Social inequalities in the demand, supply and utilisation of psychological treatment

Introduction: Socioeconomic deprivation is associated with higher prevalence of mental disorders but poor access to care. We conducted a national workforce survey to examine the demand, supply and utilisation of primary care psychological services. Aim: To understand the variability in the rates of access to psychological care in different geographical areas. Method: This was a cross-sectional survey of Improving Access to Psychological Therapies (IAPT) services. Data were collected from 144 services covering 180 local areas in England, using a freedom of information request. The access gap (AG) was defined as the percentage of cases that did not receive treatment, from the wider pool of cases referred for psychological care. We examined correlations between the demand (number of referrals), and supply (workforce size) of psychological care with local area prevalence rates of common mental disorders and the index of multiple deprivation (IMD). Regression analyses were used to assess if the variability in AG may be explained by IMD and workforce size, controlling for local population statistics. Results: Workforce size was weakly correlated with the IMD (r = 0.16, p = 0.04) and prevalence rates (r = 0.16, p = 0.03). The AG was significantly associated with IMD, number of referrals, prevalence rates and treatment waiting times, but not with workforce size. Together, these variables explained approximately 26% of variance in the AG. Conclusions: Socioeconomic deprivation is associated with psychological service utilisation, irrespective of the demand–supply function, particularly when contrasting the poorest and most affluent areas

Is there an evidence-based number of sessions in outpatient psychotherapy? – A comparison of naturalistic conditions across countries

Deciding on the number of psychotherapy sessions to satisfactorily treat a patient is a vital clinical as well as economic issue in most mental health systems worldwide. The length of outpatient psychotherapy in naturalistic conditions ranges from a single session to hundreds of sessions [1]. In randomized clinical trials, the number of sessions is typically fixed to deliver manualized treatments and to control for dosage effects (e.g., in a 16-session format [2]). Using data from Routine Outcome Monitoring studies [3, 4], we investigated whether the treatments under naturalistic conditions were fixed to a particular number of sessions or not (H1), whether naturalistic conditions tended to include unusually long treatments (e.g., >100 sessions) (H2), and how the observed number of sessions was distributed across countries (H3)

Transdermal Delivery of Cytochrome C—A 12.4kDa Protein—Across Intact Skin by Constant-Current Iontophoresis

Purpose: To demonstrate the transdermal iontophoretic delivery of a small (12.4kDa) protein across intact skin. Materials and Methods: The iontophoretic transport of Cytochrome c (Cyt c) across porcine ear skin in vitro was investigated and quantified by HPLC. The effect of protein concentration (0.35 and 0.7mM), current density (0.15, 0.3 or 0.5mA.cm−2 applied for 8h) and competing ions was evaluated. Co-iontophoresis of acetaminophen was employed to quantify the respective contributions of electromigration (EM) and electroosmosis (EO). Results: The data confirmed the transdermal iontophoretic delivery of intact Cyt c. Electromigration was the principal transport mechanism, accounting for ∼90% of delivery; correlation between EM flux and electrophoretic mobility was consistent with earlier results using small molecules. Modest EO inhibition was observed at 0.5mA.cm−2. Cumulative permeation at 0.3 and 0.5mA.cm−2 was significantly greater than that at 0.15mA.cm−2; fluxes using 0.35 and 0.7mM Cyt c in the absence of competing ions (J tot  = 182.8 ± 56.8 and 265.2 ± 149.1μg.cm−2.h−1, respectively) were statistically equivalent. Formulation in PBS (pH8.2) confirmed the impact of competing charge carriers; inclusion of ∼170mM Na+ resulted in a 3.9-fold decrease in total flux. Conclusions: Significant amounts (∼0.9mg.cm−2 over 8h) of Cyt c were delivered non-invasively across intact skin by transdermal electrotranspor

Matrix geometries and Matrix Models

We study a two parameter single trace 3-matrix model with SO(3) global symmetry. The model has two phases, a fuzzy sphere phase and a matrix phase. Configurations in the matrix phase are consistent with fluctuations around a background of commuting matrices whose eigenvalues are confined to the interior of a ball of radius R=2.0. We study the co-existence curve of the model and find evidence that it has two distinct portions one with a discontinuous internal energy yet critical fluctuations of the specific heat but only on the low temperature side of the transition and the other portion has a continuous internal energy with a discontinuous specific heat of finite jump. We study in detail the eigenvalue distributions of different observables.Comment: 20 page

