Improving Mild to Moderate Depression With an App-Based Self-Guided Intervention: Protocol for a Randomized Controlled Trial

Background: Depression is one of the most prevalent mental disorders and frequently co-occurs with other mental disorders. Despite the high direct and indirect costs to both individuals and society, more than 80% of those diagnosed with depression remain with their primary care physician and do not receive specialized treatment. Self-guided digital interventions have been shown to improve depression and, due to their scalability, have a large potential public health impact. Current digital interventions often focus on specific disorders, while recent research suggests that transdiagnostic approaches are more suitable. Objective: This paper presents the protocol for a study that aims to assess the efficacy of a self-guided transdiagnostic app-based self-management intervention in patients with mild or moderate depression with and without comorbid mental disorders. Specifically, we are investigating the impact of the intervention on symptoms of depression, quality of life, anxiety symptoms, and mental health–related patient empowerment and self-management skills. Methods: The intervention under investigation, MindDoc with Prescription, is a self-guided digital intervention aimed at supporting individuals with mild to moderate mental disorders from the internalizing spectrum, including depression. The app can be used as a low-threshold psychosocial intervention. Up to 570 adult patients will be randomized to either receive the intervention in addition to care as usual or only care as usual. We are including adults with a permanent residency in Germany and mild or moderate depression according to International Classification of Diseases, 10th Revision, criteria (F32.0, F32.1, F33.0, and F33.1). Clinical interviews will be conducted to confirm the diagnosis. Data will be collected at baseline as well as 8 weeks and 6 months after randomization. The primary outcome will be depression symptom severity after 8 weeks. Secondary outcomes will be quality of life, anxiety symptom severity, and patient empowerment and self-management behaviors. Data will be analyzed using multiple imputations, using the intention-to-treat principle, while sensitivity analyses will be based on additional imputation strategies and a per-protocol analysis. Results: Recruitment for the trial started on February 7, 2023, and the first participant was randomized on February 14, 2023. As of September 5, 2023, 275 participants have been included in the trial and 176 have provided the primary outcome. The rate of missing values in the primary outcome is approximately 20%. Conclusions: Data from this efficacy trial will be used to establish whether access to the intervention is associated with an improvement in depression symptoms in individuals diagnosed with mild or moderate depression. The study will contribute to expanding the evidence base on transdiagnostic digital interventions. Trial Registration: German Registry of Clinical Trials DRKS00030852; https://drks.de/search/de/trial/DRKS0003085

Entwicklung regionaler Vermarktungsstrategien gefährdeter Tomatensorten in NRW, Deutschland

Four old and endangered tomato cultivars were cultivated in a greenhouse under organic conditions. With an average yield between 10 to 12 kg m-2, these old cultivars can compete with those tomato cultivars currently dominating the organic market. New marketing strategies were developed, tested in focus groups and offered on the re-gional market in organic shops and in a staff canteen. Both a coloured tomato basket and a mixed tomato fruit salad were positively evaluated by the consumers. Short distribution distances, preserving biodiversity and organic production were important preference factors for the consumers

Fledermausschutz in Sachsen

Zahlreiche Aktivitäten begleiten die Aktion zum Schutz der Fledermäuse in Sachsen. Der Bevölkerung sollen mit diesem Faltblatt Informationen darüber vermittelt werden, wie jeder Einzelne am Erhalt und Ausbau von Fledermausquartieren mitwirken kann

Tiergesundheitspläne in der Ökologischen Legehennenhaltung

Über zwei Jahre (2006 – 2008) wurde der Gesundheitsstatus von Legehennen auf 20 ökologisch wirtschaftenden Betrieben evaluiert, um betriebsspezifische Tiergesundheitspläne zu erstellen. Gesucht wurden Gesundheitsindikatoren, die zuverlässig zu erheben sind und das Tiergesundheitsmanagement unterstützen. Weiterhin sollten sie das Benchmarking verschiedener Legehennenherden ermöglichen. Als sehr relevante Gesundheitsparameter wurden der Befiederungszustand, Verletzungen am Körper und Fussballenabszesse herangezogen. Analysen auf Endoparasiten wurden für jede Herde durchgeführt sowie der Vogelmilbenbefall ermittelt. In einem Interviewgespräch wurden die gesundheitsrelevanten Haltungsdaten abgefragt. Aufbauend auf diesen Ergebnissen wurden betriebsindividuelle Tiergesundheitspläne implementiert, in denen Maßnahmen und Ziele mit den Betriebsleitern zusammen erarbeitet wurden. Ziel war es, mit regelmäßigen Kontrollen und deren nachvollziehbaren Dokumentation die Häufigkeit der auftretenden Probleme zu minimieren. Hier zeigten die Tiergesundheitspläne den Betriebsleitern umsetzbare Ansätze. Im Bereich von Futteraufnahme-, Tiergewichts-, Befallskontrolle Endo- und Ektoparasiten und daraus abgeleitete Umsetzungen gab es wichtige Felder der Optimierung. Es zeigte sich, dass ein nachhaltiger Erfolg zur Verbesserung der Tiergesundheit auf betrieblicher Ebene nur durch einen fortlaufenden, intensiven Austausch zwischen Betriebsleitern und Tiergesundheitsberatern erreicht werden kann. Gemeinsam sind praxistaugliche Maßnahmen mit Erfolgskontrollen weiterzuentwickeln, da laufend wechselnde Rahmenbedingungen und damit verbundene Problemfelder auftreten. Für die Akzeptanz von Tiergesundheitsplänen auf den Betrieben wäre es von Bedeutung, die ökonomischen Auswirkungen durch die erreichten Tiergesundheitsziele aufzuzeigen

