CHICAGO—A home-based program that includes social and physical activity significantly reduces symptoms of depression in older adults who are chronically ill and have minor depression, according to a study in the April 7 issue of the Journal of the American Medical Association (JAMA).

Clinically significant depression affects 15 to 20 percent of elderly individuals in the United States, according to background information in the article. Older adults with social isolation, multiple illnesses, and physical impairment are more likely to be depressed but may be less able to seek appropriate care for depression compared with older adults without these characteristics.

Paul Ciechanowski, M.D., M.P.H., of the University of Washington School of Medicine, Seattle, and colleagues conducted a randomized controlled trial comparing a program for treating minor depression and dysthymia (a chronic depressive syndrome persisting for at least 2 years), the Program to Encourage Active, Rewarding Lives for Seniors (PEARLS), with usual care in medically ill, low-income, mostly homebound older adults. The study included 138 participants (51.4 percent with minor depression, and 48.6 percent with dysthymia) aged 60 years or older, recruited through community senior service agencies in metropolitan Seattle from January 2000 to May 2003. Seventy-two percent of the participants lived alone, 58 percent had an annual income of less than $10,000, and 69 percent received a form of home assistance.

Patients were randomly assigned to the PEARLS intervention (n = 72) or usual care (n = 66). The PEARLS intervention consisted of visits and phone calls from a therapist and the patients received a form of brief psychotherapy known as problem-solving treatment, modified to emphasize physical activity and increased socialization. There were also potential recommendations regarding antidepressant medications.

The researchers found that at 12 months, compared with the usual care group, patients receiving the PEARLS intervention were about 5 times more likely to have at least a 50 percent reduction in depressive symptoms (43 percent vs. 15 percent), nearly 5 times more likely to achieve complete remission from depression (36 percent vs. 12 percent), and to have greater health-related quality-of-life improvements in functional well-being and emotional well-being.

CHICAGO—Ejaculation frequency, a measure of sexual activity, is not associated with a higher risk for prostate cancer, according to a study in the April 7 issue of the Journal of the American Medical Association (JAMA). However, a high ejaculation frequency may be linked to a decreased risk of prostate cancer.

Sexual activity has been hypothesized to play a role in the development of prostate cancer, according to background information in the article. Given that sexual activity is common and that prostate cancer risk is high, any association between these factors would have clinical and public health relevance.

Michael F. Leitzmann, M.D., of the National Cancer Institute, Bethesda, Md., and colleagues examined the association between ejaculation frequency (which includes sexual intercourse, nocturnal emission, and masturbation) and risk of prostate cancer. The study used follow-up data from the Health Professionals Follow-up Study (February 1, 1992, through January 31, 2000) of 29,342 men in the U.S., aged 46 to 81 years, who provided information on history of ejaculation frequency on a self-administered questionnaire in 1992 and responded to follow-up questionnaires every 2 years to 2000. Ejaculation frequency was assessed by asking participants to report the average number of ejaculations they had per month during the ages of 20 to 29 years, 40 to 49 years, and during the past year (1991).

Among the participants, there were 1,449 new cases of total prostate cancer, 953 organ-confined cases, and 147 advanced cases of prostate cancer.

CHICAGO—A comparison of various guidelines and strategies for treatment of sore throat provides information that may help optimize use of diagnostic tests and reduce unnecessary use of antibiotics, according to a study in the April 7 issue of the American Medical Association (JAMA).

According to background information in the article, recent guidelines for management of a sore throat (pharyngitis) vary in their recommendations concerning antibiotic treatment and the need for laboratory confirmation of group A streptococcus (GAS, "strep throat"). An estimated 6.7 million health care visits are made by adults with a sore throat in the United States annually; between 1989 and 1999, 70 percent of adults presenting with sore throat received an antibiotic prescription.

Warren McIsaac, M.D., M.Sc., of Mount Sinai Hospital, Toronto, Ontario, and colleagues conducted a study to assess the impact of different clinical guidelines on the appropriateness of antibiotics prescribed, the proportion of GAS sore throat cases identified, and the use of throat cultures and rapid tests to detect GAS in a population of children and adults with a chief complaint of a sore throat.

Throat cultures and rapid antigen tests were obtained from 787 children and adults aged 3 to 69 years with acute sore throat attending a family medicine clinic in Calgary, Alberta, from September 1999 to August 2002. Recommendations from 2 guidelines (those of the Infectious Diseases Society of America [IDSA], and the American College of Physicians-American Society of Internal Medicine/American Academy of Family Physicians/U.S. Centers for Disease Control and Prevention [ASIM]) were compared with rapid testing alone, a clinical prediction rule (a clinical measurement called a Centor score), and a standard of treatment for positive throat culture results only.

HOUSECALLS FIGHT DEPRESSION