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This study aimed to investigate general factors associated with prognosis regardless of the type of treatment received, for adults with depression in primary care.
We searched Medline, Embase, PsycINFO and Cochrane Central (inception to 12/01/2020) for RCTs that included the most commonly used comprehensive measure of depressive and anxiety disorder symptoms and diagnoses, in primary care depression RCTs (the Revised Clinical Interview Schedule: CIS-R). Two-stage random-effects meta-analyses were conducted.
Twelve (n = 6024) of thirteen eligible studies (n = 6175) provided individual patient data. There was a 31% (95%CI: 25 to 37) difference in depressive symptoms at 3–4 months per standard deviation increase in baseline depressive symptoms. Four additional factors: the duration of anxiety; duration of depression; comorbid panic disorder; and a history of antidepressant treatment were also independently associated with poorer prognosis. There was evidence that the difference in prognosis when these factors were combined could be of clinical importance. Adding these variables improved the amount of variance explained in 3–4 month depressive symptoms from 16% using depressive symptom severity alone to 27%. Risk of bias (assessed with QUIPS) was low in all studies and quality (assessed with GRADE) was high. Sensitivity analyses did not alter our conclusions.
When adults seek treatment for depression clinicians should routinely assess for the duration of anxiety, duration of depression, comorbid panic disorder, and a history of antidepressant treatment alongside depressive symptom severity. This could provide clinicians and patients with useful and desired information to elucidate prognosis and aid the clinical management of depression.
In Peterborough, individuals over the age of 65 make up over 20% of the regional population. With an aging population, the need for a community plan addressing seniors’ issues was growing, and in response, the Age-Friendly Peterborough Community Action Plan (‘the Plan’) was created. The Plan outlines four fundamental goals: (1) older adults’ basic needs are met, (2) older adults are able to get around the community, (3) older adults are supported to build and maintain relationships, and (4) older adults have the opportunity to learn, grow, and contribute. The Plan has been up and running since 2017 and as a result, many new projects and programs have been implemented, and further research conducted. For instance, a recreation, leisure, and facilities study was recently undertaken to help figure out how to increase participation in recreational activities from older adults. The study was conducted at city, county, and First Nations scales. Despite a substantial older adult population, the study found that low participation in recreation has contributed to the challenges at Peterborough's three senior activity centres. This information will help shape how Peterborough will address recreation for older adults. Noteworthy projects under the Plan have included: the annual Summit on Aging educational conference, the annual Seniors’ Showcase (seven years running), developing local TV broadcasts on aging, helping to secure a community transportation grant to serve rural and First Nations communities, a walkability assessment program for municipalities, an age-friendly business program, and a navigation project to help older adults find housing and health services.
The impetus for the Plan can be traced back to 2013 when the Peterborough Council on Aging (PCOA) proposed the notion for the development of a community plan in accordance with the World Health Organization's Global Age-Friendly movement. The PCOA was an ad hoc organization made up of local organizations, institutions, businesses, and volunteers all interested in advancing the priorities of older adults. The Plan was made possible largely through the involvement and commitment from these various stakeholders with the financial support secured from external grants and municipal resources.
It was decided by the PCOA that the Plan would be a ‘community plan’, led by the City of Peterborough, with an understanding that a broad community collaboration would be needed to develop and implement it.
The thirtieth anniversary of the election of Wayne Goss’s Labor Party to government in Queensland was marked on 2 December 2019. Considered a landmark political event, the 1989 state election saw the once-dominant National Party dispatched from office after thirty-two years of conservative government in this state. The election of an energetic new premier kick-started a period of purposeful public administration reform and public accountability renewal that many have described since as ‘the birth of modern Queensland’. Yet the end of the divisive Bjelke-Petersen era, as Goss’s ascent was characterised, was for some an uneasy time of accelerated transformational change. From these varied perspectives, and through the recorded recollections of public figures and senior administrators of the time, this article looks back at a modern benchmark for ‘historic’ state elections in Queensland.
Queensland's 2017 state election resulted in Annastacia Palaszczuk's Labor government being returned with a slim majority. While not a resounding victory, the result seemingly vindicated the premier's decision to head to an early election, and reinforced her standing in a succession of opinion polls as ‘preferred premier’ for most voters. The result also halted the short sequence of Queensland governments being voted out of office in no uncertain terms by a supposedly volatile electorate. The extent to which Labor's recent electoral success in Queensland — and the quelling of that volatility — can be attributed to Palaszczuk's leadership is still open to debate. It is instructive, though, to note the differences in leadership and campaigning styles between Palaszczuk and her opponents, which saw her drag a decimated Labor Party back to office after a single term in opposition, then saw it returned with a working parliamentary majority. This article highlights those differences over the last term of government, contrasting the performance of the two major parties in Queensland in terms of their leadership and election campaign approaches. The analysis helps to explain some of the reasons for the respective parties’ recent electoral showings.
