Efficacy of a dilemma-focused intervention for unipolar depression: study protocol for a multicenter randomized controlled trial

Background Depression is one of the more severe and serious health problems because of its morbidity, disabling effects and for its societal and economic burden. Despite the variety of existing pharmacological and psychological treatments, most of the cases evolve with only partial remission, relapse and recurrence. Cognitive models have contributed significantly to the understanding of unipolar depression and its psychological treatment. However, success is only partial and many authors affirm the need to improve those models and also the treatment programs derived from them. One of the issues that requires further elaboration is the difficulty these patients experience in responding to treatment and in maintaining therapeutic gains across time without relapse or recurrence. Our research group has been working on the notion of cognitive conflict viewed as personal dilemmas according to personal construct theory. We use a novel method for identifying those conflicts using the repertory grid technique (RGT). Preliminary results with depressive patients show that about 90% of them have one or more of those conflicts. This fact might explain the blockage and the difficult progress of these patients, especially the more severe and/or chronic. These results justify the need for specific interventions focused on the resolution of these internal conflicts. This study aims to empirically test the hypothesis that an intervention focused on the dilemma(s) specifically detected for each patient will enhance the efficacy of cognitive behavioral therapy (CBT) for depression. Design A therapy manual for a dilemma-focused intervention will be tested using a randomized clinical trial by comparing the outcome of two treatment conditions: combined group CBT (eight, 2-hour weekly sessions) plus individual dilemma-focused therapy (eight, 1-hour weekly sessions) and CBT alone (eight, 2-hour group weekly sessions plus eight, 1-hour individual weekly sessions). Method Participants are patients aged over 18 years meeting diagnostic criteria for major depressive disorder or dysthymic disorder, with a score of 19 or above on the Beck depression inventory, second edition (BDI-II) and presenting at least one cognitive conflict (implicative dilemma or dilemmatic construct) as assessed using the RGT. The BDI-II is the primary outcome measure, collected at baseline, at the end of therapy, and at 3- and 12-month follow-up; other secondary measures are also used. Discussion We expect that adding a dilemma-focused intervention to CBT will increase the efficacy of one of the more prestigious therapies for depression, thus resulting in a significant contribution to the psychological treatment of depression. Trial registration ISRCTN92443999; ClinicalTrials.gov Identifier: NCT01542957.

Preface: Forecast and projection in climate scenario of Mediterranean intense events: uncertainties and propagation on environment (the MEDUP project)

The Mediterranean basin is a particularly vulnerable region to climate change, partly due to its quite unique character that results both from physiographic conditions and societal development. The region features indeed a near-closed sea surrounded by very urbanised littorals and mountains from which numerous rivers originate. This results in a lot of interactions and feedbacks between oceanic-atmospheric-hydrological processes that play a predominant role on climate and extreme events that frequently cause heavy dam- ages and human losses in the Mediterranean ...

Assessing trends in insured losses from floods in Spain 1971-2008

Economic impacts from floods have been increasing over recent decades, a fact often attributed to a changing climate. On the other hand, there is now a significant body of scientific scholarship all pointing towards increasing concentrations and values of assets as the principle cause of the increasing cost of natural disasters. This holds true for a variety of perils and across different jurisdictions. With this in mind, this paper examines the time history of insured losses from floods in Spain between 1971 and 2008. It as- sesses whether any discernible residual signal remains after adjusting the data for the increase in the number and value of insured assets over this period of time. Data on insured losses from floods were sourced from Consorcio de Com- pensacíon de Seguros (CCS). Although a public institution, CCS compensates homeowners for the damage produced by floods, and thus plays a role similar to that of a private insurance company. Insured losses were adjusted using two proxy measures: first, changes in the total amount of annual surcharges (premiums) paid by customers to CCS, and secondly, changes in the total value of dwellings per year. The adjusted data reveals no significant trend over the period 1971-2008 and serves again to confirm that at this juncture, societal in- fluences remain the prime factors driving insured and economic losses from natural disasters.

El medi ambient i el desenvolupament, l'economia i l'educacio. Quina economia i quina educacio?

Quan es parla d'educació, en termes econòmics i en les societats actuals, se'ns demostra la dependència que aquesta té de les formes d'organització de l'economia. Se'ns torna a recordar aquella correspondència -encara que no sempre exacta i sovint matisable- que apuntaven Bowles i Gintis entre el sistema socioeconòmic i els sistemes educatius, sobretot en els seus currículums ocults.

Educació per al desenvolupament i la cooperació: criteris de valoració dels materials didàctics

Els mitjans de comunicació ens atansen periòdicament notícies commovedores i ens sotraguegen amb imatges de fams, sequeres o misèria, les víctimes de les quals acostumen a viure al sud. També ens fan arribar els èxits més notables de l'economia i la tècnica: més producció, més vendes, més autopistes, millors avions. Tot això passa, preferentment, al nord.

