The effects of psychological treatment in primary care in Sweden—A practice-based study

Background: Practice-based studies have found substantial effects of psychological treatment in routine care, often equivalent between treatment methods. Factors that moderate treatment outcome may be important to assess. Aim: The purpose of this study was to evaluate treatment outcome in psychological treatment in primary care, and to compare outcome between the most frequently used methods. An additional aim was to study factors that might moderate outcome differences. Method: The Clinical Outcome in Routine Evaluation (CORE) system was used to evaluate psychological treatment at Swedish primary care centers. Treatment methods were coded by the therapists after treatment. Three major treatment orientations-directive (cognitive, behavioral and CBT), reflective (psychodynamic and relational) and supportive therapy were compared. Patient and therapist variables were studied as treatment moderating factors. Results: Analyses of 733 therapies, delivered by 70 therapists, showed good results in short psychological treatments (median session number = 6). Forty-three percent of the patients were remitted, 34% recovered. For patients receiving at least five sessions, the figures were 50% and 40%. Directive therapy and reflective therapy had comparable outcome, and better than supportive treatment. Patients in supportive therapy had higher age and received fewer therapy sessions. The patients' motivation, alliance capacity and reflective ability, as rated by the therapist after treatment, were lower for patients in supportive treatment. Conclusions: Psychological treatment in primary care obtains god results. Supportive therapy should be studied more systematically, particularly with regard to variables that may moderate treatment outcome.

The effects of psychological treatment in primary care in Sweden—A practice-based study

Background: Practice-based studies have found substantial effects of psychological treatment in routine care, often equivalent between treatment methods. Factors that moderate treatment outcome may be important to assess. Aim: The purpose of this study was to evaluate treatment outcome in psychological treatment in primary care, and to compare outcome between the most frequently used methods. An additional aim was to study factors that might moderate outcome differences. Method: The Clinical Outcome in Routine Evaluation (CORE) system was used to evaluate psychological treatment at Swedish primary care centers. Treatment methods were coded by the therapists after treatment. Three major treatment orientations-directive (cognitive, behavioral and CBT), reflective (psychodynamic and relational) and supportive therapy were compared. Patient and therapist variables were studied as treatment moderating factors. Results: Analyses of 733 therapies, delivered by 70 therapists, showed good results in short psychological treatments (median session number = 6). Forty-three percent of the patients were remitted, 34% recovered. For patients receiving at least five sessions, the figures were 50% and 40%. Directive therapy and reflective therapy had comparable outcome, and better than supportive treatment. Patients in supportive therapy had higher age and received fewer therapy sessions. The patients' motivation, alliance capacity and reflective ability, as rated by the therapist after treatment, were lower for patients in supportive treatment. Conclusions: Psychological treatment in primary care obtains god results. Supportive therapy should be studied more systematically, particularly with regard to variables that may moderate treatment outcome.

Use of hormonal contraceptives in relation to antidepressant therapy: A nationwide population-based study

OBJECTIVES: The relation between the use of different hormonal contraceptives and antidepressant therapy was investigated. METHODS: In a nationwide cross-sectional study among all women in Sweden aged 16-31, drug expenditure data on hormonal contraceptives and antidepressants were obtained from the Swedish Prescribed Drug Register. Odds ratios (ORs) for antidepressant use were calculated by logistic regression for progestin-only users versus non-users as well as for combined hormonal contraceptive (CHC) users versus non-users. RESULTS: In the study population (N = 917,993), 58.9% were hormonal contraceptive users, and 8.5% were antidepressant users. The age-pattern for antidepressant ORs differed between the two types of users of contraceptives; progestin-only users had significant ORs above 1 in all age groups whereas among CHC users the OR was above 1 solely in those aged 16-19. The largest difference between types of users was seen in the age group 16-19 in which women resorting to a progestin-only contraceptive had a 67% (95% confidence interval: 57- 78%) higher antidepressant use than women treated with a CHC. CONCLUSION: Progestin-only contraceptive users resorted to antidepressants more than users of CHCs. This phenomenon is particularly pronounced among teenagers. Therefore, special attention should be given to young women's mental history when prescribing hormonal contraceptives and vice versa: the contraceptive history should be taken into account when prescribing antidepressants.This is an electronic version of an article published in: Ann-Britt Wiréhn, Anniqa Foldemo, Ann Josefsson and Malou Lindberg, Use of hormonal contraceptives in relation to antidepressant therapy: A nationwide population-based study., 2010, European journal of contraception &amp; reproductive health care, (15), 1, 41-47. European journal of contraception &amp; reproductive health care is available online at informaworldTM: http://dx.doi.org/10.3109/13625181003587004 Copyright: Taylor &amp; Francis http://www.tandf.co.uk/journals/default.asp</p

To cite: Josefsson A,

Continuation rates of oral hormonal contraceptives in a cohort of first-time users: a population-based registry study, Sweden 2005

An intervention with physical activity and lifestyle counseling improves health-related quality of life and shows small improvements in metabolic risk factors in persons with psychosis

