Dysregulation of visual motion inhibition in major depression

Individuals with depression show depleted concentrations of the inhibitory neurotransmitter GABA in occipital (visual) cortex, predicting weakened inhibition within their visual systems. Yet, visual inhibition in depression remains largely unexplored. To fill this gap, we examined the inhibitory process of centersurround suppression (CSS) of visual motion in depressed individuals. Perceptual performance in discriminating the direction of motion was measured as a function of stimulus presentation time and contrast in depressed individuals (n¼27) and controls (n¼22). CSS was operationalized as the accuracy difference between conditions using large (7.5°) and small (1.5°) grating stimuli. Both depressed and control participants displayed the expected advantage in accuracy for small stimuli at high contrast. A significant interaction emerged between subject group, contrast level and presentation time, indicating that alterations of CSS in depression were modulated by stimulus conditions. At high contrast, depressed individuals showed significantly greater CSS than controls at the 66 ms presentation time (where the effect peaked in both groups). The results' specificity and dependence on stimulus features such as contrast, size and presentation time suggest that they arise from changes in early visual processing, and are not the results of a generalized deficit or cognitive bias.Accepted versio

Application and Effectiveness of Telehealth to Support Severe Mental Illness Management: Systematic Review

Background: It is important that people with SMI receive early interventions to prevent mental health deterioration or relapse. Telecommunications and other technologies are increasingly used to assist healthcare delivery (‘telehealth’) , providing service users with immediate real-time information to improve the management of chronic health conditions. Telehealth has been found to be successful in improving management and symptoms across a number of health conditions, whilst also being acceptable to users. Initial findings suggest technology could improve quality of life in people with SMI. Objectives: This systematic review aimed to identify the variety of uses and efficacy of teleheal th technology for SMI. Methods: We systematically searched electronic databases from inception to March 2016 (MEDLINE, EMBASE, PsycINFO, Cochrane Central Register of Controlled Trials, AMED, He alth Techno logy Assessment, CINAHL plus and NHS EED ) for randomised controlled trials (RCTs) evaluating telehealth for adults with SMI , published in English. Additional literature was identified by searching reference lists of key articles. The articles meeting the inclusion criteria were systematically reviewed and assessed for quality and risk of bias. Results: The search identified 31 eligible articles, describing 29 trials. The included studies evaluated the use of computers to deliver cognitive rehabilitation (1 5 trials), patient education (3 trials), online self- management interventions (2 trials), and to support consultations (1 trial). Virtual reality (VR) was used to simulate work and social sit uations (2 trials ) and to deliver cognitive training (1 trial). Telephones were used to prompt medication use (3 trials ) and report SMI symptoms to healthcare teams (1 trial ). Remote sensors were used to monitor medication use (1 trial). Telephone support was found effective for improving medication adherence and reducing symptom severity and inpatient days. Computer assisted cognitive rehabilitation was effective in improving cognitive function. The impact of telehealth on other outcomes was inconsistent. Few studies evaluated the 3 use of remote medication telemonitoring, VR, online self-management and computer -mediated consultations, suggesting these are novel technologies for managing SMI, although all were found effective for improving psycho social and behavioural outcomes. The results of this review should be taken in the context of varied quality in study design, with only five studies demonstrating a low risk of bias. Conclusions : A growing variety of telehealth technologies are used to support SMI. Specific types of technology have been found to be effective for som e outcomes, for example telephone prompts for medication adherence, while other types of telehealth had no benefit over traditional methods and were less acceptable to patients. Few studies found benefits for telehealth on quality of life, except for novel technologies with a limited number of trials. Further research is warranted to establish the full potential benefits of telehealth for improving quality of life in SMI, acceptability from the service user perspective, and cost-effectivenes

Optimization of Advertising Resources over Time: A Strategic Analysis

AMS subject classification: 90B60, 90B50, 90A80.Strategic behaviour has long been a crucial issue for modern corporations. To maximize potential profits and market share, firms are more than willing to invest in sales promotion to boost long term manufacturing output. Knowing that the sales of the firm not only respond to own advertising budgets, but also depend upon rivals’ advertising strategies, oligopolistic firms form part, therefore of a continuous race with reference to non-price competition. Efficient use of investment resources is crucial for business operations and long term strategic success. This paper aims to investigate the key issue of optimization of strategic advertising outlays. By using mathematical modelling techniques, strategic linkages between rival companies are identified and advertising impacts explained. Since advertising influences can persist through time, our discussion extends to explore this fundamental point by constructing a more advanced model to examine into the problems of optimization over time. Empirical data is used to test the predictive power of these models and assess relative efficiencies. All in all, this paper intends to highlight the importance of continuous strategic advertising investment and consequently provides comprehensive insights into the impact of modern advertising functions over time

