The extraction of single-particle diffraction patterns from a multiple-particle diffraction pattern

The structures of biological molecules may soon be determined with X-ray free-electron lasers without crystallization by recording the coherent diffraction patterns of many identical copies of a molecule. Most analysis methods require a measurement of each molecule individually. However, current injection methods deliver particles to the X-ray beam stochastically and the maximum yield of single particle measurements is 37% at optimal concentration. The remaining 63% of pulses intercept no particles or multiple particles. We demonstrate that in the latter case single particle diffraction patterns can be extracted provided the particles are sufficiently separated. The technique has the potential to greatly increase the amount of data available for three-dimensional imaging of identical particles with X-ray lasers.

Self-Help for Depression via E-mail: A Randomised Controlled Trial of Effects on Depression and Self-Help Behaviour

BACKGROUND

Self-help or self-management strategies are commonly used to deal with depression, but not all are thought to be helpful. A previous study found that sub-threshold depression symptoms were improved by an e-mail intervention that encouraged the use of evidence-based self-help strategies.

AIM

To investigate whether these e-mails were effective for adults with a range of depression symptomatology including major depression.

METHOD

The study was a parallel-group randomised controlled trial. Adult participants with any level of depressive symptoms were recruited over the internet from the United Kingdom, Australia, Canada, Ireland, New Zealand and the United States. Participants were randomised to receive a series of e-mails either promoting the use of evidence-based self-help strategies or containing depression information as a control. E-mails were sent automatically twice a week for six weeks. Depression symptoms were assessed with the self-rated Patient Health Questionnaire depression scale (PHQ-9).

RESULTS

1736 participants with a wide range of symptom severity were recruited and assigned to active (n = 862) and control (n = 874) groups. However, there was a significant attrition rate, with 66.9% lost to follow-up at post-intervention. Both groups showed large improvements in depression symptoms overall, with no significant difference in improvement at the end of the study (mean difference in improvement 0.35 points, 95% CI: -0.57 to 1.28, d = 0.11, 95% CI: -0.06 to 0.27), although there was a small effect at the study mid-point. Results were similar for the sub-group of participants with major depression. The active group showed small to moderate improvements in self-help behaviour (d = 0.40, 95% CI: 0.23 to 0.56).

CONCLUSIONS

These results suggest that the e-mails were able to increase participants' use of evidence-based self-help, but that this did not improve depression more than an attention control.

CLINICALTRIALSGOV

NCT01399502.

The Jenner Society and the Edward Jenner Museum: tributes to a physician-scientist

Dr. Edward Jenner's discovery and application of vaccination against smallpox was one of the most important medical advances of all time. In the modern era many millions of lives are saved each year by vaccines that work essentially on the same scientific principles established by Jenner more than 200 years ago. Jenner's country home in Berkeley, Gloucestershire, UK, where he carried out his work and where he spent most of his life, is now a museum and something of a shrine for vaccinologists. Jenner's house is also now the focal point of a new international learned society dedicated to advancing modern vaccinology. The aims of the new Jenner Society are to engage, support, and sustain the professional goals of vaccinologists, and to perpetuate the memory of Dr. Edward Jenner. Ultimately it is hoped that the Jenner Society will be recognized as one of the leading academic societies representing and promoting vaccine science around the world. We invite readers to consider joining the society (http://www.edwardjennersociety.org/).

Quality of information sources about mental disorders: a comparison of Wikipedia with centrally controlled web and printed sources

BACKGROUND

Although mental health information on the internet is often of poor quality, relatively little is known about the quality of websites, such as Wikipedia, that involve participatory information sharing. The aim of this paper was to explore the quality of user-contributed mental health-related information on Wikipedia and compare this with centrally controlled information sources.

METHOD

Content on 10 mental health-related topics was extracted from 14 frequently accessed websites (including Wikipedia) providing information about depression and schizophrenia, Encyclopaedia Britannica, and a psychiatry textbook. The content was rated by experts according to the following criteria: accuracy, up-to-dateness, breadth of coverage, referencing and readability.

