Chronic Care in Adulthood and Old Age: Physical and Psychosocial Management in General Practice Encounters

Managing chronic physical disease straddles two paradigms of care - the biomedical and the psychosocial. To respond to the challenges of the ageing population with increasing chronic disease, general practitioners need to understand the impact of their collective processes of care. The research objective is to compare general practitioner consultations identified by a diagnosis of chronic physical condition with those with a psychological diagnosis and both chronic physical and psychological diagnoses. The method used is a retrospective analysis of a national sample of general practitioners (GPs) who documented their consultations. In consultations where chronic physical conditions were managed, general practitioners documented few psychosocial or physical support interventions including referrals. These consultations were with an older age group, who had multiple diagnoses with high levels of continuity. This pattern persisted whether or not psychological conditions were also managed in the same encounter. In consultations where psychological diagnoses, without a chronic physical diagnosis, were managed, GPs documented high levels of psychosocial support interventions. General practitioners are less likely to document psychological and physical support care in chronic physical disease consultations than all other types of consultation. This analysis has limitations due to incomplete data and cross-sectional design, however, the study raises questions about the comprehensiveness of care in the past and provides a baseline against which to measure the impact of current reforms for complex chronic conditions. </jats:p

Gastrointestinal cancer among cement workers. A case-referent study

A matched case-referent study was conducted to investigate the risk of gastrointestinal cancer in cement workers. All male cases of cancer in esophagus, stomach, colon and rectum in the period 1922-1988 from two parishes surrounding a cement plant were identified. For each case, four referents were chosen, matched to age and year of death. Employment in the cement plant was confirmed as from plant records or job title noted in the parish books. Of 25 cases with a definite colorectal tumour, 40% had been blue-collar cement workers for 25 years or more, compared with 20% of their referents [odds ratio (OR) 3.2; 95% confidence limits (CI) 1.1-9.4]. There were indications of a dose (time of employment)-response relationship. For 18 cases with an esophageal or stomach tumour, the OR for those ever employed as cement workers was 3.2 (CI 1.0-11), but short-term employment predominated, thus making a causal relationship less likely

The blunting of the thyrotropin response to repeated thyrotropin-releasing hormone administration is reduced by dopaminergic blockade both at normal and elevated serum levels of thyroid hormones

Abstract. Fifteen premenopausal women were investigated in the follicular phase of the menstrual cycle with two TRH tests within an interval of 48 to 96 h. Ninety min before each TRH test either 10 mg metoclopramide or saline was injected iv in randomized order. The same procedure was repeated in the following menstrual cycle after pretreatment with T4 (0.5 mg daily for 6-14 days). At least 2 months later the same procedure was repeated with T3 pretreatment (60-120 μg for 6-8 days) in 9 of them. A multiple regression analysis was used in modelling the relationships between TSH release and serum free T3, T4 and estradiol levels, adjusting for the presence of metoclopramide and the order of the test. No correlation was found between the TSH response to TRH and the serum estradiol level. The TSH response to the second TRH test was approximately half the first one, both in the control situation and after treatment with T4 or T3. The blunting of the TSH response to the second TRH administration was significantly reduced by metoclopramide, both at normal and elevated thyroid hormone levels, suggesting that a dopaminergic mechanism takes part in the blunting.</jats:p