Interpretación errónea del concepto de entropía

Background Cetylpyridinium chloride (CPC) and sodium fluoride augment oral hygiene by inactivating bacteria and inhibiting enamel demineralisation, respectively. However, there are few reports in the literature documenting the antibacterial efficacy of their combined use in mouthrinses. We have used six experimental systems to compare the antibacterial effects of mouthrinses containing 0.075 % CPC (test rinse, TR) or 0.075 % CPC with sodium fluoride (test fluoride rinse, TFR). Results Effects against planktonic bacteria were determined using viable counting (for Streptococcus mutans and salivary bacteria), a redox dye (for Actinomyces viscosus and salivary bacteria) and viable counting (for ex vivo oral rinses). Effects against saliva-derived biofilms were quantified using confocal microscopy and differential viable counting. Inhibition of biofilm formation was evaluated by pre-treating hydroxyapatite coupons with mouthrinses prior to inoculation. Otherwise-identical controls without CPC (control rinse and control fluoride rinse, CR and CFR, respectively), were included throughout. Compared to the controls, TFR and TR demonstrated significant antimicrobial effects in the redox assays, by viable counts (>3 log reductions) and in oral rinse samples (>1.25 log reductions, p 3 log difference, p < 0.05). Overall, there were no consistent differences in the activities of TR and TFR. Conclusions Sodium fluoride did not influence the antibacterial and anti-biofilm potency of CPC-containing formulations, supporting the combined use of CPC and sodium fluoride in mouthrinses to control oral bacteria and protect tooth enamel

Are diabetes self-management programmes for the general diabetes population effective for people with severe mental illness?: a systematic review.

Background: Diabetes self-management education programmes are effective in improving health outcomes in the general population with diabetes. However, it is not known if these programmes include people who also have a severe mental illness (SMI) and, if so, what their outcomes are. The aim of this review was to examine if evaluations of diabetes self-management education programmes included people with SMI, and if so, whether the interventions were beneficial for this population. Methods: The inclusion criteria for this systematic review, defined by PICOS criteria, were: Population - Adults with type 2 diabetes; Intervention - self-management education programme; Comparator – another active intervention or usual care; Outcomes of interest – inclusion of people with SMI and the clinical, behavioural and psychosocial outcomes in this population; Study design - randomised controlled trials. The following bibliographic databases were searched from January 2004 to April 2018: Cochrane Library, Medline, Embase, PsychINFO, Allied and Complimentary Medicine Database, Health Technology Assessment, NHS Economic Evaluations Database and CINAHL. Data were extracted on study characteristics, inclusion and exclusion criteria, participant and intervention characteristics, number of participants with SMI, and outcomes for people with SMI, if reported. Authors were contacted by email for missing data. Results: A total of 410 trials were included. At least 42% of trials did not recruit any participants with SMI. Only nine confirmed inclusion of participants with SMI, of which six provided data on the number recruited. These six trials recruited a total of 1009 participants, of whom 31 (3.1%) had SMI. It was not possible to assess intervention effectiveness for people with SMI as none of the trials reported outcomes for these participants. Conclusions: This systematic review confirms that people with SMI are often excluded from trials of diabetes self-management education, resulting in a lack of an evidence base on which to base treatment paths for this vulnerable population. It cannot be assumed that programmes developed for the general diabetes population meet the needs of people with SMI. Future research needs to examine if and how these programmes could be adapted for people with SMI or if new programmes are required

Erectile dysfunction and its detection in the health care setting: 10 years on

Erectile dysfunction is considered an early indicator of cardiovascular disease. Jackson highlighted the important role that General Practitioners and other health care professionals have in detecting erectile dysfunction and potentially preventing subsequent cardiovascular events.(1) Results from our audit suggest that erectile dysfunction detection remains poor

Management of type 2 diabetes mellitus in people with severe mental illness: an online cross-sectional survey of healthcare professionals

