Long-term effectiveness of Self-Help Plus in refugees and asylum seekers resettled in Western Europe: 12-month outcomes of a randomised controlled trial.

AIMS: As refugees and asylum seekers are at high risk of developing mental disorders, we assessed the effectiveness of Self-Help Plus (SH + ), a psychological intervention developed by the World Health Organization, in reducing the risk of developing any mental disorders at 12-month follow-up in refugees and asylum seekers resettled in Western Europe. METHODS: Refugees and asylum seekers with psychological distress (General Health Questionnaire-12 ⩾ 3) but without a mental disorder according to the Mini International Neuropsychiatric Interview (M.I.N.I.) were randomised to either SH + or enhanced treatment as usual (ETAU). The frequency of mental disorders at 12 months was measured with the M.I.N.I., while secondary outcomes included self-identified problems, psychological symptoms and other outcomes. RESULTS: Of 459 participants randomly assigned to SH + or ETAU, 246 accepted to be interviewed at 12 months. No difference in the frequency of any mental disorders was found (relative risk [RR] = 0.841; 95% confidence interval [CI] 0.389-1.819; p-value = 0.659). In the per protocol (PP) population, that is in participants attending at least three group-based sessions, SH + almost halved the frequency of mental disorders at 12 months compared to ETAU, however so few participants and events contributed to this analysis that it yielded a non-significant result (RR = 0.528; 95% CI 0.180-1.544; p-value = 0.230). SH + was associated with improvements at 12 months in psychological distress (p-value = 0.004), depressive symptoms (p-value = 0.011) and wellbeing (p-value = 0.001). CONCLUSIONS: The present study failed to show any long-term preventative effect of SH + in refugees and asylum seekers resettled in Western European countries. Analysis of the PP population and of secondary outcomes provided signals of a potential effect of SH + in the long-term, which would suggest the value of exploring the effects of booster sessions and strategies to increase SH + adherence.

Efficacy and acceptability of psychosocial interventions in asylum seekers and refugees: systematic review and meta-analysis.

AimsIn the past few years, there has been an unprecedented increase in the number of forcibly displaced migrants worldwide, of which a substantial proportion is refugees and asylum seekers. Refugees and asylum seekers may experience high levels of psychological distress, and show high rates of mental health conditions. It is therefore timely and particularly relevant to assess whether current evidence supports the provision of psychosocial interventions for this population. We conducted a systematic review and meta-analysis of randomised controlled trials (RCTs) assessing the efficacy and acceptability of psychosocial interventions compared with control conditions (treatment as usual/no treatment, waiting list, psychological placebo) aimed at reducing mental health problems in distressed refugees and asylum seekers. METHODS: We used Cochrane procedures for conducting a systematic review and meta-analysis of RCTs. We searched for published and unpublished RCTs assessing the efficacy and acceptability of psychosocial interventions in adults and children asylum seekers and refugees with psychological distress. Post-traumatic stress disorder (PTSD), depressive and anxiety symptoms at post-intervention were the primary outcomes. Secondary outcomes include: PTSD, depressive and anxiety symptoms at follow-up, functioning, quality of life and dropouts due to any reason. RESULTS: We included 26 studies with 1959 participants. Meta-analysis of RCTs revealed that psychosocial interventions have a clinically significant beneficial effect on PTSD (standardised mean difference [SMD] = -0.71; 95% confidence interval [CI] -1.01 to -0.41; I2 = 83%; 95% CI 78-88; 20 studies, 1370 participants; moderate quality evidence), depression (SMD = -1.02; 95% CI -1.52 to -0.51; I2 = 89%; 95% CI 82-93; 12 studies, 844 participants; moderate quality evidence) and anxiety outcomes (SMD = -1.05; 95% CI -1.55 to -0.56; I2 = 87%; 95% CI 79-92; 11 studies, 815 participants; moderate quality evidence). This beneficial effect was maintained at 1 month or longer follow-up, which is extremely important for populations exposed to ongoing post-migration stressors. For the other secondary outcomes, we identified a non-significant trend in favour of psychosocial interventions. Most evidence supported interventions based on cognitive behavioural therapies with a trauma-focused component. Limitations of this review include the limited number of studies collected, with a relatively low total number of participants, and the limited available data for positive outcomes like functioning and quality of life. CONCLUSIONS: Considering the epidemiological relevance of psychological distress and mental health conditions in refugees and asylum seekers, and in view of the existing data on the effectiveness of psychosocial interventions, these interventions should be routinely made available as part of the health care of distressed refugees and asylum seekers. Evidence-based guidelines and implementation packages should be developed accordingly.

pymzML v2.0: introducing a highly compressed and seekable gzip format.

