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Claiming contribution in courts is currently a complex and uncertain task, which may lead to the unenforceability of the right to claim contribution in antitrust. The Chapter makes several recommendations that could simplify and make contribution more effective in the competition law context. Firstly, it must be clearly stated that antitrust infringers have the right to claim contribution in the context of EU competition law and that such a right does not interfere with the principle of effectiveness thereof. Secondly, rules on contribution should be the same for private and public antitrust enforcement, they should be based on one type of claim in the form of a personal right to claim contribution, available when the damages and Commission’s fine are paid. The criterion for determining internal liability should be based on a limited number of factors. A two-pillar rule based on division according to market shares and relative fault is suggested. Finally the regimes of special joint and several liability should be simplified and liability sharing agreements should be endorsed. Liability sharing agreements are the simplest and the most effective tool for securing the right to contribution.
Intended to combine the best of two worlds – the ability to estimate causal effects and to generalize to a wider population – survey experiments are increasingly used as a method of data collection in politics and international relations. This article examines their popularity over the past decades in social science research, discusses the core logic of survey experiments, and reviews the method against the principles of the total survey error paradigm.
Major depressive disorder (MDD) is a debilitating disease in Italy affects 5.4% of people over 15 and 11.6% for the elderly. Efficacy of vortioxetine in adult patients with MDD was demonstrated in randomised controlled trials, there is a need for data on treatment in daily practice in Italy.
To present the effectiveness and safety data of vortioxetine in real-world setting from patients enrolled from Italy in the RELIEVE study.
RELIEVE was a prospective, multi-national, observational study of outpatients initiating vortioxetine treatment for MDD at physician’s discretion. Data and outcomes of treatment of patients were collected at routine clinical visits. The primary outcome was functioning measured by SDS. Secondary outcomes included depressive symptoms measured by PHQ-9, cognitive funcion measured by PDQ-5, quality of life measured by EQ-5D-5L. Changes from baseline to month 6 were estimated with a linear mixed model of repeated measures approach.
A total of 231 patients (mean age, 55.5 years, 27.3% over 65 years, 62% female) were enrolled from Italy and included in the analysis. Mean(SD) SDS total score, PHQ-9, PDQ-5 scores at baseline were 17.8(7.58), 15.7(5.97) and 9.8(4.99), the scores(SE) decreased by 6.6(0.64), 5.9(0.47) and 3.6(0.36) from baseline to last visit. Mean(SE) EQ-5D-5L utility index increased by 0.13(0.01). Safety and tolerability profile of vortioxetine was in line with the established profile.
Improvements in overall functioning, depressive symptoms, cognitive function and quality of life were observed in patients treated with vortioxetine, including a wide proportion of elderly patients in a real-world setting.
A. Pugliese is an employee of Lundbeck Italy. K. Simonsen and H. Ren are employees of H. Lundbeck A/S.
Major depressive disorder (MDD) affects around 10% of the French population annually and significantly impacts patient functioning. Efficacy of vortioxetine was demonstrated in randomised controlled trials, data on its real-world performance is needed.
To describe the effectiveness and safety of vortioxetine in real-world setting from patients enrolled from France in the global RELIEVE study.
RELIEVE was a prospective, multi-national, observational study of outpatients initiating vortioxetine treatment for MDD at physician’s discretion. Data were collected at routine clinical visits. Here we present the outcomes of treatment of patients in France. The primary outcome was functioning measured by SDS. Secondary outcomes included depressive symptoms measured by PHQ-9, cognitive symptoms measured by PDQ-5 and DSST. Changes from baseline to month 6 were estimated with a linear mixed model of repeated measures approach.
A total of 184 patients (mean age, 50.2 years, 65% female, 67.9% of patients had at least one comorbidity) were enrolled from France and included in the analysis. Mean(SD) SDS total score, PHQ-9, PDQ-5 scores at baseline were 21.1(5.4), 17.5(4.7) and 11.7(4.4), the scores(SE) decreased by 10.9(0.59), 9.3(0.48) and 6.1(0.37) from baseline to month 6. Mean(SD) DSST improved from 41.6(15.2) at baseline to 49.1(19.0) at month 6. Safety and tolerability profile of vortioxetine was in line with previous studies.
