Symptoms In Primary Care Patients Research Articles

Molecular Hydrogen for Outpatients with COVID-19 (Hydro-COVID): A Phase 3 Randomised, Triple-Blinded, Pragmatic, Placebo-Controlled, Multicentre Trial.

Background. Due to its antioxidant, anti-inflammatory, anti-apoptosis, and anti-fatigue properties, molecular hydrogen (H2) is potentially a novel therapeutic nutrient for patients with coronavirus acute disease 2019 (COVID-19). We determined the efficacy and safety profile of hydrogen-rich water (HRW) to reduce the risk of COVID-19 progression. Methods: We also conducted a phase 3, triple-blind, randomised, placebo-controlled trial to evaluate treatment with HRW initiated within 5 days after the onset of signs or symptoms in primary care patients with mild-to-moderate, laboratory-confirmed COVID-19. Participants were randomised to receive HRW or placebo twice daily for 21 days. The incidence of clinical worsening and adverse events were the primary endpoints. Results: A total of 675 participants were followed up to day 30. HRW was not superior to placebo in preventing clinical worsening at day 14: in H2 group, 46.1% in the H2 group, 43.5% in the placebo group, hazard ratio 1.09, 90% confidence interval [0.90-1.31]. One death was reported at day 30 in the H2 group and two in the placebo group at day 30. Adverse events were reported in 91 (27%) and 89 (26.2%) participants, respectively. Conclusions: HRW taken twice daily from the onset of COVID-19 symptoms for 21 days did not reduce clinical worsening.

Characteristics of Patients with Subjective Sleep Problems after Cognitive Behavioral Therapy for Insomnia: Secondary Analyses of a Randomized Controlled Trial.

Objective Cognitive behavioral therapy for insomnia (CBT-I) is the first-line treatment for insomnia, but half of the patients do not reach remission. This study aimed to explore subjective remission by investigating the characteristics of patients who reported lingering sleep problems after CBT-I. Methods Secondary analyses of a randomized controlled trial of group CBT-I in 72 primary care patients with insomnia disorder. Sociodemographic characteristics and outcomes (insomnia severity, sleep variables, hypnotics use, fatigue, depressive symptoms, and dysfunctional beliefs/attitudes), including baseline data and symptom change, were investigated in relation to patients' posttreatment response to the yes-or-no question "Would you say that you have sleep problems?" Results A total of 56.9% of patients reported sleep problems after CBT-I. At baseline, they had worse depressive symptoms (14.9 (SD 7.5) vs. 10.2 (SD 5.9), p = 0.006) and more awakenings (2.6 (SD 1.5) vs. 1.8 (SD 1.3), p = 0.034) than those in subjective remission from sleep problems. Patients in the non-remission and remission groups showed similar improvements in sleep, fatigue, and depressive symptoms, but patients in the non-remission group had improved less in insomnia severity, dysfunctional beliefs/attitudes about sleep, and hypnotic use. In patients with more pronounced depressive symptoms before CBT-I, change in depressive symptoms during treatment partially explained subjective remission from sleep problems. Discussion More severe depressive symptoms prior to CBT-I and less improvements in depressive symptoms during treatment predicted remaining subjective sleep problems after treatment. These findings highlight the importance of assessing depressive symptoms in primary care patients with insomnia, as patients with pronounced depressive symptoms may need tailored treatment.

Mapping bridges between anxiety, depression, and somatic symptoms in primary care patients: a network perspective

In primary care centers, emotional disorders (EDs; depression, anxiety, and somatoform disorders) frequently appear to be associated. However, there is no previous information on the key (bridge) symptoms that maintain comorbidity. The current study aimed to identify symptoms that may play a linking role in bridging comorbidity among EDs from a network analysis perspective. A sample of adult primary care patients (N = 1704) with symptoms of EDs was assessed using the Patient Health Questionnaire (PHQ). Network analysis was applied to examine the network structure, communities, expected influence, and bridge symptoms between depressive, anxiety, and somatic symptoms. Sad mood and low energy were the most central symptoms. Furthermore, low energy, fainting spells, sad mood, and restlessness were detected as prominent bridge symptoms between anxiety, depression, and somatic symptoms. These bridge symptoms could be therapeutic targets for early intervention and prevent the development of comorbidity among EDs. The results of this research highlight the importance of symptom-specific functional properties for the activation of communities within EDs, providing new insights on a complex phenomenon such as comorbidity.

