Acceptability of an internet-delivered intervention for adjustment disorder and its role as predictor of efficacy

Background: Internet-delivered interventions offer a feasible way to facilitate access to mental healthcare and considerable evidence supports their effectiveness for the treatment of different mental disorders. However, potential users' attitudes toward these interventions are crucial for their successful implementation. A better understanding of factors related to treatment acceptance and adherence is required to exploit the full potential of internet interventions. Hence, the aim of the present work was to analyze the acceptability of a therapist-guided internet-delivered CBT intervention for adjustment disorder and its impact on treatment outcomes. Methods: The acceptability was estimated from the acceptance to participate in the randomized controlled trial addressed to explore the effectiveness of the internet intervention in question. Other indicators of acceptability were treatment adherence, expectations, satisfaction, and opinion reported by 34 participants from the trial. Results: Willingness to try an internet intervention was observed and 76.5% of participants completed all seven treatment modules. Less positive initial expectations did not reduce treatment effectiveness, yet they might have led to treatment abandonment. Overall, participants were satisfied with the internet intervention and perceived it as a useful, comfortable and attractive way of receiving psychological assistance. Treatment modules aimed at promoting identification with the treatment goals, relapse prevention, and change in the meaning of the stressor were found to be related to posttraumatic growth and increase in positive affect and quality of life. Participants also expressed that the intervention required considerable motivation. In this regard, therapeutic support was perceived as an important adherence facilitator. Conclusion: The findings from this work support the suitability of internet interventions for the treatment of adjustment disorder. However, further research is required in order to develop guidelines for the design of more attractive and engaging internet interventions

A guided Internet-delivered intervention for adjustment disorders: A randomized controlled trial

Evidence of self‐help interventions for adjustment disorder (AjD) is limited. This study aims at testing in a randomized controlled trial (RCT) the effectiveness of a disorder‐specific, Internet‐delivered cognitive-behavioural therapy (ICBT) intervention for AjD. Participants were randomly allocated to either an ICBT with brief weekly telephone support (n = 34) or a waiting list group (n = 34). Beck's inventories for depression and anxiety were used as primary outcomes. The secondary outcomes were AjD symptoms, post‐traumatic growth, positive and negative affect, and quality of life. In all, 76.5% of the participants completed the intervention. Compared with the control group, participants in the intervention condition showed significantly greater improvement in all outcomes (Cohen's d ranged from 0.54 to 1.21) except in anxiety symptoms measured by Beck Anxiety Inventory (d = 0.27). Only ICBT group showed a significant improvement in post‐traumatic growth, positive and negative affect, and quality of life. The number of cases that achieved clinically meaningful change in all outcome measures was also higher in the ICBT group. All therapeutic gains were maintained at 3‐, 6‐ and 12‐month follow‐ups. The current study provides evidence on the effectiveness of ICBT interventions to reduce the impact of AjD. Results suggest that brief self‐help intervention with minimal therapist support is more effective than the mere passage of time in reducing the distress symptoms associated to the disorder and also can confer additional benefits

Seroprevalence of select bloodborne pathogens and associated risk behaviors among injection drug users in the Paso del Norte region of the United States – Mexico border

<p>Abstract</p> <p>Background</p> <p>The region situated where the borders of Mexico, Texas and New Mexico meet is known as 'Paso del Norte'. The Paso del Norte Collaborative was formed to study the seroprevalence of select pathogens and associated risk behaviors among injection drug users (IDUs) in the region.</p> <p>Methods</p> <p>Respondent-driven sampling (RDS) was used: 459 IDU participants included 204 from Mexico; 155 from Texas; and 100 from New Mexico. Each of the three sites used a standardized questionnaire that was verbally administered and testing was performed for select bloodborne infections.</p> <p>Results</p> <p>Participants were mostly male (87.4%) and Hispanic/Latino (84.7%) whose median age was 38. In Mexico, Texas and New Mexico, respectively: hepatitis B virus (HBV) was seen in 88.3%, 48.6% and 59.6% of participants; hepatitis C virus (HCV) in 98.7%, 76.4% and 80.0%; human immunodeficiency virus (HIV) in 2.1%, 10.0% and 1.0%; and syphilis in 4.0%, 9.9% and 3.0%. Heroin was the drug injected most often. More IDUs in New Mexico were aware of and used needle exchange programs compared with Texas and Mexico.</p> <p>Conclusion</p> <p>There was mixed success using RDS: it was more successfully applied after establishing good working relationships with IDU populations. Study findings included similarities and distinctions between the three sites that will be used to inform prevention interventions.</p