Sustained improvements in overall functioning, depressive symptoms, cognitive function were observed in patients treated with vortioxetine in a real-world setting, which provided further evidence of effectiveness and safety of vortioxetine in a broad MDD population in France.
M. Rabbani is an employee of Lundbeck France. K. Simonsen and H. Ren are employees of H. Lundbeck A/S.
The approach to evaluating the effectiveness of psychosocial rehabilitation (PSR) of mentally ill patients implies a multidimensional, hierarchical consideration of mental pathology with the inclusion of clinical and psychopathological, socio-environmental and personal indicators when setting goals and objectives of PSR
Development of algorithms and models for evaluating the effectiveness of PSR taking into account: clinical, socio-demographic, psychological characteristics of the patient and the characteristics of the family environment, as well as factors of psychiatric care.
Clinical, statistical, algorithms of the analytical hierarchy process (AHP) .
Numerical estimates of changes (before and after the PSR program) in the main areas of patient’s functioning disorders, such as motivation, cognition, compliance, coping strategies, family, skills, immediate environment, and others, are proposed as particular criteria for evaluating the effectiveness of PSR. Quantitative estimates for particular criteria are obtained on the basis of rank estimates, which are converted into numerical ones based on AHP algorithms . Quantitative integral estimates of the effectiveness of PSR are obtained on the basis of partial estimates, taking into account the weight of the corresponding areas of impaired functioning of patients.
The developed approach opens up prospects for obtaining numerical, partial and integral estimates based on various rank scales, which are of interest from the point of view of forming criteria-indicators (markers) of the effectiveness of psychosocial, rehabilitation, psychoeducational and psychotherapeutic measures. References: 1. Mitikhin, V.G., Solokhina, T.A. S.S. Korsakov Journal of Neurology and Psychiatry. 2019; 119(2): 49-54
Cognitive processing therapy (CPT) and prolonged exposure (PE) delivered in an individual setting are efficacious and effective treatments for veterans with posttraumatic stress disorder (PTSD). Group CPT has been shown to be less efficacious than individual CPT, however, evidence regarding real-world effectiveness is limited.
We conducted a retrospective, observational, comparative effectiveness study including veterans that received at least eight sessions of group CPT, individual CPT, or individual PE, and were discharged from PTSD residential treatment at the Department of Veterans Affairs between 1 October 2015, and 30 September 2020. PTSD symptom severity was assessed with the PTSD Checklist for DSM-5 (PCL-5) and treatments delivered in a group (CPT) or individual (CPT or PE) setting were compared at discharge and 4-month post-discharge follow-up.
Of 6735 veterans, 3888 [653 women (17%), median (IQR) age 45 (35–55) years] received individual and 2847 [206 women (7.2%), median (IQR) age 42 (34–54)] received group therapy. At discharge, improvement in PTSD severity was statistically greater among those treated individually (mean difference on the PCL-5, 2.55 (95% CI 1.61–3.49); p = <0.001]. However, the difference was smaller than the minimal clinically important difference of 7.9 points. The groups did not differ significantly at 4-month follow-up [mean difference on the PCL-5, 0.37 (95% CI −0.86 to 1.60); p = 0.551].
Group CPT was associated with a slightly smaller reduction of PTSD symptom severity than individual CPT or PE in veterans at the end of residential treatment. There were no differences at 4-month follow-up.
Despite its potential scalability, little is known about the outcomes of internet-based cognitive behaviour therapy (iCBT) for post-traumatic stress disorder (PTSD) when it is provided with minimal guidance from a clinician.
To evaluate the outcomes of minimally guided iCBT for PTSD in a randomised control trial (RCT, Study 1) and in an open trial in routine community care (Study 2).
A RCT compared the iCBT course (n=21) to a waitlist control (WLC, n=19) among participants diagnosed with PTSD. The iCBT group was followed up 3 months post-treatment. In Study 2, treatment outcomes were evaluated among 117 adults in routine community care. PTSD symptom severity was the primary outcome in both studies, with psychological distress and co-morbid anxiety and depressive symptoms providing secondary outcomes.
iCBT participants in both studies experienced significant reductions in PTSD symptom severity from pre- to post-treatment treatment (within-group Hedges’ g=.72–1.02), with RCT findings showing maintenance of gains at 3-month follow-up. The WLC group in the RCT also significantly improved, but Study 1 was under-powered and the medium between-group effect favouring iCBT did not reach significance (g=0.64; 95% CI, –0.10–1.38).
