Treating Subthreshold Depression in Primary Care: A Randomized Controlled Trial of Behavioral Activation With Mindfulness.

PURPOSE: We undertook a randomized controlled trial to assess the efficacy of group-based behavioral activation with mindfulness (BAM) for treating subthreshold depression in primary care in Hong Kong. METHODS: We recruited adult patients aged 18 years or older with subthreshold depression from public primary care clinics and randomly assigned them to a BAM intervention group or a usual care group. The BAM group was provided with eight 2-hour weekly BAM sessions by trained allied health care workers. Patients in the usual care group received usual medical care with no additional psychological interventions. The primary outcome was depressive symptoms measured by the Beck Depression Inventory-II at 12 months. Secondary outcomes included incidence of major depressive disorder at 12 months. We assessed quality of life, activity and circumstances change, functional impairment, and anxiety at baseline, end of intervention, 5 months, and 12 months. RESULTS: We randomly allocated 115 patients to the BAM intervention and 116 patients to usual care. At 12 months, compared with usual care peers, BAM patients had a slightly more favorable change in levels of depressive symptoms on the Beck Depression Inventory-II (between-group mean difference in score = -3.85; 95% CI, -6.36 to -1.34; Cohen d = -0.46, 95% CI, -0.76 to -0.16). Incidence of major depressive disorder was lower with BAM (10.8% vs 26.8%, P = .01), whereas groups did not differ significantly on other secondary outcomes at 12 months. CONCLUSIONS: Group BAM appears to be efficacious for decreasing depressive symptoms and reducing the incidence of major depression among patients with subthreshold depression in primary care, although generalizability of our findings may be limited.

New attitudes and technologies make now the right time to create a "virtual" association.

The World Wide Web has become a convenient tool for research, communication, and even commerce, but a recent survey of foundations and corporate giving programs reveals that grant makers are not making full use of computer and Internet capabilities that might benefit them.

Endoscopic Nd:YAG laser coagulation as palliative therapy for obstructing esophageal carcinoma.

Fifteen consecutive patients who underwent endoscopic Nd:YAG laser therapy for palliation of advanced esophageal carcinoma were treated between December 1, 1983 and April 15, 1985. All but three had recurrent or persistent symptomatic disease after prior treatment with other modalities. Tumor cell type was squamous cell carcinoma in eight patients and adenocarcinoma in seven. Tumor location was distal in seven, middle in four, and upper esophagus in four. Mean tumor length was 5.6 cm and mean initial luminal diameter 2.5 mm. Twelve of 15 patients had virtually complete luminal occlusion before laser therapy. Treatment was completed in a mean of 3.47 sessions (range 2.7) over a mean of 9.18 days (range 1-18). An average of 2490 joules was delivered per session. An average of 11,695 joules was required to achieve the treatment objective of passage of a 10-mm endoscope. Mean posttreatment luminal diameter was 11.9 mm, and all but two patients noted considerable improvement in swallowing. Two patients were successfully retreated an average of 8 wk after initial laser therapy for recurrent obstruction. Two patients developed bronchoesophageal fistulae an average of 4 wk after treatment and both were successfully managed with endoscopic insertion of an esophageal prosthesis. Nd:YAG laser therapy appears to be a relatively safe and well-tolerated method to rapidly relieve luminal obstruction in patients with advanced esophageal carcinoma.