Association Between Health Risk Knowledge and Risk Behavior Among Medical Students and Residents In Yerevan

Background. The relationship between risk knowledge, attitude, and behavior among different population groups is complex and has not been sufficiently explored. It was especially interesting to look at some aspects of this relationship among future health professionals (medical students and medical residents) assuming their detailed exposure to medical knowledge and health risks. The objectives of this study were to investigate the association between risk behavior and health risk knowledge/perception among medical students and residents in Yerevan, Armenia and examine the degree and direction of association between individual characteristics and risk behavior. Methods. A descriptive-analytical crosssectional survey design was used. Risk behavior and health risk knowledge/perception were assessed through an anonymous self-administrated questionnaire. Risk-taking behavior was measured as the number of all risk behaviors in a lifetime. Knowledge/perception was measured by the extent to which subjects agreed with risk-related statements. T-test, ANOVA, and linear regression modeling were used to analyze associations between total risk, health knowledge/perception, and individual characteristics. Results. Total risk was statistically significantly associated with age, gender, education, marital status, and having children; no association was found with birth order or attitude toward religion. Knowledge/perception about health risks was not associated with behaviors of interest after adjustment for potential “confounders.” There was a statistically significant interaction between marital status and knowledge/perception. Decrease in the number of reported risk behaviors with higher knowledge/perception score in this population was less among married participants than single participants. Conclusion. In this preliminary study, knowledge/perception of health risk did not appear to be a statistically significant predictor of risk behavior. Considering the limitations of this study, more research is needed to adequately assess the effect of knowledge and perception of health risk on risk behaviors of medical students and residents in Armenia

Alcohol problems and sense of coherence among older adults

The relation between alcohol problems and sense of coherence (SOC), a salutogenic model developed by Antonovsky, was assessed on a sample of 952 older members of a health maintenance organization. Data on alcohol problems (5-item index) and SOC (9-item scale) were obtained from mailed questionnaires. Multiple regression analyses indicated that SOC was a significant negative predictor of alcohol problems while controlling for alcohol consumption level, frequency of drunkeness and demographic characteristics. In addition, SOC scores were significantly higher for a subsample of lighter drinkers who reported no alcohol problems in the last year and had not been drunk in the last year (n=419) as compared to heavier drinkers who reported at least one alcohol problem in the last year, and reported being drunk at least once in the last year (n=107). These findings emphasize the importance of assessing factors which contribute to healthier behaviors as opposed to focusing exclusively on predictors of pathogenic outcomes.alcohol problems alcohol use sense of coherence older adults salutogenic

Randomized Trial of Case-Finding for Depression in Elderly Primary Care Patients

OBJECTIVE: To determine the effect of case-finding for depression on frequency of depression diagnoses, prescriptions for antidepressant medications, prevalence of depression, and health care utilization during 2 years of follow-up in elderly primary care patients. DESIGN: Randomized controlled trial. SETTING: Thirteen primary care medical clinics at the Kaiser Permanente Medical Center, an HMO in Oakland, Calif, were randomly assigned to intervention conditions (7 clinics) or control conditions (6 clinics). PARTICIPANTS: A total of 2,346 patients aged 65 years or older who were attending appointments at these clinics and completed the 15-item Geriatric Depression Scale (GDS). GDS scores of 6 or more were considered suggestive of depression. INTERVENTIONS: Primary care physicians in the intervention clinics were notified of their patients' GDS scores. We suggested that participants with severe depressive symptoms (GDS score ≥ 11) be referred to the Psychiatry Department and participants with mild to moderate depressive symptoms (GDS score of 6 –10) be evaluated and treated by the primary care physician. Intervention group participants with GDS scores suggestive of depression were also offered a series of organized educational group sessions on coping with depression led by a psychiatric nurse. Primary care physicians in the control clinics were not notified of their patients' GDS scores or advised of the availability of the patient education program (usual care). Participants were followed for 2 years. MEASUREMENTS AND MAIN RESULTS: Physician diagnosis of depression, prescriptions for antidepressant medications, prevalence of depression as measured by the GDS at 2-year follow-up, and health care utilization were determined. A total of 331 participants (14%) had GDS scores suggestive of depression (GDS ≥ 6) at baseline, including 162 in the intervention group and 169 in the control group. During the 2-year follow-up period, 56 (35%) of the intervention participants and 58 (34%) of the control participants received a physician diagnosis of depression (odds ratio [OR], 1.0; 95% confidence interval [CI], 0.6 to 1.6; P = .96). Prescriptions for antidepressants were received by 59 (36%) of the intervention participants and 72 (43%) of the control participants (OR, 0.8; 95% CI, 0.5 to 1.2; P = .3). Two-year follow-up GDS scores were available for 206 participants (69% of survivors): at that time, 41 (42%) of the 97 intervention participants and 54 (50%) of the 109 control participants had GDS scores suggestive of depression (OR, 0.7; 95% CI, 0.4 to 1.3; P = .3). Comparing participants in the intervention and control groups, there were no significant differences in mean GDS change scores (−2.4 ± SD 3.7 vs −2.1 SD ± 3.6; P = .5) at the 2-year follow-up, nor were there significant differences in mean number of clinic visits (1.8 ± SD 3.1 vs 1.6 ± SD 2.8; P = .5) or mean number of hospitalizations (1.1 ± SD 1.6 vs 1.0 ± SD 1.4; P =.8) during the 2-year period. In participants with initial GDS scores >11, there was a mean change in GDS score of −5.6 ± SD 3.9 for intervention participants (n =13) and −3.4 ± SD 4.5 for control participants (n = 21). Adjusting for differences in baseline characteristics between groups did not affect results. CONCLUSIONS: We were unable to demonstrate any benefit from case-finding for depression during 2 years of follow-up in elderly primary care patients. Studies are needed to determine whether case-finding combined with more intensive patient education and follow-up will improve outcomes of primary care patients with depression