Freight transport, food production and consumption in the United States of America and in Europe: Or how far can you ship a bunch of onions in the United States?

CO2-emissions from traffic - increasingly from freight transport - are growing, es-pecially in the highly developed industrialized countries. The answers to thisenvironmentally problematical development are technical ones mainly: Admi-nistrators and scientists try to improve engines, transportation modes and logisticstrategies. Freight transport is influenced by production, consumption, land-usepatterns and life-styles. But these fundamental determinants of increasing trafficare rarely given the same priority as the technical solutions.The main focus of this paper is on freight transportation and food supply in theUnited States and in Europe especially in Germany. Organic, resp. healthy andsafe food is a growing demand in both countries. People who consume organicfood often believe that this contributes to an environmentally sound behaviour.But transportation issues are not or rarely taken into consideration so far, although long distance transport not only needs energy, it as well influences quality, freshness and taste of food.On both sides of the Atlantic, in freight transportation and food supply can befound a lot of differences as well as similarities. Main differences to the U.S. fromthe European standpoint are e.g. the bigger land area and larger and much moreconcentrated economic units. Quite naturally one can find a higher volume oflong distance freight transport than in Europe. Similarities can be observed, butvery often they present themselves in another extent, e.g. the trend towards pri-vatisation and liberalisation, to more extended suburbanisation or to an unreflec-ted way of consumer behaviour. In addition, this report raises some new questi-ons: is the 'technological solution' of environmental problems the only way.What can be done to include lifestyles and consumer behaviour into a new strategy. --

Shared sorrow, shared costs: cost-effectiveness analysis of the Empowerment group therapy approach to treat affective disorders in refugee populations

Background Refugees and asylum seekers (RAS) in Germany need tailored and resource-oriented mental healthcare interventions. Aims To evaluate the cost-effectiveness of group psychotherapy for RAS with moderate depressive symptoms. Method This is a post hoc cost-effectiveness analysis of Empowerment group psychotherapy that was embedded in a stratified stepped and collaborative care model (SCCM) from the multicentre randomised controlled MEHIRA trial. One hundred and forty-nine participants were randomly assigned to SCCM or treatment as usual (TAU) and underwent Empowerment (i.e. level 3 of the SCCM for adults) or TAU. Effects were measured with the nine-item Patient Health Questionnaire (PHQ-9) and quality adjusted life-years (QALY) post-intervention. Health service and intervention costs were measured. Incremental cost-effectiveness ratios (ICER) were estimated and net monetary benefit (NMB) regressions with 95% confidence intervals were performed. Cost-effectiveness was ascertained for different values of willingness to pay (WTP) using cost-effectiveness acceptability curves for probable scenarios. Trial registration number: NCT03109028 on ClinicalTrials.gov. Results Health service use costs were significantly lower for Empowerment than TAU after 1 year. Intervention costs were on average €409.6. Empowerment led to a significant change in PHQ-9 scores but not QALY. Bootstrapped mean ICER indicated cost-effectiveness according to PHQ-9 and varied considerably for QALY in the base case. NMB for a unit reduction in PHQ-9 score at WTP of €0 was €354.3 (€978.5 to −€269.9). Results were confirmed for different scenarios and varying WTP thresholds. Conclusions The Empowerment intervention was cost-effective in refugees with moderate depressive symptoms regarding the clinical outcome and led to a reduction in direct healthcare consumption. Concerning QALYs, there was a lack of confidence that Empowerment differed from TAU

Effectiveness and cost-effectiveness for the treatment of depressive symptoms in refugees and asylum seekers: a multi-centred randomized controlled trial

BACKGROUND: Current evidence points towards a high prevalence of psychological distress in refugee populations, contrasting with a scarcity of resources and amplified by linguistic, institutional, financial, and cultural barriers. The objective of the study is to investigate the overall effectiveness and cost-effectiveness of a Stepped Care and Collaborative Model (SCCM) at reducing depressive symptoms in refugees, compared with the overall routine care practices within Germany's mental healthcare system (treatment-as-usual, TAU). METHODS: A multicentre, clinician-blinded, randomised, controlled trial was conducted across seven university sites in Germany. Asylum seekers and refugees with relevant depressive symptoms with a Patient Health Questionnaires score of ≥ 5 and a Refugee Health Screener score of ≥ 12. Participants were randomly allocated to one of two treatment arms (SCCM or TAU) for an intervention period of three months between April 2018 and March 2020. In the SCCM, participants were allocated to interventions tailored to their symptom severity, including watchful waiting, peer-to-peer- or smartphone intervention, psychological group therapies or mental health expert treatment. The primary endpoint was defined as the change in depressive symptoms (Patient Health Questionnaire-9, PHQ-9) after 12 weeks. The secondary outcome was the change in Montgomery Åsberg Depression Rating Scale (MADRS) from baseline to post-intervention. FINDINGS: The intention-to-treat sample included 584 participants who were randomized to the SCCM (n= 294) or TAU (n=290). Using a mixed-effects general linear model with time, and the interaction of time by randomisation group as fixed effects and study site as random effect, we found significant effects for time (p < .001) and time by group interaction (p < .05) for intention-to-treat and per-protocol analysis. Estimated marginal means of the PHQ-9 scores after 12 weeks were significantly lower in SCCM than in TAU (for intention-to-treat: PHQ-9 mean difference at T(1) 1.30, 95% CI 1.12 to 1.48, p < .001; Cohen's d=.23; baseline-adjusted PHQ-9 mean difference at T(1) 0.57, 95% CI 0.40 to 0.74, p < .001). Cost-effectiveness and net monetary benefit analyses provided evidence of cost-effectiveness for the primary outcome and quality-adjusted life years. Robustness of results were confirmed by sensitivity analyses. INTERPRETATION: The SSCM resulted in a more effective and cost-effective reduction of depressive symptoms compared with TAU. Findings suggest a suitable model to provide mental health services in circumstances where resources are limited, particularly in the context of forced migration and pandemics. FUNDING: This project is funded by the Innovationsfond and German Ministry of Health [grant number 01VSF16061]. The present trial is registered under Clinical-Trials.gov under the registration number: NCT03109028. https://clinicaltrials.gov/ct2/show/NCT0310902

Freight transport, food production and consumption in the United States of America and in Europe : or how far can you ship a bunch of onions in the United States?

The main focus of this paper is on freight transportation and food supply in the United States and in Europe especially in Germany. Organic, resp. healthy and safe food is a growing demand in both countries. People who consume organic food often believe that this contributes to an environmentally sound behaviour. But transportation issues are not or rarely taken into consideration so far, although long distance transport not only needs energy, it as well influences quality, freshness and taste of food. On both sides of the Atlantic, in freight transportation and food supply can be found a lot of differences as well as similarities. Main differences to the U.S. from the European standpoint are e.g. the bigger land area and larger and much more concentrated economic units. Quite naturally one can find a higher volume of long distance freight transport than in Europe. Similarities can be observed, but very often they present themselves in another extent, e.g. the trend towards privatisation and liberalisation, to more extended suburbanisation or to an unreflected way of consumer behaviour. In addition, this report raises some new questions: is the ’technological solution’ of environmental problems the only way? What can be done to include lifestyles and consumer behaviour into a new strategy