highway maintenance experienced a deficit in mortality from circulatory diseases (PMR = 83) and excess mortality from emphysema (PMR = 250) and motor vehicle accidents (PMR = 196). Further epidemiologic and industrial hygiene studies are needed to confirm the apparent excess mortality and to quantify occupational and nonoccupational exposures. However, reduction of recognized hazards among highway maintenance workers is a prudent precautionary measure.
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PMID:Mortality among California highway workers. 335 85

A sample of 524 young drug addicts consecutively treated at a special hospital ward has been followed by registers for an average of 10 years. A total of 62 were found to have died drug-related deaths at an average age of 28 years; 19 of them had committed suicide. Representativeness of the sample is investigated. Sex and choice of drugs were predictive factors behind fatal outcome: male opiate addicts died 5.4 times and male amphetamine abusers 2.5 times as often as expected. The males were exposed to greater risk than the females. Those who committed suicide had an hereditary disposition for mental disturbances, especially affective disorders. Lethal substances proved to be opiates, barbiturates and alcohol and/or other psychotropic preparations. Signs of heart disease were often found in the overdose cases. Most of the addicts who died were in a compulsive stage of the drug career, but some were abstaining or trying to abstain from drugs. A critical period seems to be at 26-28 years of age, a period when the abuse seems to be most intense and compulsive, the suicide risk is high and the efforts to abstain from drugs most serious and hazardous.
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PMID:Fatal outcome in drug addiction. 340 25

To what extent, and through what mechanisms, does the deterioration of economic conditions affect the health of the population at the national level? In this paper, the author presents the results of a study of Swedish data, analyzing the post-World War II changes in mortality rates in relation to deleterious economic changes, especially unemployment, business failure rates, and declines in real per capita income. The analysis uses a version of the 'Economic Change Model of Pathology' which includes the influence of health risks related to patterns of consumption and production. It is found that economic growth plays a principal role in reducing mortality at nearly all ages, and specifically mortality due to total cardiovascular disease, cerebrovascular disease, total heart disease, ischemic heart disease, total malignancies, disorders of infancy, and motor vehicle accidents. Economic recession, by contrast, is related to increases in total mortality for virtually all age groups, in both sexes, for major causes of death and causes due to psychopathological conditions. Per capita alcohol consumption, by specific beverage, is an important risk to mortality rates in cerebrovascular disease, malignancies, cirrhosis, motor vehicle accidents, suicide, homicide, and infant diseases. Cigarette consumption rates are positively related to mortality due to cardiovascular, malignant, and infant diseases; fat consumption rates are positively related to cardiovascular and cancer mortality.
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PMID:Relation of economic change to Swedish health and social well-being, 1950-1980. 366 9

Very little is known about the long-term health risks associated with the high stress police officer occupation. We report here on a retrospective cohort of 2,376 ever-employed white male police officers employed between January 1950 and October 1979. Vital status was obtained for 96%, the officers accumulating a total of 39,462 person-years. Six-hundred sixty-one deaths were observed. Total mortality from all causes was comparable to that of the overall U.S. white male population (standardized mortality ratio [SMR] = 106). Significantly increased mortality was seen for all malignant neoplasms combined (SMR = 127), cancer of the esophagus (SMR = 286), and cancer of the colon (SMR = 180). Significantly lower than expected mortality was seen for infectious diseases (SMR = 26), respiratory diseases (SMR = 64), and accidents (SMR = 60). Internal cohort comparisons revealed that policeman exhibited significantly higher mortality from suicide compared to all other municipal employees (rate ratio = 2.9). Analysis of mortality by length of service as a police officer showed that those employed 10-19 years were at significantly increased risk of digestive cancers and cancers of the colon and lymphatic and hematopoietic tissues and decreased risk for all diseases of the circulatory system. Policeman employed more than 40 years had significantly elevated SMRs for all causes, all malignant neoplasms combined, digestive cancers, cancers of the bladder and lymphatic and hematopoietic tissues, and arteriosclerotic heart disease. Risk of mortality from arteriosclerotic heart disease tended to increase with increasing years employed. These findings are discussed in light of the police stress literature. The hypotheses generated in this study must be tested through study of the role of important confounders including reactions to stress on the job.
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PMID:Mortality of a municipal worker cohort: III. Police officers. 378 83

Of 543 patients with organic mental disorders hospitalized at the University of Iowa Psychiatric Hospital, Iowa City, during a ten-year period, 87 died. This mortality was significant based on a control population. Patients of all ages were at risk for early death, especially those younger than 40 years. Risk was greatest during the first two years of follow-up; thereafter the observed death rate approached the expected rate. Patients were at special risk for death from "natural" causes, particularly cancer and heart disease among women, and influenza or pneumonia or "other" natural causes among men. During the first two years of follow-up, men were also at risk for death from accidents or suicide. Women with alcohol- and drug-related psychoses were at risk for death early in follow-up, but the diagnosis was not associated with risk from "unnatural death" in either sex.
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PMID:The Iowa record-linkage study. II. Excess mortality among patients with organic mental disorders. 396 55


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