754 Insomnia and Depression Symptoms in Primary Care Patients Referred for Mental Health Care

Abstract Introduction Past epidemiological research indicates that insomnia and depression are both highly prevalent and tend to co-occur in the general population. The present study further assesses this association by estimating: (1) the concurrence rates of insomnia and depression in outpatients referred by their primary care providers for mental health care; and (2) whether the association between depression and insomnia varies by insomnia subtype (initial, middle, and late). Methods Data were collected from 3,174 patients (mean age=42.7; 74% women; 50% Black) who were referred to the integrated care program for assessment of mental health symptoms (2018–2020). All patients completed an Insomnia Severity Index (ISI) and a Patient Health Questionnaire (PHQ-9) during their evaluations. Total scores for the ISI and PHQ-9 were computed. These scores were used to categorize patients into diagnostic groups for insomnia (no-insomnia [ISI < 8], subthreshold-insomnia [ISI 8–14], and clinically-significant-insomnia [ISI>14]) and depression (no-depression [PHQ-914]). Items 1–3 of the ISI were also used to assess the association between depression and subtypes of insomnia. Results Rates of insomnia were as follows: 34.6% for subthreshold-insomnia, 35.5% for clinically-significant insomnia, and 28.9% for mild-depression and 26.9% for clinically-significant-depression. 92% of patients with clinically significant depression reported at least subthreshold levels of insomnia. While the majority of patients with clinical depression reported having insomnia, the proportion of patients that endorsed these symptoms were comparable across insomnia subtypes (percent by subtype: initial insomnia 63%; middle insomnia 61%; late insomnia 59%). Conclusion According to these data, the proportion of outpatients referred for mental health evaluations that endorse treatable levels of insomnia is very high (approximately 70%). This naturally gives rise to at least two questions: how will such symptomatology be addressed (within primary or specialty care) and what affect might targeted treatment for insomnia have on health were it a focus of treatment in general? Support (if any) Vargas: K23HL141581; Perlis: K24AG055602

The association between different domains of quality of life and symptoms in primary care patients with emotional disorders

Despite the importance of quality of life (QoL) in primary care patients with emotional disorders, the specific influence of the symptoms of these disorders and the sociodemographic characteristics of patients on the various QoL domains has received scant attention. The aim of the present study of primary care patients with emotional disorders was to analyse the associations between four different QoL domains and the most prevalent clinical symptoms (i.e., depression, anxiety and somatization), while controlling for sociodemographic variables. A total of 1241 participants from 28 primary care centres in Spain were assessed with the following instruments: the Patient Health Questionnaire (PHQ)-9 to evaluate depression; the Generalized Anxiety Disorder Scale (GAD)-7 for anxiety; PHQ-15 for somatization; and the World Health Organization Quality of Life Instrument-Short Form (WHOQOL-Bref) to assess four broad QoL domains: physical health, psychological health, social relationships, and environment. The associations between the symptoms and QoL domains were examined using hierarchical regression analyses. Adjusted QoL mean values as a function of the number of overlapping diagnoses were calculated. The contribution of sociodemographic variables to most QoL domains was modest, explaining anywhere from 2% to 11% of the variance. However, adding the clinical variables increased the variance explained by 12% to 40% depending on the specific QoL domain. Depression was the strongest predictor for all domains. The number of overlapping diagnoses adversely affected all QoL domains, with each additional diagnosis reducing the main QoL subscales by 5 to 10 points. In primary care patients with a diagnostic impression of an emotional disorders as identified by their treating GP, clinical symptoms explained more of the variance in QoL than sociodemographic factors such as age, sex, level of education, marital status, work status, and income. Given the strong relationship between depressive symptoms and QoL, treatment of depression may constitute a key therapeutic target to improve QoL in people with emotional disorders in primary care.

