[Depression, health status and lifestyles of residents of a rural community].

A survey was conducted to examine the prevalence of depressive symptomatology among residents of a rural community using the Center for Epidemiologic Studies Depression (CES-D) Scale. Subjects were 220 men and 319 women aged between 30 and 69 who participated in annual community health examinations. The relation of depressive symptomatology to the results of physical examination, self-rated health status, subjective symptoms and lifestyles were also examined. The results are as follows. 1) Of the subjects, 13.2% of the men and 16.3% of the women had depressive symptomatology (CES-D score > or = 16), with 4.5% of the men and 9.4% of the women having moderate or severe depressive symptomatology (CES-D score > or = 20). Prevalence was higher for younger men and for women in their forties, but these differences were not statistically significant. 2) There was a weak correlation between depressive symptomatology and the results of physical examination. Self-rated health status was more significantly correlated with depressive symptomatology. Self-rated health status and depressive symptomatology each correlated independently with the number of symptoms experienced by the subjects over the past year. The subjective symptoms that were correlated with depressive symptomatology were different from those correlated to self-rated health status. Men and women also had differences in links between depressive symptomatology, self-rated health status and symptoms experienced. 3) Lifestyles of those who had depressive symptomatology were worse than those who did not. But only duration of sleep and food intake had statistically significant relation to depressive symptomatology. Only weak correlations between lifestyles and self-rated health status were observed.(ABSTRACT TRUNCATED AT 250 WORDS)

The power of compassion: truth-telling among American doctors in the care of dying patients.

The perceptions of American doctors about their practice regarding truth-telling in the care of dying patients were examined based on semi-structured interviews with 32 physicians in a teaching hospital. The doctors inform patients of their disease using three basic styles; 'telling what patients want to know', 'telling what patients need to know' and 'translating information into terms that patients can take'. These styles are supported by five basic normative principles; 'respect the truth', 'patients rights', 'doctors' duty to inform', 'preserve hope' and 'individual contract between patients and doctors'. These styles and principles suggest that physicians adhere to the recent trends of American medical ethics based on informed consent doctrine, and give the impression that patients have control over obtaining information. But close analysis of their accounts shows that physicians still hold power to control information through their management of the information-giving process. The styles and principles are flexibly interpreted and selectively used in the process so that they facilitate a discourse which justifies, rather than eliminates, the information control. Clinical contexts of information control are analyzed by examining dissimilar manners of providing information about treatment as opposed to prognosis. Physicians give less, and vaguer information about prognosis, citing its uncertainty and lesser relevance to future actions as reasons. Information about treatment is more readily shared in order to counterbalance the negative impact of the news on patients. The analysis reveals that the way doctors control information is closely related to the way they handle aspects of the reality of clinical practice, such as physicians' own emotional coping, institutional and legal constraints, and power relationships among patients, doctors and other care-givers. Situating the findings in the historical context of normative discourse in American medicine, discussion focuses on the issues of trust and power of doctors. The humanistic role of the doctor, although suppressed in the currently dominant, contractual ethical framework, is still powerful in doctors' narratives. It expresses doctors' commitment to patients while preserving their authority. Implications of the individualistic approach to the doctor-patient relationship are also discussed.