What do general practitioners think depression is? A taxonomy of distress and depression for general practice

Objective:
To create a taxonomy of distress and depression for use in primary care, that mirrors the thinking and practice of experienced general practitioners.

Design:
Qualitative study, using an ethnomethodological approach, with observation of videotaped routine GP–patient consultations and in-depth interviews with GPs.

Setting and participants:
The study was conducted in metropolitan Melbourne in 2005. Fourteen GPs conducted 36 patient consultations where depression was a focus; nine GPs participated in in-depth interviews to elicit details of how they recognised and diagnosed depression in their patients.

Results:
GPs consider distress and depression in three steps. In the first step, a change in a group of symptoms and signs is observed (eg, facial expression, loss of drive). The second step categorises the syndrome according to whether or not there is an identifiable environmental cause (reactive or “endogenous”), with the final step categorising the reactive syndromes according to their most prominent symptoms: either anxiety and worry, or helplessness and hopelessness. The resulting taxonomy includes: endogenous depression (a chronic and perhaps characterological depression characterised by a lack of interest and motivation); anxious depressive reaction (stress or worry); and hopeless depressive reaction (demoralisation).

Conclusion:
This simple and parsimonious taxonomy has validity based on its derivation from within the primary care setting.

Shear-free perfect fluids with a solenoidal electric curvature

We prove that the vorticity or the expansion vanishes for any shear-free perfect fluid solution of the Einstein field equations where the pressure satisfies a barotropic equation of state and the spatial divergence of the electric part of the Weyl tensor is zero.

Somatic symptoms, hypochondriasis and psychological distress: a study of somatisation in Australian general practice

Objective: To measure the prevalence of somatisation (multiple somatic symptoms and hypochondriasis) among Australian general practice attendees, its recognition by general practitioners, and its relationship with symptoms of depression and anxiety. Design, setting and participants: Self-reported questionnaires completed by 10 507 consecutive patients aged ≥18 years attending 340 GPs enrolled in a 6-hour national mental health program of continuing professional development who accepted invitations to participate; audit form completed by GPs for each patient during the period March 2004 to December 2006. Main outcome measures: Somatic symptom severity (measured with the 15-item Patient Health Questionnaire [PHQ-15]); hypochondriasis (measured with the Whiteley Index [Whiteley-7]; depression and anxiety (measured by the Kessler Psychological Distress scale [K10]); prevalence of “somatisers” (defined by medium to severe somatic symptom severity and hypochondriasis); GP recognition of somatisation (determined by their responses on audit forms to questions on whether patient’s complaints were most likely to have a physical or psychological explanation). Results: 18.5% of patients were classified as somatisers and 9.5% as probable cases of depression or anxiety. While 29.6% of somatisers had high anxiety or depression scores, 57.9% of people with anxiety or depression were also somatisers. Sex and age asserted significant but weak effects on psychometric scores. GPs identified somatic complaints as “mostly explained by a psychological disturbance” in 25.1% of somatisers. Conclusions: Somatisation is common in general practice, and more prevalent than depression or anxiety. While a minority of somatisers have significant anxiety and depression, most patients with depression and anxiety have a significant degree of somatisation. Recognition of depression and anxiety can be hindered by a somatic presentation and attribution. On the other hand, managing somatisation does not just involve recognising depression and anxiety, but also dealing with the health anxieties that underpin hypochondriasis.

A cluster randomised controlled trial of vascular risk factor management in general practice

Letter to the editor: Harris and colleagues report failure to obtain reduction in several important risk factor-based intermediate outcomes for vascular disease from their lifestyle intervention in the Health Improvement and Prevention Study (HIPS).1 Using intention-to-treat analysis, if only 117 of 384 participants completed at least two of six group sessions, a positive result could not be expected. We know that interventions for prevention of cardiovascular disease (CVD) and diabetes can be run successfully in Australian primary care, which raises questions about the design of Harris et al’s intervention.

