Depression is present in up to 60% of patients with chronic obstructive pulmonary disease. It jeopardizes patients' ability to utilize treatment and may increase their risk for poor outcomes. Effective management will require high-quality studies and a multidisciplinary approach.
Individuals with COPD have a higher prevalence of co-morbid depression than either the general population or patients with other chronic illnesses. The best estimates report a prevalence of approximately 40% in COPD patients, compared to 15% in the general population. Depression in COPD patients leads to a lower quality of life, greater objective impairment in function, and decreased adherence to therapeutic interventions. While many depressed COPD patients have been treated empirically with antidepressants--subjecting them to antidepressant side effects, toxicities, and costs--there is a surprising lack of evidence supporting or directing that treatment. We review the current literature regarding the management of depression in COPD, suggest strategies for management, and future research needs.
We argue for the value of postmodernism in illuminating the roles or subject positions of ethnographic program evaluators. Drawing upon data from an ethnographic study of a summer college readiness program for African American, Asian American, and Anglo youth, we explore how postmodern theories can provide insights into the multiple roles of evaluators and increase reflexivity in ethnographic program evaluation. [ethnographic program evaluation, evaluators, postmodernism, reflexivity]
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