RESULTS

Ratings varied significantly between resources according to topic. Across all topics, Wikipedia was the most highly rated in all domains except readability.

CONCLUSIONS

The quality of information on depression and schizophrenia on Wikipedia is generally as good as, or better than, that provided by centrally controlled websites, Encyclopaedia Britannica and a psychiatry textbook.

Email-based promotion of self-help for subthreshold depression: Mood Memos randomised controlled trial

BACKGROUND

Subthreshold depression is common, impairs functioning and increases the risk of major depression. Improving self-help coping strategies could help subthreshold depression and prevent major depression.

AIMS

To test the effectiveness of an automated email-based campaign promoting self-help behaviours.

METHOD

A randomised controlled trial was conducted through the website: www.moodmemos.com. Participants received automated emails twice weekly for 6 weeks containing advice about self-help strategies. Emails containing general information about depression served as a control. The principal outcome was depression symptom level on the nine-item Patient Health Questionnaire (PHQ-9) (trial registration: ACTRN12609000925246).

RESULTS

The study recruited 1326 adults with subthreshold depression. There was a small significant difference in depression symptoms at post-intervention, favouring the active group (d = 0.17, 95% CI 0.01-0.34). There was a lower, although non-significant, risk of major depression in the active group (number needed to treat (NNT) 25, 95% CI 11 to ∞ to NNT(harm) 57).

CONCLUSIONS

Emails promoting self-help strategies were beneficial. Internet delivery of self-help messages affords a low-cost, easily disseminated and highly automated approach for indicated prevention of depression.

Usage and reported helpfulness of self-help strategies by adults with sub-threshold depression

BACKGROUND

Informal self-help has the potential to reduce the population burden from sub-threshold forms of depression. Evaluating the effectiveness of self-help is difficult in controlled trials, but can be assessed with direct ratings by consumers. Depression experts have previously rated the likely effectiveness of self-help for sub-threshold depression but it is unclear whether the strategies are helpful in practice. We report ratings of the effectiveness of self-help as used by adults with sub-threshold depression.

METHODS

1326 adults with sub-threshold depression were recruited over the internet and completed questionnaires about their use of 26 self-help strategies for depression symptoms. Strategies that had been used were then assessed for their perceived helpfulness.

RESULTS

Reported strategy helpfulness tended to be consistent with expert ratings of likely helpfulness. Exercise or physical activity was rated as most helpful while spending time alone was rated as least helpful. There was little association at the sample level between how helpful a strategy was rated and how frequently it was used. This suggests that the use of self-help is not optimal at the population level. Limitations The sample was self-selected and frequency of use of self-help was self-rated.

CONCLUSIONS

There is room for improvement in the use of self-help through increasing the usage of strategies that are likely to be helpful and reducing the use of strategies that are unhelpful.

Protocol for a randomised controlled trial investigating self-help email messages for sub-threshold depression: the Mood Memos study

BACKGROUND

Sub-threshold depression is common, impairs functioning, and increases the risk of developing major depression. Although psychological treatments have been investigated for sub-threshold depression, they are costly. A less costly alternative could be an educational health promotion campaign about effective self-help for depression symptoms. The aim of the study is to test the efficacy of a low-cost email-based mental health promotion campaign in changing self-help behaviour and preventing more severe depression in adults with sub-threshold depression.

METHODS/DESIGN

The project is a randomised controlled trial of an automated preventive email-intervention aimed at people with sub-threshold depression. Adults aged 18+ with sub-threshold depression (as measured with the Patient Health Questionnaire-9), who are not already receiving professional treatment for depression, are eligible for admission to the study. Internet users will sign up via the study website http://www.moodmemos.com and be randomly allocated to receive emails twice weekly for six weeks containing either self-help coping advice or general information about depression as a control. Outcomes will be assessed at the start, midpoint, and end of the intervention, as well as six months later. Outcomes assessed include symptoms, incidence of major depression, psychological distress, social and occupational functioning, coping strategies, and coping self-efficacy. The primary hypothesis is that the Mood Memo emails containing coping strategies will reduce depression symptoms and be better at preventing major depression than the control emails that contain general information about depression.