This research provides preliminary support for the utility of iCBT for PTSD when provided with minimal clinician guidance. Future studies are needed to clarify the effect of differing levels of clinician support on PTSD iCBT outcomes, as well as exploring how best to integrate iCBT into large-scale, routine clinical care of PTSD.
Over the last two decades, international humanitarian law (IHL) has seen a stalling with regard to States’ willingness to adopt treaties or to be formally involved in the development of IHL. This raises the question of whether holding on to the doctrine of sources as laid down in Article 38 of the Statute of the International Court of Justice is the only way to meaningfully further develop IHL. Indeed, in recent years IHL instruments have often dispensed with certain formalities that are traditionally linked to (the formal sources of) international law; this phenomenon is also called “informal international law-making” (IIL). The present contribution will analyze IIL as an alternative way forward in light of the current “deadlock” caused by States’ unwillingness to conclude new IHL treaties or to recognize customary IHL. In this article, we will investigate and assess the opportunities, shortcomings and pitfalls offered by informality by looking into examples of IIL within IHL. More concretely, we will look into State practice in relation to (1) the Safe Schools Declaration, (2) the Tallinn Manual and Tallinn Manual 2.0, and (3) the Montreux Document. Most importantly, our findings will assess whether IIL can overcome one of its alleged main disadvantages: its lack of effectiveness.
Suicide remains an important public health problem worldwide. Many countries have developed national suicide prevention policies or guidelines, which often include family-based recommendations regarding suicide prevention, intervention or postvention. A recent systematic review, published in this journal, failed to find evidence of an impact of family-based recommendations in national guidelines on national suicide rates. In this editorial, we review other studies providing promising evidence of effectiveness of family-based interventions in the field of suicide prevention and postvention, and note that further studies are needed, especially in adult and older adult populations.
Unhealthy diets are a major threat to population health and are especially prevalent among those with a low socioeconomic status (SES). Health promotion initiatives often rely on nutrition information interventions (NIIs), but are usually less effective among adults with a low SES than in their high-SES counterparts. Explanations for this lower effectiveness are set out in extant studies. These have been conducted across a wide range of disciplines and subject fields and using a variety of methodological approaches. We have therefore conducted a scoping review to identify and synthesise the following: (1) explanations suggested in studies carried out in high-income countries for why NIIs are (in)effective among adults with a low SES and (2) whether these suggested explanations were studied empirically. Eight databases were searched for relevant studies published since 2009 across various disciplines. This identified 4951 papers, 27 of which were included in our review after screening. Only fifteen of these proposed an explanation for the (in)effectiveness of NIIs among adults with a low SES. The following four main themes were uncovered: health literacy, economic resources, social resources and convenience. Ten studies tested their explanations empirically, but the results were inconsistent. The reasons why NIIs are (in)effective among low-SES adults are therefore still largely unclear. Also, current literature predominantly relies on individualistic explanations, most notably focusing on psychological and economic attributes. Consequently, if the effectiveness of NIIs among low-SES populations is to be improved, future studies should examine a wider range of explanations and test them systematically and empirically.
This study assesses misconceptions about coronavirus disease 2019 (COVID-19) vaccine and the factors associated with misconception among Jordanians.
A cross-sectional online survey was conducted. The survey was formulated on Google Forms, and was hosted on an online platform. These questions were created based on extensive review of online information about the vaccines. Frequencies and percentages (%) were used for categorical variables, while means and standard deviations (SDs) were used for continuous variables. Stepwise binary logistic regression was conducted to evaluate variables associated with participant’s misconception questions.
