European mental health research resources: Picture and recommendations of the ROAMER project

As part of the Roamer project, we sought to have a picture of the available mental health research (MHR) funding, capacity-building and infrastructures resources and to establish consensus-based recommendations that would allow an increase of European MHR resources and enable better use and accessibility to them. The methods fell into three sections (i) a review of the literature, (ii) a mental health-related keywords search within the Cordis^®, On-Course^® and Meril^® databases which contain information on European research funding, training and infrastructures. These reviews provided an overview that was presented to (iii) two experts workshops with 28 participants drawn from academic which identified gaps and produced recommendations. The literature review illustrates the debates in the scientific community on funding, training and infrastructures. The database searches estimated the fraction of health research resources available for mental health. Eight overarching goals for MHR resources were identified by the workshops; each of them was carried out with several practical recommendations. Resources for MHR are scarce considering the burden of mental disorders, the high rate of return of MHR and the under-investment of the field. The recommendations are urgently warranted to increase resources and their optimal access and use.

Unraveling the Black Box: Exploring Usage Patterns of a Blended Treatment for Depression in a Multicenter Study

BACKGROUND

Blended treatments, combining digital components with face-to-face (FTF) therapy, are starting to find their way into mental health care. Knowledge on how blended treatments should be set up is, however, still limited. To further explore and optimize blended treatment protocols, it is important to obtain a full picture of what actually happens during treatments when applied in routine mental health care.

OBJECTIVE

The aims of this study were to gain insight into the usage of the different components of a blended cognitive behavioral therapy (bCBT) for depression and reflect on actual engagement as compared with intended application, compare bCBT usage between primary and specialized care, and explore different usage patterns.

METHODS

Data used were collected from participants of the European Comparative Effectiveness Research on Internet-Based Depression Treatment project, a European multisite randomized controlled trial comparing bCBT with regular care for depression. Patients were recruited in primary and specialized routine mental health care settings between February 2015 and December 2017. Analyses were performed on the group of participants allocated to the bCBT condition who made use of the Moodbuster platform and for whom data from all blended components were available (n=200). Included patients were from Germany, Poland, the Netherlands, and France; 64.5% (129/200) were female and the average age was 42 years (range 18-74 years).

RESULTS

Overall, there was a large variability in the usage of the blended treatment. A clear distinction between care settings was observed, with longer treatment duration and more FTF sessions in specialized care and a more active and intensive usage of the Web-based component by the patients in primary care. Of the patients who started the bCBT, 89.5% (179/200) also continued with this treatment format. Treatment preference, educational level, and the number of comorbid disorders were associated with bCBT engagement.

CONCLUSIONS

Blended treatments can be applied to a group of patients being treated for depression in routine mental health care. Rather than striving for an optimal blend, a more personalized blended care approach seems to be the most suitable. The next step is to gain more insight into the clinical and cost-effectiveness of blended treatments and to further facilitate uptake in routine mental health care.

BMI, a performance parameter for speed improvement

The purpose of this study is to investigate the association between anthropometric characteristics and performance in all track and field running events and assess Body Mass Index (BMI) as a relevant performance indicator. Data of mass, height, BMI and speed were collected for the top 100 international men athletes in track events from 100 m to marathon for the 1996-2011 seasons, and analyzed by decile of performance. Speed is significantly associated with mass (r = 0.71) and BMI (r = 0.71) in world-class runners and moderately with height (r = 0.39). Athletes, on average were continuously lighter and smaller with distance increments. In track and field, speed continuously increases with BMI. In each event, performances are organized through physique gradients. « Lighter and smaller is better » in endurance events but « heavier and taller is better » for sprints. When performance increases, BMI variability progressively tightens, but it is always centered around a distance-specific optimum. Running speed is organized through biometric gradients, which both drives and are driven by performance optimization. The highest performance level is associated with narrower biometric intervals. Through BMI indicators, diversity is possible for sprints whereas for long distance events, there is a more restrictive aspect in terms of physique. BMI is a relevant indicator, which allows for a clear differentiation of athletes' capacities between each discipline and level of performance in the fields of human possibilities.