DISCUSSION

Promotion of actions an individual can take to prevent physical disease is a technique often used in public health. This study applies this approach to mental health, and explores whether a low-cost, easily disseminated email-based campaign can improve self-help coping behaviour and prevent depression in adults with sub-threshold depression.

TRIAL REGISTRATION

Australia and New Zealand Clinical Trials Register (ANZCTR): ACTRN12609000925246.

Parenting strategies for reducing adolescent alcohol use: a Delphi consensus study

BACKGROUND

International concern regarding the increase in preventable harms attributed to adolescent alcohol consumption has led to growing political and medical consensus that adolescents should avoid drinking for as long as possible. For this recommendation to be adopted, parents and guardians of adolescents require information about strategies that they can employ to prevent or reduce their adolescent's alcohol use that are supported by evidence.

METHODS

The Delphi method was used to obtain expert consensus on parenting strategies effective in preventing and reducing adolescent alcohol consumption. A literature search identified 457 recommendations for parents to reduce their adolescent child's alcohol use. These recommendations were presented to a panel of 38 Australian experts who were asked to rate their importance over three survey rounds.

RESULTS

There were 289 parenting strategies that were endorsed as important or essential in reducing adolescent alcohol use by ≥90% of the panel. These strategies were categorised into 11 sub-headings: things parents should know about adolescent alcohol use, delaying adolescent's introduction to alcohol, modelling responsible drinking and attitudes towards alcohol, talking to adolescents about alcohol, establishing family rules, monitoring adolescents when unsupervised, preparing adolescents for peer pressure, unsupervised adolescent drinking, what to do when an adolescent has been drinking without parental permission, hosting adolescent parties, and establishing and maintaining a good parent-child relationship. The endorsed strategies were written into a document suitable for parents.

CONCLUSIONS

A comprehensive set of parenting strategies for preventing or reducing adolescent alcohol consumption were identified. These strategies can be promoted to parents to help them implement national recommendations for use of alcohol by young people.

Helping someone with problem drug use: a Delphi consensus study of consumers, carers, and clinicians

BACKGROUND

Problem use of illicit drugs (i.e. drug abuse or dependence) is associated with considerable health and social harms, highlighting the need for early intervention and engagement with health services. Family members, friends and colleagues play an important role in supporting and assisting individuals with problem drug use to seek professional help, however there are conflicting views about how and when such support should be offered. This paper reports on the development of mental health first aid guidelines for problem drug use in adults, to help inform community members on how to assist someone developing problem drug use or experiencing a drug-related crisis.

METHODS

A systematic review of the scientific and lay literature was conducted to develop a 228-item survey containing potential first-aid strategies to help someone developing a drug problem or experiencing a drug-related crisis. Three panels of experts (29 consumers, 31 carers and 27 clinicians) were recruited from Australia, Canada, New Zealand, the United Kingdom, and the United States. Panel members independently rated the items over three rounds, with strategies reaching consensus on importance written into the guidelines.

RESULTS

The overall response rate across three rounds was 80% (86% consumers, 81% carers, 74% clinicians). 140 first aid strategies were endorsed as essential or important by 80% or more of panel members. The endorsed strategies provide information and advice on what is problem drug use and its consequences, how to approach a person about their problem drug use, tips for effective communication, what to do if the person is unwilling to change their drug use, what to do if the person does (or does not) want professional help, what are drug-affected states and how to deal with them, how to deal with adverse reactions leading to a medical emergency, and what to do if the person is aggressive.

CONCLUSIONS

The guidelines provide a consensus-based resource for community members who want to help someone with a drug problem. It is hoped that the guidelines will lead to better support and understanding for those with problem drug use and facilitate engagement with professional help.

