Primary care physicians' and psychiatrists' approaches to treating mild depression.

OBJECTIVE: To measure how primary care physicians (PCPs) and psychiatrists treat mild depression. METHOD: We surveyed a national sample of US PCPs and psychiatrists using a vignette of a 52-year-old man with depressive symptoms not meeting Major Depressive Episode criteria. Physicians were asked how likely they were to recommend an antidepressant counseling, combined medication, and counseling or to make a psychiatric referral. RESULTS: Response rate was 896/1427 PCPs and 312/487 for psychiatrists. Compared with PCPs, psychiatrists were more likely to recommend an antidepressant (70% vs. 56%), counseling (86% vs. 54%), or the combination of medication and counseling (61% vs. 30%). More psychiatrists (44%) than PCPs (15%) were 'very likely' to promote psychiatric referral. PCPs who frequently attended religious services were less likely (than infrequent attenders) to refer the patient to a psychiatrist (12% vs. 18%); and more likely to recommend increased involvement in meaningful relationships/activities (50% vs. 41%) and religious community (33% vs. 17%). CONCLUSION: Psychiatrists treat mild depression more aggressively than PCPs. Both are inclined to use antidepressants for patients with mild depression.

Factors influencing physicians' advice about female sterilization in USA: a national survey.

BACKGROUND: Tubal ligation can be a controversial method of birth control, depending on the patient's circumstances and the physician's beliefs. METHODS: In a national survey of 1800 US obstetrician-gynecologist (Ob/Gyn) physicians, we examined how patients' and physicians' characteristics influence Ob/Gyns' advice about, and provision of, tubal ligation. Physicians were presented with a vignette in which a patient requests tubal ligation. The patient's age, gravida/parity and her husband's agreement/disagreement were varied in a factorial experiment. Criterion variables were whether physicians would discourage tubal ligation, and whether physicians would provide the surgery. RESULTS: The response rate was 66% (1154/1760). Most Ob/Gyns (98%) would help the patient to obtain tubal ligation, although 9-70% would attempt to dissuade her, depending on her characteristics. Forty-five percent of physicians would discourage a G2P1 (gravida/parity) woman, while 29% would discourage a G4P3 woman. Most physicians (59%) would discourage a 26-year-old whose husband disagreed, while 32% would discourage a 26-year-old whose husband agreed. For a 36-year-old patient, 47% would discourage her if her husband disagreed, while only 10% would discourage her if her husband agreed. Physicians' sex had no significant effect on advice about tubal ligation. CONCLUSIONS: Regarding patients who seek surgical sterilization, physicians' advice varies based on patient age, parity and spousal agreement but almost all Ob/Gyns are willing to provide or help patients obtain surgical sterilization if asked. An important limitation of the study is that a brief vignette, while useful for statistical analysis, is a rough approximation of an actual clinical encounter.

Detection of hepatitis A virus from clotting factors implicated as a source of HAV infection among haemophilia patients in Korea.

To investigate the causal relationship of blood clotting factors and hepatitis A virus (HAV) infection in haemophilia patients during 1998-1999 in Korea, we performed a 1:3 matched case-control study and molecular detection of HAV from clotting factors and patients. The epidemiological investigation showed that one lot of clotting factor VIII was related epidemiologically to patients with hepatitis A with an odds ratio of 35.0, or 38.4 when adjusted for the interval between injections. We examined 17 sera collected from seven patients and 124 lots of blood clotting factors (factor VIII and factor IV) by HAV reverse transcriptase-polymerase chain reaction (RT-PCR). HAV RNA was detected in five clotting factors and six sera. The HAV sequence of one of the factor VIII samples was identical to the sequences found in three patients' sera. Findings from the laboratory and epidemiological studies suggested that the clotting factor was causally related to HAV infection in three haemophilia patients.

A seroprevalence study of poliovirus antibody among primary schoolchildren in Korea.

We aimed to determine the seroprevalence of poliovirus antibody in Korea by using the cell culture neutralization method recommended by the WHO. A total of 500 sera collected from children at eight primary schools in Kyunggi province were used for this study. We found that 82.2% of children were positive for all three types of poliovirus and antibody-positive rates for types I, II and III were 94.4, 96.6 and 86.8% respectively, indicating that seropositive rates for types I and II were considerably higher than for type III (P<0.0001). This result implies that the type III component of the oral polio vaccine should be evaluated further. Although a greater number of children, including young infants, need to be tested for seroprevalence, this study still provides us with valuable information on the effectiveness of vaccination against polioviruses in Korea.

Genetic analysis of the VP1 region of human enterovirus 71 strains isolated in Korea during 2000.

We have isolated Human enterovirus 71 (EV71) from stool and CSF samples taken from patients with acute flaccid paralysis, herpangina, or hand, foot and mouth disease in 2000. Both the cell culture-neutralization test and RT-PCR were used to detect enteroviruses. Rhabdomyosarcoma (RD), HEP2c, and BGM cells were used for the isolation of viruses, and serotypes were determined by the neutralization test using EV71-specific antiserum. For genomic analysis, we amplified a 437-bp fragment of the 5'-noncoding region of the enterovirus genome and a 484-bp fragment of the VP3/VP1 region of EV71 by RT-PCR, with positive results. Products amplified using an EV71-specific primer pair were sequenced and compared with other isolates of EV71. Analysis of the nucleotide sequences of the amplified fragments showed that the EV71 isolates from patients were over 98% homologous and belonged to the genotype C.

PCR-RFLP based molecular typing of enteroviruses isolated from patients with aseptic meningitis in Korea.

We have evaluated PCR-RFLP as a practical method for rapid typing of enteroviruses causing aseptic meningitis in Korea. Through blind examination of 80 clinical isolates from patients with aseptic meningitis, we have compared the results of conventional serotyping with PCR-RFLP based genotyping, which was developed for this study. Among the 80 case isolates, which had been previously typed by routine neutralization test, only 42 cases (52.5%) were matched with typing by PCR-RFLP. The result clearly demonstrated that the enterovirus serotype does not coincide with the genotype. Therefore, the classification of enteroviruses by genotyping with PCR-RFLP, although rapid and simple, may be complicated by regional or seasonal differences. However, the PCR-RFLP method developed in this study is applicable to the epidemiological study of enteroviruses when regional or seasonal differences exist, and is useful in identifying the source of an infection.