Depression is a prevalent long-term condition that is associated with substantial resource use. Telehealth may offer a cost-effective means of supporting the management of people with depression.
To investigate the cost-effectiveness of a telehealth intervention (‘Healthlines’) for patients with depression.
A prospective patient-level economic evaluation conducted alongside a randomised controlled trial. Patients were recruited through primary care, and the intervention was delivered via a telehealth service. Participants with a confirmed diagnosis of depression and PHQ-9 score ≥10 were recruited from 43 English general practices. A series of up to 10 scripted, theory-led, telephone encounters with health information advisers supported participants to effect a behaviour change, use online resources, optimise medication and improve adherence. The intervention was delivered alongside usual care and was designed to support rather than duplicate primary care. Cost-effectiveness from a combined health and social care perspective was measured by net monetary benefit at the end of 12 months of follow-up, calculated from incremental cost and incremental quality-adjusted life years (QALYs). Cost–consequence analysis included cost of lost productivity, participant out-of-pocket expenditure and the clinical outcome.
A total of 609 participants were randomised – 307 to receive the Healthlines intervention plus usual care and 302 to receive usual care alone. Forty-five per cent of participants had missing quality of life data, 41% had missing cost data and 51% of participants had missing data on either cost or utility, or both. Multiple imputation was used for the base-case analysis. The intervention was associated with incremental mean per-patient National Health Service/personal social services cost of £168 (95% CI £43 to £294) and an incremental QALY gain of 0.001 (95% CI −0.023 to 0.026). The incremental cost-effectiveness ratio was £132 630. Net monetary benefit at a cost-effectiveness threshold of £20 000 was –£143 (95% CI –£164 to –£122) and the probability of the intervention being cost-effective at this threshold value was 0.30. Productivity costs were higher in the intervention arm, but out-of-pocket expenses were lower.
The Healthlines service was acceptable to patients as a means of condition management, and response to treatment after 4 months was higher for participants randomised to the intervention. However, the positive average intervention effect size was modest, and incremental costs were high relative to a small incremental QALY gain at 12 months. The intervention is not likely to be cost-effective in its current form.
To map the availability and types of depression and anxiety groups, to examine men's experiences and perception of this support as well as the role of health professionals in accessing support.
The best ways to support men with depression and anxiety in primary care are not well understood. Group-based interventions are sometimes offered but it is unknown whether this type of support is acceptable to men.
Interviews with 17 men experiencing depression or anxiety. A further 12 interviews were conducted with staff who worked with depressed men (half of whom also experienced depression or anxiety themselves). There were detailed observations of four mental health groups and a mapping exercise of groups in a single English city (Bristol).
Some men attend groups for support with depression and anxiety. There was a strong theme of isolated men, some reluctant to discuss problems with their close family and friends but attending groups. Peer support, reduced stigma and opportunities for leadership were some of the identified benefits of groups. The different types of groups may relate to different potential member audiences. For example, unemployed men with greater mental health and support needs attended a professionally led group whereas men with milder mental health problems attended peer-led groups. Barriers to help seeking were commonly reported, many of which related to cultural norms about how men should behave. General practitioners played a key role in helping men to acknowledge their experiences of depression and anxiety, listening and providing information on the range of support options, including groups. Men with depression and anxiety do go to groups and appear to be well supported by them. Groups may potentially be low cost and offer additional advantages for some men. Health professionals could do more to identify and promote local groups.
Psychological therapies have been shown to be effective in the treatment of depression. However, evidence is focused on individually delivered therapies, with less evidence for group-based therapies.
To conduct a systematic review and meta-analysis of the efficacy of group-based psychological therapies for depression in primary care and the community.
We searched MEDLINE, Embase, PsycINFO, the Cochrane Central Register of Controlled Trials and the Cochrane Collaboration Depression, Anxiety and Neurosis Review Group database from inception to July 2010. The Cochrane risk of bias methodology was applied.
Twenty-three studies were included. The majority showed considerable risk of bias. Analysis of group cognitive–behavioural therapy (CBT) v. usual care alone (14 studies) showed a significant effect in favour of group CBT immediately post-treatment (standardised mean difference (SMD) −0.55 (95% CI −0.78 to −0.32)). There was some evidence of benefit being maintained at short-term (SMD =–0.47 (95% CI −1.06 to 0.12)) and medium- to long-term follow-up (SMD =–0.47 (95% CI – 0.87 to −0.08)). Studies of group CBT v. individually delivered CBT therapy (7 studies) showed a moderate treatment effect in favour of individually delivered CBT immediately post-treatment (SMD = 0.38 (95% CI 0.09–0.66)) but no evidence of difference at short- or medium- to long-term follow-up. Four studies described comparisons for three other types of group psychological therapies.
