Depression is common in primary care but is suboptimally managed. Collaborative care has emerged as a potentially effective candidate intervention to improve the quality of care and patient outcomes for depression. In this issue, Gilbody et al review randomized evidence from 37 studies involving 12 355 people with depression. They found unequivocal evidence of benefit of collaborative care over usual primary care at 6 months and a persistent benefit at up to 5 years. By applying cumulative meta-analysis, they found that sufficient randomized evidence had emerged by the year 2000 to demonstrate significant benefit. This method of organizing care was initially developed and studied within the United States, and further trials in the United States are probably no longer justified. Further research should focus on the implementation of this method of care and in demonstrating its effectiveness in non-US settings.
Body size is inversely related to the risk of premenopausal breast cancer, but the mechanisms underlying this perplexing association have remained unknown. Studying 113 130 premenopausal participants of the Nurses' Health Study II, Michels et al found that body mass index at age 18 years was more informative about breast cancer risk among premenopausal women compared with body mass index thereafter, and the inverse association was not explained by menstrual cycle characteristics or infertility due to ovulatory disorder. The authors conclude that body size during early phases of adult life seems to be particularly important for the development of premenopausal breast cancer and that factors other than anovulation are likely to mediate the protection conferred by a high body mass index.
A cardiovascular disease risk score was derived from the Pathobiological Diagnosis of Atherosclerosis in Youth (PDAY) study and applied to participants in the Coronary Artery Risk Development in Young Adults (CARDIA) study who underwent computed tomographic scans in year 15 of the study. The risk score calculated at baseline and 5-year intervals thereafter predicted the presence and intensity of coronary calcium at each assessment. Maintaining or lowering risk over the 15 years of the study lowered risk for future coronary calcium presence, whereas increasing risk increased the likelihood of a positive finding.
Ischemic mitral regurgitation (MR) is a common echocardiographic finding among patients with acute myocardial infarction. This study tested the hypothesis that the presence of MR during the acute phase of infarction may predict the long-term development of heart failure. The study included 1190 patients with acute myocardial infarction, who were followed up for a median of 24 months after hospital discharge. Mild and moderate/severe ischemic MR were present in 39.7% and 6.3% of patients, respectively. There was a graded association between the severity of ischemic MR and development of heart failure. Compared with patients without ischemic MR, the adjusted hazard ratio for heart failure was 2.8 (95% confidence interval, 1.8-4.2; P<.001) and 3.6 (95% confidence interval, 2.0-6.4; P<.001) in patients with mild and moderate/severe ischemic MR, respectively.
The term lower urinary tract symptoms (LUTS) is the preferred terminology to describe a constellation of voiding dysfunction symptoms common to both aging men and women. Data from the Boston Area Community Health (BACH) Survey, a population-based, racially and ethnically diverse random sample of 5506 adults aged from 30 to 79 years, were used to estimate the prevalence of LUTS (American Urological Association symptom index [AUA-SI] score ≥8), its impact on quality of life, and the prevalence of prescription medication use for LUTS. The prevalence of LUTS was 18% and increased with age but did not differ by sex or race/ethnicity. Quality of life was significantly reduced among those with LUTS across age, sex, and racial/ethnic groups. Prevalence of prescription medication use was low, with less than 10% of participants with LUTS reporting prescription medication use for LUTS.
Prevalence of prescription medication use by AUA-SI score and sex.
In This Issue of Archives of Internal Medicine. Arch Intern Med. 2006;166(21):2303. doi:10.1001/archinte.166.21.2303