Effect of temperature and compression/decompression rates on high pressure inactivation of Listeria

The main objective of the present study was to evaluate the effect of temperature and different compression/ decompression rates on the efficiency of Listeria inactivation by HPP. Stationary phase cultures of Listeria innocua were subjected to 300 MPa for 5 min at 4, 10, and 20 °C using different compression and decompression rates. Inactivation was more efficient at low temperature and with lowest compression and decompression rates (1.5 MPa s–1 and 3.2 MPa s–1, respectively). Kinetics of pressure building up and decompression, as well as temperature, have a significant impact on the outcome of Listeria inactivation by HPP. The results may contribute to the design of HPP protocols that ensure food safety, while preserving nutritional and organoleptic properties better

Improving Access to Psychological Therapies (IAPT) in the United Kingdom: A systematic review and meta‐analysis of 10‐years of practice‐based evidence

Objectives: Improving Access to Psychological Therapies (IAPT) is a national‐level dissemination programme for provision of evidence‐based psychological treatments for anxiety and depression in the United Kingdom. This paper sought to review and meta‐analyse practice‐based evidence arising from the programme. Design: A pre‐registered (CRD42018114796) systematic review and meta‐analysis. Methods: A random effects meta‐analysis was performed only on the practice‐based IAPT studies (i.e. excluding the clinical trials). Subgroup analyses examined the potential influence of particular methodologies, treatments, populations, and target conditions. Sensitivity analyses investigated potential sources of heterogeneity and bias. Results: The systematic review identified N = 60 studies, with N = 47 studies suitable for meta‐analysis. The primary meta‐analysis showed large pre‐post treatment effect sizes for depression (d = 0.87, 95% CI [0.78–0.96], p < .0001) and anxiety (d = 0.88, 95% CI [0.79–0.97], p < .0001), and a moderate effect on functional impairment (d = 0.55, 95% CI [0.48–0.61], p < .0001). The methodological features of studies influenced ESs (e.g., such as whether intention‐to‐treat or completer analyses were employed). Conclusions: Current evidence suggests that IAPT enables access to broadly effective evidence‐based psychological therapies for large numbers of patients. The limitations of the review and the clinical and methodological implications are discussed. Practitioner points: IAPT interventions are associated with large pre‐post treatment effect sizes in depression and anxiety measures. IAPT interventions are associated with moderate treatment effect sizes with regards to work and social adjustment. A reduction in dropout and also the prevention of post‐treatment relapse via the offer of follow‐up support are important areas for future development

Heterogeneity in patient-reported outcomes following low-intensity mental health interventions: a multilevel analysis.

BACKGROUND: Variability in patient-reported outcomes of psychological treatments has been partly attributed to therapists--a phenomenon commonly known as therapist effects. Meta-analytic reviews reveal wide variation in therapist-attributable variability in psychotherapy outcomes, with most studies reporting therapist effects in the region of 5% to 10% and some finding minimal to no therapist effects. However, all except one study to date have been conducted in high-intensity or mixed intervention groups; therefore, there is scarcity of evidence on therapist effects in brief low-intensity psychological interventions. OBJECTIVE: To examine therapist effects in low-intensity interventions for depression and anxiety in a naturalistic setting. DATA AND ANALYSIS: Session-by-session data on patient-reported outcome measures were available for a cohort of 1,376 primary care psychotherapy patients treated by 38 therapists. Outcome measures included PHQ-9 (sensitive to depression) and GAD-7 (sensitive to general anxiety disorder) measures. Three-level hierarchical linear modelling was employed to estimate therapist-attributable proportion of variance in clinical outcomes. Therapist effects were evaluated using the intra-cluster correlation coefficient (ICC) and Bayesian empirical predictions of therapist random effects. Three sensitivity analyses were conducted: 1) using both treatment completers and non-completers; 2) a sub-sample of cases with baseline scores above the conventional clinical thresholds for PHQ-9 and GAD-7; and 3) a two-level model (using patient-level pre- and post-treatment scores nested within therapists). RESULTS: The ICC estimates for all outcome measures were very small, ranging between 0% and 1.3%, although most were statistically significant. The Bayesian empirical predictions showed that therapist random effects were not statistically significantly different from each other. Between patient variability explained most of the variance in outcomes. CONCLUSION: Consistent with the only other study to date in low intensity interventions, evidence was found to suggest minimal to no therapist effects in patient-reported outcomes. This draws attention to the more prominent source of variability which is found at the between-patient level