Of 1195 survey respondents who participated in the study, 41.3% had received the COVID-19 vaccine. The mean misconception score was (60.0 ± 19.1). The statement with the highest mean was “The vaccine hasn’t been tested on enough people” (3.6 ± 1.0). The statement with the lowest mean was “The COVID-19 vaccine includes a microchip to control us” (2.2 ± 1.1) in the conspiracy theory portion. Females, 18- to 29-age group, higher educational level, living in a city, the participants who took lectures about the COVID-19 vaccine and vaccinated participants had higher odds of being in the low misconception level group.
Targeted campaigns and vaccine safety information should be part of a broader health education campaign to alleviate vaccination safety concerns.
Beginning with an illustration of the potential and perils of engaging private operators to run prisons, this introductory chapters lays out the focus and argument of the book: the need to pursue a comparative analysis of the pros and cons of public, private, and public–private forms of service delivery, and the importance of government capability to successfully scrutinize and implement plural arrangements.
This cluster-randomised study analyses the implementation of a family intervention model (the HOLF model) on four target areas: parental employment, the financial and housing situations, and the social inclusion of children. The study compares family coordinators implementing the HOLF model including tools, schemes and supervision structures, with those implementing local family intervention practices. All twenty-nine participating Labour and Welfare offices received two family coordinators per office, with a caseload of twenty-one families. Of the offices, fifteen were randomised to implement the HOLF model, while fourteen implemented local family intervention practices. In a twelve-month follow-up of 862 parents, baseline and T2 questionnaires and administrative data show a significant improvement on financial situation and children’s social inclusion; however, with no differences between offices implementing the HOLF model and those implementing local family intervention practices. The results show the need for further analyses of key elements and implementation practices within family intervention projects.
Community health workers (CHWs) are up-front health workers delivering the most effective life-saving health services to communities. They are the key driver to achieve Universal Health Coverage. However, maintaining CHWs’ performance is one of the challenges in sustaining their effectiveness. This article assessed the effectiveness of the four interventions and their combinations on the CHWs’ performance in terms of health knowledge, job satisfaction, and household coverage.
We used the longitudinal survey data collected in western Kenya. Our study participants were the representative of all CHWs working in the four districts, Kenya. The four types of interventions were composed of a basic core intervention (i.e., refresher training with/without defaulter tracing) and three supplementary interventions (i.e., provision of a bicycle, frequent supportive supervision, and financial incentives). We performed the three fixed-effect models to assess the effectiveness of the four interventions and their combinations on the three performance indicators.
Three single and combination interventions significantly increased CHWs’ health knowledge: refresher training only [Coef.: 48.43, 95% CI: 42.09–54.76, P < 0.001]; refresher training plus defaulter-tracing [Coef.: 38.80, 95% CI: 32.71–44.90, P < 0.001]; combination of refresher training plus defaulter-tracing and frequent supervision [Coef.: 17.02, 95% CI: 7.90–26.15, P < 0.001]. Financial support was the only intervention that significantly increased job satisfaction among CHWs [Coef.: 4.97, 95% CI: 0.20–9.75, P = 0.041]. There was no single intervention that significantly increased household coverage. Yet, the combinations of the interventions significantly increased household coverage.
There was no single intervention to improve all the aspects of CHWs’ performance. The refresher training significantly improved their health knowledge, while financial incentive enhanced the level of their job satisfaction. The combinations of regular refresher training and other intervention(s) are the recommended as the effective interventions in improving and further sustaining CHWs’ performance.
Contrasting the well-described effects of early intervention (EI) services for youth-onset psychosis, the potential benefits of the intervention for adult-onset psychosis are uncertain. This paper aims to examine the effectiveness of EI on functioning and symptomatic improvement in adult-onset psychosis, and the optimal duration of the intervention.
360 psychosis patients aged 26–55 years were randomized to receive either standard care (SC, n = 120), or case management for two (2-year EI, n = 120) or 4 years (4-year EI, n = 120) in a 4-year rater-masked, parallel-group, superiority, randomized controlled trial of treatment effectiveness (Clinicaltrials.gov: NCT00919620). Primary (i.e. social and occupational functioning) and secondary outcomes (i.e. positive and negative symptoms, and quality of life) were assessed at baseline, 6-month, and yearly for 4 years.