The effect of mindfulness group therapy on a broad range of psychiatric symptoms: A randomised controlled trial in primary health care

BackgroundThe need for psychotherapy in primary health care is on the increase but individual-based treatment is costly. The main aim of this randomised controlled trial (RCT) was to compare the effect of mindfulness-based group therapy (MGT) with treatment as usual (TAU), mainly individual-based cognitive behavioural therapy (CBT), on a broad range of psychiatric symptoms in primary care patients diagnosed with depressive, anxiety and/or stress and adjustment disorders. An additional aim was to compare the effect of MGT with TAU on mindful attention awareness. MethodsThis 8-week RCT took place in 2012 at 16 primary care centres in southern Sweden. The study population included both men and women, aged 20–64years (n=215). A broad range of psychiatric symptoms were evaluated at baseline and at the 8-week follow-up using the Symptom Checklist-90 (SCL-90). Mindful attention awareness was also evaluated using the Mindful Attention Awareness Scale (MAAS). ResultsIn both groups, the scores decreased significantly for all subscales and indexes in SCL-90, while the MAAS scores increased significantly. There were no significant differences in the change in psychiatric symptoms between the two groups. The mindfulness group had a somewhat larger change in scores than the control group on the MAAS (P=0.06, non-significant). ConclusionsNo significant differences between MGT and TAU, mainly individual-based CBT, were found in treatment effect. Both types of therapies could be used in primary care patients with depressive, anxiety and/or stress and adjustment disorders, where MGT has a potential to save limited resources. Trial registrationClinicalTrials.gov identifier: NCT01476371.

The prevalence of comorbidities in COPD patients, and their impact on health status and COPD symptoms in primary care patients: a protocol for an UNLOCK study from the IPCRG.

Funding The IPCRG provided funding for this research project as an UNLOCK Group study for which the funding was obtained through an unrestricted grant by Novartis AG, Basel, Switzerland. Novartis has no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. This study will include data from the Optimum Patient Care Research Database, and is undertaken in collaboration with Optimum Patient Care and the Respiratory Effectiveness Group, which will provide the data for this initiative without charge to the UNLOCK Group.

Multiple somatic symptoms in primary care patients: a cross-sectional study of consultation content, clinical management strategy and burden of encounter

BackgroundConsultations involving patients with multiple somatic symptoms may be considered as challenging and time-consuming by general practitioners (GPs). Yet, little is known about the possible links between consultation characteristics and GP-experienced burden of encounter. We aimed to explore consultation content, clinical management strategies, time consumption and GP-experienced burden of encounters with patients suffering from multiple somatic symptoms as defined by the concept of bodily distress syndrome (BDS).MethodsCross-sectional study of patient encounters in primary care from December 2008 to December 2009; 387 GPs participated (response rate: 44.4 %). Data were based on a one-page registration form completed by the GP and a patient questionnaire including the 25-item BDS checklist for somatic symptoms. Using logistic regression analyses, we compared patients who met the BDS criteria with patients who did not.ResultsA total of 1505 patients were included (response rate: 55.6 %). Health problems were less frequently reported as ‘new’ in patients with BDS (odds ratio (OR) = 0.73, 95 % confidence interval (CI): 0.54; 0.97). Medical prescriptions and referral rates were comparable in the two patient groups. Consultations focusing on mainly biomedical aspects were less frequent among patients with BDS (OR = 0.31, 95 % CI: 0.22; 0.43), whereas additional biomedical and psychosocial problems were more often discussed. GPs were more likely to ensure continuity of care in BDS patients by watchful waiting strategies (OR = 2.32, 95 % CI: 1.53; 3.52) or scheduled follow-up visits (OR = 1.61, 95 % CI: 1.09; 2.37). Patients with BDS were found to be more time-consuming (OR = 1.77, 95 % CI: 1.26; 2.48) and burdensome (OR = 2.54, 95 % CI: 1.81; 3.55) than patients without BDS. However, after adjustments for biomedical and psychosocial content of the consultation, the identified differences for time consumption and burden were no longer statistically significant.ConclusionsPatients with BDS represent higher care complexity in terms of biomedical and psychosocial needs. GPs seem to allow space and time for discussing these issues and to aim at ensuring continuity in care through watchful waiting or scheduled follow-up consultations. However, the reported GP-experienced burden call for professional development.

