Improving Health Outcomes for Patients with Depression: A Population Health Imperative. Report on an Expert Panel Meeting

Improving Health Outcomes for Patients with Depression: A Population Health Imperative. Report on an Expert Panel Meeting Janice L. Clarke, RN, Alexis Skoufalos, EdD, Alice Medalia, PhD, and A. Mark Fendrick, MD Editorial: A Call to Action: David B. Nash, MD, MBA???S-2 Overview: Depression and the Population Health Imperative???S-3 Promoting Awareness of the Issues and Opportunities for Improvement???S-5 Cognitive Dysfunction in Affective Disorders???S-5 Critical Role of Employers in Improving Health Outcomes for Employees with Depression???S-6 Closing the Behavioral Health Professional and Process Gaps???S-6 Achieving the Triple Aim for Patients with Depressive Disorders???S-6 Improving the Experience of Care for Patients with Depression???S-6 Improving Quality of Care and Health Outcomes for Patients with Depression???S-7 Changing the Cost of Care Discussion from How Much to How Well???S-8 Panel Insights and Recommendations???S-9 Conclusion???S-10Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/140195/1/pop.2016.0114.pd

Twelve weeks of supervised exercise improves self-reported symptom burden and fatigue in chronic kidney disease : a secondary analysis of the ‘ExTra CKD’ trial

Background Chronic kidney disease (CKD) patients experience a high symptom burden including fatigue, sleep difficulties, muscle weakness and pain. These symptoms reduce levels of physical function (PF) and activity, and contribute to poor health-related quality of life (HRQoL). Despite the gathering evidence of positive physiological changes following exercise in CKD, there is limited evidence on its effect on self-reported symptom burden, fatigue, HRQoL and physical activity. Methods Thirty-six patients [mean ± SD 61.6 ± 11.8 years, 22 (61%) females, estimated glomerular filtration rate: 25.5 ± 7.8 mL/min/1.73 m2] not requiring renal replacement therapy underwent 12 weeks (3 times/week) of supervised aerobic exercise (AE), or a combination (CE) of AE plus resistance training. Outcomes included self-reported symptom burden, fatigue, HRQoL and physical activity. Results Exercise reduced the total number of symptoms reported by 17% and had favourable effects on fatigue in both groups. AE reduced the frequency of ‘itching’, ‘impotence’ and ‘shortness of breath’ symptoms, and the intrusiveness for symptoms of ‘sleep disturbance’, ‘loss of muscular strength/power’, ‘muscle spasm/stiffness’ and ‘restless legs’. The addition of resistance exercise in the CE group saw a reduction in ‘loss of muscular strength/power’. No changes were seen in subjective PF or physical activity levels. AE increased self-efficacy for physical activity. Conclusions Supervised exercise had favourable effects on symptom frequency and intrusiveness, including substantial improvements in fatigue. Although the intervention did not improve self-reported physical activity levels, AE increased patients’ self-efficacy for physical activity. These favourable changes in self-reported outcomes support the important role of exercise in CKD

Epibenthic and mobile species colonisation of a geotextile artificial surf reef on the south coast of England

With increasing coastal infrastructure and use of novel materials there is a need to investigate the colonisation of assemblages associated with new structures, how these differ to natural and other artificial habitats and their potential impact on regional biodiversity. The colonisation of Europe’s first artificial surf reef (ASR) was investigated at Boscombe on the south coast of England (2009–2014) and compared with assemblages on existing natural and artificial habitats. The ASR consists of geotextile bags filled with sand located 220m offshore on a sandy sea bed at a depth of 0-5m. Successional changes in epibiota were recorded annually on differently orientated surfaces and depths using SCUBA diving and photography. Mobile faunal assemblages were sampled using Baited Remote Underwater Video (BRUV). Distinct stages in colonisation were observed, commencing with bryozoans and green algae which were replaced by red algae, hydroids and ascidians, however there were significant differences in assemblage structure with depth and orientation. The reef is being utilised by migratory, spawning and juvenile life-history stages of fish and invertebrates. The number of non-native species was larger than on natural reefs and other artificial habitats and some occupied a significant proportion of the structure. The accumulation of 180 benthic and mobile taxa, recorded to date, appears to have arisen from a locally rich and mixed pool of native and non-native species. Provided no negative invasive impacts are detected on nearby protected reefs the creation of novel yet diverse habitats may be considered a beneficial outcome

