Atypical depression and alcohol misuse are related to the cardiovascular risk in the general population.

OBJECTIVE: The aims of the present study were to assess the associations between mood, anxiety and substance use disorders, including their subtypes, and the prevalence of cardiovascular risk factors (CVRFs). METHOD: Thorough physical investigations, biological measures and standardized interview techniques were used to assess 3716 subjects of an urban area, aged 35-66 years. RESULTS: Atypical depression was associated with increased prevalence of overweight, diabetes and the metabolic syndrome (OR = 1.5, 95% C.I. 1.1-2.0; OR = 2.0, 95% C.I. 1.1-3.5, OR = 1.6, 95% C.I. 1.0-2.4 respectively), whereas decreased prevalence of overweight was found in melancholic (OR = 0.7, 95% C.I. 0.6-0.9) and unspecified depression (OR = 0.8, 95% C.I. 0.7-1.0). Alcohol abuse was associated with diabetes (OR = 1.8, 95% C.I. 1.1-2.9) and dyslipidemia (OR = 1.3, 95% C.I. 1.0-1.8), alcohol dependence with dyslipidemia only (OR = 1.4, 95% C.I. 1.0-2.0). Almost all mental disorders were associated with a lifetime history of regular cigarette smoking, and atypical depression, alcohol misuse and drug dependence were associated with inactivity. CONCLUSION: To conclude results emphasize the need to subtype depression and to pay particular attention to the atypical subtype. Comorbid alcohol misuse may further increase the cardiovascular risk. Efforts to diminish smoking in subjects with mental disorders could be crucial measures to reduce their high incidence of cardiovascular disease.

What interventions facilitate client progress through the assimilation model? A task analysis of interventions in the psychodynamic treatment of depression.

A variation of task analysis was used to build an empirical model of how therapists may facilitate client assimilation process, described in the Assimilation of Problematic Experiences Scale. A rational model was specified and considered in light of an analysis of therapist in-session performances (N = 117) drawn from six inpatient therapies for depression. The therapist interventions were measured by the Comprehensive Psychotherapeutic Interventions Rating Scale. Consistent with the rational model, confronting interventions were particularly useful in helping clients elaborate insight. However, rather than there being a small number of progress-related interventions at lower levels of assimilation, therapists' use of interventions was broader than hypothesized and drew from a wide range of therapeutic approaches. Concerning the higher levels of assimilation, there was insufficient data to allow an analysis of the therapist's progress-related interventions.

Aspirin and statin use and the subsequent development of depression in men and women: Results from a longitudinal population-based study.

OBJECTIVE: Low-grade chronic inflammation is one potential mechanism underlying the well-established association between major depressive disorder (MDD) and increased cardiovascular morbidity. Both aspirin and statins have anti-inflammatory properties, which may contribute to their preventive effect on cardiovascular diseases. Previous studies on the potentially preventive effect of these drugs on depression have provided inconsistent results. The aim of the present paper was to assess the prospective association between regular aspirin or statin use and the incidence of MDD. METHOD: This prospective cohort study included 1631 subjects (43.6% women, mean age 51.7 years), randomly selected from the general population of an urban area. Subjects underwent a thorough physical evaluation as well as semi-structured interviews investigating DSM-IV mental disorders at baseline and follow-up (mean duration 5.2 years). Analyses were adjusted for a wide array of potential confounders. RESULTS: Our main finding was that regular aspirin or statin use at baseline did not reduce the incidence of MDD during follow-up, regardless of sex or age (hazard ratios, aspirin: 1.19; 95%CI, 0.68-2.08; and statins: 1.25; 95%CI, 0.73-2.14; respectively). LIMITATIONS: Our study is not a randomized clinical trial and could not adjust for all potential confounding factors, information on aspirin or statin use was collected only for the 6 months prior to the evaluations, and the sample was restricted to subjects between 35 and 66 years of age. CONCLUSION: Our data do not support a large scale preventive treatment of depression using aspirin or statins in subjects aged from 35 to 66 years from the community.

Cross-border post-acquisition integration performed by a Nordic information & telecommunication technology company in the transition economy context of the Czech Republic

Diplomityön tarkoituksena oli arvioida akvisition jälkeistä integraatioprosessia. Integraation tarkoitus on mukauttaa ostettu yritys toimivaksi osaksi konsernia. Työn empiirisenä ongelmana oli yleisesti tunnustettu integraatiojohtamisen kompleksisuus. Samoin myöskin akateemisesta kirjallisuudesta puuttui koherentti malli, jolla arvioida integraatiota. Tutkimuskohteena oli akvisitio, jossa suomalainen tietotekniikkan suuryritys osti osake-enemmistön tsekkiläisestä keskisuuresta ohjelmistoyrityksestä. Tutkimuksessa generoitiin integraatiojohtamisen malli tietopohjaiseen organisaatioon. Mallin mukaan integraatio koostuu kolmesta eriävästä, mutta toisiaan tukevasta alueesta: organisaatiokulttuurin yhdentyminen, tietopääoman tasaaminen ja konsernin sisäisten prosessien yhdenmukaistaminen. Näistä kaksi kaksi jälkimmäistä ovat johdettavissa, mutta kulttuurin yhdentymiseen integraatiojohtamisella voidaan vaikuttaa vain katalysoivasti. Organisaatiokulttuuri levittäytyy vain osallisten vuorovaikuksien kautta. Lisäksi tutkimus osoitti, miten akvisitio on revolutionaarinen vaihe yrityksen kehityksessä. Integraation ensimmäinen ajanjakso on revolutionaarista. Tällöin suurimmat ja näkyvimmät johdettavat muutokset pyritään saamaan aikaan, jotta integraatiossa edettäisiin evolutionaariseen kehitykseen. Revolutionaarisen intergaation vetojuhtana toimii integraatiojohto, kun taas evolutionaarinen integraatio etenee osallisten (organisaation jäsenten) itsensä toiminnan ja vuorovaikutusten kautta.