Resolving Residual Symptoms in Primary Care Patients With Depression

This CME activity is expired. For more CME activities, visit CMEInstitute.com. Find more articles on this and other psychiatry and CNS topics: The Journal of Clinical Psychiatry The Primary Care Companion for CNS Disorders Article Abstract In this CME podcast, listen to experts discuss the case of Mrs J, an elderly woman with a history of depression. She has reported insomnia and has requested a benzodiazepine to help her sleep. Although she claims that her depressed mood is well controlled, her husband reports differently. The experts review her treatment options, taking into account both her symptoms and her age.

Collaborative treatment of late-life depression in primary care (GermanIMPACT): study protocol of a cluster-randomized controlled trial.

BackgroundDepression is not a normal side effect of aging, however it is one of the most prevalent mental health issues in later life, imposing a tremendous burden on patients, their families, and the healthcare system. We describe the experimental implementation of a collaborative, stepped-care model for the treatment of late-life depression (GermanIMPACT trial) in the German primary care context. GermanIMPACT was developed as an adaptation of a successful and widely used American model. The aim of the study is to evaluate the model’s applicability to the German primary care setting and its cost-effectiveness.Methods/DesignThe study will be conducted as a cluster-randomized controlled trial comparing the development of depressive symptoms in primary care patients who either receive treatment as usual (control arm) or treatment according to the GermanIMPACT model (intervention arm). In two German cities (Freiburg and Hamburg), a total of 60 general practice offices will be selected and randomized. Each general practice office will be asked to enroll five patients into the trial who are 60 years of age or older and who show moderate depressive symptoms in the scope of a diagnosed depressive episode, recurrent depressive disorder, or dysthymia. General practices in the control arm will provide treatment as usual; general practices in the intervention arm will work closely with a specially trained care manager and a supervising mental health specialist. Evidence-based elements of the treatment plan manual include patient education, identification and integration of positive activities into the daily routine, relapse prevention, and training of problem-solving techniques as needed. The intervention period per patient will be one year. Data will be collected at baseline, 6, and 12 months. Primary outcome is the patient-reported change of depressive symptoms (Patient Health Questionnaire, PHQ-9). Secondary outcomes include measures of quality of life, anxiety, depression-related behavior, problem-solving skills, resilience, and an overall economic evaluation of the program.DiscussionThe GermanIMPACT trial will provide evidence about the effectiveness, feasibility, and cost-effectiveness of collaborative stepped care in treating late-life depression in German primary care. Positive results will be a first step toward integrating specialized depression care managers into the primary care setting.Trial registrationGerman Clinical Trials Register: DRKS00003589 (September 2012).

On the confluence of optimism and hope on depressive symptoms in primary care patients: Does doubling up on bonum futurun Proffer any added benefits?