Actions that young people can take to prevent depression, anxiety and psychosis: beliefs of health professionals and young people

BACKGROUND

Members of the public know about actions they can take to prevent major physical diseases, but there has been less attention to the public's capacity to take action to prevent mental disorders. Since mental disorders often have first onset during youth, young people's beliefs about prevention are of particular relevance.

METHODS

Young people's prevention beliefs were assessed by a national telephone survey of 3746 Australian youth aged 12-25 years. To allow a comparison with professional beliefs, postal surveys were carried out with 470 GPs, 591 psychiatrists, 736 psychologists and 522 mental health nurses. Respondents were asked to rate the helpfulness of 9 potential strategies in relation to the prevention of four disorders: depression, depression with alcohol misuse, social phobia and psychosis.

RESULTS

Both young people and professionals believed that mental disorders could be prevented by physical activity, keeping contact with family and friends, avoiding use of substances, and making time for relaxing activities. However, professionals disagreed with young people about the benefits of avoiding stressful situations, particularly for social phobia. Professionals were also less optimistic about the prevention of psychosis than depression and anxiety.

LIMITATIONS

The surveys assessed beliefs, but not actual use of preventive strategies.

CONCLUSIONS

Given the beliefs of young people and professionals that prevention is possible, there is fertile ground for health promotion in this area. However, young people need to be aware that avoiding stressful situations may not be helpful for anxiety.

Molecular genetic differentiation in earthworms inhabiting a heterogeneous Pb-polluted landscape

A Pb-mine site situated on acidic soil, but comprising of Ca-enriched islands around derelict buildings was used to study the spatial pattern of genetic diversity in Lumbricus rubellus. Two distinct genetic lineages ('A' and 'B'), differentiated at both the mitochondrial (mtDNA COII) and nuclear level (AFLPs) were revealed with a mean inter-lineage mtDNA sequence divergence of approximately 13%, indicative of a cryptic species complex. AFLP analysis indicates that lineage A individuals within one central 'ecological island' site are uniquely clustered, with little genetic overlap with lineage A individuals at the two peripheral sites. FTIR microspectroscopy of Pb-sequestering chloragocytes revealed different phosphate profiles in residents of adjacent acidic and calcareous islands. Bioinformatics found over-representation of Ca pathway genes in EST(Pb) libraries. Subsequent sequencing of a Ca-transport gene, SERCA, revealed mutations in the protein's cytosolic domain. We recommend the mandatory genotyping of all individuals prior to field-based ecotoxicological assays, particularly those using discriminating genomic technologies.

Outcomes of self-help efforts in anxiety disorders

Anxiety disorders are prevalent mental disorders that are a significant burden on the community. There are effective treatments available, but many people do not seek treatment and there is a lack of professionals available to provide evidence-based treatment to all those with anxiety disorders. Recently, there has been increased attention on ways to cost effectively meet the demand for treatment with minimal cost to health services. Self-help efforts have been proposed to play a role, either as an initial minimal treatment in stepped-care models of treatment, or as strategies undertaken by an individual to prevent a full disorder developing. This review examines what is known from randomized controlled trials about the efficacy of self-help interventions for anxiety disorders.

Helping someone with problem drinking: mental health first aid guidelines - a Delphi expert consensus study

BACKGROUND

Alcohol is a leading risk factor for avoidable disease burden. Research suggests that a drinker's social network can play an integral role in addressing hazardous (i.e., high-risk) or problem drinking. Often however, social networks do not have adequate mental health literacy (i.e., knowledge about mental health problems, like problem drinking, or how to treat them). This is a concern as the response that a drinker receives from their social network can have a substantial impact on their willingness to seek help. This paper describes the development of mental health first aid guidelines that inform community members on how to help someone who may have, or may be developing, a drinking problem (i.e., alcohol abuse or dependence).

METHODS

A systematic review of the research and lay literature was conducted to develop a 285-item survey containing strategies on how to help someone who may have, or may be developing, a drinking problem. Two panels of experts (consumers/carers and clinicians) individually rated survey items, using a Delphi process. Surveys were completed online or via postal mail. Participants were 99 consumers, carers and clinicians with experience or expertise in problem drinking from Australia, Canada, Ireland, New Zealand, the United Kingdom, and the United States. Items that reached consensus on importance were retained and written into guidelines.

