Notice bibliographique
Résumé
Murray and Lopez1 estimated that, in 1990, unipolar major depression accounted for 13% of all years lived with disability, making it the leading cause of disability in developed regions of the world. They also estimated that, in the established market economies, only 35% of people with unipolar major depression were actually treated, even though treatment can reduce the disability by 50%.2 Primary care services have an essential role if the best public health outcome is to be achieved (that is, the best possible reduction in morbidity as a result of improved awareness, detection, diagnosis, and treatment) because this goal far exceeds what is feasible for existing secondary and specialist level services. Thus the questions raised in this In Review section by Busker et al3 and Kates and Mach4-how to define the responsibilities of primary care and construct the best interface between primary care and specialist services, what primary care should be able to manage, and what are the best methods for managing depression-are critical to improving both the system of care and patient outcomes. Primary health care is under considerable stress in Canada, as in other countries,5 owing to the overall low numbers of physicians and to particular problems regarding recruitment into primary care. Overall, Canada has 2.1 doctors per 1000 population. The figure is 3.5 per 1000 in the Euro area, 2.7 per 1000 in the United States, and 2.0 per 1000 in the United Kingdom. Clearly, Canada's ratio of physicians to population is considerably lower than the ratio in most Western European countries and in the United States, although higher than that in the United Kingdom.6 A further concern is that the level of expertise and the complexity of the work required in primary care has reached the stage where it may be beyond what can reasonably be expected from most individuals. This shortfall may be partly attributed to the short-sighted physician recruitment policies adopted in Canada a decade ago, which led to cutbacks in medical school enrolment; it may also be attributed to payment systems that financially disadvantage those who choose to work and provide services in teams of health care providers. Across the country, the problem is now being in addressed by various schemes to encourage and support primary care reform. About 30% of the population have symptoms of a mental disorder over a 1 -year period, and over 80% of the population see a family physician. A mental disorder is detected in about 14% of the population each year; about 3.4% will see a psychiatrist, 3% a psychologist, and fewer than 0.5% will be admitted to hospital. Less than one-half of those who have symptoms of a mental disorder within a given year actually get treatment.7 Bilsker et al3 show that the physician-treated prevalence of depression in British Columbia increased from 7.7% in 1991-1992 to 9.5% in 2000-2001. Consistently, however, more than 95% were seen by family physicians, and in the last year, only 7.5% were seen by psychiatrists. (Busker and colleagues are to be congratulated on accessing the British Columbia billing database, which that province has sensibly made available to researchers. …
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,002 | 0,009 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,001 | 0,002 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,003 | 0,001 |
| Science ouverte | 0,001 | 0,002 |
| Intégrité de la recherche | 0,003 | 0,003 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,005 | 0,001 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».