Internet-based Treatment for Depression and Panic disorder : From development to deployment

Major depression (MD) and panic disorder (PD) are two common disorders for which evidence based psychological treatments such as cognitive behaviour therapy (CBT) have been developed. The accessibility of such treatment is however limited. The use of Internet-based CBT (self-help programmes accompanied by brief therapist support by e-mail) is a promising way to increase accessibility. The first aim of this thesis was to investigate if Internet treatment was effective in reducing depressive symptoms and if it was possible to predict which participants would benefit from such treatment. The second aim of the thesis was to investigate if Internet treatment was effective for PD patients in a regular care setting, in comparison with traditional group-administered CBT, and in addition, to compare the cost-effectiveness of the two treatments. In Study I 85 participants were randomised to either an Internet treatment or to an attention control condition (an online discussion group). Post-treatment measures of depression showed large effect sizes and improvements were sustained at a 6-month follow-up, thus showing that Internet treatment was effective in reducing mild to moderate symptoms of depression. Study II analysed predictors of treatment outcome at the 6-month follow-up of Study I. Higher selfreported severity at baseline was associated with poorer outcome and a negative correlation was found between number of previous episodes of depression and improvement in treatment. Study III was an open effectiveness trial evaluating Internet treatment, which in previous studies had been shown to be effective with self-recruited participants, within a regular psychiatric setting for 20 PD patients referred for treatment. After treatment 75% of patients were considered to have responded to treatment, and at the 6-month follow-up this proportion was 70%, indicating that this treatment form was transferable to a regular care setting with sustained effectiveness. Study IV was a randomised clinical trial comparing Internet- and groupadministered CBT for PD with 104 patients in a psychiatric setting. Both treatments produced significant improvements, and there were no statistically significant differences between them at post-treatment or at the 6-month follow up. A cost-effectiveness analysis showed that the Internet treatment was more cost-effective than the group treatment with regard to therapist time. This thesis provides evidence that Internet treatment is effective in reducing symptoms of depression and of PD. Internet treatment is as effective as traditionally administered group CBT in a regular care setting with PD patients referred for treatment. The thesis also provides evidence that Internet treatment for PD is more cost-effective than group treatment. Taken together, the results support the implementation of Internet treatment for depression and PD within regular health care settings

Les nouvelles thérapies par Internet

Cet article propose une synthèse du développement scientifique du traitement psychologique par Internet, en explicitant et discutant ses traits caractéristiques. L’auteur y compare ce type de soin avec la psychothérapie traditionnelle et dessine les enjeux que revêtent les traitements sur Internet dans le champ de la psychothérapie ; avant tout au niveau théorique mais aussi au niveau pratique. Plus précisément, il met en évidence les nombreux facteurs indiquant que les thérapies utilisant Internet constituent, cent ans après la naissance de la discipline, un défi profond et durable pour la psychothérapie.This article provides an overview and discussion of the scientific developments in Internet-based psychological treatment. The author compares these therapeutic forms with those of traditional psychotherapy and delves into the issues this raises in the field of psychotherapy, primarily at a theoretical level, but also in practical terms. Specifically, the paper highlights the many factors indicating that a century after the discipline's birth, online therapies pose a fundamental challenge for psychotherapy