Gesundheitserhebung bei Legehennen zur Verbesserung der Tiergesundheit durch Implementierung von Tiergesundheitsplänen

This study was implemented to improve animal health of laying hens on organic farms. 20 farms were selected and animal health was evaluated. The farmers were inter-viewed about the housing system and management practices. Health and behavioural problems of the herd, as well as the incidence of endo- and ectoparasites were as-sessed. Housing facilities were evaluated and potential causes of health problems noted. Most of the farms have problems with damaged plumage and with the red mite (Dermanyssus gallinae). In most cases farmers know about these problems, but the reasons are difficult to find. This was the next step within the project (results not shown). Potential causes of problems were identified and farm specific animal health plans implemented to improve the animal health status on the farms

Die Verzerrung von Erinnerungen durch das Vorwissen der Befragten: die Rolle impliziter Theorien

'Implizite Theorien sind schematische Wissenstrukturen über die Stabilität oder die Veränderbarkeit von Merkmalen (Ross 1989). Diese Theorien haben die Funktion, Gedächtnislücken zu füllen, wenn eine genaue Erinnerung nicht möglich ist. Wenn sie jedoch nicht mit der Realität übereinstimmen, führen implizite Theorien zu systematischen Erinnerungsverzerrungen. Es wurde davon ausgegangen, daß Patienten nach einer Operation einen monotonen Genesungsverlauf im Hinblick auf Schmerzen und Schlaf erwarten, und daß diese implizite Theorie die Erinnerung beeinflußt. Sechzig Patienten wurden an fünf aufeinanderfolgenden Tagen im Anschluß an eine orthopädische Operation nach ihren Schmerzen und dem Schlaf der letzten Nacht befragt: am fünften Tag sollten sie sich an ihre Antworten der vergangenen vier Tage erinnern. Es traten systematische Erinnerungsverzerrungen auf. Der Befindlichkeits zustand des ersten Tages wurde in der Erinnerung unterschätzt. In der Erinnerung gab es mehr monotone Verläufe als im täglichen Bericht, Rückfälle im Genesungsprozeß wurden systematisch vergessen. Korrekte implizite Theorien können aber auch zuverlässig Erinnerungslücken schließen. Personen mit monotonen Genesungsverläufen zeigten eine bessere Erinnerungsleistung als Personen, in deren Genesungsverlauf Rückfälle aufgetreten waren.' (Autorenreferat)'Implicit theories are defined as schematic structures of knowledge about the stability or change of characteristics (Ross 1989). These theories can be used to fill in gaps in recall when memory fails. However, if an implicit theory is incorrect, it may lead to a systematic bias in recall. We hypothesized that patients expect a linear improvement in pain and sleep after an operation so that this implicit theory influences subsequent recall of pain and sleep quality. Sixty surgical patients were asked to rate their pain intensity and sleep quality on each of the 5 days following their operation. On day 5 they were also asked to recall their previous ratings. The recall errors we observed were systematic: The recalled health status of the first post-operative day was worse than the actual reported status. Improvement was recalled more often monotonously than actually reported. Setbacks and relapses in recovery over the the 5-day period tended to be systematically forgotten. On the other hand, correct implicit theories can help to fill recall gaps. Our results suggest that patients whose condition improves linearly post-operatively recalled their ratings more accurately than patients with non-linear patterns of recovery.' (author's abstract)

Konzeptioneller und empirischer Vergleich zweier Instrumente zur Bindungsmessung

Clashausen U, Grau I, Höger D. Konzeptioneller und empirischer Vergleich zweier Instrumente zur Bindungsmessung. Bielefelder Arbeiten zur Sozialpsychologie, 193. Bielefeld: Univ. Bielefeld, Fak. für Soziologie; 2000

Survey of Long-Term Experiences of Sperm Cryopreservation in Oncological and Non-Oncological Patients: Usage and Reproductive Outcomes of a Large Monocentric Cohort

Progress in oncological treatment has led to an improved long-term survival of young male cancer patients over the last decades. However, standard cancer treatments frequently implicate fertility-damaging potential. Cryopreservation of sperm is the current standard option to preserve patient's fertility after treatment, yet long-term data on usage and reproductive experiences is still limited. Natural fertility after treatment and especially in relation to the type of treatment has been poorly analyzed so far. Therefore, we performed a retrospective survey including male patients with an indication for gonadotoxic treatment who cryopreserved reproductive material at our institution between 1994 and 2017. Study questionnaires regarding treatment, material usage, and reproductive outcomes were sent to eligible patients. Additionally, semen analyses of study participants from the time of cryopreservation were evaluated. A total of 99 patients were included in the study. Respondents' median age was 38.0 years. Most frequent diagnoses were testicular cancer (29.3%) and lymphoma (26.3%). A further 8.1% suffered from autoimmune diseases. Testicular cancer patients had a significantly lower pre-treatment median sperm concentration (18.0 million/ml) compared to non-testicular cancer patients (54.2 million/ml). Until November 2020, the determined sperm usage and cumulative live-birth rate per couple were 17.2% and 58.8%, respectively. Most sperm users received treatments with high (40.0%) or intermediate (33.3%) gonadotoxic potential. 20.7% of all patients reported to had fathered at least one naturally conceived child after treatment, this being the case especially if they had been treated with less or potentially gonadotoxic therapies. In conclusion, our findings emphasize the importance of sperm cryopreservation in the context of male fertility preservation. Furthermore, they indicate that the gonadotoxic potential of patients' treatments could represent a predictive factor for sperm usage