A model involving optimism and hope as predictors of depressive symptoms was tested in a sample of 28 male and 67 female primary care patients. Beyond the distinct influence of the two predictors on depressive symptoms, optimism and hope were also hypothesized to interact together to predict depressive symptoms. Results of a regression analysis indicated that, independent of demographic variables (viz. age, sex, race/ethnicity, marital status, and educational level), optimism and hope were significant and unique predictors of depressive symptoms in adults. Noteworthy, beyond optimism and hope, the Optimism × Hope interaction term was found to significantly augment the prediction of depressive symptoms. Some implications of the present findings are discussed.

The course of depressive symptoms in primary care patients with type 2 diabetes: results from the Diabetes, Depression, Type D Personality Zuidoost-Brabant (DiaDDZoB) Study

Aims/hypothesisThe aim of the study was to examine the course (incidence, recurrence/persistence) of depressive symptoms in primary care patients with type 2 diabetes and to identify significant predictors of these different course patterns.MethodsA cohort of 2,460 primary care patients with type 2 diabetes was assessed for demographic, clinical and psychological factors in 2005 and followed-up in 2007 and 2008. Depression was defined as a score of ≥12 on the Edinburgh Depression Scale. Multivariate logistic regression analyses were used to determine whether several depression-course patterns could be predicted by means of demographics, medical co-morbidities and psychological factors.ResultsA total of 630 patients (26%) met the criterion for depression at one or more assessments. In the subgroup with no baseline depression, incident depression at follow-up was present in 14% (n = 310), while recurrence/persistence in those with baseline depression was found in 66% (n = 212).The presence of any depression was associated with being female, low education, non-cardiovascular chronic diseases, stressful life events and a self-reported history of depression. Incident depression was predicted by female sex, low education and depression history, while patients with a history of depression had a 2.5-fold increased odds of recurrent/persistent depression.Conclusions/interpretationDepression is common in primary care patients with type 2 diabetes, with one in seven patients reporting incident depression during a 2.5 year period. Once present, depression often becomes a chronic/recurrent condition in this group. In order to identify patients who are vulnerable to depression, clinicians can use questionnaire data and/or information about the history of depression.Electronic supplementary materialThe online version of this article (doi:10.1007/s00125-011-2411-2) contains peer-reviewed but unedited supplementary material, which is available to authorised users.

Psychological risk factors of micro- and macrovascular outcomes in primary care patients with type 2 diabetes: rationale and design of the DiaDDZoB Study

BackgroundDepression is a common psychiatric complication of diabetes, but little is known about the natural course and the consequences of depressive symptoms in primary care patients with type 2 diabetes. While depression has been related to poor glycemic control and increased risk for macrovascular disease, its association with microvascular complications remains understudied. The predictive role of other psychological risk factors such as Type D (distressed) personality and the mechanisms that possibly link depression and Type D personality with poor vascular outcomes are also still unclear.Methods/DesignThis prospective cohort study will examine: (1) the course of depressive symptoms in primary care patients with type 2 diabetes; (2) whether depressive symptoms and Type D personality are associated with the development of microvascular and/or macrovascular complications and with the risk of all-cause or vascular mortality; and (3) the behavioral and physiological mechanisms that may mediate these associations. The DiaDDZoB Study is embedded within the larger DIAZOB Primary Care Diabetes study, which covers a comprehensive cohort of type 2 diabetes patients treated by over 200 primary care physicians in South-East Brabant, The Netherlands. These patients will be followed during their lifetime and are assessed annually for demographic, clinical, lifestyle and psychosocial factors. Measurements include an interviewer-administered and self-report questionnaire, regular care laboratory tests and physical examinations, and pharmacy medication records. The DiaDDZoB Study uses data that have been collected during the original baseline assessment in 2005 (M0; N = 2,460) and the 2007 (M1; N = 2,225) and 2008 (M2; N = 2,032) follow-up assessments.DiscussionThe DiaDDZoB Study is expected to contribute to the current understanding of the course of depression in primary care patients with type 2 diabetes and will also test whether depressed patients or those with Type D personality are at increased risk for (further) development of micro- and cardiovascular disease. More knowledge about the mechanisms behind this association is needed to guide new intervention studies.