RESULTS

The overall response rate across all three rounds was 68.7% (67.6% consumers/carers, 69.2% clinicians), with 184 first aid strategies rated as essential or important by > or =80% of panel members. The endorsed guidelines provide guidance on how to: recognize problem drinking; approach someone if there is concern about their drinking; support the person to change their drinking; respond if they are unwilling to change their drinking; facilitate professional help seeking and respond if professional help is refused; and manage an alcohol-related medical emergency.

CONCLUSION

The guidelines provide a consensus-based resource for community members seeking to help someone with a drinking problem. Improving community awareness and understanding of how to identify and support someone with a drinking problem may lead to earlier recognition of problem drinking and greater facilitation of professional help seeking.

As-resistance in laboratory-reared F1, F2 and F3 generation offspring of the earthworm Lumbricus rubellus inhabiting an As-contaminated mine soil

Previous studies provided no unequivocal evidence demonstrating that field populations of Lumbricus rubellus Hoffmeister (1843), exhibit genetically inherited resistance to As-toxicity. In this study F1, F2 and F3 generation offspring derived from adults inhabiting As-contaminated field soil were resistant when exposed to 2000 mg kg(-1) sodium arsenate. The offspring of uncontaminated adults were not As-resistant. Cocoon viability was 80% for F1 and 82% for F2 offspring from As-contaminated adults and 59% in the F1 control population. High energy synchrotron analysis was used to determine whether ligand complexation of As differed in samples of: resistant mine-site adults, the resistant F1 and F2 offspring of the mine-site earthworms exposed to the LC(25) sodium arsenate (700 mg kg(-1)) of the F1 parental generation; and adult L. rubellus from an uncontaminated site exposed to LC(25) concentrations of sodium arsenate (50 mg kg(-1)). XANES and EXAFS indicated that As was present as a sulfur-coordinated species.

Recall of news stories about mental illness by Australian youth: associations with help-seeking attitudes and stigma

OBJECTIVE

The aim of the present study was to investigate what news stories about mental illness are recalled by Australian youth and whether these are associated with stigma and help-seeking beliefs.

METHOD

A random sample of 3746 Australian youth aged 12-25 years were interviewed about mental health literacy in 2006. As part of the interview, they were asked whether they could recall any news stories about mental health problems during the past 12 months. Stigma was assessed, as well as willingness to seek help for a mental illness described in a vignette. Common news story themes were entered as predictors of stigma components and willingness to seek help in a series of logistic regressions.

RESULTS

Only a minority of youth could recall a news story about mental illness. The most common stories recalled were those involving crime or violence; mental health system failures; or disclosures of mental illness by prominent individuals. Recall of a disclosure by a prominent individual was associated with beliefs that people with mental illness are sick rather than weak, while recall of a story involving crime or violence was associated with greater reluctance to tell anyone about a mental health problem. There were no types of stories that predicted willingness to seek help.

CONCLUSIONS

There is some evidence that recall of positive or negative news stories is associated with specific components of stigma. Overall, however, recall of news stories about mental illness added little explanatory power to differences in stigma or help-seeking intentions.

Self-help strategies that are helpful for sub-threshold depression: a Delphi consensus study

BACKGROUND

Sub-threshold depressive symptoms cause substantial disability in the population and are often managed with self-help strategies. However, it is unclear which self-help strategies are likely to be helpful and should be encouraged.

METHODS

The Delphi method was used to assess expert consensus on helpful self-help strategies. An international sample of 63 depression consumers and 34 professionals participated. A literature search found 282 self-help strategies that have been proposed as helpful for depressive symptoms. A systematic review of the evidence was carried out and given to panellists to assist their judgments. Panellists rated the likely helpfulness of each strategy in reducing sub-threshold depressive symptoms. Helpful strategies were then assessed for feasibility of implementation.

