The chronic disease management model for depression in primary care

Objective: This paper reviews the development of chronic disease management approaches, and explores the suitability and effectiveness of these ways of organizing care for depression. Method: The relevant literature including systematic reviews, service evaluations, and clinical guidelines have been appraised to provide a review of the development of health care management approaches for long term conditions and their application to depression. Results: The chronic care model originally developed in the USA has been successfully adopted in other countries, and has been applied to the management of depression in primary care. This multicomponent approach involves enhanced collaboration between primary and secondary care clinicians often by means of case managers, support for improved patient self-management, and systematic follow-up. These approaches to health care organization significantly enhance the quality of care for depression: reviews consistently show improvements in depression severity, treatment adherence, and patient satisfaction. Conclusions: There appears value in the continued use of chronic disease management approaches for depression in primary care. For depression alone and depression combined with medical conditions there is consistent evidence for beneficial effects on depression outcomes. However there remain challenges in tailoring these approaches to influence physical outcomes in patients with medical comorbidity

Sex Trafficking: Explanations and Suggested Solutions

This thesis employs framing theory (Goffman 1974) to analyze interviews with sex workers and three groups of service providers experienced with sex trafficking: (1) law enforcement officials, (2) social service agents, and (3) health care providers. The data set, \u27International and Domestic Trends in Sex Trafficking of Women in the United States, 1999-2000,\u27 was collected in 2000 by Dr. Donna Hughes and Dr. Janice Raymond and entails verbatim interviews on various topics regarding sex trafficking including explanations for occurrence and solutions for combating sex trafficking in the United States. Framing theory was used to analyze the diagnostic and prognostic frames for variation between and within groups and measure the consistency of solutions and explanations. I find that the dominant diagnostic frame was a financial frame, whereas the dominant prognostic frame was a need for law change. Groups vary somewhat in their articulation of frames. Moreover, the prognostic frames do not coordinate with diagnostic frames. In other words, suggested solutions do not match perceived explanations. This thesis adds to the current literature on sex trafficking as it introduces a new perspective for explaining the occurrence of domestic and international sex trafficking, while offering solutions for combating the practice in the United States

Mood disorders in primary care

The majority of patients with mental health problems are treated solely within primary care. This article discusses the epidemiology, diagnosis, and management of mood disorders in primary care. Factors influencing recognition, the use of screening instruments, and somatization are discussed. The article also outlines the latest recommendations for the management of depression in primary care using a stepped care model

Experience of primary care services among early adolescents in England and association with health outcomes

This document is the Accepted Manuscript version of the following article: Arrash A. Yassaee, Dougal S. Hargreaves, Kayleigh Chester, Stephanie Lamb, Ann Hagell, and Fiona Brooks, Experience of Primary Care Services Among Early Adolescents in England and Associated with Health Outcomes, Journal of Adolescent Health, Vol. 60 (4): 388-394, first published 1 December 2016. This manuscript version is made available under the CC-BY-NC-ND 4.0 license http://creativecommons.org/licenses/by-nc-nd/4.0/ The version of record is available online at doi: http://dx.doi.org/10.1016/j.jadohealth.2016.09.22 © 2016 Society for Adolescent Health and Medicine. All rights reserved.Purpose The aim of this study was to investigate adolescents' (11–15 years) experience of their general practitioner (GP), whether poor reported GP experience was associated with worse physical and mental health measures and whether poor previous GP experience was linked to lower utilization of these services. Methods We used logistic regression to analyze data from the 2014 Health Behaviour in School-aged Children study. Four aspects of recent care experience were studied: feeling at ease, feeling treated with respect, satisfaction with doctor's explanation, and feeling able to discuss personal matters. Five dichotomized measures of health status were used: ever self-harmed; fair or poor self-reported health; frequent (at least weekly) low mood; sleeping problems; or headaches. Results Of 5,335 students, 4,149 reported having visiting their GP within the past year. Of these, 91.8% felt treated with respect, 78.7% felt at ease, 85.7% were satisfied with explanation, and 53.9% felt able to discuss personal matters. After adjusting for ethnicity, age, gender, and family affluence score, poor experience on any indicator was strongly associated with increased risk of self-harm (adjusted odds ratio range, 2.01–2.70; all p < .001); feeling low (AOR range, 1.53–2.11; all p < .001); and sleeping problems (AOR range, 1.49–1.91; all p ≤ .001). Poor experience on all indicators, except discussing personal matters, was associated with worse self-reported health. Conclusions Nearly half of this large, national study of adolescents did not feel able to discuss personal matters with their doctor. There was a consistent, strong association between reported lack of good GP experience and poor health measures.Peer reviewedFinal Accepted Versio