Dos biomarcadores de la plasticidad de la expresión génica en corales Pocillopora del arrecife Carrizales, Pacífico Tropical Mexicano

Background. Gene expression (GE) plasticity is an acclimation response that allows organisms to adjust rapidly to environmental changes, providing an adaptive advantage. GE biomarkers are emerging as a valua-ble tool for linking the organism’s physiological plasticitywith the synergetic effects of large-scale climatic conditions and local impacts such as temperature and nutrients. Objectives. In this study, we investigate the GE plasticity of the 70-kDa heat shock protein (hsp70) and the carbonic anhydrase enzyme (CA) to confirm the ability of those two genes as biomarkers of the Cellular Stress Response and Cellular Homeostasis Res-ponse, respectively. Methods. Using qPCR, we evaluate the GE plasticity of coral colonies from Pocillopora capitata, Pocillopora damicornis,and Pocillopora verrucosa at the Carrizales reef (Colima coast of Mexico) naturally exposed to environmental changes in the Sea Surface Temperature (SST), productivity and nutrients using the cellular density of Symbiodiniaceae and chlorophyll content as health indices. Results. Our results clearly show GE plasticity in the hsp70 for Pocillopora verrucosa and Pocillopora damicornis related to a daily environmental change in temperature and nutrients. On the other hand, the CA gene expression shows no change in response to daily variations. However, there was a significantly high expression of CA and a lower expression of hsp70 in Pocillopora capitata. Furthermore, we found no significant differences in the health in-dices, suggesting some degree of physiological plasticity in Pocillopora corals like its extensive morphological plasticity that could reflect different adaptation capacities to low temperatures and high nutrients during the spring season in the central Mexican Pacific. Conclusions. Evaluating the phenotypic plasticity (morphology and molecular physiology) could help identify coral colonies with a more significant potential to survive en-vironmental stressors. The latter is an essential consideration for managing, conserving, and restoring coral reefs in the Mexican Pacific.Antecedentes. La plasticidad de la expresión génica (GE) es una respuesta inmediata de aclimatación al cambio ambiental que puede proporcionar una ventaja adaptativa. Los biomarcadores de GE están emer-giendo como una herramienta valiosa para vincular la plasticidad fisiológica del organismo con los efectos sinérgicos del cambio climático y el impacto local como la temperatura y nutrientes. Objetivos. Investigamos la plasticidad de la expresión de genes que codifican para la proteína de choque térmico de 70-kDa (hsp70) y la enzima anhidrasa carbónica (CA) para confirmar su utilidad como biomarcadores de la respuesta de estrés y de homeostasis celular, respectivamente. Métodos. Evaluamos la GE mediante qPCR en colonias de corales Pocilloporacapitata, Pocillopora damicornis y Pocillopora verrucosa del arrecife Carrizales (Colima, México) expuestas a un cambio natural en la temperatura de la superficie del mar (SST), productividad pri-maria y nutrientes utilizando la densidad de Symbiodiniaceae y el contenido de clorofila como indicadores de salud. Resultados. La plasticidad de la GE de hsp70 en Pocillopora damicornis y Pocillopora verrucosa se asocia con la variación diaria de temperatura y nutrientes, mientras que el gen de la CA no muestra cambios de expresión relacionada con esta variabilidad. Sin embargo, en Pocillopora capitata se encontró una expresión significativamente mayor de CA y una menor expresión de hsp70. Estos resultados reflejan un grado de plasticidad fisiológica en corales Pocillopora similar a la extensa plasticidad morfológica dentro de este género, lo que podría sugerir diferentes capacidades de adaptación a la temporada primave-ral de bajas temperaturas y alto contenido de nutrientes en la región. Conclusiones. Evaluar la plasticidad fenotípica (morfología y fisiolo-gía molecular) podría ser útil para identificar colonias de corales con un mayor potencial de sobrevivencia al estrés ambiental. Lo anterior resulta relevante para la conservación, manejo y restauración de los arrecifes de coral del Pacífico mexicano. &nbsp; &nbsp