Motivation: In the new release of pymzML (v2.0), we have optimized the speed of this established tool for mass spectrometry data analysis to adapt to increasing amounts of data in mass spectrometry. Thus, we integrated faster libraries for numerical calculations, improved data retrieving algorithms and have optimized the source code. Importantly, to adapt to rapidly growing file sizes, we developed a generalizable compression scheme for very fast random access and applied this concept to mzML files to retrieve spectral data. Results: pymzML performs at par with established C programs when it comes to processing times. However, it offers the versatility of a scripting language, while adding unprecedented fast random access to compressed files. Additionally, we designed our compression scheme in such a general way that it can be applied to any field where fast random access to large data blocks in compressed files is desired. Availability and implementation: pymzML is freely available on https://github.com/pymzML/pymzML under GPL license. pymzML requires Python3.4+ and optionally numpy. Documentation available on http://pymzml.readthedocs.io.

Policies, guideline implementation and practice change - how can the process be understood?

Politics and policy: It is important to understand why, in the translational continuum from pilot research and randomised controlled efficacy trials to roll-out programmes and routine effectiveness studies, some service innovations are taken up by health service purchasers and providers, while others are not. Why do some innovative interventions or models of care get to the stage of implementation, while others fail to be funded?

[Psychiatric Day Clinics--Evidence for and Importance of Patient-Centered Care]. / Psychiatrische Tageskliniken--Evidenzlage und Stellenwert im Versorgungssystem.

OBJECTIVE: The aim of the study was to summarize and evaluate the recent literature on treatment in psychiatric day clinics, and to assess the importance of such clinics in the current healthcare system. METHOD: We conducted a systematic review of recent studies in order to compare the efficacy and cost effectiveness of day clinics in relation to in- and outpatient treatment. RESULTS: The evidence is still sparse and inconclusive. CONCLUSION: Psychiatric day clinics act as a link between inpatient and outpatient treatment in community mental healthcare. However, evidence in support of the efficacy and cost-effectiveness of day clinics is still sparse.

[If the general practitioner has to decide: what is the evidence for the selection of antidepressants?]. / Wenn sich der Hausarzt entscheiden muss: Was sagt die Evidenz zur Auswahl von Antidepressiva?

The review summarises the evidence supporting the choice of an antidepressant in primary care. We report current guidance on the choice of antidepressants and the current use of antidepressants in Germany. Evidence for the comparative efficacy of modern antidepressants, such as venlafaxine, duloxetine or agomelatine will be summarized with respect to depressive and accompanying symptoms. Furthermore, differences in adverse events between antidepressants will be reviewed.

Psychopathological long-term outcome of schizophrenia -- a review.

OBJECTIVE: In the past, the comparability of empirical studies that examined the course and outcome of schizophrenia was limited by their use of different diagnostic systems. Focussing on the psychopathological long-term outcome, the present article aims to review follow-up studies that used modern operationalized diagnostic criteria for schizophrenia (DSM-III, DSM-III-R, DSM-IV and ICD-10). METHOD: We searched MEDLINE, the Cochrane Central Register of Controlled Trials, EMBASE, PsycINFO and PSYNDEX for relevant studies up to the year 2011. Twenty-one studies were included in the final analysis. RESULTS: The long-term outcome of schizophrenia was heterogeneous and included full remissions as well as severe chronic states. Schizophrenia, however, showed a considerably more unfavourable outcome than other diagnostic groups such as schizoaffective or affective disorders. Psychopathological symptoms remained relatively stable in the course of illness. Several predictors for a poor outcome were identified, such as male gender or pronounced negative symptoms. CONCLUSION: Recent studies using modern diagnostic systems largely confirm the results of earlier studies. Current diagnostic criteria for schizophrenia identify a heterogeneous sample of patients. The influence of therapeutic interventions on long-term outcome remains unclear.

