Cost-effectiveness of collaborative care for chronically ill patients with comorbid depressive disorder in the general hospital setting, a randomised controlled trial

Background. Depressive disorder is one of the most common disorders, and is highly prevalent in chronically ill patients. The presence of comorbid depression has a negative influence on quality of life, health care costs, self-care, morbidity, and mortality. Early diagnosis and well-organized treatment of depression has a positive influence on these aspects. Earlier research in the USA has reported good results with regard to the treatment of depression with a collaborative care approach and an antidepressant algorithm. In the UK 'Problem Solving Treatment' has proved to be feasible. However, in the general hospital setting this approach has not yet been evaluated. Methods/Design. CC: DIM (Collaborative Care: Depression Initiative in the Medical setting) is a two-armed randomised controlled trial with randomisation at patient level. The aim of the trial is to evaluate the treatment of depressive disorder in general hospitals in the Netherlands based on a collaborative care framework, including contracting, 'Problem Solving Treatment', antidepressant algorithm, and manual-guided self-help. 126 outpatients with diabetes mellitus, chronic obstructive pulmonary disease, or cardiovascular diseases will be randomised to either the intervention group or the control group. Patients will be included if they have been diagnosed with moderate to severe depression, based on the DSM-IV criteria in a two-step screening method. The intervention group will receive treatment based on the collaborative care approach; the control group will receive 'care as usual'. Baseline and follow-up measurements (after 3, 6, 9, and 12 months) will be performed by means of questionnaires. The primary outcome measure is severity of depressive symptoms, as measured with the PHQ-9. The secondary outcome measure is the cost-effectiveness of these treatments according to the TiC-P, the EuroQol and the SF-36. Discussion. Earlier research has indicated that depressive disorder is a chronic, mostly recurrent illness, which tends to cluster with physical comorbidity. Even though the treatment of depressive disorder based on the guidelines for depression is proven effective, these guidelines are often insufficiently adhered to. Collaborative care and 'Problem Solving Treatment' will be specifically tailored to patients with depressive disorders and evaluated in a general hospital setting in the Netherlands

The effect of attitude toward the target language and culture, and of input on English second language proficiency in a study-abroad immersion setting

Thesis (MA)--Stellenbosch University, 2015.ENGLISH ABSTRACT: As the number of Asian students studying English abroad continues to increase, there is a growing need for language learning programs that help students to increase their English proficiency in the most effective way possible. Studies have shown that exposure alone is not sufficient for improving proficiency. The question is: “Can a second language (L2) learner truly learn the target language if they do not like the people who speak it?” Schumman’s (1978) acculturation theory proposes that the degree to which a learner integrates into the target culture through decreasing their social and psychological distance from it will determine the degree to which they learn the target language. Central to this process is the learner’s attitude toward the target language and the target culture. By fostering positive attitudes toward the target language and culture, can we aid L2 students in transforming the L2 input that they receive while studying abroad into meaningful intake through which they can, in turn, achieve greater proficiency in the L2? This thesis explores the above questions through a research study investigating the relationship between attitude toward the target language and target culture, and L2 proficiency; amount of L2 input and L2 proficiency; and amount of L2 input and attitude toward the target language and target culture. A small-scale study was conducted with Korean L2 English students studying abroad in the USA. Ten participants completed a language background questionnaire, an attitude questionnaire, and an English proficiency test. The data collected via these instruments were analysed to determine if any correlations exist between the above-mentioned three sets of variables. Results showed no correlations between attitude and L2 proficiency. However, descriptive analysis showed a clear positive correlation to exist between several L2 input variables and L2 proficiency, and between L2 input and attitudes toward the target language.AFRIKAANSE OPSOMMING: Namate die aantal Asiese studente wat Engels oorsee studeer toeneem, styg die behoefte aan taalonderrig-programme wat studente help om hulle Engelse vaardigheid op die mees effektiewe wyse moontlik te ontwikkel. Studies toon dat blootstelling op sigself nie voldoende is vir die bevordering van taalvaardigheid nie. Die vraag is: “Kan tweedetaal- (T2-) leerders werklik ’n teikentaal aanleer indien hulle nie hou van die sprekers van daardie taal nie?” Schumman (1978) se akkulturasie-teorie stel voor dat die mate waartoe leerders hulself in die teikenkultuur integreer deur hulle sosiale en psigologiese afstand daarvan te verminder, bepalend is van die mate waartoe hulle die teikentaal sal aanleer. Sentraal tot hierdie proses is die leerders se houding teenoor die teikentaal en die teikenkultuur. Deur positiewe houdings teenoor die teikentaal en -kultuur onder T2-studente te bevorder, kan ons hulle help om die T2-toevoer wat hulle tydens oorsese studies ontvang te omskep in sinvolle T2-inname wat verhoogde T2-vaardigheid tot gevolg kan hê? Hierdie tesis verken die bostaande vrae op grond van ’n navorsingstudie wat ondersoek doen na die verhouding tussen T2-vaardigheid en houding teenoor die teikentaal en -kultuur; hoeveelheid T2-toevoer en T2-vaardigheid; en hoeveelheid T2-toevoer en houding teenoor die teikentaal en -kultuur. ’n Kleinskaal-studie is uitgevoer met Koreaanse T2-Engelssprekers aan’t studeer in Amerika. Tien deelnemers het elk ’n taalagtergrond-vraelys, ’n houding-vraelys en ’n Engels-vaardigheidstoets voltooi. Die data wat deur middel van hierdie instrumente ingesamel is, is geanaliseer ten einde vas te stel of daar enige korrelasies bestaan tussen die bogenoemde drie stelle veranderlikes. Resultate toon geen korrelasies tussen houdings en T2-vaardigheid nie, maar beskrywende analise dui wel op ’n duidelike positiewe korrelasie tussen verskeie T2-toevoer-veranderlikes en T2-vaardigheid, asook tussen T2- toevoer en houdings teenoor die teikentaal

Since Cairo

Abstract not availabl