General purpose: To study the effects of a lifestyle intervention on health-related quality of life (HRQoL) and metabolic risk factors in persons with psychosis. Methodology: A longitudinal intervention study with a matched reference sample. Results: HRQoL measured by the EQ-VAS improved from 57.6 to 63.3 (17.8) in the intervention group (p=0.05). The HDL cholesterol concentration increased from 1.03 to 1.11 (0.19) mmol/l in the intervention group (p=0.02). There was no significant change in body weight. Conclusion: A lifestyle intervention based on group meetings improves HRQoL in patients with psychosis. There are also small improvements in metabolic risk factors

Metabolic engineering of Escherichia coli for the biosynthesis of astaxanthin

Carotenoids hold great promise due to their numerous health promoting properties. Of the plethora of carotenoids isolated, astaxanthin is one of the most intensively investigated. Astaxanthin can be synthesised by a number of organisms, however these are often not amenable to current industrial production methods, and those that are produce low or impure yields. In this thesis, data are presented' regarding the development of an Escherichia coli based astaxanthin production system that is able to rapidly accumulate industrially relevant quantities of highly pure astaxanthin. In pursuit of this, the genomes of five cyanobacterial strains are screened in order to identify putative genes involved in the final stages of astaxanthin biosynthesis, specifically in the conversion of f3-carotene to astaxanthin. Subsequently the sixteen putative genes identified are functionally characterised, via co-expression in E. coli, and investigated with respect to their capacity to function in astaxanthin biosynthesis. This reveals that all twelve f3-carotene ketolase genes identified are functional, as are two of the four f3-carotene hydroxylase genes. However, only the CrtW type f3. carotene ketolase genes are able to participate in astaxanthin biosynthesis. The best performing elements, with respect to astaxanthin biosynthesis, are combined and employed in the creation of a number of E. coli based astaxanthin production strains. Subsequent studies focus on metabolic restrictions within this system, employing heterologous gene expression and directed evolution methods, as well as a novel PCR based cloning method, in the creation of an E. coli production strain capable of the synthesis of 4.7 mg L-1 astaxanthin in a 24 hour period, at> 90% purity. Further, this study identifies a range of restrictions within the system, and presents methods by which future work could negotiate these, allowing the development of an industrially competitive production strain.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Persons with psychosis perceptions of participating in a lifestyle intervention

AIMS AND OBJECTIVES: To describe how persons with psychosis perceive participation in a lifestyle intervention, and use these perceptions to present factors to for consideration in future interventions. BACKGROUND: Metabolic syndrome is common in persons with psychosis. A healthy lifestyle is the primary option for preventing and treating metabolic syndrome, which is why the importance of lifestyle interventions has come into focus among health care professionals. Identifying perceptions of participation in a lifestyle intervention can increase the understanding of how to design future interventions. DESIGN: A qualitative, phenomenographic approach was selected, using semi-structured interviews. METHODS: The sample consisted of 40 participants with a psychotic disorder, who had undergone a lifestyle intervention focusing on theoretical education in healthy eating and physical activities. The interviews were conducted in 2011 and 2012, six to seven months after the intervention had been completed. RESULTS: The findings comprise three categories that emphasise the need for a moderate intervention level that facilitates participation and thereby social interactions among group members. The experience of success in the intervention supported the perception of oneself as a capable individual. However, it could also be the opposite, another experience of failure. CONCLUSION: Content in moderation can facilitate participation, and participants can thereby achieve health benefits and find social contacts. In addition to physical activity and lifestyle habits, interventions should have a social focus and be continuous. Professional support is a prerequisite and should facilitate the participants' ability to mirror themselves against healthy people in society by introducing activities that ordinary people do. RELEVANCE FOR CLINICAL PRACTICE: Identifying perceptions of participation in a lifestyle intervention can increase the understanding of how to design and manage future interventions. This is also an aspect that is important to consider in everyday clinical practice

Persons with psychosis perceptions of participating in a lifestyle intervention

AIMS AND OBJECTIVES: To describe how persons with psychosis perceive participation in a lifestyle intervention, and use these perceptions to present factors to for consideration in future interventions. BACKGROUND: Metabolic syndrome is common in persons with psychosis. A healthy lifestyle is the primary option for preventing and treating metabolic syndrome, which is why the importance of lifestyle interventions has come into focus among health care professionals. Identifying perceptions of participation in a lifestyle intervention can increase the understanding of how to design future interventions. DESIGN: A qualitative, phenomenographic approach was selected, using semi-structured interviews. METHODS: The sample consisted of 40 participants with a psychotic disorder, who had undergone a lifestyle intervention focusing on theoretical education in healthy eating and physical activities. The interviews were conducted in 2011 and 2012, six to seven months after the intervention had been completed. RESULTS: The findings comprise three categories that emphasise the need for a moderate intervention level that facilitates participation and thereby social interactions among group members. The experience of success in the intervention supported the perception of oneself as a capable individual. However, it could also be the opposite, another experience of failure. CONCLUSION: Content in moderation can facilitate participation, and participants can thereby achieve health benefits and find social contacts. In addition to physical activity and lifestyle habits, interventions should have a social focus and be continuous. Professional support is a prerequisite and should facilitate the participants' ability to mirror themselves against healthy people in society by introducing activities that ordinary people do. RELEVANCE FOR CLINICAL PRACTICE: Identifying perceptions of participation in a lifestyle intervention can increase the understanding of how to design and manage future interventions. This is also an aspect that is important to consider in everyday clinical practice

Copyright: Elsevier

quality of life and metabolic ris