Doing more with less : concise and standard treatment for depressive and anxiety disorders compared in clinical practice

  In this thesis the effectiveness of concise formats of psycho- and/or pharmacotherapy (concise care) in patients suffering from mild to moderate depressive and anxiety disorders in secondary mental health care is evaluated. A pragmatic randomised controlled equivalence trial was set up and carried out as part of routine clinical practice. Evidence for equivalence of concise care compared with standard care was found. Severity of illness was reduced and general health status and subdomains of quality of life improved in both conditions. Moreover, in concise care, the beneficial effects started earlier and patients were more satisfied with overall treatment than patients in standard care. No significant differences in healthcare costs between both treatments were found. In addition, patients suffering from any anxiety disorder (without comorbid depressive disorder) benefitted less from concise care than from standard care. No other clinical or demographic factors were associated with differential treatment effects. Exploring the agreement between a brief screening questionnaire (the Web Screening Questionnaire (WSQ)), and the gold standard diagnostic interview MINI-Plus, reveals that the WSQ is a good screening tool for depressive and anxiety disorders in clinical practice and it might be a further step in the economization and optimization of mental healthcare.  LUMC / Geneeskund

Improving mental health and social participation outcomes in older adults with depression and anxiety: Study protocol for a randomised controlled trial

Background Increasing both the frequency and quality of social interactions within treatments for anxiety and depressive disorders in older adults may improve their mental health outcomes and quality of life. This study aims to evaluate the clinical efficacy and cost utility of an enhanced cognitive behavioural therapy (CBT) plus social participation program in a sample of older adults with depression and/or anxiety. Methods A total of 172 community-dwelling adults aged 65 years or older with an anxiety and/or depressive disorder will be randomly allocated to either an enhanced CBT plus social participation program (n = 86) or standard CBT (n = 86). Both treatments will be delivered during 12 weekly individual sessions utilising structured manuals and workbooks. Participants will be assessed at pre-treatment, post-treatment, and 12-month follow-up. The primary outcome evaluates mean change in clinician-rated diagnostic severity of anxiety and depressive disorders from baseline to post-treatment (primary endpoint) based on a semi-structured diagnostic interview. Secondary outcomes evaluate changes in symptomatology on self-report anxiety and depression measures, as well as changes in social/community participation, social network, and perceived social support, loneliness, quality of life, and use of health services. Economic benefits will be evaluated using a cost-utility analysis to derive the incremental cost utility ratios for the enhanced CBT program. Discussion Outcomes from this study will provide support for the establishment of improved psychosocial treatment for older adults with anxiety and/or depression. Study outcomes will also provide health systems with a clear means to reduce the impact of poor emotional health in older age and its associated economic burden. In addition to the empirical validation of a novel treatment, the current study will contribute to the current understanding of the role of social participation in older adult wellbeing

Defect structure and charge transport in solid solutions Ba

In this paper we have investigated the defect structure and the charge-transport properties of solid solutions of the type Ba1-xLaxF2+x. The defect structure has been studied by means of samples which had been doped slightly with trivalent gadolinium ions. These probes have been employed to investigate the surrounding crystal lattice, which contains in some cases large amounts of trigonal La3+-Fi- dipoles. It appears that the Gd3+ impurities do not participate in an eventual clustering process, because we have not observed EPR signals with significant intensities which can be assigned to clusters. In the solid solutions studied in this paper we have observed two different dipolar defects: (a) the nearest-neighbor (NN) or tetragonal La3+-Fi- dipole and (b) the nextnearest-neighbor (NNN) or trigonal La3+-Fi- dipole, the latter being the more dominant defect. The concentration ratio of the NN and NNN dipoles varies with the concentration of La3+ ions in the sample. With increasing La3+ concentration the above-mentioned ratio changes in favor of the NNN dipoles. In our ionic thermocurrent experiments on the system Ba1-xLaxF2+x we have observed three peaks: a weak one at about 137 K, which is associated with NN dipoles; a stronger one at about 190 K, which is due to NNN complexes; and a very strong one, which shifts to lower temperatures with increasing values of x. This strong peak is due to space charges which are produced by the polarizing field. The conductivity mechanism will be discussed in terms of the two-jump mechanism proposed in an earlier paper. In the range of low concentrations the eventual role of monovalent cations and oxide impurities is discussed. In order to obtain more information about the defect structure of the solid solutions Ba1-xLaxF2+x, we have investigated the development of the linewidth of the different resonances observed for trigonal Gd3+ probes which had been introduced into the samples. The observations have been analyzed, and it has been concluded that the Gd3+ probes are perturbed by distant La3+-Fi- dipoles. The broadening of the EPR lines will be calculated using a statistical model; the electrostatic interactions of the dipoles are found to shift the fine lines of the Gd3+ probes. The theoretical model employed here is found to give reasonable agreement with the experimental results

