Collaborative stepped care for anxiety disorders in primary care: aims and design of a randomized controlled trial

Background. Panic disorder (PD) and generalized anxiety disorder (GAD) are two of the most disabling and costly anxiety disorders seen in primary care. However, treatment quality of these disorders in primary care generally falls beneath the standard of international guidelines. Collaborative stepped care is recommended for improving treatment of anxiety disorders, but cost-effectiveness of such an intervention has not yet been assessed in primary care. This article describes the aims and design of a study that is currently underway. The aim of this study is to evaluate effects and costs of a collaborative stepped care approach in the primary care setting for patients with PD and GAD compared with care as usual. Methods/design. The study is a two armed, cluster randomized controlled trial. Care managers and their primary care practices will be randomized to deliver either collaborative stepped care (CSC) or care as usual (CAU). In the CSC group a general practitioner, care manager and psychiatrist work together in a collaborative care framework. Stepped care is provided in three steps: 1) guided self-help, 2) cognitive behavioral therapy and 3) antidepressant medication. Primary care patients with a DSM-IV diagnosis of PD and/or GAD will be included. 134 completers are needed to attain sufficient power to show a clinically significant effect of 1/2 SD on the primary outcome measure, the Beck Anxiety Inventory (BAI). Data on anxiety symptoms, mental and physical health, quality of life, health resource use and productivity will be collected at baseline and after three, six, nine and twelve months. Discussion. It is hypothesized that the collaborative stepped care intervention will be more cost-effective than care as usual. The pragmatic design of this study will enable the researchers to evaluate what is possible in real clinical practice, rather than under ideal circumstances. Many requirements for a high quality trial are being met. Results of this study will contribute to treatment options for GAD and PD in the primary care setting. Results will become available in 2011. Trial registration. NTR1071

RELATIONSHIP BETWEEN FRUIT AND VEGETABLE CONSUMPTION AND TYPE II DIABETES RISK FACTORS IN UNDERGRADUATE STUDENTS

K. Cosby, J. Amado, C. Kirkpatrick, T. Peña, W. M. Silvers Whitworth University, Spokane, WA The empirical evidence to support the impact of diet on type II diabetes mellitus (T2DM) has grown over the years, along with the use of anthropometric measurements to determine T2DM risk. Both overall diets and individual dietary components have been evaluated in regard to their respective impacts on T2DM risk. PURPOSE: The purpose of this study was to determine the relationship between fruit and vegetable consumption and T2DM risk factors in undergraduate students. METHODS: Forty-five undergraduate male and female students (age: 20.5 ± 1.3 y; ht: 172.9 ± 10.4 cm; wt: 71.1 ± 17.8 kg) participated via convenience sampling. Participants attended information sessions in order to review the informed consent. Each participant then signed a consent form and attended a single session for approximately 20 minutes. During each session, researchers conducted a 24-hour diet recall interview for the previous day that focused on fruit and vegetable intake. Each participant’s height in centimeters and weight in kilograms were measured with a Detecto Weight Beam Eye-Level Scale and Measure. Waist circumference was measured in centimeters with a flexible measurement tape. Pearson product-moment correlations were used to determine the correlations between BMI, WC, and fruit and vegetable consumption. RESULTS: Descriptive data included BMI (23.5 ± 4.0 kg/m2), WC (76.9 ± 10.7 cm), and cups of fruit and vegetables consumed (4.5 ± 3.1 cups). There was no correlation between WC and fruit and vegetable consumption (r = -0.062, p = 0.687) or BMI and fruit and vegetable consumption (r = -0.001, p = 0.730). CONCLUSIONS: No correlations were found between BMI, WC, and fruit and vegetable consumption. These results might have been due to limitations inherent to BMI (e.g. BMI does not account for muscle mass) or a sample population that consisted largely of females and Health Science majors, which was not representative of research university’s undergraduate population. Additionally, the use of a single day diet recall might have given an inaccurate representation of the participants’ overall diets (e.g. a participant could have eaten more fruits and vegetables than normal on the day the diet was recalled). Finally, WC and BMI might have been better indicators of T2DM risk for an older population (as shown through previous research), and a different indicator might have been needed (e.g. blood glucose levels) for a younger population. Future research should include a larger and more diverse sample population and a longer diet recall in order to determine if any correlations exist between the variables in the present study

Importance ofeps genes fromBacillus subtilis in biofilm formation and swarming

International audienceUnicellular organisms naturally form multicellular communities, differentiate into specialized cells, and synchronize their behaviour under certain conditions. Swarming, defined as a movement of a large mass of bacteria on solid surfaces, is recognized as a preliminary step in the formation of biofilms. The main aim of this work was to study the role of a group of genes involved in exopolysaccharide biosynthesis during pellicle formation and swarming in Bacillus subtilis strain 168. To assess the role of particular proteins encoded by the group of epsI-epsO genes that form the eps operon, we constructed a series of insertional mutants. The results obtained showed that mutations in epsJ-epsN, but not in the last gene of the eps operon (epsO), have a severe effect on pellicle formation under all tested conditions. Moreover, the inactivation of 5 out of the 6 genes analysed caused total inhibition of swarming in strain 168 (that does not produce surfactin) on LB medium. Following restoration of the sfp gene (required for production of surfactin, which is essential for swarming of the wild-type bacteria), the sfp+ strains defective in eps genes (except epsO) generated significantly different patterns during swarming on synthetic B medium, as compared to the parental strain 168 sfp+

