Breast and cervical cancer screening specific effects of depression and obesity.

BACKGROUND: Obesity and depression may each be associated with lower rates of cervical and breast cancer screening. Studies have examined obesity or depression alone, but not together, despite the established link between them. PURPOSE: This article aims to disentangle the effects of depression and obesity on receipt of breast and cervical cancer screening. METHODS: A stratified sampling design was used to recruit women aged 40-65 years with information on BMI from an integrated health plan in Washington State in 2003-2005. A telephone survey included the Patient Health Questionnaire-9 for depression, weight, and height. Automated data assessed Paps for 3097 women over a 3-year period and screening mammograms over a 2-year period for 2163 women aged > or =51 years. Logistic regression models (conducted in 2008) examined the association between obesity and depression and receipt of screening tests. RESULTS: In univariate logistic regression models, women were less likely to receive a Pap if they were obese (OR=0.53, 95% CI=0.41, 0.69) or depressed (OR=0.60, 95% CI=0.42, 0.87). Further, women were less likely to receive a screening mammogram if they were depressed (OR=0.45, 95% CI=0.30, 0.67). In multivariable models, only obesity remained significantly associated with a lower likelihood of Pap screening (OR=0.67, 95% CI=0.0.49, 0.93), and only depression remained significantly associated with lower rates of screening mammography (OR=0.49, 95% CI=0.31, 0.76). Obesity and depression did not interact significantly in either model. CONCLUSIONS: Obesity and depression appear to have specific effects on receipt of different cancer-screening tests.

Relation of body mass index to depression and weighing frequency in overweight women.

OBJECTIVE: Research suggests that overweight and obesity are associated with depressive symptoms, particularly among women. Evidence from weight control trials suggests that higher weighing frequency is associated with greater weight loss or less weight gain. As limited data exist on the effects of self-weighing on body mass index (BMI) among overweight adults with or without depression, this study seeks to examine this issue using data from a population-based epidemiologic survey. METHODS: Data from a large population-based survey of 4655 women ages 40-65 in the greater Seattle area, surveyed from November 2003 to February 2005, were used to examine associations of depression and weight self-monitoring with BMI. Sample-weighted regression models were used to examine associations of depression, self-weighing frequency, and BMI, with demographic factors (race/ethnicity, employment status, smoking status, age, martial status, educational attainment) entered as covariates. RESULTS: Regression models indicated that higher self-weighing frequency and negative depression status were independently associated with lower BMI, with no interaction observed between depression and self-weighing. CONCLUSION: Frequent self-weighing appears to be associated with lower BMI in both depressed and non-depressed overweight women.

Sexually transmitted diseases and managed care: an inquiry and review of issues affecting service delivery.

To understand the potential role of managed care organizations (MCOs) in prevention and control of sexually transmitted diseases (STDs), we conducted a systematic review of articles on STDs and managed care and sought qualitative information from MCOs on STD-related activities. The review focused on prevention, risk assessment, patient education, counseling, screening, and costs of care, but revealed relatively few published articles. Barriers to STD service delivery included competing priorities, lack of time or supporting organizational structures, and differing mandates of health departments and MCOs. Facilitators included collaboration between health departments and MCOs, regulatory and performance incentives, buy-in from key stakeholders, availability of infrastructure to support data collection, and inclusion of chlamydia screening in the Health Employer Data and Information Set to monitor plan performance. Because of the shift of STD service delivery from the public to private sector, incentives need to maximize interest and cooperation of patients, clinicians, and MCOs in STD prevention.

STD prevention and treatment guidelines: a review from a managed care perspective.

OBJECTIVE: To conduct a standardized review of sexually transmitted disease (STD) clinical practice guidelines from a managed care perspective. STUDY DESIGN: Eight guidelines that address STD prevention and care received dual review on selected content and formatting criteria. Content criteria included currency of information, coverage of 7 selected STDs, attention to primary prevention areas (risk assessment, patient education, counseling), attention to system/implementation issues (time/costs/training) of integrating STD practices into routine clinical care, and referencing of scientific literature. Format/presentation criteria included ease of accessing STD information, clear identification of STD recommendations, availability of handbook/pocket versions, and availability of online version. Chlamydia screening and treatment recommendations were compared for 3 guidelines. RESULTS: The 8 guidelines addressed a variety of target populations. Two focused exclusively on STDs. Three were current at the time of the review (1998 or later), 2 covered all selected STDs, 3 gave considerable emphasis to primary prevention, and 4 cited relevant scientific sources. One guideline was classed as having good coverage of system/implementation issues. Information for specific STDs was readily located and concisely presented in 2 of the guidelines. Four sources had handbook/pocket versions, and 5 had on-line versions. Based on these findings, we suggest modifications for future versions of these guidelines that may increase their usefulness to managed care settings. CONCLUSIONS: Currently available STD guidelines potentially can be of great use to managed care providers and decisionmakers. The relevance to managed care organizations of a number of guidelines could be increased in several areas, particularly by greater focus on primary prevention and by providing access to tools and strategies to foster integration of STD services into routine clinical care.