Clinical effectiveness of online computerised cognitive-behavioural therapy without support for depression in primary care: randomised trial

BACKGROUND: Computerised cognitive-behavioural therapy (CCBT) might offer a solution to the current undertreatment of depression. AIMS: To determine the clinical effectiveness of online, unsupported CCBT for depression in primary care. METHOD: Three hundred and three people with depression were randomly allocated to one of three groups: Colour Your Life; treatment as usual (TAU) by a general practitioner; or Colour Your Life and TAU combined. Colour Your Life is an online, multimedia, interactive CCBT programme. No assistance was offered. We had a 6-month follow-up period. RESULTS: No significant differences in outcome between the three interventions were found in the intention-to-treat and per protocol analyses. CONCLUSIONS: Online, unsupported CCBT did not outperform usual care, and the combination of both did not have additional effects. Decrease in depressive symptoms in people with moderate to severe depression was moderate in all three interventions. Online CCBT without support is not beneficial for all individuals with depressio

Visual determinants of reduced performance on the Stroop Color-Word test in normal aging individuals.

It is unknown to what extent the performance on the Stroop color-word test is affected by reduced visual function in older individuals. We tested the impact of common deficiencies in visual function (reduced distant and close acuity, reduced contrast sensitivity, and color weakness) on Stroop performance among 821 normal individuals aged 53 and older. After adjustment for age, sex, and educational level, low contrast sensitivity was associated with more time needed on card 1 (word naming), red/green color weakness with slower card 2 performance (color naming), and reduced distant acuity with slower performance on card 3 (interference). Half of the age-related variance in speed performance was shared with visual function. The actual impact of reduced visual function may be underestimated in this study when some of this age-related variance in Stroop performance is mediated by visual function decrements. It is suggested that reduced visual function has differential effects on Stroop performance which need to be accounted for when the Stroop test is used both in research and in clinical settings. Stroop performance measured from older individuals with unknown visual status should be interpreted with caution

Mild hearing impairment can reduce verbal memory performance in a healthy adult population.

We studied to what extent immediate and delayed recall in an auditory verbal learning paradigm was affected by basic information processing speed (digit copying) and hearing acuity (average hearing acuity at 1, 2 and 4 KHz at the better ear). A group of 453 individuals in the age between 23 and 82 years with no overt hearing pathology was recruited from a larger study of cognitive aging (Maastricht Aging Study, MAAS). After controlling for age, sex, educational level, and processing speed it was found that a mild to moderate hearing loss predicted lower verbal memory performance. Auditory administered verbal memory tests can underestimate true memory performance, particularly in older individuals with unknown hearing status. Short-term and long-term memory function is generally assessed in clinical practice by using multi-trial word learning tests, such as the Buschke selective reminding paradigm, the Rey Auditory Verbal Learning Test and the Califor-nia Verbal Learning Test (Lezak, 1995). In suc

Development of out-of-hours primary care by general practitioners (GPs) in The Netherlands: from small-call rotations to large-scale GP cooperatives.

Contains fulltext : 51273.pdf ( ) (Open Access)BACKGROUND: Over the last 10 years, care outside office hours by primary care physicians in The Netherlands has experienced a radical change. While Dutch general practitioners (GPs) formerly performed these services in small-call rotations, care is nowadays delivered by large-scale GP cooperatives. METHODS: We searched the literature for relevant studies on the effect of the out-of-hours care reorganization in The Netherlands. We identified research that included before- and afterintervention studies, descriptive studies, and surveys. These studies focused on the consequences of reorganizing several aspects of out-of-hours care, such as patient and GP satisfaction, patient characteristics, utilization of care, and costs. RESULTS: Various studies showed that the reorganization has successfully addressed many of the critical issues that Dutch GPs were confronted with delivering these services. GPs' job satisfaction has increased, and patients seem to be satisfied with current out-of-hours care. DISCUSSION: Several aspects of out-of-hours care are discussed, such as telephone triage, self referrals, and future expectations, which should receive extra attention by researchers and health policy makers in the near future

Chronic low back pain in primary care: a prospective study on the management and course

Background. There is little evidence about the management and course of chronic low back pain in primary care. Objectives. Our aim was to describe the course of chronic low back pain and the performed diagnostic and therapeutic procedures for patients with chronic low back pain in general practice. Methods. Twenty-six GPs involved in the Registration Network Family Practices participated in this prospective follow-up study. All patients and GPs were asked to complete questionnaires at baseline and at 4, 8 and 12 months follow-up. Results. The GPs provided information about diagnostic and therapeutic procedures concerning 524 patients with chronic low back pain. Diagnostic tests other than history-taking and physical examination were not frequently used. Medication, mostly NSAIDs, was the most frequently used type of treatment (21.6%). The most frequent referrals concerned physiotherapy (16.3%) and neurology or neurologic surgery (6.3%). Information about the course of their chronic low back pain was provided by 368 patients participating in our study. The course of chronic low back pain appeared to be quite stable, as there was only a slight improvement in pain intensity and physical functioning over the 12 months of follow-up. Conclusions. A variety of options for the treatment and referral of chronic low back pain patients is available for and used by GPs. Efforts should be made to establish which diagnostic and therapeutic procedures are the most effective for chronic low back pain