ABSTRACT
Objective The study is designed to evaluate the difference in identification for depression and clinical effectiveness of its treatment between psychiatrists and non-psychiatric Dhysieians at out-patient departments of general hospitals and to analyze its related factors.Methods Totally,680 patients who visited psychiatric clinics in nine general hospitals of Shanghai at first time were screened by psychiatrists using Composite International Diagnostic Interview(CIDI)for depression and the screening resuhs were compared to the diagnosis made by non-psychiatric physicians as goal-keepers there.Altogether 297 patients with depression were recruited and assessed using Hamilton Depression Rating Scale(HAMD)and Hamilton Anxiety Rating Scale(HAMA).A self-made questionnaire for basic information was used to assess the ability for identification of depression in non-psychiatric physicians of general hospitals.Results Psychiatrists identified depression correctly in 337 of 680 patients who visited psychiatric clinics in general hospitals at their first visit,but non-psychiatric physicians only identified 216 patients,with statistically significant difference(χ2=30.73,P=0.000).A consistent agreement on depression diagnosis between the findings by psychiatrists and by CIDI was reached with Kappa of 0.774,but Kappa for that between the findings by non-psychiatric physicians and CIDI was 0.439.Effectiveness of treatment for depression by psychiatrists was better than that by non-psychiatric physicians,with higher total score and scores for each item of HAMD four,eight and 12 weeks after treatment,respectively(P＜0.05 or P＜0.01).Length of professional work of non-psychiatric physicians and annual time for professional training in management of mental disorders associated with their ability of identification for depression(P＜0.05).Conclusion Ability of non-psychiatric physicians to identify alQd cope with depression in the psychiatric department of general hospitals was insufficient,suggesting that more importance should be attached to the management of service quality at psychiatric department of general hospitals.
ABSTRACT
BACKGROUND: Many studies have suggested that angiotensin-converting enzyme inhibitors(ACEI) protect blood vessels through anti-atherosclerosis independent of lowering blood pressure, but its mechanism is still unclear.OBJECTIVE: To investigate the anti-atherosclerotic mechanism of ACEI by observing the effects of Enalapril on lipoprotein(a) and oxygen free radicals in patients with acute myocardial infarction (AMI) .DESIGN: A controlled study based on the observation of the patients with AMI.SETTING: Second Department of the South Building, General Hospital of Chinese PLAPARTICIPANTS: Thirty-five inpatients with AMI(19 males and 16 females, aged 42 -75 years old, and averaged (62 ± 9) years old and hospitalized at the Department of Cardiology of Tianjin Harbor Hospital from April 2001 to August 2002 were chosen. These patients were randomly divided into 2 groups: the therapeutic group(20 cases) and the control group(15cases). Inclusion criteria: the diagnosis of patients with AMI was confirmed by WHO criteria. Exclusion criteria: patients with renal dysfunction, shock,hypotension, a history of allergy to ACEI, and a history of severe cough induced by ACEI. All patients had not taken ACEI in the past 2 weeks and agreed to participate in this study.METHODS: On early morning of the third day after AMI, patients in the treatment group took 5 mg of Enalapril one time. If they had no first-dose reaction of hypotension, on the fourth day after AMI, the patients of the treatment group were given a dose of 5 mg twice per day for the following 2 weeks. Then, they were given the drug at a dose of 10 mg twice per day for 2 weeks. The patients in the control group were not given Enalapril. Blood samples were taken respectvely prior to the administration and 2 weeks and 4 weeks after the administration in the two groups. Serum content of lipoprotein(a), oxygen free radicals, triglyceride, total cholesterol, high density lipoprotein(HDL) cholesterol, Apo(a) were measured.MAIN OUTCOME MEASURES: We compared the level of serum of lipoprotein (a), oxygen free radicals (OFR), triglyceride, total cholesterol,HDL cholesterol, Apo(a) pre-treatment and post-treatment respectively in patients of the two groups.RESULTS: Serum levels of OFR were significantly lowered in the treatment group, which were(1 423.14±216.23), (1 076.62±287.12) and (566.57 ± 138.02) U/mL respectively 2 weeks and 4 weeks before and after the treatment(t =2. 937, 3. 571, P ＜0. 01), but there were no significant changes in serum concentrations of lipoprotein(a) and lipids( P ＞ 0.05) .CONCLUSION: Enalapril improved the prognosis of patients with AMI by antioxidation, but not by lowering the serum levels of lipoprotein(a) and lipids. The study can serve as a theoretical reference that the mechanism of Enalapril might inhibit atherosclerosis in patients with AMI.