Mutations in the iron-sulfur cluster ligands of the human ferrochelatase lead to erythropoietic protoporphyria

Ferrochelatase (FECH; EC 4.99.1.1) catalyzes the terminal step of the heme biosynthetic pathway. Defects in the human FECH gene may lead to erythropoietic protoporphyria (EPP), a rare inherited disorder characterized by diminished FECH activity with protoporphyrin overproduction and subsequent skin photosensitivity and in rare cases liver failure. Inheritance of EPP appeared to be autosomal dominant with possible modulation by low expression of the wild-type FECH allele. Animal FECHs have been demonstrated to be [2Fe-2S] cluster-containing proteins. Although enzymatic activity and stability of the protein appear to be dependent on the presence of the [2Fe-2S] cluster, the physiologic role of the iron-sulfur center remains to be unequivocally established. Three of the 4 [2Fe-2S] cluster-coordinating cysteines (ie, C403, C406, and C411 in the human enzyme) are located within the C-terminal domain. In this study 5 new mutations are identified in patients with EPP. Three of the point mutations, in 3 patients, resulted in FECH variants with 2 of the [2Fe-2S] cluster cysteines substituted with tyrosine, serine, and glycine (ie, C406Y, C406S, and C411G) and with undetectable enzymatic activity. Further, one of the patients exhibited a triple point mutation (T(1224)-->A, C(1225)-->T, and T(1231)-->G) leading to the N408K/P409S/C411G variant. This finding is entirely novel and has not been reported in EPP. The mutations of the codons for 2 of the [2Fe-2S] cluster ligands in patients with EPP supports the importance of the iron-sulfur center for the proper functioning of mammalian FECH and, in at least humans, its absence has a direct clinical impact. (Blood. 2000;96:1545-1549)

Spontaneous amplification of the ADH4 gene in Saccharomyces cerevisiae

Five spontaneous amplifications of the ADH4 gene were identified among 1,894 antimycin A-resistant mutants isolated from a diploid strain after growth at 15 degrees. Four of these amplifications are approximately 40-kb linear extrachromosomal palindromes carrying telomere homologous sequences at each end similar to a previously isolated amplification. ADH4 is located at the extreme left end of chromosome VII, and the extrachromosomal fragments appear to be the fusion of two copies of the end of this chromosome. The fifth amplification is a chromosomal amplification carrying an extra copy of ADH4 on both homologs of chromosome VII. These results suggest that the ADH system can be used to study amplification in Saccharomyces cerevisiae.

A spontaneous chromosomal amplification of the ADH2 gene in Saccharomyces cerevisiae

A spontaneous antimycin A-resistant mutant carrying approximately four extra copies of ADH2 on chromosome XII was isolated from yeast strain 315-1D which lacks a functional copy of ADH1 and thus is antimycin A-sensitive. The additional copies of the normally glucose-repressed ADH2 are expressed during growth on glucose accounting for the antimycin A resistance. These extra copies are inserted into nonadjacent ribosomal DNA sequences (rDNA) near the recombination stimulating sequence HOT1. Each extra copy of the ADH2 gene (1548 bp) replaces most of the 37S transcript (approximately 7400 bp) in one of the approximately 200 copies of the rDNA present in the yeast genome. All four extra copies of ADH2 are lost at a rate of approximately 1 x 10(-5) deletions per cell per generation. One of the joints between the rDNA and ADH2 DNA is located 7 nucleotides downstream from 20 adenine residues in the normal copy of ADH2. This joint occurs at the end of a stretch of 16-29 thymidines in the rDNA which has been expanded to 57-59 thymidines. The other novel joint is located in a short region of sequence similarity between ADH2 and the rDNA. These observations suggest that amplification of ADH2 was a two step process: first the ADH2 gene was inserted into the rDNA, then multiple copies were generated by unequal crossing over or gene conversion within the rDNA.

Relationships among and demographic predictors of dentists' self-reported adherence to national guidelines

How dentists learn about and integrate new procedures and techniques into dental practice are major concerns in innovation research in dentistry. The purposes of this study were to: (1) develop reliable measures of self-reported adherence to different national guidelines; (2) to examine the relationships among the different measures; and (3) to determine if predictors of these adherence behaviours exist. One thousand U.S. general dentists were asked to complete a survey of adherence behaviours to established guidelines in infection control, radiation protection, and antibiotic prophylaxis. Thirty-five percent responded to the mailed survey. Reliable scales were developed in infection control and antibiotic prophylaxis behaviors. Step-wise multiple regression analysis produced several weak predictors of adherence to guidelines in these two areas. Characteristics of early adopters such as office complexity, membership in professional associations, and year of graduation, were consistent with other dental innovation literature. Significant correlations were found between adherence behaviors in infection control and antibiotic prophylaxis. These correlations do support the findings that practitioners who are early adopters of innovation are likely to do so in more than one area.

The acceptability of electric shock programs

Vignette methodology was used to assess factors associated with decisions regarding the acceptability of treatment programs involving Response Contingent Electric Shock. Ninety-four mental retardation professionals each reviewed unique vignettes that described a program involving the use of electric shock to consequate some form of behavior. They then were asked to rate three related acceptability dimensions with regard to the vignette. The use of Response Contingent Electric Shock was rated as more appropriate if the behavior was a serious behavior, occurred frequently, and had been unresponsive to less intrusive methods of therapy.