Objective To explore the association between depression and physical, emotional, and sexual abuse by partners or ex-partners of women attending general practice.Design Descriptive, cross sectional survey.Setting 30 general practitioners in Victoria, Australia.Participants 1257 consecutive female patients.Main outcome measures Some type of abuse in an adult intimate relationship (composite abuse scale), depression (Beck depression inventory or Edinburgh postnatal depression scale), and physical health (SF-36).Results 18.0% (218/1213) of women scored as currently probably depressed and 24.1% (277/1147) had experienced some type of abuse in an adult intimate relationship. Depressed women were significantly more likely to have experienced severe combined abuse than women who were not depressed after adjusting for other significant sociodemographic variables (odds ratio 5.8, 95% confidence interval 2.8 to 12.0). These variables included not being married, having a poor education, being on a low income, being unemployed or receiving a pension, pregnancy status, or being abused as a child.Conclusion Physical, emotional, and sexual abuse are strongly associated with depression in women attending general practice. Doctors should sensitively ask depressed women about their experiences of violence and abuse in intimate relationships. Research into depression should include measures of partner abuse in longitudinal and intervention studies.
Bovine Tuberculosis (bTB) in cattle is a global health problem and eradication of the disease requires accurate estimates of diagnostic test performance to optimize their efficiency. The objective of this study was, through statistical meta-analyses, to obtain estimates of sensitivity (Se) and specificity (Sp), for 14 different ante-mortem and post-mortem diagnostic tests for bTB in cattle. Using data from a systematic review of the scientific literature (published 1934-2009) diagnostic Se and Sp were estimated using Bayesian logistic regression models adjusting for confounding factors. Random effect terms were used to account for unexplained heterogeneity. Parameters in the models were implemented using Markov Chain Monte Carlo (MCMC), and posterior distributions for the diagnostic parameters with adjustment for covariates (confounding factors) were obtained using the inverse logit function. Estimates for Se and/or Sp of the tuberculin skin tests and the IFN-γ blood test were compared with estimates published 2010-2015. Median Se for the single intradermal comparative cervical tuberculin skin (SICCT) test (standard interpretation) was 0.50 and Bayesian credible intervals (CrI) were wide (95% CrI 0.26, 0.78). Median Sp for the SICCT test was 1.00 (95% CrI 0.99, 1.00). Estimates for the IFN-γ blood test Bovine Purified Protein Derivative (PPD)-Avian PPD and Early Secreted Antigen target 6 and Culture Filtrate Protein 10 (ESAT-6/CFP10) ESAT6/CFP10 were 0.67 (95% CrI 0.49, 0.82) and 0.78 (95% CrI 0.60, 0.90) respectively for Se, and 0.98 (95% CrI 0.96, 0.99) and 0.99 (95% CrI 0.99, 1.00) for Sp. The study provides an overview of the accuracy of a range of contemporary diagnostic tests for bTB in cattle. Better understanding of diagnostic test performance is essential for the design of effective control strategies and their evaluation.
Objectives: To report the baseline characteristics of the Diagnosis, Management and Outcomes of Depression in Primary Care (diamond) study cohort and discuss the implications for depression care in general practice. Design: A prospective longitudinal study beginning in January 2005. Participants and setting: Adult patients with depressive symptoms identified via screening with the Center for Epidemiologic Studies Depression Scale (CES‐D ≥ 16) in 30 randomly selected Victorian general practices. Main outcome measure: Depression status on the Patient Health Questionnaire (PHQ). Results: 789 patients form the cohort (71% women). At baseline, 47% were married, 21% lived alone, 36% received a pension or benefit, 15% were unable to work, 23% reported hazardous drinking, 32% were smokers, 39% used antidepressants and 19% used sedatives. 27% satisfied criteria for current major depressive syndrome (MDS) on the PHQ, while 52% had “persistent” depressive symptoms, and 22% had “transient” depressive symptoms, lasting at most a few weeks. Of those satisfying criteria for MDS, 49% were also classified with an anxiety syndrome, 40% reported childhood sexual abuse, 57% reported childhood physical abuse, 42% had at some time been afraid of their partner, and 72% reported a chronic physical condition; 84% were receiving mental health care (either taking antidepressants or seeing a health practitioner specifically for mental health care) compared with 66% of those with persistent depressive symptoms and 57% with transient depressive symptoms. Conclusion: This method of screening for depressive symptoms in general practice identifies a group of patients with substantial multiple comorbidities — psychiatric, physical and social problems coexist with depressive symptoms, raising challenges for the management of depression in general practice.
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