JJ-factors for self-interacting dark matter in 20 dwarf spheroidal galaxies

Dwarf spheroidal galaxies are among the most promising targets for indirect dark matter (DM) searches in $\gamma$-rays. The $\gamma$-ray flux from DM annihilation in a dwarf spheroidal galaxy is proportional to the $J$-factor of the source. The $J$-factor of a dwarf spheroidal galaxy is the line-of-sight integral of the DM mass density squared times $\langle \sigma_{\rm ann} v_{\rm rel} \rangle/(\sigma_{\rm ann} v_{\rm rel})_0$, where $\sigma_{\rm ann} v_{\rm rel}$ is the DM annihilation cross-section times relative velocity $v_{\rm rel}=|{\bf v}_{\rm rel}|$, angle brackets denote average over ${\bf v}_{\rm rel}$, and $(\sigma_{\rm ann} v_{\rm rel})_0$ is the $v_{\rm rel}$-independent part of $\sigma_{\rm ann} v_{\rm rel}$. If $\sigma_{\rm ann} v_{\rm rel}$ is constant in $v_{\rm rel}$, $J$-factors only depend on the DM space distribution in the source. However, if $\sigma_{\rm ann} v_{\rm rel}$ varies with $v_{\rm rel}$, as in the presence of DM self-interactions, $J$-factors also depend on the DM velocity distribution, and on the strength and range of the DM self-interaction. Models for self-interacting DM are increasingly important in the study of the small scale clustering of DM, and are compatible with current cosmological observations. Here we derive the $J$-factor of 20 dwarf spheroidal galaxies from stellar kinematic data under the assumption of Yukawa DM self-interactions. $J$-factors are derived through a profile Likelihood approach, assuming either NFW or cored DM profiles. We also compare our results with $J$-factors derived assuming the same velocity for all DM particles in the target galaxy. We find that this common approximation overestimates the $J$-factors by up to one order of magnitude. $J$-factors for a sample of DM particle masses, self-interaction coupling constants and density profiles are provided electronically, ready to be used in other projects.Comment: 10 pages, 3 figures and 2 table

Fotosyntesprocessens evolution

Fotosyntesen är växternas fantastiska och för oss livgivande metod att med hjälp av energin i solljuset omvandla luftens koldioxid till växtbiomassa och syre. Men många lägre organismer har en fotosyntes som inte producerar nŒgot syre, medan åter andra organismer kan binda koldioxid med hjälp av någon annan energikälla än solljuset. Lars Olof Björn och Jan Bergström reder ut begreppen

Inventering och modellering av fisk- och kräftdjurssamhället i Stigfjorden sommaren 2012

Under 31 juli-3 augusti 2012 utförde Kustlaboratoriet vid SLU Aqua ett inventeringsfiske med småryssjor i Stigfjorden mellan Orust och Tjörn med syfte att beskriva fisksamhället i fjorden och att kartlägga viktiga fiskhabitat. Totalt fiskades 80 stationer på djup från ytan ner till 20 m. Området uppvisade ovanligt höga tätheter av juvenil rödspotta, gråsej och torsk. Även fångsterna av stensnultra och tånglake var höga, och bland kräftdjuren dominerade strandkrabban. Resultaten från Stigfjorden jämförs med resultat från tidigare och samtida undersökningar av samma karaktär. Den rumsliga fördelningen av olika arter i förhållande till habitatet beskrevs statistiskt med hjälp av generella additiva modeller, där fångsterna i ryssjorna relateras till data på olika miljövariabler. De statistiska modellerna i kombination med kartor över miljövariabler i området användes sedan för att i GIS producera heltäckande kartor över potentiella habitat för arterna. De arter som modellerades var torsk <18 cm, torsk >18 cm, ål, rödspotta, vitling, stensnultra, tånglake och strandkrabba. Modellernas förklaringsgrad var generellt god, och vattendjup utgjorde den variabel som var viktigast för fördelningen av de flesta arter. Ungtorsk och rödspotta förekom i högst tätheter i de djupare delarna av fjorden, medan gulål, tånglake och strandkrabba, där de två förstnämnda tillsammans med torsken är rödlistade, främst återfanns i de grunda delarna av fjorden. Sammantaget tyder resultaten på att Stigfjorden håller viktiga livsmiljöer för ett flertal fiskarter, framför allt som uppväxtområde för arter som t ex rödspotta och gråsej

The COMTval158met polymorphism is associated with symptom relief during exposure-based cognitive-behavioral treatment in panic disorder

