Depression in primary care: linking clinical and systems strategies.

Depression is a serious, often chronic disease that can be managed effectively with a chronic care model in primary care settings. Depressed persons are likely to be seen by a primary care physician, but their condition often goes unrecognized and untreated. There are effective treatment models that consist of efficacious psychotherapeutic and pharmacological interventions, use of evidence-based guidelines for primary care treatment of depression, development of explicit plans and protocols, reorganization of practice, longitudinal follow-up, patient self-management, decision-making support, access to community resources and leadership commitment. Moving these models into everyday practice requires overcoming both clinical and system barriers. Barriers consist of issues surrounding patients, providers, practices, plans, and purchasers. An understanding of these barriers at each level helps to provide a framework for the changes required to overcome them. The Robert Wood Johnson Foundation National Program on Depression in Primary Care will seek to apply simultaneously both clinical and system strategies in a new five-year initiative to overcome these barriers.

Programs of the Robert Wood Johnson Foundation to develop minority medical careers.

The Robert Wood Johnson Foundation (RWJF) is the nation's largest philanthropy devoted to health. The foundation long has been concerned about increasing diversity in the health professions. Between 1972 and 1981, grants totaling nearly $6.7 million were made to medical, medical/dental schools, or other educational organizations to support minority students. Funds enabled students who were interested in applying to medical or dental school to enroll in special preparatory courses. Most students were African American. One program, however, targeted US Puerto Rican students and other Hispanic students. Nearly 2500 students enrolled in these preapplication enrichment programs. Data reported to the foundation on medical or dental school acceptance for 1959 of these students indicated that 57% of students were successful. An additional $10.5 million in grants were awarded during this period: $2.5 million to provide scholarships for minority group medical students, $580,000 to support preceptorships with minority physicians/mentors, and $7.5 million to strengthen Meharry Medical College's Comprehensive Primary Care Health Science Program. In the early 1980s, the RWJF Board of Trustees considered a series of staff analyses, which resulted in additional direct support to historically black medical schools, including Meharry and those at Drew University and Morehouse College. These analyses also set the stage for two RWJF programs, the Minority Medical Faculty Development Program and the Minority Medical Education Program, which exist today. This article describes these programs, along with the more recent Health Professions Partners Initiative, and offers reflection and analysis about their impact on diversity in the medical profession.

Programs of the Robert Wood Johnson Foundation to develop minority medical careers.

The Robert Wood Johnson Foundation (RWJF) is the nation's largest philanthropy devoted to health. The foundation long has been concerned about increasing diversity in the health professions. Between 1972 and 1981, grants totaling nearly $6.7 million were made to medical, medical/dental schools, or other educational organizations to support minority students. Funds enabled students who were interested in applying to medical or dental school to enroll in special preparatory courses. Most students were African American. One program, however, targeted US Puerto Rican students and other Hispanic students. Nearly 2500 students enrolled in these preapplication enrichment programs. Data reported to the foundation on medical or dental school acceptance for 1959 of these students indicated that 57% of students were successful. An additional $10.5 million in grants were awarded during this period: $2.5 million to provide scholarships for minority group medical students, $580,000 to support preceptorships with minority physicians/mentors, and $7.5 million to strengthen Meharry Medical College's Comprehensive Primary Care Health Science Program. In the early 1980s, the RWJF Board of Trustees considered a series of staff analyses, which resulted in additional direct support to historically black medical schools, including Meharry and those at Drew University and Morehouse College. These analyses also set the stage for two RWJF programs, the Minority Medical Faculty Development Program and the Minority Medical Education Program, which exist today. This article describes these programs, along with the more recent Health Professions Partners Initiative, and offers reflection and analysis about their impact on diversity in the medical profession.

Postnatal rat nigrostriatal dopaminergic neurons exhibit five types of potassium conductances.

1. We have investigated the electrical properties of neurons acutely dissociated from the substantia nigra zona compacta (SNZC) of the postnatal rat with whole cell patch-clamp recordings. Retrogradely labeled nigrostriatal neurons were identified with the use of rhodamine-labeled fluorescent latex microspheres. Over 90% of the rhodamine-labeled neurons in the SNZC demonstrated formaldehyde/glutaraldehyde-induced catecholamine fluorescence, indicating that they were dopaminergic (DA) neurons. 2. DA neurons had 15-20 microns ovoid or fusiform-shaped cell bodies with 2-3 thick proximal processes. Labeled neurons generated spontaneous action-potential activity in both regular and irregular patterns. These cells exhibited input resistances of 300-600 M omega and action-potential amplitudes of 60-80 mV. Locally applied dopamine inhibited the spontaneous activity of these neurons by hyperpolarizing the cells. 3. Outward currents were examined with voltage-clamp recordings using a tetrodotoxin (TTX)-containing medium. In all DA cells, depolarizing voltage commands activated several components of outward current depending on the holding potential of the cell. When cells were held at -40 mV (or more positive), voltage steps activated a sustained outward current. If the membrane potential was held more negative than -50 mV, a rapidly activating and inactivating component of outward current response could also be detected. 4. From a hyperpolarized holding potential (-90 mV) the transient outward current activated with depolarizing commands to -55 mV, peaking within 5 ms. The current inactivated with a monoexponential time constant of 53 +/- 4 (SE) ms. At more positive holding potentials (-40 mV) the steady-state inactivation of the current could be removed by applying a conditioning hyperpolarizing prepulse. In response to a fixed depolarizing voltage step, half-maximal inactivation occurred at about -65 mV. The transient current was blocked by 4-aminopyridine (4-AP). 5. The sustained outward currents were isolated by holding the cells at -40 mV. Two components of sustained outward current were distinguished by their sensitivity to the calcium channel blockers Co2+ (5 mM) and/or Cd2+ (200 microM). The current remaining in the presence of Co2+/Cd2+ was activated by depolarizing voltage commands more positive than -40 mV.(ABSTRACT TRUNCATED AT 400 WORDS)

Spinal neurons which project to the periaqueductal gray and the medullary reticular formation via axon collaterals: a double-label fluorescence study in the rat.

Fluorescent retrograde double-labeling methods were used in which Fast blue and Nuclear yellow or Diamidino yellow dihydrochloride were injected into the midbrain periaqueductal gray (PAG) and medullary reticular formation (MRF). Double-labeled neurons were most frequently observed in the lateral part of lamina V, in laminae VII, VIII and X and in the lateral cervical and lateral spinal nuclei. The data demonstrate that some spinal neurons project to both the PAG and the MRF via axon collaterals.

Activation of pontine cholinergic sites implicated in unconsciousness following cerebral concussion in the cat.

Low levels of cerebral concussion in the cat produce reversible behavioral suppression presumably associated with unconsciousness. This injury is also associated with increased rates of glucose utilization in regions within the dorsomedial pontine tegmentum. Microinjection of carbachol into these regions produced behavioral suppression resembling that following concussion. These data, together with previously published observations on cholinergic responses to brain injury, suggest that concussive unconsciousness may be attributable in part to activation of cholinergic pontine sites.