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OBJECTIVES To measure primary care physicians' attitudes toward psychosocial issues, determine their relationship to the style of the medical interview, and assess whether attitudes and interview behaviors lead to correct diagnosis in patients with depression. DESIGN Physicians were videotaped while interviewing four patients standardized with criteria symptoms of major depression. Physicians were unaware of the mental health focus of the study. SETTING Patient examining rooms. PARTICIPANTS Physicians were eligible for recruitment if they were board certified or eligible in family practice or internal medicine, practiced primary care medicine, and were listed in regional directories. Standardized patients were recruited from the community. MAIN OUTCOME MEASURES Attitudes toward psychosocial issues (measured by the Physician Belief Scale), interview content (measured by review of the videotaped encounters), interview behaviors (measured by the Interaction Analysis System for Interview Evaluation), and a listing of depression in the differential diagnosis (determined by physician debriefing interviews). RESULTS Forty-seven community-based practitioners participated. Forty-eight percent of interviews resulted in a diagnosis of depression. Physician Belief Scale scores were not significantly correlated with patient-centered interviewing, psychosocial questions, inquiry about depression symptoms, or a depression diagnosis. Longer interviews were more likely to result in a depression diagnosis. CONCLUSIONS High interest in psychosocial issues was not associated with patient-centered interviewing behaviors, questions about psychosocial or depression symptoms, or depression diagnoses. However, certain patient-centered interviewing behaviors, particularly those defined as "affective," did lead to the recognition of depression.

Correlation of locations of sacral insufficiency fractures is made to regions of stress depicted by finite element analysis derived from biomechanical models of patient activities.Sacral insufficiency fractures occur at consistent locations. It was postulated that sacral anatomy and sites of stress within the sacrum with routine activities in the setting of osteoporosis are foundations for determining patterns for the majority of sacral insufficiency fractures.The predominant vertical components of sacral insufficiency fractures most frequently occur bilaterally through the alar regions of the sacrum, which are the thickest and most robust appearing portions of the sacrum instead of subjacent to the central sacrum, which bears the downward force of the spine.First, the exact locations of 108 cases of sacral insufficiency fractures were catalogued and compared to sacral anatomy. Second, different routine activities were simulated by pelvic models from CT scans of the pelvis and finite element analysis. Analyses were done to correlate sites of stress with activities within the sacrum and pelvis compared to patterns of sacral insufficiency fractures from 108 cases.The sites of stress depicted by the finite element analysis walking model strongly correlated with identical locations for most sacral and pelvic insufficiency fractures. Consistent patterns of sacral insufficiency fractures emerged from the 108 cases and a biomechanical classification system is introduced. Additionally, alteration of walking mechanics and asymmetric sacral stress may alter the pattern of sacral insufficiency fractures noted with hip pathology (P = 0.002).Locations of sacral insufficiency fractures are nearly congruous with stress depicted by walking biomechanical models. Knowledge of stress locations with activities, cortical bone transmission of stress, usual fracture patterns, intensity of sacral stress with different activities, and modifiers of walking mechanics may aid medical management, interventional, or surgical efforts.

This study was undertaken in order to better understand the detection of depression by primary care physicians. Specifically, we investigated the relationship between information gathered during the course of the medical interview and the subsequent diagnosis of depression. Forty-seven community-based primary care physicians, unaware of the mental health focus of this research, were videotaped in the office setting, as they interviewed two "typical" standardized patients who met DSM-III-R criteria for major depression. One patient presented with headaches and the other presented with palpitations and chest pain. After each interview, physicians were provided with physical findings and results of any diagnostic procedures they ordered, then asked to construct and explicate their differential diagnoses. The two patients were correctly diagnosed as depressed by 53 and 45% of the physicians. Although detection was related to greater amounts of information gathered, inquiry about the DSM-III-R criteria symptoms was generally low, and in no case was sufficient information acquired to make a formal DSM-III-R diagnosis of depression. However, a subset of the DSM-III-R symptoms (those related to disturbances of appetite, sleep, and other neurovegetative functions) were among the reasons cited for inclusion of depression in the differential, as were psychosocial stressors and the patient's appearance. These findings suggest that detection of depression is low by primary care physicians.