<p>Abstract</p> <p>Background</p> <p>Cognitive behavioral therapy (CBT) represents a learning process leading to symptom relief and resulting in long-term changes in behavior. CBT for panic disorder is based on exposure and exposure-based processes can be studied in the laboratory as extinction of experimentally acquired fear responses. We have recently demonstrated that the ability to extinguish learned fear responses is associated with a functional genetic polymorphism (COMTval158met) in the <it>COMT </it>gene and this study was aimed at transferring the experimental results on the COMTval158met polymorphism on extinction into a clinical setting.</p> <p>Methods</p> <p>We tested a possible effect of the COMTval158met polymorphism on the efficacy of CBT, in particular exposure-based treatment modules, in a sample of 69 panic disorder patients.</p> <p>Results</p> <p>We present evidence that panic patients with the COMTval158met met/met genotype may profit less from (exposure-based) CBT treatment methods as compared to patients carrying at least one val-allele. No association was found with the 5-HTTLPR/rs25531 genotypes which is presented as additional material.</p> <p>Conclusions</p> <p>We were thus able to transfer findings on the effect of the COMTval158met polymorphism from an experimental extinction study obtained using healthy subjects to a clinical setting. Furthermore patients carrying a COMT val-allele tend to report more anxiety and more depression symptoms as compared to those with the met/met genotype. Limitations of the study as well as possible clinical implications are discussed.</p> <p>Trial registration</p> <p>Clinical Trial Registry name: Internet-Versus Group-Administered Cognitive Behavior Therapy for Panic Disorder (IP2). Registration Identification number: NCT00845260, <url>http://www.clinicaltrials.gov/ct2/show/NCT00845260</url></p

The value of multiple data set calibration versus model complexity for improving the performance of hydrological models in mountain catchments

The assessment of snow, glacier, and rainfall runoff contribution to discharge in mountain streams is of major importance for an adequate water resource management. Such contributions can be estimated via hydrological models, provided that the modeling adequately accounts for snow and glacier melt, as well as rainfall runoff. We present a multiple data set calibration approach to estimate runoff composition using hydrological models with three levels of complexity. For this purpose, the code of the conceptual runoff model HBV-light was enhanced to allow calibration and validation of simulations against glacier mass balances, satellite-derived snow cover area and measured discharge. Three levels of complexity of the model were applied to glacierized catchments in Switzerland, ranging from 39 to 103 km2. The results indicate that all three observational data sets are reproduced adequately by the model, allowing an accurate estimation of the runoff composition in the three mountain streams. However, calibration against only runoff leads to unrealistic snow and glacier melt rates. Based on these results, we recommend using all three observational data sets in order to constrain model parameters and compute snow, glacier, and rain contributions. Finally, based on the comparison of model performance of different complexities, we postulate that the availability and use of different data sets to calibrate hydrological models might be more important than model complexity to achieve realistic estimations of runoff composition

Direct Constraints on Minimal Supersymmetry from Fermi-LAT Observations of the Dwarf Galaxy Segue 1

The dwarf galaxy Segue 1 is one of the most promising targets for the indirect detection of dark matter. Here we examine what constraints 9 months of Fermi-LAT gamma-ray observations of Segue 1 place upon the Constrained Minimal Supersymmetric Standard Model (CMSSM), with the lightest neutralino as the dark matter particle. We use nested sampling to explore the CMSSM parameter space, simultaneously fitting other relevant constraints from accelerator bounds, the relic density, electroweak precision observables, the anomalous magnetic moment of the muon and B-physics. We include spectral and spatial fits to the Fermi observations, a full treatment of the instrumental response and its related uncertainty, and detailed background models. We also perform an extrapolation to 5 years of observations, assuming no signal is observed from Segue 1 in that time. Results marginally disfavour models with low neutralino masses and high annihilation cross-sections. Virtually all of these models are however already disfavoured by existing experimental or relic density constraints.Comment: 22 pages, 5 figures; added extra scans with extreme halo parameters, expanded introduction and discussion in response to referee's comment

Экология человека как предмет преподавания в медицинском вузе

ОБРАЗОВАНИЕ МЕДИЦИНСКОЕМЕДИЦИНСКИЕ УЧЕБНЫЕ ЗАВЕДЕНИЯВУЗЫЭКОЛОГИЯ ЧЕЛОВЕКАМЕТОДИКА ПРЕПОДАВАНИ