Time-Invariant and Time-Varying Predictors of Depression Symptoms in Primary Care Patients

The aims of this study were to examine correlates of depression symptoms, baseline predictors of change in depression symptoms, and time-varying predictors of depression symptoms in a primary care sample. In this study, we assessed depression symptoms and other variables at 3 time points over the course of 6 months in 103 primary care patients with elevated depression symptoms at baseline. Data collection occurred from May 2004 to September 2007. Individuals with lower income levels and those who were not married had a poorer course of depression, as assessed by Center for Epidemiologic Studies Depression Scale score, over time. Several variables fluctuated in concert with depression symptoms within individuals over time. As depression symptoms improved, family functioning, problem-solving, pain, and general health perceptions also improved. A multivariate analysis showed that problem-solving and general health perceptions predicted significant (P < .001) unique variance in fluctuations in depression symptoms within individuals. Care management programs for primary care depression may benefit from the inclusion of psychosocial interventions that directly target variables closely linked to depression, such as problem-solving and general health perceptions. In addition, special efforts must be made to help depressed individuals with low income and less social support.

Results of Screening With the Brief Headache Screen Compared With a Modified IDMigraineTM

Patients with chronic migraine and chronic daily headache syndromes have greater morbidity than patients with episodic migraine, and are less frequently diagnosed. A screening tool which identifies daily headache syndromes as well as migraine would promote more patients receiving appropriate treatment, including prophylaxis. A post-hoc analysis of data obtained to evaluate the prevalence of somatic symptoms in primary care patients was conducted on a convenience sample of primary care patients who completed the Patient Health Questionnaire portion of the PRIME-MD (Primary Care Evaluation of Mental Disorders). Patients who endorsed the symptom of headache were asked to complete the Brief Headache Screen (BHS), a 4-item screening tool, supplemented by 3 clinical questions (nausea, light sensitivity, and noise sensitivity). The data obtained allowed a post-hoc comparison of the BHS with a modified version of the screening tool, IDMigraine(TM) (IDM(TM)). Diagnostic interviews were performed on patients whose diagnoses differed by the 2 screening methods, and on patients who screened positive for daily headache on BHS. Of the 1000 patients who completed the PRIME-MD, 302 (30.2%) indicated headache as a concern, and there were sufficient data for both the BHS and IDM(TM) for 259. There was substantial concordance between the 2 instruments with 82.6% agreement in identified migraine (95% confidence interval: 77.8%-87.4%). The BHS screened positive for migraine in an additional 15.1% of patients who were not identified by IDM(TM), whereas the IDM(TM) identified an additional 2.3% of patients. Of the 173 which both tools recognized as migraine, the BHS identified 42.8% as having a daily headache syndrome (chronic migraine: 23.1%; episodic migraine + chronic tension-type headache [CTTH]: 19.7%). BHS also identified 7 non-migraine patients as having CTTH alone. Diagnostic interviews confirmed that 6/18 (33%) of BHS+ but IDM-, and one of 2 (50%) patients BHS-/IDM+ met full criteria for migraine. Additionally, interviews confirmed the diagnoses of 85.4% of those patients who the BHS identified with daily headache and 67% of those who were identified as medication overuse headache. The BHS and a modified IDM(TM) are concordant in screening for migraine in 82.6% of a primary care population who endorsed the symptom of headache. However, the BHS screens effectively not only for migraine but also for chronic daily headache and medication overuse. A screening paradigm based on headache frequency and the frequency of medication use can rapidly and sensitively identify migraine, daily headache syndromes, and medication overuse. This paradigm may improve clinical care by identifying patients who merit preventive as well as acute therapy for migraine.