Objectives To establish healthcare professionals’ (HCPs) views about clinical roles, and the barriers and enablers to delivery of diabetes care for people with severe mental illness (SMI). Design Cross-sectional, postal and online survey. Setting Trusts within the National Health Service (NHS), mental health and diabetes charities and professional bodies. Participants HCPs who care for people with type 2 diabetes mellitus (T2DM) and/or SMI in the UK. Primary and secondary outcome measures The barriers, enablers and experiences of delivering T2DM care for people with SMI, informed by the Theoretical Domains Framework (TDF). Results Responders were 273 HCPs, primarily mental health nurses (33.7%) and psychiatrists (32.2%). Only 25% of respondents had received training in managing T2DM in people with SMI. Mental health professionals felt responsible for significantly fewer recommended diabetes care standards than physical health professionals (p<0.001). For those seeing diabetes care as part of their role, the significant barriers to its delivery in the regression analyses were a lack of knowledge (p=0.003); a need for training in communication and negotiation skills (p=0.04); a lack of optimism about the health of their clients (p=0.04) and their ability to manage T2DM in people with SMI (p=0.003); the threat of being disciplined (p=0.02); fear of working with people with a mental health condition (p=0.01); a lack of service user engagement(p=0.006) and a need for incentives (p=0.04). The significant enablers were an understanding of the need to tailor treatments (p=0.04) and goals (p=0.02) for people with SMI. Conclusions This survey indicates that despite current guidelines, diabetes care in mental health settings remains peripheral. Even when diabetes care is perceived as part of a HCP’s role, various individual and organisational barriers to delivering recommended T2DM care standards to people with SMI are experienced

Psychosocial interventions for improving quality of life outcomes in adults undergoing strabismus surgery (Protocol)

This is the protocol for a review and there is no abstract. The objectives are as follows: To investigate the effects of psychosocial interventions versus no intervention on quality of life and psychosocial outcomes in adults undergoing strabismus surgery. The primary objective is to assess whether patients who have taken part in a sychosocial intervention prior to their strabismus surgery report significantly improved quality of life compared to those who receive standard care,i.e. strabismus surgery alone. The secondary outcome measures will include anxiety, depression, social anxiety and social avoidance, as well as degree of success in terms of surgical outcome

Hemodialysis Self-management Intervention Randomized Trial (HED-SMART): A Practical Low-Intensity Intervention to Improve Adherence and Clinical Markers in Patients Receiving Hemodialysis

Background: Poor adherence to treatment is common in hemodialysis patients. However, effective interventions for adherence in this population are lacking. Small studies of behavioral interventions have yielded improvements, but clinical effectiveness and long-term effects are unclear. Study Design: Multicenter parallel (1:1) design, blinded cluster-randomized controlled trial. Setting & Participants: Patients undergoing maintenance hemodialysis enrolled in 14 dialysis centers. Intervention: Dialysis shifts of eligible patients were randomly assigned to either an interactive and targeted self-management training program (HED-SMART; intervention; n = 134) or usual care (control; n = 101). HED-SMART, developed using the principles of problem solving and social learning theory, was delivered in a group format by health care professionals over 4 sessions. Outcomes & Measurements: Serum potassium and phosphate concentrations, interdialytic weight gains (IDWGs), self-reported adherence, and self-management skills at 1 week, 3 months, and 9 months postintervention. Results: 235 participants were enrolled in the study (response rate, 44.2%), and 82.1% completed the protocol. IDWG was significantly lowered across all 3 assessments relative to baseline (P < . 0.001) among patients randomly assigned to HED-SMART. In contrast, IDWG in controls showed no change except at 3 months, when it worsened significantly. Improvements in mineral markers were noted in the HED-SMART arm at 3 months (P < . 0.001) and in potassium concentrations (P < . 0.001) at 9 months. Phosphate concentrations improved in HED-SMART at 3 months (P = 0.03), but these effects were not maintained at 9 months postintervention. Significant differences between the arms were found for the secondary outcomes of self-reported adherence, self-management skills, and self-efficacy at all time points. Limitations: Low proportion of patients with diabetes. Conclusions: HED-SMART provides an effective and practical model for improving health in hemodialysis patients. The observed improvements in clinical markers and self-report adherence, if maintained at the longer follow-up, could significantly reduce end-stage renal disease-related complications. Given the feasibility of this kind of program, it has strong potential for supplementing usual care. Trial Registration: Registered at ISRCTN with study number ISRCTN31434033