RESULTS

Forty-eight strategies were endorsed by at least 80% of both consumers and professionals as likely to be helpful. Consumers and professionals rated a few strategies quite differently, but overall there was considerable agreement about the types of strategies most likely to be helpful, which were typically lifestyle or psychosocial in nature. Strategies rated helpful but difficult to implement were eliminated from the final list.

LIMITATIONS

Panellists found rating feasibility difficult and there was limited evidence from trials on which panellists could base their helpfulness ratings.

CONCLUSIONS

We identified a list of self-help strategies which are likely to be helpful and are feasible to implement by people with sub-threshold depression. The promotion of these strategies to the public needs to be evaluated to see if it could reduce the disability burden of sub-threshold depression.

Earthworm genomes, genes and proteins: the (re)discovery of Darwin's worms

Small incremental biological change, winnowed by natural selection over geological time scales to produce large consequences, was Darwin's singular insight that revolutionized the life sciences. His publications after 1859, including the ‘earthworm book’, were all written to amplify and support the evolutionary theory presented in the Origin. Darwin was unable to provide a physical basis for the inheritance of favoured traits because of the absence of genetic knowledge that much later led to the ‘modern synthesis’. Mistaken though he was in advocating systemic ‘gemmules’ as agents of inheritance, Darwin was perceptive in seeking to underpin his core vision with concrete factors that both determine the nature of a trait in one generation and convey it to subsequent generations. This brief review evaluates the molecular genetic literature on earthworms published during the last decade, and casts light on the specific aspects of earthworm evolutionary biology that more or less engaged Darwin: (i) biogeography, (ii) species diversity, (iii) local adaptations and (iv) sensitivity. We predict that the current understanding will deepen with the announcement of a draft earthworm genome in Darwin's bicentenary year, 2009. Subsequently, the earthworm may be elevated from the status of a soil sentinel to that elusive entity, an ecologically relevant genetic model organism.

Interventions that are helpful for depression and anxiety in young people: a comparison of clinicians' beliefs with those of youth and their parents

BACKGROUND

The aim of the research was to assess the consensus of clinicians about the appropriate treatments for depression and anxiety in youth, to discover any major differences between clinicians' beliefs and those of young people and their parents, and to assess whether clinicians' beliefs were consistent with clinical practice guidelines for young people.

METHODS

Postal surveys were carried out on the beliefs of Australian general practitioners, psychiatrists, psychologists, and mental health nurses about what are helpful interventions for depression and social phobia in a 15-year old and in a 21-year old. The clinician data were compared to findings from an earlier national survey of Australian youth aged 12-25 years and their parents.

RESULTS

The clinicians showed consensus about the helpfulness of a number of professions, reducing substance use, cognitive-behavior therapy, counseling, physical activity, relaxation training, and (for social phobia) meditation. Antidepressants were generally recommended only for depression in a 21-year old. Young people and their parents showed much lower endorsement than clinicians of antidepressants and cognitive-behavior therapy, while clinicians had much lower endorsement than the public of informal supports such as family, friends and support groups.

LIMITATIONS

The survey was adapted from one designed for the public and did not allow clinicians to express complex opinions.

CONCLUSIONS

Clinicians show substantial consensus about appropriate treatments. However, there are some major differences in beliefs between clinicians and young people, which may be a barrier to optimal help-seeking.

Relaxation for depression

BACKGROUND

Many members of the public have negative attitudes towards antidepressants. Psychological interventions are more acceptable but require considerable therapist training. Acceptable psychological interventions that require less training and skill are needed to ensure increased uptake of intervention. A potential intervention of this sort is relaxation techniques.

OBJECTIVES

To determine whether relaxation techniques reduce depressive symptoms and improve response/remission.

SEARCH STRATEGY

The register of trials kept by the Cochrane Collaboration Depression, Anxiety and Neurosis Group was searched up to February 2008. We also searched the reference lists of included studies.

