Major depression in outpatients attending a regional cancer centre: screening and unmet treatment needs

A screening programme designed to identify cases of Major Depressive Disorder (MDD) in patients attending a Regional Cancer Centre outpatient department was established. It comprised two stages: (1) The Hospital Anxiety and Depression Scale (HADS) self-rating questionnaire administered by a touch-screen computer; (2) we interviewed patients with high scores on the HADS (15 or more total score) over the telephone using the depression section of the Structured Clinical Interview for DSMIV (SCID). A large consecutive sample (5613) of oncology clinic attenders was screened, and practical difficulties in the screening process were identified. The estimated prevalence of major depressive disorder (MDD) in the sample surveyed was approximately 8% (7.8%; 95% confidence intervals 6.9-8.5%). We assessed a consecutive series of 150 patients identified as having MDD to determine how many had received evidence-based treatment for MDD. Only half had discussed their low mood with their general practitioner, only one-third had been prescribed any antidepressant medication, and very few had taken a therapeutic dose for an adequate period. Very few had received psychological treatment or had been referred to mental health services. Most were receiving no potentially effective therapy

Policy challenges for the pediatric rheumatology workforce: Part II. Health care system delivery and workforce supply

The United States pediatric population with chronic health conditions is expanding. Currently, this demographic comprises 12-18% of the American child and youth population. Affected children often receive fragmented, uncoordinated care. Overall, the American health care delivery system produces modest outcomes for this population. Poor, uninsured and minority children may be at increased risk for inferior coordination of services. Further, the United States health care delivery system is primarily organized for the diagnosis and treatment of acute conditions. For pediatric patients with chronic health conditions, the typical acute problem-oriented visit actually serves as a barrier to care. The biomedical model of patient education prevails, characterized by unilateral transfer of medical information. However, the evidence basis for improvement in disease outcomes supports the use of the chronic care model, initially proposed by Dr. Edward Wagner. Six inter-related elements distinguish the success of the chronic care model, which include self-management support and care coordination by a prepared, proactive team

Tectonic implications of garnet-bearing mantle xenoliths exhumed by Quaternary magmatism in the Hangay dome, central Mongolia

Garnet-bearing mantle xenoliths have been recovered from Quaternary alkali basalts, both within and peripheral to the Hangay dome of central Mongolia. Microfabric analysis and thermobaromery, combining empirical thermobarometers and the self-consistent dataset of THERMOCALC, indicate that garnet websterites from the Shavaryn-Tsaram volcanic centre at the dome core were formed in the spinel-lherzolite upper mantle at pressures of 17–18 kbars and temperatures of 1,070–1,090°C, whereas garnet lherzolites were derived from greater depths (18–20 kbars). Garnet lherzolites from the Baga Togo Uul vents near the dome edge were formed at 18–22 kbars under significantly cooler conditions (960–1,000°C). These xenoliths reveal reaction coronas of (1) orthopyroxene, clinopyroxene, plagioclase and spinel mantling garnets; (2) spongy rims of olivine replacing orthopyroxene and (3) low-Na, low-Al clinopyroxene replacing primary clinopyroxene. Trace-element abundances indicate that clinopyroxene from these coronas is in chemical equilibrium with the host magma. The thermobarometric and textural data suggest that lherzolite xenoliths from both sites were derived from depths of 60–70 km and entrained in magma at 1,200–1,300°C. The average rate of ascent, as determined by olivine zoning, lies in the range 0.2–0.3 m s?1. The contrast in thermal profiles of the upper mantle between the two sites is consistent with a mantle plume beneath the Hangay dome with elevated thermal conditions beneath the core of the dome being comparable to estimates of the Pleistocene geotherm beneath the Baikal rift