Aids epidemic in Puerto Rico - ideas for geography teaching

The diffusion of the infection with the Human Immunodeficiency Virus (HIV) can be studied and understood as a spatial process. Modelling and forecasting the geographical distribution of an epidemic is a main contribution of the discipline of geography for diseases intervention purposes. A particular example is presented for Puerto Rico. In a classroom setting, the study of the diffusion of health-related phenomena offers the opportunity to introduce students to the basic concepts of spatial diffusion and to acquire familiarity with the subdiscipline of medical geography. As with all human diseases, the dimensions of the AIDS epidemic go beyond that which can be detected with medical instruments. Diseases have social, economic and political variables associated with them. The AIDS epidemic can be used to study a range of issues such as power and gender relations, problems of the less developed countries, or world population growth. Thus, the complex and many-faceted diffusion process of HIV offers a contemporary subject for the study of several geographical issues not only on the upper secondary or high school level but also as introductory courses of human geography on college level

Disease rate as an artifact of the health care system: Tubercolosis in Puerto Rico

It is demonstrated that the reported rates of tubercolosis in Puerto Rico comprise a direct, positive measurement of location, infrastructure and numbers of personnel in the health care system. The disease map does not reflect true geographic prevalence, but it is a measurable artifact of the health care system. Areas of high and low reporting and zones of minimum patient contact, are identified in the interests of program management.

Field testing along a disease gradient: Some geographical dimensions of tuberculosis in Puerto Rico

The spatial pattern of reported tuberculosis incidence in Puerto Rico is characterized by numerous high-low gradients among continguous municipios. Tuberculin testing of some 1500 subjects along one such gradient reveals that there is no difference in sensitivity and suggests that the gradients are artifacts of reporting. Correlative associations with tuberculin conversion were generally weak, except for age-dependency. Collected personal histories demostrated that the web of familial and intergenerational relationships is a major force in perpetuating the disease. Concealment of infection, denial and poor compliance in chemotherapy regimens compound the difficulties of case-discovery and case-control. Interviews in a sample of twelve health centers confirmed that, without the presence of trained and assigned tuberculosis nurses, the health care providers' 'index of suspicion' for tuberculosis is generally low. Absence of a tuberculosis clinic virtually dictates serious under-reporting of incidence in that municipio. Despite the success of Puerto Rico's control program over past decades, a reservoir of tuberculosis persists. The level of endemicity is relatively low but unsatisfactory in the context of public health aspirations.

The tooth as a marker of developing world quality of life: A field study in Guatemala

A geographical sample in a rural area of eastern Guatemala revealed widespread, premature and heavy losses of permanent teeth. Social and environmental influences that affect tooth loss include inadequate diet, refined sugar, poor oral hygiene, absence of fluoride, lack of preventive education and insufficiency of dental care services. Land hunger and family poverty are of paramount importance. Gender-based cultural differences are apparent in tooth extraction rates, and use of dentures. No one escapes visitations of severe orofacial pain that cast a blight upon the quality of rural life. Periodontal disease drives the poorest of the poor to spend disproportionately large sums on pharmaceutical pain-killers and destructive traditional medicines. Lay 'tooth-pullers' visit remote rural homes to extract teeth. Only full edentulism can bring patients permanent somatic and financial relief. Community dental health is conspicuously neglected in official policies and plans for rural development.dental health edentulism gender orofacial pain developing areas rural Guatemala

The transcription factor AREB1 regulates primary metabolic pathways in tomato fruits

Tomato fruit development is regulated both by the action of plant hormones and by tight genetic control. Recent studies suggest that abscisic acid (ABA) signalling may affect different aspects of fruit maturation. Previously, it was shown that SlAREB1, an ABA-regulated transcription factor involved in stress-induced responses, is expressed in seeds and in fruit tissues in tomato. Here, the role of SlAREB1 in regulating the expression of genes relevant for primary metabolic pathways and affecting the metabolic profile of the fruit was investigated using transgenic tomato lines. Metabolite profiling using gas chromatography–time of flight mass spectrometry (GC-TOF-MS) and non-targeted liquid chromatography–mass spectrometry (LC-MS) was performed on pericarp tissue from fruits harvested at three stages of fruit development. Principal component analysis of the data could distinguish the metabolite profiles of non-transgenic fruits from those that overexpress and down-regulate SlAREB1. Overexpression of SlAREB1 resulted in increased content of organic acids, hexoses, hexose-phosphates, and amino acids in immature green, mature green, and red ripe fruits, and these modifications correlated with the up-regulation of enzyme-encoding genes involved in primary carbohydrate and amino acid metabolism. A non-targeted LC-MS analysis indicated that the composition of secondary metabolites is also affected in transgenic lines. In addition, gene expression data revealed that some genes associated with fruit ripening are also up-regulated in SlAREB1-overexpressing lines compared with wild-type and antisense lines. Taken together, the results suggest that SlAREB1 participates in the regulation of the metabolic programming that takes place during fruit ripening and that may explain part of the role of ABA in fruit development in tomato