Evaluation of a bibliotherapy manual for reducing psychological distress in people with depression: a randomized controlled trial

Aim. This article reports a study to evaluate the efficacy of a self‐help manual in reducing psychological distress in individuals with moderate depression. Background. The prevalence of depression in Thailand is increasing markedly (e.g. from 56–197 per 100,000 population between 1997–2007). Design. We conducted a randomized controlled trial with 54 outpatients with depression in Chiang Mai Province in Thailand. Method. Participants were assigned randomly to an intervention or control group. The intervention group participants were given a self‐help manual in addition to standard care and treatment while the control group received standard care and treatment. Psychological distress was measured with the Kessler Psychological Distress Scale. Data were collected between October 2007–April 2008. Results. The findings showed statistically significant differences between both groups in their levels of psychological distress (e.g. tiredness, hopelessness, restlessness). At post‐test, the distress scores of the intervention group were lower than those in the control group. Between post‐test and 1‐month follow‐up, distress scores continued to decrease steadily in the intervention group but only decreased slightly in the control group. Conclusion. The findings affirm the benefits of bibliotherapy or self‐help therapy in book form in helping to reduce psychological distress in people with moderate depression. The approach is easy to use and can be incorporated as an adjunct to standard care and treatment. Bibliotherapy can be used by community mental health nurses and other clinicians to reduce psychological distress and promote recovery in people with moderate depression.     

First Aid and Management of Rattlesnake Bites (Part 2 of 2)

In brief: Rattlesnake bites are rarely fatal, but prevention is the best treatment. People who live in areas indigenous to rattlesnakes should take routine precautionary measures such as wearing boots and long pants. A person who encounters or is bitten by a snake should get away from it as soon as possible. First aid includes applying a constricting band and suction; incisions are not recommended. The victim should be transported to a medical facility as soon as possible. Medical management includes a history and physical examination and laboratory data, including blood coagulation studies and urinalysis. Intravenous antivenom is the mainstay of treatment.     

Comparison of the mouse spleen cell assay and a radioimmunoassay for the measurement of serum erythropoietin

The mouse spleen cell assay (MSCA) has been compared with a radioimmunoassay for the measurement of serum erythropoietin (Ep). In 20 normal subjects the serum values ranged from 15 to 73 mU/ml for the MSCA compared with 5-30 mU/ml for the RIA. For normal sera there was no correlation between the results of the two assays. In 37 patients with anaemias of differing aetiologies and at various stages of treatment values ranged from 10 to 3645 mU/ml for the MSCA and 13-10,000 mU/ml for the RIA. Although patient values from the two assays were highly correlated (r = 0.98, P less than 0.001), the MSCA results were generally lower. These discrepancies can be largely accounted for by two factors. Firstly the MSCA is sensitive to non-specific matrix effects. Secondly, heat inactivation of serum, a prerequisite for the MSCA, but not for the RIA, destroys a variable and unpredictable proportion of the Ep in the test sera leading to an underestimation of Ep in the MSCA. We conclude that the RIA is more reliable than the MSCA which, in its present form, cannot be recommended for the accurate measurement of serum erythropoietin.     

Seroprevalence of H. pylori Infection and Symptoms of Upper Gastrointestinal Tract Disease in Two Groups of Health-Care Workers

The purpose of this study was to determine the seroprevalence of Helicobacter pylori and risk factors for infection in gastrointestinal endoscopy personnel and those caring for developmentally disabled individuals. We administered a structured, one-page questionnaire. Helicobacter pylori status was determined serologically. In all, 107 health-care workers participated. Direct patient contact, exposure to gastrointestinal secretions, history of peptic ulcer, and acid-suppressing medicine use were more frequent among those who worked with the developmentally disabled. Seroprevalence of Helicobacter pylori was 24% in endoscopy personnel and 47% among those who cared for the developmentally disabled (P = 0.02). Bed-sharing with a sibling during childhood, working with the developmentally disabled, and direct patient contact were associated with Helicobacter pylori infection; exposure to patients' gastrointestinal secretions was not. We conclude that those caring for developmentally disabled individuals have a higher risk of occupational acquisition of Helicobacter pylori infection than endoscopy personnel.     

Peak oxygen intake and cardiac mortality in women referred for cardiac rehabilitation

OBJECTIVES: This study investigated the prognostic importance of measured peak oxygen intake (VO(2peak)) in women with known coronary heart disease referred for outpatient cardiac rehabilitation. BACKGROUND: Exercise capacity is a powerful predictor of prognosis in men with known or suspected coronary disease. Similar findings are described in women, but fewer studies have utilized measured VO(2peak), the most accurate measure of exercise capacity. METHODS: A single-center design took data from 2,380 women, age 59.7 +/- 9.5 years (1,052 myocardial infarctions, 620 coronary bypass procedures, and 708 with proven ischemic heart disease), who underwent cardiorespiratory exercise testing. They were followed for an average of 6.1 +/- 5 years (median 4.5 years, range 0.4 to 25 years) until cardiac and all-cause death. RESULTS: We recorded 95 cardiac deaths and 209 all-cause deaths. Measured VO(2peak) was an independent predictor of risk, values > or =13 ml/kg/min (3.7 multiples of resting metabolic rate) conferring a 50% reduction in cardiac mortality (hazard ratio [HR] 0.5, p = 0.001). Considered as a continuous variable, a 1 ml/kg/min advantage in initial VO(2peak) was associated with a 10% lower cardiac mortality. Adverse predictors were diabetes (HR 2.73, p = 0.0005) and antiarrhythmic therapy (HR 3.93, p = 0.0001). CONCLUSIONS: As in men, measured VO(2peak) is a strong independent predictor of cardiac mortality in women referred for cardiac rehabilitation.