Field-friendly anti-PGL-I serosurvey in children to monitor Mycobacterium leprae transmission in Bihar, India

Background It has been amply described that levels of IgM antibodies against Mycobacterium leprae (M. leprae) phenolic glycolipid I (PGL-I) correlate strongly with the bacterial load in an infected individual. These findings have generated the concept of using seropositivity for antibodies against M. leprae PGL-I as an indicator of the proportion of the population that has been infected. Although anti-PGL-I IgM levels provide information on whether an individual has ever been infected, their presence cannot discriminate between recent and past infections. Since infection in (young) children by definition indicates recent transmission, we piloted the feasibility of assessment of anti-PGL-I IgM seroprevalence among children in a leprosy endemic area in India as a proxy for recent M. leprae transmission.Material and methods A serosurvey for anti-PGL-I IgM antibodies among children in highly leprosy endemic villages in Bihar, India, was performed, applying the quantitative anti-PGL-I UCP-LFA cassette combined with low-invasive, small-volume fingerstick blood (FSB).Results Local staff obtained FSB of 1,857 children (age 3-11 years) living in 12 leprosy endemic villages in Bihar; of these, 215 children (11.58%) were seropositive for anti-PGL-I IgM.Conclusion The anti-PGL-I seroprevalence level of 11.58% among children corresponds with the seroprevalence levels described in studies in other leprosy endemic areas over the past decades where no prophylactic interventions have taken place. The anti-PGL-I UCP-LFA was found to be a low-complexity tool that could be practically combined with serosurveys and was well-accepted by both healthcare staff and the population. On route to leprosy elimination, quantitative anti-PGL-I serology in young children holds promise as a strategy to monitor recent M. leprae transmission in an area.Immunogenetics and cellular immunology of bacterial infectious disease

Scale-up of Microwave Assisted Flow Synthesis by Transient Processing through Monomode Cavities in Series

A new scale-up concept for microwave assisted flow processing is presented where modular scale-up is achieved by implementing microwave cavities in series. The scale-up concept is demonstrated for case studies of a packed-bed reactor and a wall-coated tubular reactor. With known kinetics and reaction temperature, a packed-bed reactor gave a conversion of 99% with the highest production rate of 170 kgprod/kgcat·h for esterification of acetic acid and ethanol catalyzed by ion-exchange resin in 18 cavities. A similar approach for a multicomponent reaction of benzaldehyde, piperidine, and phenylacetylene catalyzed by a thin Cu film in a wall-coated tubular reactor gave 99% conversion with the highest production rate of 7740 kgprod/kgcat·h in 28 cavities. In both cases, the pseudo first order reaction rate with respect to the limiting reactant yielded a typical rise in conversion and production rate. In a packed-bed reactor-heat exchanger operated at a temperature between 343 and 348 K, the conversion in the esterification reaction increased from 22% to 88% when the number of cavities was increased from one to eight. The experimental conversions matched the predictions of a packed bed reactor model within 5%. The production capacity in flow reactors, restricted to smaller sizes due to a limited microwave penetration depth and dominated mainly by the reaction kinetics, was increased by modular scale-up with implementation of the microwave multicavity assembly