How Do Aggregate Fluctuations Depend on the Network Structure of the Economy?

[spa] En este artículo, analizamos la volatilidad agregada de una economía estilizada donde los agentes estann conectados en redes. Si hay relaciones estratégicas entre las acciones de los agentes, choques idiosincráticos pueden generar fluctuaciones agregadas. Demonstramos que la volatilidad agregada depende de la estructura de redes de la economía de dos maneras. Por un lado, si hay más conexiones en la economía en su conjunto, la volatilidad agregada es más baja. Por otro lado, si las conexiones están más concentradas, la volatilidad agregada es más alta. Presentamos una aplicación de nuestras predicciones teóricas que utiliza datos de EEUU de conexiones intrasectoriales y de diversificación de las empresas.

How Do Aggregate Fluctuations Depend on the Network Structure of the Economy?

[spa] En este artículo, analizamos la volatilidad agregada de una economía estilizada donde los agentes estann conectados en redes. Si hay relaciones estratégicas entre las acciones de los agentes, choques idiosincráticos pueden generar fluctuaciones agregadas. Demonstramos que la volatilidad agregada depende de la estructura de redes de la economía de dos maneras. Por un lado, si hay más conexiones en la economía en su conjunto, la volatilidad agregada es más baja. Por otro lado, si las conexiones están más concentradas, la volatilidad agregada es más alta. Presentamos una aplicación de nuestras predicciones teóricas que utiliza datos de EEUU de conexiones intrasectoriales y de diversificación de las empresas.

The political economy of international regulatory convergence in public utilities

To what extent should public utilities regulation be expected to converge across countries? When it occurs, will it generate good outcomes? Building on the core proposition of the New Institutional Economics that similar regulations generate different outcomes depending on their fit with the underlying domestic institutions, we develop a simple model and explore its implications by examining the diffusion of local loop unbundling (LLU) regulations. We argue that: one should expect some convergence in public utility regulation but with still a significant degree of local experimentation; this process will have very different impacts of regulation.

Efficacy of modern antipsychotics in placebo-controlled trials in bipolar depression: a meta-analysis.

Randomized, controlled trials have demonstrated efficacy for second-generation antipsychotics in the treatment of acute mania in bipolar disorder. Despite depression being considered the hallmark of bipolar disorder, there are no published systematic reviews or meta-analyses to evaluate the efficacy of modern atypical antipsychotics in bipolar depression. We systematically reviewed published or registered randomized, double-blind, placebo-controlled trials (RCTs) of modern antipsychotics in adult bipolar I and/or II depressive patients (DSM-IV criteria). Efficacy outcomes were assessed based on changes in the Montgomery-Asberg Depression Rating Scale (MADRS) during an 8-wk period. Data were combined through meta-analysis using risk ratio as an effect size with a 95% confidence interval (95% CI) and with a level of statistical significance of 5% (p<0.05). We identified five RCTs; four involved antipsychotic monotherapy and one addressed both monotherapy and combination with an antidepressant. The two quetiapine trials analysed the safety and efficacy of two doses: 300 and 600 mg/d. The only olanzapine trial assessed olanzapine monotherapy within a range of 5-20 mg/d and olanzapine-fluoxetine combination within a range of 5-20 mg/d and 6-12 mg/d, respectively. The two aripiprazole placebo-controlled trials assessed doses of 5-30 mg/d. Quetiapine and olanzapine trials (3/5, 60%) demonstrated superiority over placebo (p<0.001). Only 2/5 (40%) (both aripiprazole trials) failed in the primary efficacy measure after the first 6 wk. Some modern antipsychotics (quetiapine and olanzapine) have demonstrated efficacy in bipolar depressive patients from week 1 onwards. Rapid onset of action seems to be a common feature of atypical antipsychotics in bipolar depression. Comment in The following popper user interface control may not be accessible. Tab to the next button to revert the control to an accessible version.Destroy user interface controlEfficacy of modern antipsychotics in placebo-controlled trials in bipolar depression: a meta-analysis--results to be interpreted with caution.

Influence of Equipment Operation and Performance Deterioration on Power Plant Economy.

