Deep brain stimulation (DBS) of the globus pallidus pars interna (GPi) is an effective treatment for generalized dystonia. Its role in the management of other types of dystonia is uncertain. Therefore we performed a prospective, single-blind, multicentre study assessing the efficacy and safety of bilateral GPi-DBS in 10 patients with severe, chronic, medication-resistant cervical dystonia. Two blinded neurologists assessed patients before surgery and at 6 and 12 months post-operatively using the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS). The primary outcome measure was the severity subscore (range 0-30, higher scores indicating greater impairment). Secondary outcomes included disability (0 to 30), pain (0 to 40) subscores and total scores of the TWSTRS, Short Form-36 and Beck depression inventory. Swallowing and neuropsychological assessment were also performed at baseline and 12 months. One-way repeated measures analysis of variance was used to analyse the data. The TWSTRS severity score improved from a mean (SD) of 14.7 (4.2) before surgery to 8.4 (4.4) at 12 months post-operatively (P = 0.003). The disability and pain scores improved from 14.9 (3.8) and 26.6 (3.6) before surgery, to 5.4 (7.0) and 9.2 (13.1) at 12 months, respectively (both P
This study evaluated the effectiveness of a stress management intervention combining individual cognitive behavioral therapy (CBT) with a brief workplace intervention on self-reported measures of sleep and cognitive functioning among patients on sick leave due to work-related stress complaints.
Participants were patients referred to the regional Department of Occupational Medicine. Inclusion criteria were (i) sick leave due to work-related stress complaints and (ii) a diagnosis of adjustment disorder/reactions to stress or mild depression. Participants (N=137) were randomized to either an intervention (N=57) or control (N=80) group. The intervention comprised six sessions with a psychologist and the offer of a small workplace intervention. Questionnaires were answered at baseline and after 4, and 10 months.
Symptoms were significantly reduced over time in both groups but there was no significant treatment effect on sleep or cognitive outcomes at any time point. From 0-4 months, there was a tendency for larger improvements in the intervention group with regards to sleep and cognitive failures in distraction. Although neither was significant, the results came close to significance depicting a small effect size (Cohen's d) on sleep complaints and distractions (but not memory).
The specific intervention was not superior to the control condition in reducing symptoms of sleep problems and cognitive difficulties at any time point during the 10-month follow-up period. Substantial improvements in symptoms over time were seen in both groups.
Depression is one of the leading causes of disability and affects 10-15% of the population. The majority of people with depressive symptoms seek care and are treated in primary care. Evidence internationally for high quality care supports collaborative care with a care manager. Our aim was to study clinical effectiveness of a care manager intervention in management of primary care patients with depression in Sweden.
In a pragmatic cluster randomized controlled trial 23 primary care centers (PCCs), urban and rural, included patients aged =?18 years with a new (
Dr. Kenneth Rothman, a critic of the use of placebos in clinical trials, recently discussed the issue with Health Canada employees. Some researchers insist this is not a black-and-white issue, and that in some cases patients who receive a placebo are the lucky ones.
This study investigated the relationship between light and strenuous exercise and depression, as well as gender differences in this relationship, in a representative sample of 860 elderly Swedish suburb-dwelling men and women in age cohorts from 60 to 96 years, drawn from among participants in the Swedish National Aging and Care study. The relationship between depression and self-reported changes in exercise status over time was also examined. Exercise activities were measured with four survey questions, and depression, with the Montgomery Asberg Depression Rating Scale. The inactive elderly had higher depression scores than more active individuals, both in terms of light and strenuous exercise. The continuously active group had lower depression scores than both continuously inactive individuals and individuals reporting a shift from activity to inactivity during the preceding year. Light exercise had a somewhat stronger effect on depression for women.
Depression has received increasing attention as a significant public health issue over the past ten years, both in Canada and elsewhere in the industrialized west. During the same period, many of the social and economic policies adopted by governments in these jurisdictions have reflected neoliberal goals and orientations. The purpose of this article is to explore the points of contact between these two features of contemporary social and political life in the industrialized west, using the Canadian province of British Columbia as an empirical site. My analysis draws on the Foucauldian literature on governmentality in presenting a close reading of provincial government documents concerned with depression and mental health literacy that have been produced since the election of the Liberal Party to office in British Columbia in 2001. This analysis identifies discourses of "responsibilization" circulating in these documents, within which individuals, families, communities and workplaces - rather than publicly-funded services - appear as key resources in responding to experiences of mental distress. It also points to a number of strategies visible in the documents that work to align the interests of individuals and their practitioners in pursuing particular approaches to treatment with a governing interest in reducing public spending on services and supports. The article concludes by identifying a number of resistive discourses and proposing further research in a range of empirical contexts within which they may be evident.
The purpose for this study was to evaluate the association between depression-focused interpersonal counseling (IPC) and the use of healthcare services in Finland after myocardial infarction (MI).
The measures were done at 6 and 18 months after MI in the randomized intervention (n= 51) and the control group (n= 52).
There was less use of somatic specialized healthcare services in the intervention group from 6 to 18 months after hospital discharge, and with intervention patients who had no other long-term disease during 6 months.
Confirmation of possible benefits of IPC for practice calls for more specific studies.