Compared with SC, patients with 4-year EI had better Role Functioning Scale (RFS) immediate [interaction estimate = 0.008, 95% confidence interval (CI) = 0.001–0.014, p = 0.02] and extended social network (interaction estimate = 0.011, 95% CI = 0.004–0.018, p = 0.003) scores. Specifically, these improvements were observed in the first 2 years. Compared with the 2-year EI group, the 4-year EI group had better RFS total (p = 0.01), immediate (p = 0.01), and extended social network (p = 0.05) scores at the fourth year. Meanwhile, the 4-year (p = 0.02) and 2-year EI (p = 0.004) group had less severe symptoms than the SC group at the first year.
Specialized EI treatment for psychosis patients aged 26–55 should be provided for at least the initial 2 years of illness. Further treatment up to 4 years confers little benefits in this age range over the course of the study.
This meta-analysis examines the effectiveness of technology-assisted second language (L2) vocabulary learning as well as identifies factors that may play a role in their effectiveness. We found 34 studies with 2,511 participants yielding 49 separate effect sizes. Following the procedure developed by Hunter and Schmidt (2004), we corrected for sample size bias and measurement error. The overall effect size for using technology to learn L2 vocabulary was d = 0.64, which is a moderate effect size. The Q statistic indicated a significant variability in effect size, so we followed up with a theory-driven moderator analysis. The results of the moderator analysis revealed that learners benefited more from technology-assisted L2 vocabulary learning with incidental instruction than with intentional instruction; types of assessment were not significant moderators of the effect on technology-assisted L2 vocabulary learning; technology-assisted L2 vocabulary learning is more effective when the target language is close to the learner’s first language; college students benefited more from technology-assisted L2 vocabulary learning than K–12 students; and, finally, mobile-assisted L2 vocabulary learning was more effective than computer-assisted L2 vocabulary learning.
The concluding chapter draws together the key arguments raised in this book and offers some observations on how Article 36 mechanisms would need to be reconceptualised to meet the challenges posed by the emerging military technology. It also emphasises that conducting weapons reviews involves a learning curve. As much as Article 36 mechanisms require a good level of legal and technical expertise, they cannot operate without institutional commitment and a settled interpretation of the review elements. [76 words]
The impacts of COVID-19 for people with obsessive-compulsive disorder (OCD) may be considerable. Online cognitive behavioural therapy (iCBT) programmes provide scalable access to psychological interventions, although the effectiveness of iCBT for OCD during COVID-19 has not been evaluated.
This study investigated the uptake and effectiveness of iCBT for OCD (both self- and clinician-guided courses) during the first 8 months of the pandemic in Australia (March to October 2020) and compared outcomes with the previous year.
1,343 adults (824/1343 (61.4%) female, mean age 33.54 years, SD = 12.00) commenced iCBT for OCD (1061 during the pandemic and 282 in the year before) and completed measures of OCD (Dimensional Obsessive-Compulsive Scale) and depression (Patient Health Questionaire-9) symptom severity, psychological distress (Kessler-10), and disability (WHO Disability Assessment Schedule) pre- and post-treatment.
During COVID-19, there was a 522% increase in monthly course registrations compared with the previous year, with peak uptake observed between April and June 2020 (a 1191% increase compared with April to June 2019). OCD and depression symptom severity were similar for the COVID and pre-COVID groups, although COVID-19 participants were more likely to enrol in self-guided courses (versus clinician-guided). In both pre- and during-COVID groups, the OCD iCBT course was associated with medium effect size reductions in OCD (g = 0.65–0.68) and depression symptom severity (g = 0.56–0.65), medium to large reductions in psychological distress (g = 0.77–0.83) and small reductions in disability (g = 0.35–.50).
Results demonstrate the considerable uptake of online psychological services for those experiencing symptoms of OCD during COVID-19 and highlight the scalability of effective digital mental health services.
This article aims to map how soft law tools have complemented and supported the overall regulatory strategies implemented by European countries to counter the Covid-19 crisis (the soft law atlas), to shed light on some key topics of general interest for legal theory and practice: how soft law tools interact and complement one another including on different levels (the soft law web), how soft law tools interact and complement the sources of pandemic law (the interplay between soft and hard law), and the positive and negative impacts on governance and policy-making of soft law tools during the pandemic and beyond (soft law bright and dark sides).