Pysyäkseen kilpailukykyisenä vapautuneilla sähkömarkkinoilla on voimalaitoksen energiantuotantokustannusten oltava mahdollisimman matalia, tinkimättä kuitenkaan korkeasta käytettävyydestä. Polttoaineen energiasisällön mahdollisimman hyvä hyödyntäminen on ratkaisevan tärkeää voimalaitoksen kannattavuudelle. Polttoainekustannusten osuus on konvektiivisilla laitoksilla yleensä yli puolet koko elinjakson kustannuksista. Kun vielä päästörajat tiukkenevat koko ajan, korostuu polttoaineen korkea hyötykäyttö entisestään. Korkea energiantuotannon luotettavuus ja käytettävyys ovat myös elintärkeitä pyrittäessä kustannusten minimointiin. Tässä työssä on käyty läpi voimalaitoksen kustannuksiin vaikuttavia käsitteitä, kuten hyötysuhdetta, käytettävyyttä, polttoaineen hintoja, ylös- ja alasajoja ja tärkeimpiä häviöitä. Ajostrategiassa ja poikkeamien hallinnassa pyritään hyvään hyötysuhteeseen ja alhaisiin päästöihin joka käyttötilanteessa. Lisäksi on tarkasteltu tiettyjen suureiden, eli höyryn lämpötilan ja paineen, savukaasun hapen pitoisuuden, savukaasun loppulämpötilan, sekä lauhduttimen paineen poikkeamien vaikutusta ohjearvostaan energiantuotantokustannuksiin. Happi / hiilimonoksidi optimoinnissa on otettu huomioon myös pohjatuhkan palamattomat.

A systematic review and meta-analysis of lithium augmentation of tricyclic and second generation antidepressants in major depression.

BACKGROUND: Lithium augmentation of antidepressants for treatment of unipolar major depression was one of the first adjunctive strategies based on a neuropharmacologic rationale. Randomized controlled trials supported its efficacy but most trials added lithium to tricyclic antidepressants (TCAs). Despite its efficacy, use of lithium augmentation remains infrequent. The current systematic review and meta-analysis examines the efficacy of lithium augmentation as an adjunct to second generation antidepressants as well as to TCAs and considers reasons for its infrequent use. METHOD: A systematic search of Medline and the Cochrane Clinical Trials database was performed. Randomized, placebo-controlled trials of lithium augmentation were selected. A fixed-effects meta-analysis was performed. Odds ratios for response were calculated for each treatment-control contrast, for the trials grouped by type of initial antidepressant (TCA or second generation antidepressant), and as a meta-analytic summary for all treatments combined. RESULTS: Nine trials that included 237 patients were selected. The odds ratio for response to lithium vs. placebo in all contrasts combined was 2.89 (95% CI 1.65, 5.05, z=3.72, p=0.0002). Heterogeneity was very low, I(2)=0%. Adjunctive lithium was effective with TCAs (7 contrasts) and with second generation agents (3 contrasts). Discontinuation due to adverse events was infrequent and did not differ between lithium and placebo. LIMITATIONS: The meta-analysis is limited by the small size and number of trials and limited data for treatment resistant patients. CONCLUSIONS: Adjunctive lithium appears to be as effective for second generation antidepressants as it was for the tricyclics.

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.

Evaluation of a pharmacist intervention on patients initiating pharmacological treatment for depression: a randomized controlled superiority trial

Major depression is associated with high burden, disability and costs. Non-adherence limits the effectiveness of antidepressants. Community pharmacists (CP) are in a privileged position to help patients cope with antidepressant treatment. The aim of the study was to evaluate the impact of a CP intervention on primary care patients who had initiated antidepressant treatment. Newly diagnosed primary care patients were randomised to usual care (UC) (92) or pharmacist intervention (87). Patients were followed up at 6 months and evaluated three times (Baseline, and at 3 and 6 months). Outcome measurements included clinical severity of depression (PHQ-9), health-related quality of life (HRQOL) (Euroqol-5D) and satisfaction with pharmacy care. Adherence was continuously registered from the computerised pharmacy records. Non-adherence was defined as refilling less than 80% of doses or having a medication-free gap of more than 1 month. Patients in the intervention group were more likely to remain adherent at 3 and 6 months follow-up but the difference was not statistically significant. Patients in the intervention group showed greater statistically significant improvement in HRQOL compared with UC patients both in the main analysis and PP analyses. No statistically significant differences were observed in clinical symptoms or satisfaction with the pharmacy service. The results of our study indicate that a brief intervention in community pharmacies does not improve depressed patients' adherence or clinical symptoms. This intervention helped patients to improve their HRQOL, which is an overall measure of patient status.

Optimal Exchange Rate Policy in a Growing Semi-Open Economy

This paper considers an alternative perspective to China's exchange rate policy. It studies a semi-open economy where the private sector has no access to international capital markets but the central bank has full access. Moreover, it assumes limited financial development generating a large demand for saving instruments by the private sector. The paper analyzes the optimal exchange rate policy by modeling the central bank as a Ramsey planner. Its main result is that in a growth acceleration episode it is optimal to have an initial real depreciation of the currency combined with an accumulation of reserves, which is consistent with the Chinese experience. This depreciation is followed by an appreciation in the long run. The paper also shows that the optimal exchange rate path is close to the one that would result in an economy with full capital mobility and no central bank intervention.