Sexual harassment of Australian female general practitioners by patients

In 2010, an Australian survey was undertaken to examine the nature and extent of female general practitioners’ experience of sexual harassment by patients and how they respond to such episodes. Previous research has shown the high prevalence of sexual harassment or abuse of medical practitioners, but little is known about the nature of harassment and responses of individual practitioners.

Load frequency control of power systems with electric vehicles and diverse transmission links using distributed functional observers

This paper presents a load frequency control scheme using electric vehicles (EVs) to help thermal turbine units to provide the stability fluctuated by load demands. First, a general framework for deriving a state-space model for general power system topologies is given. Then, a detailed model of a four-area power system incorporating a smart and renewable discharged EVs system is presented. The areas within the system are interconnected via a combination of alternating current/high voltage direct current links and thyristor controlled phase shifters. Based on some recent development on functional observers, novel distributed functional observers are designed, one at each local area, to implement any given global state feedback controller. The designed observers are of reduced order and dynamically decoupled from others in contrast to conventional centralized observer (CO)-based controllers. The proposed scheme can cope better against accidental failures than those CO-based controllers. Extensive simulations and comparisons are given to show the effectiveness of the proposed control scheme.

A cluster randomised controlled trial of vascular risk factor management in general practice

Objective: To evaluate the impact of a lifestyle intervention in Australian general practice to reduce the risk of vascular disease.

Design, setting and participants: Stratified cluster randomised controlled trial among 30 general practices in New South Wales from July 2008 to January 2010. Patients aged 40–64 years were invited to participate. The subgroup who were 40–55 years of age were included only if they had either hypertension or dyslipidaemia.

Intervention: A general practice-based health-check with brief lifestyle counselling and referral of high-risk patients to a program consisting of one to two individual visits with an exercise physiologist or dietitian, and six group sessions.

Main outcome measures: Outcomes at baseline, 6 and 12 months included the behavioural and physiological risk factors for vascular disease — self-reported diet and physical activity, and measured weight, body mass index, waist circumference, blood lipid and blood sugar levels, and blood pressure.

Results: Of the 3128 patients who were invited, 958 patients (30.6%) responded and 814 were eligible to participate. Of these, 699 commenced the study, and 655 remained in the study at 12 months. Physical activity levels increased to a greater extent in the intervention group than the control group at 6 and 12 months (P = 0.005). There were no other changes in behavioural or physiological outcomes or in estimated absolute risk of cardiovascular disease at 12 months. Of the 384 enrolled in the intervention group, 117 patients (30.5%) attended the minimum number of group program sessions and lost more weight (mean weight loss, 1.06 kg) than those who did not attend the minimum number of sessions (mean weight gain, 0.73 kg).

Conclusion: While patients who received counselling by their general practitioner increased self-reported physical activity, only those who attended the group sessions sustained an improvement in weight. However, more research is needed to determine whether group programs offer significant benefits over individual counselling in general practice.

Putting the spoils of litigation into the shareholders’ pockets: when can shareholders bring a personal action against the directors of their company?

company is legally incorporated it must be treated like any other independent person with its rightsand liabilities appropriate to itself”.2 A consequence of this is the “proper plaintiff” principleestablished in Foss v Harbottle (1843) 2 Hare 461; 67 ER 189: the proper plaintiff in an action inrespect of a wrong done to a corporation is the corporation itself.3 It is also a “hallowed rule” thatdirectors owe their duties to the company, not the shareholders,4 and so any loss accruing to thecompany as a result of the directors’ breach of their duties is recoverable only by the company.5An obvious problem with this state of affairs is that a company will be unlikely to initiateproceedings against its directors when the company is controlled by those directors.6 While there aregood economic reasons for this division of management and ownership,7 shareholders are left with acritical question: under what circumstances can they initiate proceedings to recover loss suffered as aresult of company directors’ breach of their duties? Although one writer has referred to the“expansive statutory and common law arsenals” available to aggrieved shareholders,8 it seems ratherthe case that there are few effective remedies. For shareholders have no contractual relationship withdirectors,9 and the personal rights conferred on shareholders by statute or general law are largelyprocedural10 and seem a rather ineffective basis for “scrutinising directorial performance”.