[Team-based community psychiatry: importance of context factors and transferability of evidence from studies]. / Teambasierte Gemeindepsychiatrie : Bedeutung von Kontextfaktoren und Übertragbarkeit der Studienevidenz.

The German Society for Psychiatry, Psychotherapy and Neurology (DGPPN) guidelines on psychosocial interventions for people with severe mental illness appraise the transferability of results of trials evaluating community-based mental health services to the German situation. This assessment has to draw on research results on factors determining effectiveness. This must be seen against the background of a lack of high-quality trials in Germany. The article discusses system, context and setting factors related to the transfer of evidence on community-based service models from other countries. These issues are discussed on the basis of evidence concerning the models of case management, assertive community treatment and community mental health teams. International differences in study findings are highlighted and the importance of treatment-as-usual in influencing study results is emphasized. The more control services including elements of community-based care there are and the less the pressure to reduce inpatient treatment (threshold to inpatient care admission), the smaller the relative effect sizes of innovative care models will be.In the absence of direct evidence, careful examination of transferability is required before introducing health care models. Research has revealed solid evidence for several factors influencing the effects of innovative community mental health care. Among key factors in the care of people with severe mental illness, home visits and joint team responsibility for both psychiatric and social care were identified. This evidence can facilitate the adaptation of successful mental health care models in Germany.

Discharge planning in mental health care: a systematic review of the recent literature.

OBJECTIVE: To determine and estimate the efficacy of discharge planning interventions in mental health care from in-patient to out-patient treatment on improving patient outcome, ensuring community tenure, and saving costs. METHOD: A systematic review and meta-analysis identified studies through an electronic search on the basis of defined inclusion and exclusion criteria and extracted data. RESULTS: Of eleven studies included, six were randomised controlled trials, three were controlled clinical trials, and two were cohort studies. The discharge planning strategies used varied widely, most were limited to preparation of discharge during in-patient treatment. Pooled risk ratios were 0.66 (95% CI = 0.51 to 0.84; P < 0.001) for hospital readmission rate, and 1.25 (1.07 to 1.47; P < 0.001) for adherence to out-patient treatment. Effect sizes (Hedge's g) were -0.25 (-0.45 to -0.05; P = 0.02) for mental health outcome, and 0.11(-0.05 to 0.28; NS) for quality of life. CONCLUSION: Discharge planning interventions are effective in reducing rehospitalisation and in improving adherence to aftercare among people with mental disorders.

Kinetics of photorefractive recording for circular light beams.

We show, theoretically and experimentally, that the buildup of the space-charge field in photorefractive crystals is far from monoexponential for circular light beams. This is a general property of the two-dimensional (2D) case, in contrast to the one-dimensional case. The results form a basis for determination of the photoelectric parameters of photorefractive crystals within a wide intensity range, which is important, e.g., for solving of the optical-damage problem in LiNbO3 and LiTaO3 crystals.

High-temperature-recorded index gratings in periodically poled lithium niobate.

Holographic index gratings based on a zero-electric-field photorefractive effect are recorded at high temperatures in copper-doped periodically poled lithium niobate crystals. The interplay between the domain structure and the index grating is studied: the fundamental grating with spatial frequency K is strongly suppressed. Pronounced sideband gratings with K(s)=K+sG appear, where G is the domain grating vector and s is an integer number. After development, an additional grating based on the electro-optic effect shows up. In contrast with the previously mentioned gratings, this grating allows anisotropic diffraction.

Frequency mixing of photorefractive and ferroelectric gratings in lithium niobate crystals.

Holographically recorded photorefractive gratings in periodically poled lithium niobate crystals (PPLNs) are investigated. The principal spatial frequency K of the grating is strongly suppressed. Sideband gratings with grating vectors K +/- G appear. From the measurements the domain grating vector G and the duty cycle of the domain structure can be obtained. These findings allow for fast nondestructive quality inspection of PPLN and are of importance for any optical application combining holography and PPLN.

A very fast program for visualizing protein surfaces, channels and cavities.

A method for visualizing molecular surfaces is described that uses a grid to store the distance to the nearest atom. Using on-the-fly three-dimensional (3D) contouring of a molecular graphics program such as FRODO, one can obtain a good impression of van der Waals surfaces and solvent-accessible surfaces. The main advantages of the method described here are its high speed and the fact that no recalculations need to be done to obtain the solvent-accessible surface visualized for a probe with another radius.