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Depression is expensive to treat, but providing ineffective treatment is more expensive. Such is the case for many patients who do not respond to antidepressant medication.
To assess the cost-effectiveness of cognitive–behavioural therapy (CBT) plus usual care for primary care patients with treatment-resistant depression compared with usual care alone.
Economic evaluation at 12 months alongside a randomised controlled trial. Cost-effectiveness assessed using a cost-consequences framework comparing cost to the health and social care provider, patients and society, with a range of outcomes. Cost-utility analysis comparing health and social care costs with quality-adjusted life-years (QALYs).
The mean cost of CBT per participant was £910. The difference in QALY gain between the groups was 0.057, equivalent to 21 days a year of good health. The incremental cost-effectiveness ratio was £14 911 (representing a 74% probability of the intervention being cost-effective at the National Institute of Health and Care Excellence threshold of £20 000 per QALY). Loss of earnings and productivity costs were substantial but there was no evidence of a difference between intervention and control groups.
The addition of CBT to usual care is cost-effective in patients who have not responded to antidepressants. Primary care physicians should therefore be encouraged to refer such individuals for CBT.
In early twentieth-century Suzhou, business and state leaders deployed female prostitution to foster commerce despite its controversial nature and sometime illegality. This political-economic policy variously pitted prostitutes and madams, police, commercial interests and social reformers against one another as tensions between gender reform and economic growth played out in urban development. This article analyses these conflicts to highlight the actions of prostitutes and the prerogatives of male desire in Suzhou's spatial and economic transformation.
The potential for mountain pine beetle, Dendroctonus ponderosae Hopkins (Coleoptera: Curculionidae: Scolytinae), to expand its historical range in North America from west of the continental divide into the eastern boreal forest was assessed on the basis of analyses of the effects of climate and weather on brood development and survival, and key aspects of the interaction of mountain pine beetle with its hosts and associated organisms. Variation in climate suitability and high host susceptibility in the boreal forest create a finite risk of establishment and local persistence of low-level mountain pine beetle populations outside their historical range. Eventually, these populations could become widespread and cause epidemic infestations, creating an ecological pathway eastward through the boreal forest. Such infestations would reduce the commercial value of forests and impose an additional disturbance on native ecological systems.
Carbon nanotubes nanocomposites with unique opto-mechanical properties have been developed as smart coatings. Remote polarized Raman spectroscopy has been used to monitor optical strain sensitivity of deformed coatings and determine local strains on the micron scale directly from stress/strain induced Raman band shifts.
Chemically engineered carbon nanotubes and polymer matrices have been developed in order to overcome the limitations highlighted in previous reports. They have proved to be of significance importance in the optimization of the stress transfer between the nanotubes and the polyurethane matrix.
IUCN (The World Conservation Union) published its first Action Plan more than a decade ago (Oates 1986). Many taxon-specific Specialist Groups working under the auspices of the IUCN Species Survival Commission (SSC) have since produced such documents, some of which are now in their second editions (e.g. Reeves and Leatherwood 1994). As we know only too well ourselves, Action Plans take a great deal of time and effort to compile, but what evidence is there to show that they are effective in achieving their prime objective of increasing the amount and quality of work that gets done to save threatened species from extinction?
Patients in an affective disorders out-patient clinic were studied with four depression rating scales: the Hamilton rating scale (HRS) the Carroll rating scale (CRS) a clinical global rating of depression (CGRD) and the visual analogue scale (VAS). The overall correlations between the self ratings (CRS, VAS) and the observer ratings (HRS, CGRD) were highly significant. Both the HRS and the CRS distinguished mild from moderate, and moderate from severe depression. CRS scores increased more rapidly than HRS scores with increasing severity of depression. The concordance of self ratings and observer ratings was highest for the two structured instruments (HRS and CRS), and was lowest for the two global scales (CGRD and VAS). The global scales have the advantages of speed and simplicity, but at the cost of some reliability. Patients with non-endogenous depression had significantly increased self rating scores in comparison to patients with unipolar or bipolar endogenous depression. The correlations between the self ratings and the observer ratings were notably lower in patients with non-endogenous depression than in patients with endogenous depression. Euthymic bipolar patients rated themselves on the VAS as significantly less well than euthymic unipolar patients. The clinical and research implications of these findings are discussed.
The Carroll rating scale (CRS) was developed as a self rating instrument for depression, closely matching the information content and specific items of the Hamilton rating scale (HRS). The CRS was found to have acceptable face validity and reliability. The concurrent validity of the CRS was acceptable, based on comparisons with the HRS and the Beck Depression Inventory (BDI). The internal consistency of the CRS was very similar to that of the HRS. The CRS contained information about HRS scores beyond what could be predicted from BDI scores, but the BDI did not predict HRS scores beyond what could be predicted from CRS scores. The CRS and BDI scores were strongly correlated and both had access to a subjective dimension of depression that could not be predicted from HRS scores. The complementary uses of self ratings and observer ratings are evident from these results. The CRS may be a useful alternative to the BDI as a self rating scale, with the additional advantage of closer correspondence to the HRS.
Factor analyses were conducted for the Hamilton depression rating scale (HRS) and the self administered Carroll counterpart (CRS). The factor loadings for the respective first factors were similar; those for the respective second factors showed strict sign consistency but only moderate consistency of magnitude; the loadings for the respective third factors showed no particular consistency. The first three CRS and first three HRS factor scores were computed for each individual and correlations were computed from these factor scores. The first and second factors were highly correlated but the third factors were negatively correlated indicating that they were not measuring the same thing. The first factors of the CRS and HRS correlated highly with their respective raw total scores and were indices of the severity of illness. The self-administered CRS (with matching weights) is a credible alternative to the HRS for routine clinical assessment of the severity of depression.
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