VEROTILI – KÄYTTÖÖNOTON HAASTEELLISUUS

VEROTILI – KÄYTTÖÖNOTON HAASTEELLISUUS Opinnäytetyön tavoitteena oli tutkia mielipiteitä verotilistä sekä haasteita ja ongelmia, joita verotilijärjestelmän käyttöönotossa ilmeni käyttäjille, lähinnä pienyritysten näkökulmasta. Mielenkiintoinen tutkimuskysymys oli myös, miten yrittäjä sai informaatiota verotilijärjestelmästä ja selviytyy muutostilanteessa. Ongelmia ja haasteita tutkiessa on pyritty selvittämään myös sitä, mistä syystä nämä aiheutuivat. Tutkimuksessa on myös käsitelty, ovatko kyseiset asiat tiedostettu verohallinnossa ja millaisia muutosehdotuksia tai muutoksia on tähän mennessä tehty verotilijärjestelmään. Tutkimusaineistona käytettiin sekundaariaineistona yritysjärjestön teettämää kyselytutkimusta käyttäjille sekä muita lähteitä, kuten esimerkiksi verkkojulkaisuja sekä lehtiartikkeleita ja haastattelua. Kyselytutkimuksessa oli kysymyksiä, joihin oli valmiit vastausvaihtoehdot sekä kysymys mahdollisista haasteista ja ongelmista, johon saattoi vastata vapaasti. Tutkimuksessa yhdisteltiin sekä laadullisen että määrällisen tutkimuksen menetelmiä. Tutkimus osoittaa, että haasteita ja ongelmia on esiintynyt verotilijärjestelmään liittyen. Haasteet ja ongelmat saattavat olla yksilöllisiä, mutta pääosin ne ovat olleet yh-denmukaisia liittyen tunnistautumiseen sekä ilmoittamis- ja veronmaksun ajankohtiin. Oman ongelmansa ovat tuoneet veroista vähennettävät hyvitykset, miten niitä voi käyttää hyödykseen ja milloin. Pääosin verotilijärjestelmän käyttäjät pitävät järjestelmää entistä käytäntöä parempana ja byrokratiaa vähentävänä järjestelmänä, kun tietyt ongelmakohdat saadaan selvitettyä. Käyttöönotto tapahtui nopeasti lain vahvistamisen jälkeen tiukalla aikataululla, mikä tutkimuksen mukaan aiheutti eniten ongelmia verotilijärjestelmään siirryttäessä. Verotilijärjestelmän käyttäjät eivät saaneet tarpeeksi informaatiota järjestelmästä ennen siirtymistä, jotta olisivat voineet toimia, kuten järjestelmä edellyttää. Ohjeistus on ollut osin puutteellista, osin sekavaa. Tämä aiheutti ongelmia ja sekaannuksia, mikä on aiheuttanut lisätyötä sekä yrittäjille että verohallinnolle. Verotilijärjestelmässä ja Katso-tunnistautumisessa esiintyneet ongelmat toivat oman lisänsä ongelmiin. Tehdyn tutkimuksen perusteella voidaan sanoa, että verotilijärjestelmä ei ole vielä toiminut niin kuin odotettiin, eikä verotilijärjestelmän tavoitteisiin ole vielä kokonaisuudessaan päästy.THE TAX ACCOUNT – CHALLENGES OF INTRODUCTION ABSTRACT The objective of this thesis was to find out user’s opinions of the Tax Account system and also research challenges and problems, which appeared to using system, mainly perspective of small business companies. The interesting research question was how entrepreneurs and other small business companies got information from the Tax Account system and how they survived in situation of change. On researching challenges and problems has also tried to clarify which caused the problems. In the report has also handled, has the Tax Administration recognized these problems and what kind of changes or amendments has made concerning the Tax Account system so far. The research material consists of the inquiry as secondary material which business organization had made. The other research sources, which has used, were web publishings, journal articles and an interview. There were multiple questions in the inquiry which the answer alternatives had been ready defined and a question of possible challenges and problems in which man could answer openly with own words. Thus both quantitative and qualitative methods were combined in the research. The study shows that there have been challenges and problems in the introduction of the Tax Account system. The challenges and problems could be individuals, but mainly they have been consistent with the other sources. Most of problems are related to identification to Tax Account system and both report and tax payment timings. The own problem in the Tax Account system are those rebates which man can reduce from taxes; how man can use them and when. Most of users of the Tax Account system think that the new system is better than the old one and they also think that the new system reduces bureaucracy as the problems would be solved. After verifying the Tax Account Act was the introduction happened fast by tight timetable, which caused most of problems moving to the Tax Account system according to the study. The users of the Tax Account system don’t get enough information of the system before moving that they could act like the system demands. This caused problems and confusion, which again caused more work to companies and also to the Tax Administration. The problems in the Katso- identification and technical problems in the Tax Account system brought more problems. According to the study can it be said that the Tax Account system doesn’t yet operate like expected and to the objectives hadn’t been yet gotten