Patient's perceptions of chronic kidney disease and their association with psychosocial and clinical outcomes: a narrative review

Abstract Patients with chronic kidney disease (CKD) form organized beliefs regarding their illness and treatment. These perceptions influence the coping strategies employed by an individual to manage his/her illness and may act as a predictor for his/her willingness to engage in self-management behaviours. While illness perceptions have been identified as predictors of nonadherence, depression and mortality in dialysis patients, there is a paucity of research in CKD patients not requiring renal replacement therapy. This narrative review synthesizes the existing literature regarding the role of illness perceptions and associated clinical and psychosocial outcomes in non-dialysis CKD patients. Studies were identified following database searches of AMED, BNI, CINAHL, EMBASE, Health Business Elite, HMIC, Medline, PsycINFO and Google Scholar in January 2016. Despite the small evidence base, existing studies indicate that negative illness perceptions are associated with disease progression and a number of psychosocial outcomes in non-dialysis CKD patients. Evidence from other clinical populations suggests that illness perceptions are modifiable through psychological intervention, which may be most effective if delivered early before beliefs have the chance to become more established. Therefore, targeting illness perceptions in the earlier stages of CKD may be optimal. Further studies are now required to ascertain the mechanisms through which illness perceptions predict psychosocial and clinical outcomes in CKD patients and to ultimately test the efficacy of illness perception-based interventions

Relationships between illness representations, physical activity and depression in chronic kidney disease

Background: Chronic Kidney Disease (CKD) is exacerbated by depression and confers significant healthcare costs. Whilst adverse impacts may be mitigated by physical activity, many patients with CKD remain physically inactive, with this physical inactivity potentially influenced by how CKD is appraised. Objectives: The study aims to explore the relationship between physical activity, depression and illness representations in CKD. Methods: Non-dialysing patients with CKD completed the Revised Illness Perception Questionnaire (IPQ-R), Beck Depression Inventory (BDI-II) and Short-Form International Physical Activity Questionnaire (IPAQ-SF) while demographic information was obtained via medical records. Correlation and regression analyses were conducted to determine the relationship of illness representations with levels of physical activity. Moderation and mediation analyses were performed to investigate the role of depression in any relationship between illness representations and physical activity levels. Results: Seventy respondents, with a mean age of 60 ± 16 years, the majority being male (60%), took part in the study. Of illness representation dimensions, personal control was positively associated with levels of physical activity (r=.288, p<.05) while timeline cyclical was a significant predictor (Beta=-.423, p=.008). Severity of depression was neither a moderator (b= .023, 95% CI [-.015, .061], t=1.201, p=.23) nor a mediator (b=-.021, BCa CI [-.082, .008], p=.33). Conclusions: Facets of illness representations had significant relationships with levels of physical activity. Future research concerning the development and validation of psychological interventions based on an illness representations framework for patients with CKD not on renal-replacement therapy is proposed. The efficacy of such interventions could be then evaluated using a randomised controlled method

The association of physical function and physical activity with all-cause mortality and adverse clinical outcomes in non-dialysis chronic kidney disease : a systematic review