Mood and thyroid immunity assessed by ultrasonographic imaging in a primary health care

Background Psychiatric morbidity is highly prevalent in the primary health care settings and it may be related to autoimmune thyroid disease (AITD). The aim of this study was to evaluate the impact of thyroid immunity, evident by hypo-echoic thyroid ultrasound pattern, on prevalence of depression and anxiety in a primary care setting. Methods In a cross-sectional design, 504 consecutive primary care patients were invited to the study and 474 patients completed the study. They were screened for depression and anxiety using the Hospital Anxiety and Depression Scale (HADS), were interviewed for affective disorders using the Mini International Neuropsychiatric Interview, and were evaluated by ultrasonographic imagining of the thyroid gland. Results Among patients with hypo-echoic thyroid ( n = 122) prevailed women and those patients were older than patients with normo-echoic thyroid ( n = 352). Women, but not men, with hypo-echoic thyroid compared to those with normo-echoic thyroid had higher scores on the anxiety subscale of the HADS ( p = 0.03). Among women with hypo-echoic thyroid, only those pre-menopause, but not those post-menopause, had greater prevalence of high scores on the depression subscale of the HADS ( p = 0.02) and a greater likelihood of using psychiatric medications ( p = 0.001). Limitations Lack of cytological evaluation of the thyroid gland; lack of serum thyroid antibodies concentrations; and lack of thyroid hormone concentrations. Conclusions Thyroid immunity is related to mood symptoms in primary care patients. These effects are gender specific and in women, they are most evident before menopause.

Herpes Virus Type 2 Infection and Genital Symptoms in Primary Care Patients

We aimed to identify whether genital symptoms were associated with unrecognized herpes simplex virus type 2 (HSV-2) infection in a primary care population. Five thousand four hundred fifty-two individuals aged 18 to 59 seeking general care at 36 suburban medical offices in 6 U.S. cities were tested for HSV-2 antibody and asked about 10 types of genital symptoms. In patients with no known history of genital herpes, we assessed whether HSV-2 infection was independently associated with symptoms. HSV-2 infection was associated with increases in reports of "sores, blisters, ulcers, crusts, or small cuts/slits" in men [adjusted odds ratio (OR), 1.79; 95% CI, 1.24-2.58] and with increases in reports of "redness, irritation, or a rash" among women (adjusted OR, 1.50; 95% CI, 1.06-2.11). HSV-2 was not significantly associated with other types of genital symptoms. Primary-care physicians should consider unrecognized HSV-2 infection as a potential cause of some common genital symptoms.

Natural History of Menopause Symptoms in Primary Care Patients: A MetroNet Study

The association between changes in menopausal status and menopause-related symptom reporting over the course of the menopause transition is not well understood, especially whether there are any racial differences in this association. To determine (1) the prevalence and the natural history of menopause symptoms among primary care patients approaching, or at menopause; (2) the relationship between self-reported symptoms and menopausal status; and (3) whether this relationship varies in African American and white women. Cross-sectional self-report survey of 342 women aged 40 to 55 years (31.6% African American) were recruited from 8 family practice centers in 2000 and 2001. Among 251 women without surgical menopause, 133 (53.0%) were premenopausal, 72 (28.7%) were peri-menopausal, and 46 (18.3%) were postmenopausal. The most commonly reported symptoms were joint/muscle pain and headache, which did not vary by menopausal status. As many as 28.6% of the women with regular menstruation reported hot flashes, and 18.8% had night sweats; although both symptoms were strongly associated with changes in menopausal status (P < .01). During the natural menopausal transition, white women had increasing trends of nervousness, memory loss, vaginal dryness, loss of sexual interest, hot flashes, and night sweats while African American women only had increasing trend of painful sex and hot flashes. In multivariate analyses, loss of sexual interest was associated with postmenopause status in white but not in African American women. Symptoms are not uncommon among premenopausal women and become more prevalent as the transition through menopause occurs. The prevalence of vasomotor symptoms in premenopausal women may be an under-recognized aspect of the natural history of the menopause transition. African American and white women may present different symptoms through menopause transition.