The snow storm of the 8th of March 2010 in Barcelona: a paradigmatic case

A heavy precipitation event swept over Catalonia (NE Spain) on 8 March 2010, with a total amount that ex- ceeded 100mm locally and snowfall of more than 60cm near the coast. Unusual for this region and at this time of the year, this snowfall event affected mainly the coastal region and was accompanied by thunderstorms and strong wind gusts in some areas. Most of the damage was due to"wet snow", a kind of snow that favours accretion on power lines and causes line-breaking and subsequent interruption of the electricity supply. This paper conducts an interdisciplinary analysis of the event to show its great societal impact and the role played by the recently developed social networks (it has been called the first"Snowfall 2.0"), as well to analyse the meteorologi- cal factors associated with the major damage, and to propose an indicator that could summarise them. With this aim, the paper introduces the event and its societal impact and com- pares it with other important snowfalls that have affected the Catalan coast, using the PRESSGAMA database. The sec- ond part of the paper shows the event"s main meteorological features and analyses the near-surface atmospheric variables responsible for the major damage through the application of the SAFRAN (Système d"analyse fournissant des renseigne- ments atmosphériques à la neige) mesoscale analysis, which, together with the proposed"wind, wet-snow index" (WWSI), allows to estimate the severity of the event. This snow storm provides further evidence of our vulnerability to natural haz- ards and highlights the importance of a multidisciplinary ap- proach in analysing societal impact and the meteorological factors responsible for this kind of event.

Cost-effectiveness of a community pharmacist intervention in patients with depression: a randomized controlled trial (PRODEFAR study)

Background: Non-adherence to antidepressants generates higher costs for the treatment of depression. Little is known about the cost-effectiveness of pharmacist's interventions aimed at improving adherence to antidepressants. The study aimed to evaluate the cost-effectiveness of a community pharmacist intervention in comparison with usual care in depressed patients initiating treatment with antidepressants in primary care. Methods: Patients were recruited by general practitioners and randomized to community pharmacist intervention (87) that received an educational intervention and usual care (92). Adherence to antidepressants, clinical symptoms, Quality-Adjusted Life-Years (QALYs), use of healthcare services and productivity losses were measured at baseline, 3 and 6 months. Results: There were no significant differences between groups in costs or effects. From a societal perspective, the incremental cost-effectiveness ratio (ICER) for the community pharmacist intervention compared with usual care was 1,866 for extra adherent patient and 9,872 per extra QALY. In terms of remission of depressive symptoms, the usual care dominated the community pharmacist intervention. If willingness to pay (WTP) is 30,000 per extra adherent patient, remission of symptoms or QALYs, the probability of the community pharmacist intervention being cost-effective was 0.71, 0.46 and 0.75, respectively (societal perspective). From a healthcare perspective, the probability of the community pharmacist intervention being cost-effective in terms of adherence, QALYs and remission was of 0.71, 0.76 and 0.46, respectively, if WTP is 30,000. Conclusion: A brief community pharmacist intervention addressed to depressed patients initiating antidepressant treatment showed a probability of being cost-effective of 0.71 and 0.75 in terms of improvement of adherence and QALYs, respectively, when compared to usual care. Regular implementation of the community pharmacist intervention is not recommended.

Identidad, percepción de vitalidad etnolingüística y comunicación intergrupal en Cataluña: An identity and ethnolinguistic perception vitality study in Catalonia

Catalan has drawn considerable attention given its impressive institutional support and increased usage since the restoration of the Generalitat of Catalonia. We report a study on 112 Catalan-speaking students who were administered the"subjective vitality questionnaire". Results show (and these are compared with reports 20 years ago) that it continues to gain momentum and status, even with the International stature of Spanish. The theoretical and pragmatic significance of these findings are discussed in terms of vitality"s role in shaping Language choices (Catalan vs. Castilian) in everyday communication as well as the societal level in forging Language policies for communicating in Catalan in business, political, educational, and media arenas

The Transformation of Practical Teaching Focusing on Dialogic Learning

This study investigates the transformation of practical teaching in a Catalan school, connected to the design, implementation and development of project-based learning, and focusing on dialogic learning to investigate its limits and possibilities. Qualitative and design-based research (DBR) methods are applied. These methods are based on empirical educational research with the theory-driven of learning environments. DBR is proposed and applied using practical guidance for the teachers of the school. It can be associated with the current proposals for Embedding Social Sciences and Humanities in the Horizon 2020 Societal Challenges. This position statement defends the social sciences and the humanities as the most fundamental and important ideas to face all societal challenges. The results of this study show that before the training process, teachers apply dialogic learning in specific moments (for example, when they speak about the weekend); however, during the process and after the process, they work systematically with dialogic learning through the PEPT: they start and finish every activity with a individual and group reflection about their own processes, favouring motivation, reasoning and the implication of all the participants. These results prove that progressive transformations of teaching practice benefit cooperative work in class