SELECTION CRITERIA

Studies were included if they were randomised or quasi-randomised controlled trials of relaxation techniques (progressive muscle relaxation, relaxation imagery, autogenic training) in participants diagnosed with depression or having a high level of depression symptoms. Self-rated and clinician-rated depression scores and response/remission were the primary outcomes.

DATA COLLECTION AND ANALYSIS

Two reviewers selected the trials, assessed the quality and extracted trial and outcome data, with discrepancies resolved by consultation with a third. Trial authors were approached for missing data where possible and missing data were estimated or imputed in some cases. Continuous measures were summarised using standardised mean differences and dichotomous outcomes by risk ratios.

MAIN RESULTS

There were 15 trials with 11 included in the meta-analysis. Five trials showed relaxation reduced self-reported depression compared to wait-list, no treatment, or minimal treatment post intervention (SMD -0.59 (95% CI -0.94 to -0.24)). For clinician-rated depression, two trials showed a non-significant difference in the same direction (SMD -1.35 (95% CI -3.06 to 0.37)).Nine trials showed relaxation produced less effect than psychological (mainly cognitive-behavioural) treatment on self-reported depression (SMD = 0.38 (95% CI 0.14 to 0.62)). Three trials showed no significant difference between relaxation and psychological treatment on clinician-rated depression at post intervention (SMD 0.29 (95% CI -0.18 to 0.75)).Inconsistent effects were found when comparing relaxation training to medication and there were few data available comparing relaxation with complementary and lifestyle treatments.

AUTHORS' CONCLUSIONS

Relaxation techniques were more effective at reducing self-rated depressive symptoms than no or minimal treatment. However, they were not as effective as psychological treatment. Data on clinician-rated depressive symptoms were less conclusive. Further research is required to investigate the possibility of relaxation being used as a first-line treatment in a stepped care approach to managing depression, especially in younger populations and populations with subthreshold or first episodes of depression.

A comparison of clinician, youth, and parent beliefs about helpfulness of interventions for early psychosis

OBJECTIVE

This study explored whether there are gaps between the beliefs of clinicians and those of young people and their parents about the appropriate interventions for early psychosis.

METHODS

Postal surveys of 105 Australian general practitioners, 155 psychiatrists, 183 psychologists, and 106 mental health nurses asked about the likely helpfulness of a wide range of potential interventions, covering helping professions, medications, psychological interventions, complementary interventions, and self-help. The results from these clinicians were compared with data from a national telephone survey of 968 Australian youths (ages 12-25 years) and 531 of their parents.

RESULTS

Young people and their parents were less likely than the clinicians to endorse the helpfulness of seeing a psychiatrist, using mental health services, and taking antipsychotic medication. On the other hand, young people and their parents were more likely to endorse informal social supports, generic counseling, and general stress reduction methods.

CONCLUSIONS

The gap in intervention beliefs may be a contributor to delays in seeking professional help and adherence to treatment. Efforts are needed to improve public knowledge about psychosis treatment and to change mental health services so that they better meet consumer expectations.

Self-help interventions for depressive disorders and depressive symptoms: a systematic review

BACKGROUND

Research suggests that depressive disorders exist on a continuum, with subthreshold symptoms causing considerable population burden and increasing individual risk of developing major depressive disorder. An alternative strategy to professional treatment of subthreshold depression is population promotion of effective self-help interventions that can be easily applied by an individual without professional guidance. The evidence for self-help interventions for depressive symptoms is reviewed in the present work, with the aim of identifying promising interventions that could inform future health promotion campaigns or stimulate further research.

METHODS

A literature search for randomised controlled trials investigating self-help interventions for depressive disorders or depressive symptoms was performed using PubMed, PsycINFO and the Cochrane Database of Systematic Reviews. Reference lists and citations of included studies were also checked. Studies were grouped into those involving participants with depressive disorders or a high level of depressive symptoms, or non-clinically depressed participants not selected for depression. A number of exclusion criteria were applied, including trials with small sample sizes and where the intervention was adjunctive to antidepressants or psychotherapy.