Canadian Consensus Conference on the Management of Gastroesophageal Reflux Disease in Adults – Update 2004

Gastroesophageal reflux disease (GERD) is the most prevalent acid-related disorder in Canada and is associated with significant impairment of health-related quality of life. Since the last Canadian Consensus Conference in 1996, GERD management has evolved substantially. To develop up-to-date evidence-based recommendations relevant to the needs of Canadian health care providers for the management of the esophageal manifestations of GERD. A multidisciplinary group of 23 voting participants developed recommendation statements using a Delphi approach; after presentation of relevant data at the meeting, the quality of the evidence, strength of recommendation and level of consensus were graded by participants according to accepted principles. GERD applies to individuals who reflux gastric contents into the esophagus causing symptoms sufficient to reduce quality of life, injury or both; endoscopy-negative reflux disease applies to individuals who have GERD and a normal endoscopy. Uninvestigated heartburn-dominant dyspepsia - characterised by heartburn or acid regurgitation - includes erosive esophagitis or endoscopy-negative reflux disease, and may be treated empirically as GERD without further investigation provided there are no alarm features. Lifestyle modifications are ineffective for frequent or severe GERD symptoms; over-the-counter antacids or histamine H2-receptor antagonists are effective for some patients with mild or infrequent GERD symptoms. Proton pump inhibitors are more effective for healing and symptom relief than histamine H2-receptor antagonists; their efficacy is proportional to their ability to reduce intragastric acidity. Response to initial therapy - a once-daily proton pump inhibitor unless symptoms are mild and infrequent (fewer than three times per week) - should be assessed at four to eight weeks. Maintenance medical therapy should be at the lowest dose and frequency necessary to maintain symptom relief; antireflux surgery is an alternative for a small proportion of selected patients. Routine testing for Helicobacter pylori infection is unnecessary before starting GERD therapy. GERD is associated with Barrett's epithelium and esophageal adenocarcinoma but the risk of malignancy is very low. Endoscopic screening for Barrett's epithelium may be considered in adults with GERD symptoms for more than 10 years; Barrett's epithelium and low-grade dysplasia generally warrant surveillance; endoscopic or surgical management should be considered for confirmed high-grade dysplasia or malignancy. Prospective studies are needed to investigate clinically relevant risk factors for the development of GERD and its complications; GERD progression, on and off therapy; optimal management strategies for typical GERD symptoms in primary care patients; and optimal management strategies for atypical GERD symptoms, Barrett's epithelium and esophageal adenocarcinoma.

Somatic complaints among pregnant women cared for in obstetrics: normal pregnancy or depressive and anxiety symptom amplification revisited?

Despite the extensive research documenting the significance of medically unexplained somatic symptoms in primary care patients, few studies have examined somatic symptoms as a predictor of depressive and anxiety disorders among pregnant women cared for in Obstetrics. We utilized the Primary Care Evaluation of Mental Disorders Patient Health Questionnaire (PHQ) to assess current depressive and anxiety disorders and self-reported somatic symptoms among 186 women receiving prenatal care. We examined the bivariate relationships between depressive and anxiety disorders and mean number of somatic symptoms. Linear regression analyses assessed the unique association between maternal depression, anxiety and somatic symptoms, while controlling for selected demographics and maternal medical risk. Twenty three percent ( N=43) of women met screening criteria for depressive and/or anxiety disorders. Women with depression and/or anxiety were significantly more likely to report somatic symptoms (mean=7.1, SD=2.6) compared to women without depression or anxiety (mean=5.0, SD=2.6) [t(df)=4.54(184), P<.001]. This association persisted in multivariate models. Our findings suggest that antenatal depressive and anxiety disorders are associated with an amplification of physical symptoms of pregnancy. Eliciting and tracking somatic symptoms during prenatal visits could potentially improve detection of depressive and anxiety disorders in the obstetrical sector.