The thermal desorption of carbon monoxide from alumina-supported platinum has been studied by monitoring of the infrared spectrum of adsorbed CO as the temperature is increased. For the 0.5, 1, 2, and 10 wt% Pt samples studied, the areas of the peaks in the linear region increased with temperature until 100 °C, whereupon they decreased steadily, reaching zero at about 400 °C. The rate of disappearance of linearly adsorbed CO had two maxima, one at about 150 °C and the other at about 250 °C. The 0.5, 1, and 2% samples, which were fully dispersed, all displayed a peak at 2060 cm−1, with a shoulder at about 2078 cm−1. The 10% sample, which was 75% dispersed, had its main peak at 2083 cm−1 with a shoulder at 2069 cm−1. For all samples, these peaks shifted to lower frequency as the temperature increased. The 2083 cm−1 peak is attributed to CO linearly adsorbed on Pt crystal faces, whereas the 2060 cm−1 peak is attributed to CO adsorbed by Pt particles that do not have extended crystal faces.

Mental disorder diagnoses among 51 patients, made by a group of 20 family physicians, were compared with diagnoses generated by the Diagnostic Interview Schedule (DIS). Processes of diagnosis, decision making, and treatment planning were then examined through structured physician interviews and chart audits. In this study, 75 of 94 DIS diagnoses (79%) were undetected. During interview and chart audit, the physicians were found to have consistently under-estimated, misinterpreted, or neglected psychiatric aspects of care among a majority of patients in the study. These physicians had all satisfactorily completed a psychiatry curriculum designed for family physicians. Analysis of these results suggests that a mental health role is often not integrated into primary care practice, regardless of physician performance during psychiatric training experiences. Assumption of this role appears to be state dependent on involvement with a psychiatric treatment setting. Primary care practice patterns do not seem to result in application of appropriate skills and therapeutic attitudes to detect, diagnose, and correctly manage the majority of mental disorders that occur. The need is reaffirmed for active collaboration between mental health professional and primary care providers in training and in incorporation of psychiatric skills into primary care practice.

It is our opinion that, due to the lack of an adequate analytic framework, much of current kinship study has too much of an either-or character and often is more simplistic than it need be. One of the shortcomings is that we have not yet developed culture-free units, either for the positional units and ascriptions thereto, or for the interactional systems that kinship entails. It is our contention that scientific investigation into any body of phenomena calls for a system of units if the investigation is to proceed very far. The profession, we think, has arrived at a point where many of its members who are engaged in kinship studies recognize the need for the development of a system of units. We present here our version of something of this nature, not so much with the hope of acceptance as with the hope that it will serve some sort of catalyst function for those who are interested in this aspect of anthropology.

A case is presented of a sarcoma arising from a solitary osteochondroma of six years duration, in a eighteen-year-old woman. Attention is brought to the rarity of malignant lesions arising within solitary osteochondromas.

IN the parasitic wasp, H1abrobracon juglandis (Ashmead) crosses of orange-eyed (recessive) females by wild type (black) males produce, according to sex-linkoid inheritance, black heterozygous females from fertilized eggs and orange azygous males from unfertilized eggs. In 1921 (Whiting, P. W., '21) black biparental males were also reported. These anomalous males were called patroclinous because they showed the dominant paternal trait. They were supposed to be haploid mosaics with part of the body derived from the sperm nucleus alone (androgenesis). A few proved such by breeding test, but later genetic evidence indicated that the majority at least are diploid (Whiting, P. MT., and Anna R. Whiting, '25). The genetic and chromosomal constitution of these males is of interest, bearing as it does on the problem of sexdetermination in Hymenoptera. The ratios in which biparental males, females and haploid males occur has likewise excited interest. The two phases of the problem of male biparentalism, ratios and composition, have appeared somewhat separate, but doubtless each has an important relation to the other. As a result of accumulation of several groups of data bearing especially on variation in ratios, it has been planned in the present paper to report such as seem likely to aid in solving the problem. The material is reported here for the first time except for that of Anna

This curriculum is designed with the expectation of considerable involvement by family physicians in mental health care delivery. Psychiatry education is initiated early, before attitudes become fixed, to emphasize self-reliance and mental health problem-solving skills, to make the learning experience longitudinal, and to integrate psychiatric training into the rest of the residents' curriculum. Seminars, clinical experience, and liaison with a mental health team are all utilized in the training design. The effectiveness of this training program will be studied over time to obtain needed data about the best teaching model for the mental health role of the family physician.