Cost-effectiveness of collaborative care for chronically ill patients with comorbid depressive disorder in the general hospital setting, a randomised controlled trial

Background. Depressive disorder is one of the most common disorders, and is highly prevalent in chronically ill patients. The presence of comorbid depression has a negative influence on quality of life, health care costs, self-care, morbidity, and mortality. Early diagnosis and well-organized treatment of depression has a positive influence on these aspects. Earlier research in the USA has reported good results with regard to the treatment of depression with a collaborative care approach and an antidepressant algorithm. In the UK 'Problem Solving Treatment' has proved to be feasible. However, in the general hospital setting this approach has not yet been evaluated. Methods/Design. CC: DIM (Collaborative Care: Depression Initiative in the Medical setting) is a two-armed randomised controlled trial with randomisation at patient level. The aim of the trial is to evaluate the treatment of depressive disorder in general hospitals in the Netherlands based on a collaborative care framework, including contracting, 'Problem Solving Treatment', antidepressant algorithm, and manual-guided self-help. 126 outpatients with diabetes mellitus, chronic obstructive pulmonary disease, or cardiovascular diseases will be randomised to either the intervention group or the control group. Patients will be included if they have been diagnosed with moderate to severe depression, based on the DSM-IV criteria in a two-step screening method. The intervention group will receive treatment based on the collaborative care approach; the control group will receive 'care as usual'. Baseline and follow-up measurements (after 3, 6, 9, and 12 months) will be performed by means of questionnaires. The primary outcome measure is severity of depressive symptoms, as measured with the PHQ-9. The secondary outcome measure is the cost-effectiveness of these treatments according to the TiC-P, the EuroQol and the SF-36. Discussion. Earlier research has indicated that depressive disorder is a chronic, mostly recurrent illness, which tends to cluster with physical comorbidity. Even though the treatment of depressive disorder based on the guidelines for depression is proven effective, these guidelines are often insufficiently adhered to. Collaborative care and 'Problem Solving Treatment' will be specifically tailored to patients with depressive disorders and evaluated in a general hospital setting in the Netherlands

Genetic Differences in the Immediate Transcriptome Response to Stress Predict Risk-Related Brain Function and Psychiatric Disorders

Depression risk is exacerbated by genetic factors and stress exposure; however, the biological mechanisms through which these factors interact to confer depression risk are poorly understood. One putative biological mechanism implicates variability in the ability of cortisol, released in response to stress, to trigger a cascade of adaptive genomic and non-genomic processes through glucocorticoid receptor (GR) activation. Here, we demonstrate that common genetic variants in long-range enhancer elements modulate the immediate transcriptional response to GR activation in human blood cells. These functional genetic variants increase risk for depression and co-heritable psychiatric disorders. Moreover, these risk variants are associated with inappropriate amygdala reactivity, a transdiagnostic psychiatric endophenotype and an important stress hormone response trigger. Network modeling and animal experiments suggest that these genetic differences in GR-induced transcriptional activation may mediate the risk for depression and other psychiatric disorders by altering a network of functionally related stress-sensitive genes in blood and brain

Prevention of antler growth in deer : a thesis presented in partial fulfilment of the requirements for the degree of Master in Veterinary Clinical Science at Massey University

The behavioural measures of 31 red and 39 fallow deer yearlings prior to, during and following application of rubber ring to prevent antler growth were determined. Animals were mechanically or manually restrained and treated according to their random allocation to one of the following groups: control (C), local anaesthesia only(LC), local anaesthesia and rubber ring application (LR) , rubber ring application only(R). In a further field trial 45 yearling red deer stags and 84 yearling fallow bucks were randomly allocated to control or rubber ring application. In both studies the development of the pedicle/antler post treatment was examined at intervals to investigate the percentage of loss of pedicle/antler due to the treatment and to detect possible side effects of the treatment. In red deer during the first three hours post treatment a significant increase in walking, standing and feeding and a decrease in lying were seen in the R group. Twenty minutes after treatment the R group showed a significantly higher frequency of scratching. In fallow deer a significant increase in frequency of ear flicks was observed in the R group until six hours post treatment. Other activities (walking,standing, lying) varied significantly at some time periods but no consistent patterns were observed. In both species a substantial reduction of the pedicle/antler could be observed two to four weeks after application of rubber rings. However, the loss of distal parts of the pedicle/antler varied in percentage and time until the loss. A rate of 38-100% regrowth occurred in the first study in fallow and red deer, respectively. In red deer the application of rubber rings stopped further antler growth in 36 of 37 stags thirty days after treatment. The loss of pedicle/antler occurred in 60-66.7%. In fallow deer 93% pedicle/antler loss occurred in bucks. A rate of 10 % regrowth occurred. No infections or other untoward side effects of the treatment were seen

Programm des Königlichen Gymnasiums zu Weilburg : für d. Schuljahr ...

Hauptsacht. bis 1874/75: ProgrammZusatz bis 1874/75: mit welchem zu der ... stattfindenden öffentlichen Prüfung und Schulfeier des Königlichen Gymnasiums zu Weilburg ergebenst einlade

Fürstlich- Nassau-Saarbrücken-Weilburgische Feuer-Bau- und Brand-Concurrentz-Ordnung 1751 : [So geschehen Kirchheim den 17ten April. 1751.]

[Carl August, Fürst zu Nassau]Autopsie nach Ex. der ULB Sachsen-AnhaltVorlageform des Erscheinungsvermerks: Wetzlar, Gedruckt bey Nicolaus Ludwig Winckler. - Erscheinungsjahr nach der Datierung im Titel bestimm

Industrielle Fertigung von Quarzfasern Erfolgskontrollbericht. Laufzeit: 1.1.1982-31.12.1984

SIGLETIB: D.Dt.F./AC 1000 (24,18) / FIZ - Fachinformationszzentrum Karlsruhe / TIB - Technische InformationsbibliothekDEGerman