RESULTS

The majority of interventions searched had no relevant evidence to review. Of the 38 interventions reviewed, the ones with the best evidence of efficacy in depressive disorders were S-adenosylmethionine, St John's wort, bibliotherapy, computerised interventions, distraction, relaxation training, exercise, pleasant activities, sleep deprivation, and light therapy. A number of other interventions showed promise but had received less research attention. Research in non-clinical samples indicated immediate beneficial effects on depressed mood for distraction, exercise, humour, music, negative air ionisation, and singing; while potential for helpful longer-term effects was found for autogenic training, light therapy, omega 3 fatty acids, pets, and prayer. Many of the trials were poor quality and may not generalize to self-help without professional guidance.

CONCLUSION

A number of self-help interventions have promising evidence for reducing subthreshold depressive symptoms. Other forms of evidence such as expert consensus may be more appropriate for interventions that are not feasible to evaluate in randomised controlled trials. There needs to be evaluation of whether promotion to the public of effective self-help strategies for subthreshold depressive symptoms could delay or prevent onset of depressive illness, reduce functional impairment, and prevent progression to other undesirable outcomes such as harmful use of substances.

First aid strategies that are helpful to young people developing a mental disorder: beliefs of health professionals compared to young people and parents

BACKGROUND

Little is known about the best ways for a member of the public to respond when someone in their social network develops a mental disorder. Controlled trials are not feasible in this area, so expert consensus may be the best guide.

METHODS

To assess expert views, postal surveys were carried out with Australian GPs, psychiatrists and psychologists listed on professional registers and with mental health nurses who were members of a professional college. These professionals were asked to rate the helpfulness of 10 potential first aid strategies for young people with one of four disorders: depression, depression with alcohol misuse, social phobia and psychosis. Data were obtained from 470 GPs, 591 psychiatrists, 736 psychologists and 522 mental health nurses, with respective response rates of 24%, 35%, 40% and 32%. Data on public views were available from an earlier telephone survey of 3746 Australian youth aged 12-25 years and 2005 of their parents, which included questions about the same strategies.

RESULTS

A clear majority across the four professions believed in the helpfulness of listening to the person, suggesting professional help-seeking, making an appointment for the person to see a GP and asking about suicidal feelings. There was also a clear majority believing in the harmfulness of ignoring the person, suggesting use of alcohol to cope, and talking to them firmly. Compared to health professionals, young people and their parents were less likely to believe that asking about suicidal feelings would be helpful and more likely to believe it would be harmful. They were also less likely to believe that talking to the person firmly would be harmful.

CONCLUSION

Several first aid strategies can be recommended to the public based on agreement of clinicians about their likely helpfulness. In particular, there needs to be greater public awareness of the helpfulness of asking a young person with a mental health problem about suicidal feelings.

Comparative transcriptomic responses to chronic cadmium, fluoranthene, and atrazine exposure in Lumbricus rubellus

Transcriptional responses of a soil-dwelling organism (the earthworm Lumbricus rubellus) to three chemicals, cadmium (Cd), fluoranthene (FA), and atrazine (AZ), were measured following chronic exposure, with the aim of identifying the nature of any shared transcriptional response. Principal component analysis indicated full or partial separation of control and exposed samples for each compound but not for the composite set of all control and exposed samples. Partial least-squares discriminant analysis allowed separation of the control and exposed samples for each chemical and also for the composite data set, suggesting a common transcriptional response to exposure. Genes identified as changing in expression level (by the least stringent test for significance) following exposure to two chemicals indicated a substantial number of common genes (> 127). The three compound overlapping gene set, however, comprised only 25 genes. We suggest that the low commonality in transcriptional response may be linked to the chronic concentrations (approximately 10% EC50) and chronic duration (28 days) used. Annotations of the three compound overlapping gene set indicated that genes from pathways most often associated with responses to environmental stress, such as heat shock, phase I and II metabolism, antioxidant defense, and cation balance, were not represented. The strongest annotation signature was for genes important in mitochondrial function and energy metabolism.