Box 1 The metabolic syndrome changes associated with insulin resistance

Cigarette smoking Sedentary behavior Increased free fatty acids Increased apolipoprotein B Decreased apolipoprotein A-1 Small, dense low-density lipoprotein and high-density lipoprotein Increased apolipoprotein C-III Increased plasminogen activator inhibitor 1 Increased viscosity Inflammatory markers Increased white blood cell count Increased interleukin 6 Increased tumor necrosis factor Increased resistin Increased C-reactive protein Decreased adiponectin Increased asymmetric dimethylarginine...

The significance of psychosocial stress

It follows from the previous sections that psychosocial factors, such as a physical threat, may induce an allostatic response and thus have profound effects on the integrity of the body and add to the wear and tear on tissues and organs. Excessive weight gain, for example, is a physical threat that, in turn, may be the outcome of a complex interaction between an adverse life style caused by psychosocial factors in the setting of a genetic predisposition to metabolic inflexibility 53 and complex...

Scientific evaluation of the Intermed

There are different approaches to developing and evaluating measurement instruments. The essence of classic test theory is that the measure of Patient identification Diagnostics And Treatment Case conference after initial consults Fig. 5. Form for recording treatment plan. any construct involves the use of all possible items that can be identified to measure the target construct accurately. Item-analysis evaluates the degree to which items in a given set correlate (a correlation between...

Description of the Intermed

The material presented in the articles in this issue provides the knowledge base on which the INTERMED was constructed. The reader is referred to these articles. A few additional references are provided here. In the History biologic domain information is collected about the chronicity of a given illness (Chronicity) and about prior episodes of diagnostic uncertainty (Diagnostic dilemma''). The distinction between acute and chronic diseases has proven helpful for the conceptualization of somatic...

Systems issues and barriers

Although the need for improved integration of primary medical care and behavioral health care is well documented, and models such as those described previously are being developed and tested, numerous systems issues and barriers continue to impact effective integration adversely at multiple levels, involving all six key stakeholder groups (Fig. 8) 59 . At the patient level, stigma, resistance to diagnosis, and health beliefs that tend to emphasize somatic presentations act as barriers to...

The Clinics Are Now Available Online

Access your subscription at http www.theclinics.com INTEGRATED CARE FOR THE COMPLEX MEDICALLY ILL Frits J. Huyse and Friedrich C. Stiefel Assessing the Effectiveness of Integrated Interventions It may appear self-evident that the integrated care of patients who have a complex or chronic illness is a necessity whose proper application will result in better health outcomes achieved as economically as possible. The uncritical application of integrated interventions produced disappointing results...

Box 1 Barriers to recognition diagnosis and optimal treatment of depression

Denial, minimization of symptoms, believing can handle by self Not seeing depression as medical in nature Concerns about confidentiality Not ready to accept diagnosis Fear of treatments or nonadherence with treatment plan Stigma of mental health treatment Not believing it is real illness, serious, or particularly distressing Interviewing skill deficiencies Medicalization of symptoms Fear of offending patient Knowledge deficit regarding diagnosis or treatment Diagnosis obscured by comorbidity...

Joris PJ Slaets MD PhD

Department of Internal Medicine, University Medical Center Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands Earlier in this issue the highly complex interrelations between the multitude of factors that are active in the pathophysiology of the metabolic syndrome were described. Based on that an argument was made for an integrated approach, even though the current available research does not support such an approach to its full extent. From the patient's perspective, however, it seems...

Box 1 Translating PHQ9 scores into action

0-4 No action (community screens) 5-9 Watchful waiting in most 10-14 Education counseling active drug prescription based upon diagnosis, duration, impairment, and patient preferences 20+ May need combined medication and or referral the primary focus of the Pathway program was to intervene in depression, most nurses involved in the program were specially trained mental health nurses. Cora Hartwell, one of the nurses who was professionally dual trained, saw the need for a broad spectrum of roles...

Rijk OB Gans MD PhD

University Medical Center Groningen, Hanzeplein 1 9700 RB, Groningen, The Netherlands The concept of the metabolic syndrome has existed for at least 80 years 1 . It was first described in the 1920s by Kylin, a Swedish physician, who noted a clustering of hypertension, hyperglycemia, and gout. Next, the concept of upper-body adiposity (android or male-type obesity, as opposed to female-type obesity) was recognized as the obesity phenotype that was commonly associated with the metabolic...

Leonard E Egede MD MSab

AMedical University of South Carolina, Center for Health Disparities Research, 135 Rutledge Avenue, Room 280H, PO Box 250593, Charleston, SC 29425, USA bCharleston VA Targeted Research Enhancement Program, Ralph H. Johnson VAMC, The prevalence of diabetes mellitus is approaching epidemic proportions across the world. In the United States, current estimates indicate that 7.0 of the population or 20.8 million people have diabetes. Of this number, 14.6 million are diagnosed cases, whereas 6.2...

Case complexity and its assessment

Since the 1980s several attempts have been made to operationalize case complexity by using different perspectives and by aiming at different objectives. A distinction can be made between three groups of case complexity assessment methodologies patient grouping methodologies, complexity screening instruments, and theoretic constructs. The term ''case complexity or case mix has been used most frequently in the area of patient grouping methodologies. Several patient grouping methodologies have...

References

1 Ormel J, VonKorff M, Ustun TB, et al. Common mental disorders and disability across cultures results from the WHO collaborative study on psychological problems in general health care. JAMA 1994 272 1471-8. 2 De Groot M, Anderson R, Freedland KE, et al. Association of depression and diabetes complications a meta analysis. Psychosom Med 2001 63 619-30. 3 Ciechanowski PS, Katon WJ, Russo JE. Depression and diabetes impact of depressive symptoms on adherence, function and costs. Arch Intern Med...

Symptoms Syndromes and the Value of Psychiatric Diagnostics in Patients Who Have Functional Somatic Disorders

Rosmalen, PhD, MAc'd aDepartment of Medicine, Indiana University School of Medicine Regenstrief Institute, RG-6, 1050 Wishard Boulevard, Indianapolis, IN 46202, USA cDepartment of Psychiatry, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands dGraduate School for Experimental Psychopathology, The Netherlands The epidemiology of physical symptoms has been reviewed recently 1,2 . Symptoms account for more...

Box 1 The Groningen Frailty Indicator

Is the patient able to carry out these tasks without any help The use of help resources, such as walking stick, walking frame, wheelchair, is considered as independent 2. Walking around outside around the house or to the neighbors 4. Going to the toilet Physical fitness 5. What mark does the patient give him herself for physical fitness scale 0 to 10 6. Does the patient experience problems in daily life as a result of poor vision 7. Does the patient experience problems in daily life because of...