A qualitative study of primary care professionals’ views of case finding for depression in patients with diabetes or coronary heart disease in the UK

<p>Background Routinely conducting case finding (also commonly referred to as screening) in patients with chronic illness for depression in primary care appears to have little impact. We explored the views and experiences of primary care nurses, doctors and managers to understand how the implementation of case finding/screening might impact on its effectiveness.</p> <p>Methods Two complementary qualitative focus group studies of primary care professionals including nurses, doctors and managers, in five primary care practices and five Community Health Partnerships, were conducted in Scotland.</p> <p>Results We identified several features of the way case finding/screening was implemented that may lead to systematic under-detection of depression. These included obstacles to incorporating case finding/screening into a clinical review consultation; a perception of replacing individualised care with mechanistic assessment, and a disconnection for nurses between management of physical and mental health. Far from being a standardised process that encouraged detection of depression, participants described case finding/screening as being conducted in a way which biased it towards negative responses, and for nurses, it was an uncomfortable task for which they lacked the necessary skills to provide immediate support to patients at the time of diagnosis.</p> <p>Conclusion The introduction of case finding/screening for depression into routine chronic illness management is not straightforward. Routinized case finding/screening for depression can be implemented in ways that may be counterproductive to engagement (particularly by nurses), with the mental health needs of patients living with long term conditions. If case finding/screening or engagement with mental health problems is to be promoted, primary care nurses require more training to increase their confidence in raising and dealing with mental health issues and GPs and nurses need to work collectively to develop the relational work required to promote cognitive participation in case finding/screening.</p&gt

Validation of simple epidemiological or clinical methods for the measurement of body composition in young children

The present study aimed to determine the validity of simple epidemiological and clinical methods for the assessment of body fatness in preschool children. In 89 children (42 boys, 47 girls; mean age 4.1 SD 1.3y) measures of body fatness were made using total body water (TBW), dual energy x-ray absorptiometry (DXA), air displacement plethysmography (BODPOD) and skinfold thickness. Methods were compared by Bland–Altman analysis using TBW as the reference method, and by paired comparisons and rank order correlations. Bias for DXA was +1.8% body fat percentage units (limits of agreement +15.5% to -11.9%), bias for BODPOD was -3.5% (limits of agreement +18.9% to -5.9%) and bias for skinfolds using the Slaughter equations was -6.5% (limits of agreement +10.0% to –23.1%). Significant rank order correlations with TBW measures of fatness were obtained for DXA estimates of fatness (r=0.54, P=0.01), but not for estimates of fat by skinfold thickness (r=0.20, P=0.2) or BODPOD (r=0.25, P=0.1). Differences between both DXA and BODPOD and the reference TBW estimates of body fatness were not significant (P=0.06 and P=0.1 respectively); however, the difference in estimated body fatness between skinfold thickness and TBW was significant (P<0.001). Estimates of body fatness in preschool children were inaccurate at the level of the individual child using all the methods, but DXA might provide unbiased estimates and a means of making relative assessments of body fatness

Design and Performance of the Wide-Field X-Ray Monitor on Board the High-Energy Transient Explorer 2

The Wide-field X-ray Monitor (WXM) is one of the scientific instruments carried on the High Energy Transient Explorer 2 (HETE-2) satellite launched on 2000 October 9. HETE-2 is an international mission consisting of a small satellite dedicated to provide broad-band observations and accurate localizations of gamma-ray bursts (GRBs). A unique feature of this mission is its capability to determine and transmit GRB coordinates in almost real-time through the burst alert network. The WXM consists of three elements: four identical Xe-filled one-dimensional position-sensitive proportional counters, two sets of one-dimensional coded apertures, and the main electronics. The WXM counters are sensitive to X-rays between 2 keV and 25 keV within a field-of-view of about 1.5 sr, with a total detector area of about 350 cm$^2$. The in-flight triggering and localization capability can produce a real-time GRB location of several to 30 arcmin accuracy, with a limiting sensitivity of $10^{-7}$ erg cm$^{-2}$. In this report, the details of the mechanical structure, electronics, on-board software, ground and in-flight calibration, and in-flight performance of the WXM are discussed.Comment: 28 pages, 24 figure

HETE Observations of the Gamma-Ray Burst GRB030329: Evidence for an Underlying Soft X-ray Component

An exceptionally intense gamma-ray burst, GRB030329, was detected and localized by the instruments on board the High Energy Transient Explorer satellite (HETE) at 11:37:14 UT on 29 March 2003. The burst consisted of two \~10s pulses of roughly equal brightness and an X-ray tail lasting >100s. The energy fluence in the 30-400 keV energy band was 1.08e-4 erg/cm2, making GRB030329 one of the brightest GRBs ever detected. Communication of a 2 arcmin error box 73 minutes after the burst allowed the rapid detection of a counterpart in the optical, X-ray, radio and the ensuing discovery of a supernova with most unusual characteristics. Analyses of the burst lightcurves reveal the presence of a distinct, bright, soft X-ray component underlying the main GRB: the 2-10 keV fluence of this component is ~7e-6 erg/cm2. The main pulses of GRB030329 were preceded by two soft, faint, non-thermal bumps. We present details of the HETE observations of GRB030329.Comment: 22 pages, 5 figures, to be published in ApJ 617, no. 2 (10 December 2004). Referee comments have been incorporated; results of improved spectral analysis are include

HETE-2 Observation of two gamma-ray bursts at z > 3

GRB 020124 and GRB 030323 constitute half the sample of gamma-ray bursts with a measured redshift greater than 3. This paper presents the temporal and spectral properties of these two gamma-ray bursts detected and localized with HETE-2. While they have nearly identical redshifts (z=3.20 for GRB 020124, and z=3.37 for GRB 030323), these two GRBs span about an order of magnitude in fluence, thus sampling distinct regions of the GRB luminosity function. The properties of these two bursts are compared with those of the bulk of the GRB population detected by HETE-2. We also discuss the energetics of GRB 020124 and GRB 030323 and show that they are compatible with the Epeak - Eiso relation discovered by Amati et al. (2002). Finally, we compute the maximum redshifts at which these bursts could have been detected by HETE-2 and we address various issues connected with the detection and localization of high-z GRBs.Comment: 19 pages, 4 figures, submitted to Ap