Bond graph modeling of nuclear reactor dynamics. [PWR]

A tenth-order linear model of a pressurized water reactor (PWR) is developed using bond graph techniques. The model describes the nuclear heat generation process and the transfer of this heat to the reactor coolant. Comparisons between the calculated model response and test data from a small-scale PWR show the model to be an adequate representation of the actual plant dynamics. Possible application of the model in an advanced plant diagnostic system is discussed

GENOME-WIDESTUDIES OF AUTISM IDENTIFY ALTERED IMMUNOLOGIC AND NEURODEVELOPMENTAL PATHWAYS AND HIGHLIGHT PUTATIVE DIAGNOSTIC BIOMARKER SIGNALS

Autism is a complex neurodevelopmental syndrome that can be challenging to identify in young children. Family-based and genetic studies indicate that autism has a strong genetic component, though immunologic processes may also contribute to altered neurodevelopment. Over the past two decades, genome-wide investigations have provided critical insights into the genetic causes and molecular correlates of autism at the levels of both the individual and the population. Studies of DNA have identified highly penetrant genetic factors that appear to explain a sizable minority (20-40%) of autism-affected individuals. However, patho-developmental mechanisms are less-clearly understood for the remaining majority of individuals for whom no highly penetrant factors are identifiable(i.e., idiopathic autism). The present body of work contains three studies that used genome-wide assessment methods to predict the diagnosis of autism and to characterize its molecular correlates using samples that predominantly reflect idiopathic etiology. In Chapter 1, we demonstrate that large numbers of low-penetrance genetic factors(i.e., commonly varying single nucleotide polymorphisms; SNPs) can be harnessed with machine-learning methods to predict autism risk. Throughout this document, we provide a review and critical evaluation of DNA-and RNA-based autism biomarkers. In Chapters 2 and 3, we use microarray and RNA sequencing to identify consistent patterns of autism-related gene expression in peripheral blood samples. These patterns shed light on altered immunologic signaling and also implicate signaling pathways that are known to be involved in neurodevelopment and to influence autism-related clinical and neurobiological phenotypes. Importantly, our findings indicate that the molecular correlates of idiopathic autism may converge with mechanisms understood from high-penetrance genetic causes. Furthermore, our findings support the idea that immunologic mechanisms could contribute to perturbations of neurodevelopmental pathways. We integrate our findings in the context of existing literature, highlight current gaps in knowledge, and propose future experiments to address these questions.NAUpstate Medical UniversityNeuroscience and PhysiologyPh

Altered cardiac autonomic nervous function in depression

Background:Depression is an independent risk factor for coronary artery disease. Autonomic instability may play a mediating or moderating role in this relationship; however this is not well understood. The objective of this study was to explore cardiac autonomic function and cardiac arrhythmia in depression, the correlation between depression severity and Heart Rate Variability (HRV) related indices, and the prevalence of arrhythmia.Methods:Individuals (n&thinsp;=&thinsp;53) with major depression as assessed by the Diagnostic and Statistical Manual of Mental Disorders, who had a Hamilton Rating Scale for Depression (HAMD) score &ge;20 and a Zung Self-Rating Depression Scale score&thinsp;&gt;&thinsp;53 were compared to 53 healthy individuals, matched for age and gender. Multichannel Electrocardiograph ECG-92C data were collected over 24 hours. Long-term changes in HRV were used to assess the following vagally mediated changes in autonomic tone, expressed as time domain indices: Standard deviation of the NN intervals (SDNN), standard deviation of 5 min averaged NN intervals (SDANN), Root Mean Square of the Successive Differences (RMSSD) and percentage of NN intervals&thinsp;&gt;&thinsp;50 ms different from preceding interval (pNN50). Pearson&rsquo;s correlations were conducted to explore the strength of the association between depression severity (using the SDS and HRV related indices, specifically SDNN and low frequency domain / high frequency domain (LF/HF)).Results:The values of SDNN, SDANN, RMSSD, PNN50 and HF were lower in the depression group compared to the control group (P&lt;.05). The mean value of the LF in the depression group was higher than the in control group (P&lt;.05). Furthermore the ratio of LF/HF was higher among the depression group than the control group (P&lt;.05). A linear relationship was shown to exist between the severity of the depression and HRV indices. In the depression group, the prevalence of arrhythmia was significantly higher than in the control group (P&lt;.05), particularly supraventricular arrhythmias.Conclusions:Our findings suggest that depression is accompanied by dysfunction of the cardiac autonomic nervous system, and further, that depression severity is linked to severity of this dysfunction. Individuals with depression appear to be susceptible to premature atrial and/or ventricular disease