Group CBT confers benefit for individuals who are clinically depressed over that of usual care alone. Individually delivered CBT is more effective than group CBT immediately following treatment but after 3 months there is no evidence of difference. The quality of evidence is poor. Evidence about group psychological therapies not based on CBT is particularly limited.
A generation ago, Queensland's economy relied heavily — as did the standing of the state government — upon a booming resources sector, a bountiful agricultural sector and a still-growing tourist market. ‘Rocks and crops’ (to use a favourite phrase of Peter Beattie's) were mainstays of the state's economic activity, and had long underpinned the government's investment, development and budgetary planning. While to a large extent the same might be said today, critical changes have taken place in the local economy in the intervening period, cultivated by successive state administrations with the express aim of diversifying an economy that was overwhelmingly geared towards primary production. Now it can be argued that Queensland's economy has metamorphosed into a modern, knowledge-based economy that demands greater emphasis on technology, expertise and innovation — what Premier Peter Beattie liked to promote with his catch-all phrase ‘Smart State’. But how effective was this push for diversification in renewing the state's economic foundations? Since the advent of the Goss Labor government in late 1989, has Queensland really moved from a ‘farm and quarry’ to a ‘smart’ economy?
The aim of this study was to prioritize hospital admissions for ambulatory care sensitive conditions (ACSCs) and interventions for future research and implementation.
Initiatives aimed at reducing hospital admission need to be targeted at those patients who could avoid admission to hospital, either by prevention, earlier detection and treatment, or by the provision of alternative types of care. Admissions for ACSCs should ideally be prevented by care provided outside hospital.
The study used a modified Delphi method to elicit the views of an expert panel. The Delphi process comprised two rounds and used a Web-based questionnaire. Participants were purposively sampled and comprised primary and community care clinicians, emergency clinicians and commissioning managers. Quantitative data were analysed to produce descriptive statistics. Qualitative data were analysed using content analysis.
A total of 36 participants responded to both rounds of the Delphi survey. The condition given top priority was dementia, not currently a widely recognized ACSC or a national priority. The proportion of admissions that could be avoided by provision of care outside hospital was the most important factor in deciding which conditions to prioritize. Access to rapid response nursing and social care at home, intermediate care beds and mental health crisis teams were identified as key interventions to reduce admissions. Analysis of qualitative data showed several themes underlying clinical decisions to admit potentially avoidable admissions.
In conclusion, the conditions selected by the panel for prioritization showed some concordance with the National Health Services’ priorities in this area; but the condition given top priority by the panel – dementia – is not currently a national priority. The panel showed a high degree of consensus around interventions that might lower the rate of avoidable admissions. The highest rated interventions involve the direct delivery of rapid access care in the community.
To compare patterns of population service use and preference in areas with and without one-stop shop services.
A number of strategy documents have recommended adopting a more integrated approach to sexual health service provision. One proposed model of integration is one-stop shops, where services for contraception and sexually transmitted infections are provided under the same roof. Currently, the potential impact of one-stop shop services on patient service use and preference is unclear, particularly at a population level.
Three different models of one-stop shop were studied: a dedicated young persons’ service, a specialist mainstream service, and an enhanced general practice. In each model, the one-stop shop site was matched to two control sites with traditional service provision. Random samples of male and female patients were selected from general practices close to either the one-stop shop or control sites. These patients received a postal survey asking about their use or preference for services for six sexual health needs. One-stop shop and control samples were compared using multivariate logistic regression.
Of the 14 387 patients surveyed, 3101 (21.6%) responded. In the young persons’ model, few significant differences were found in service use or preference between those living in one-stop shop and control site areas. In the specialist services model, women in the one-stop shop area were significantly more likely to cite specialist services for emergency contraception and abortion advice, when compared to those served by non-integrated control services. In the general practice model, respondents in the one-stop shop area were significantly more likely to cite general practice for all six sexual health needs. Overall, general practice was the preferred service provider cited for all sexual health needs, except condoms and pregnancy tests. These findings are discussed in terms of their implications for the provision of integrated sexual health services. In addition, key methodological issues and future research possibilities are identified.
Heavyweight civil engineering in Romanized Europe means Roman, one thinks naturally enough. A tree-ring date now identifies a timber-framed bridge pier, previously thought Roman, as dating to the first half of the 8th century AD — Mercian, and the earliest known Saxon bridge in Britain.
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