Objective: People with nondialysis-dependent chronic kidney disease (CKD) and renal transplant recipients (RTRs) have compromised physical function and reduced physical activity (PA) levels. Whilst established in healthy older adults and other chronic diseases, this association remains underexplored in CKD. We aimed to review the existing research investigating poor physical function and PA with clinical outcome in nondialysis CKD. Data sources: Electronic databases (PubMed, MEDLINE, EMBASE, Web of Science, Cochrane Central Register of Controlled Trials) were searched until December 2017 for cohort studies reporting objective or subjective measures of PA and physical function and the associations with adverse clinical outcomes and all-cause mortality in patients with nondialysis CKD stages 1–5 and RTRs. The protocol was registered on the International Prospective Register of Systematic Reviews (PROSPERO) (CRD42016039060). Review methods: Study quality was assessed using the Newcastle-Ottawa Scale and the Agency for Healthcare and Research Quality (AHRQ) standards. Results: A total of 29 studies were included; 12 reporting on physical function and 17 on PA. Only eight studies were conducted with RTRs. The majority were classified as ‘good’ according to the AHRQ standards. Although not appropriate for meta-analysis due to variance in the outcome measures reported, a coherent pattern was seen with higher mortality rates or prevalence of adverse clinical events associated with lower PA and physical function levels, irrespective of the measurement tool used. Sources of bias included incomplete description of participant flow through the study and over reliance on self-report measures. Conclusions: In nondialysis CKD, survival rates correlate with greater PA and physical function levels. Further trials are required to investigate causality and the effectiveness of physical function and PA interventions in improving outcomes. Future work should identify standard assessment protocols for PA and physical function

Impact and amelioration of sediment pollution on coral reefs of St. Lucia, West Indies

Includes Policy and Management Brief 1: Annex A2.# Appendix 1 of the Final Technical Report of project R766

Vladimir Filipović\u27s Attempts at Bringing Philosophy and the natural Sciences closer together

U radu se iznose Filipovićeva gledišta o vezi prirodnih znanosti i filozofije, osobito ona koja su zastupana u njegovom predavanju Prirodne znanosti i filozofija na simpoziju Hrvatskoga prirodoslovnog društva 1975. godine. Ističe se važnost Filipovićeve tvrdnje da je nemoguć izolirani razvitak prirodnih znanosti i filozofije. Prikazuje se i Filipovićevo praktično djelovanje u tom pogledu, pa se opisuju njegova nastojanja na povezivanju i koordinaciji istraživanja povijesti prirodnih znanosti i povijesti filozofije u Hrvatskoj, kao i njegova suradnja na postdiplomskom studiju Filozofija znanosti.The paper .presents Fililpović\u27s views on the bond between the natural sciences and philosophy, especially those presented in his lecture Natural Sciences and Philosophy at a symposium of the Hrvatsko prirodoslovno društvo (Croatian Natural History Society) in 1975. Emphasis is placed on the importance of Filipović\u27s statement that isolated development of the natural sciences and philosophy is impossible. Filipović\u27s practical activity on this topic is presented, and his attempts to interconnect and coordinate research into the history of the natural sciences and the history philosophy in Croatia is described, as well as his cooperation in the graduate studies program of Philosophy of Science

An assets-based intervention before and after birth to improve breastfeeding initiation and continuation: the ABA feasibility RCT

The UK has low levels of breastfeeding initiation and continuation, with evident socioeconomic disparities. To be inclusive, peer-support interventions should be woman-centred rather than breastfeeding-centred. Assets-based approaches to public health focus on the positive capabilities of individuals and communities, rather than their deficits and problems. The Assets-based feeding help Before and After birth (ABA) intervention offers an assets-based approach based on behaviour change theory. Objective To investigate the feasibility of delivering the ABA infant feeding intervention in a randomised controlled trial. Design This was an individually randomised controlled feasibility trial; women were randomised in a 1 : 1 ratio to either the intervention group or the comparator (usual care) group. Setting Two separate English sites were selected because they had an existing breastfeeding peer support service, relatively high levels of socioeconomic disadvantage and low rates of breastfeeding. Participants Women aged ≥ 16 years who were pregnant with their first child, irrespective of feeding intention (n = 103), were recruited by researchers in antenatal clinics. Interventions Proactive, woman-centred support, using an assets-based approach and including behaviour change techniques, was provided by an infant-feeding helper (a breastfeeding peer supporter trained in the ABA intervention) and delivered through face-to-face contact, telephone conversations and text messages. The intervention commenced at around 30 weeks’ gestation and could continue until 5 months postnatally. Main outcome measures The main outcome measures were feasibility of intervention delivery with the requisite intensity and duration; acceptability to women, infant-feeding helpers and maternity services; and feasibility of a future randomised controlled trial. Outcomes included recruitment rates and follow-up rates at 3 days, 8 weeks and 6 months postnatally, and outcomes for a future full trial were collected via participant questionnaires. A mixed-methods process evaluation included qualitative interviews with women, infant-feeding helpers and maternity services; infant-feeding helper logs; and audio-recordings of antenatal contacts to check intervention fidelity. Results Of the 135 eligible women approached, 103 (76.3%) agreed to participate. The study was successful in recruiting teenagers (8.7%) and women living in areas of socioeconomic disadvantage (37.3% resided in the most deprived 40% of small areas in England). Postnatal follow-up rates were 68.0%, 85.4% and 80.6% at 3 days, 8 weeks and 6 months, respectively. Feeding status at 8 weeks was obtained for 95.1% of participants. Recruitment took place from February 2017 until August 2017. It was possible to recruit and train existing peer supporters to the infant-feeding helper role. The intervention was delivered to most women with relatively high fidelity. Among the 50 women in the intervention group, 39 received antenatal visits and 40 received postnatal support. Qualitative data showed that the intervention was acceptable. There was no evidence of intervention-related harms. Limitations Birth notification delays resulted in delays in the collection of postnatal feeding status data and in the offer of postnatal support. In addition, the intervention needs to better consider all infant-feeding types and did not adequately accommodate women who delivered prematurely. Conclusion It is feasible to deliver the intervention and trial. Future work The intervention should be tested in a fully powered randomised controlled trial. Trial registration Current Controlled Trials ISRCTN14760978. Funding This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 8, No. 7. See the NIHR Journals Library website for further project information

Diversity and abundance of pteropods and heteropods along a latitudinal gradient across the Atlantic Ocean

AbstractShelled pteropods and heteropods are two independent groups of holoplanktonic gastropods that are potentially good indicators of the effects of ocean acidification. Although insight into their ecology and biogeography is important for predicting species-specific sensitivities to ocean change, the species abundances and biogeographical distributions of pteropods and heteropods are still poorly known. Here, we examined abundance and distribution patterns of pteropods (euthecosomes, pseudothecosomes, gymnosomes) and heteropods at 31 stations along a transect from 46°N to 46°S across the open waters of the Atlantic Ocean (Atlantic Meridional Transect cruise AMT24). We collected a total of 7312 pteropod specimens belonging to at least 31 species. Pteropod abundances were low north of 40°N with <15 individuals per 1000m3, varied between 100 and 2000ind./1000m3 between 30°N and 40°S, and reached >4000ind./1000m3 just south of 40°S. This accounted for an estimated biomass of 3.2mgm−3 south of 40°S and an average of 0.49mgm−3 along the entire transect. Species richness of pteropods was highest in the stratified (sub)tropical waters between 30°N and 30°S, with a maximum of 15 species per station. The biogeographical distribution of pteropod assemblages inferred by cluster analysis was largely congruent with the distribution of Longhurst’s biogeochemical provinces. Some pteropod species distributions were limited to particular oceanographic provinces, for example, subtropical gyres (e.g. Styliola subula) or warm equatorial waters (e.g. Creseis virgula). Other species showed much broader distributions between ∼35°N and ∼35°S (e.g. Limacina bulimoides and Heliconoides inflatus). We collected 1812 heteropod specimens belonging to 18 species. Highest heteropod abundances and species richness were found between 30°N and 20°S, with up to ∼700ind./1000m3 and a maximum of 14 species per station. Heteropods were not restricted to tropical and subtropical waters, however, as some taxa were also relatively abundant in subantarctic waters. Given the variation in distribution patterns among pteropod and heteropod species, it is likely that species will differ in their response to ocean changes