Six-year outcome of cognitive behavior therapy for prevention of recurrent depression

OBJECTIVE: A paucity of studies use nonpharmacological strategies for preventing recurrence in depression. Cognitive behavior treatment of residual symptoms was found to yield a significantly lower relapse rate than clinical management in recurrent depression at a 2-year follow-up. The objective of this investigation was to provide a 6-year follow-up of cognitive behavior treatment versus clinical management. METHOD: Forty patients with recurrent major depression who had been successfully treated with antidepressant drugs were randomly assigned to either cognitive behavior treatment of residual symptoms (supplemented by lifestyle modification and well-being therapy) or clinical management. In both groups, antidepressant drugs were tapered and discontinued. A 6-year follow-up was undertaken. During this period, no antidepressant drugs were used unless a relapse ensued. RESULTS: Cognitive behavior treatment resulted in a significantly lower relapse rate (40%) at a 6-year follow-up than did clinical management (90%). When multiple recurrences were considered, the group that received cognitive behavior treatment had a significantly lower number of relapses in comparison with the clinical management group. CONCLUSIONS: The results suggest that the sequential use of cognitive behavior treatment after pharmacotherapy may improve the long-term outcome in recurrent depression. A significant proportion of patients with recurrent depression might be able to withdraw from medication successfully and to stay well for at least 6 years with a focused course of psychotherapy.     

Mobbing and working environment: towards an organizational prevention

BACKGROUND: Psychological violence in the workplaces is increasing and the Italian national health service and trade unions are mostly involved in single cases of diagnosis strategy. OBJECTIVES: To analyse published mobbing cases using a mobbing prevention approach that takes account of the main civil rights violation in mobbing actions. METHODS: 25 cases were analysed in order to identify the type of mobbing, gender, the professional position and the main civil rights that were violated. RESULTS: Seven main civil rights had been violated in the 25 mobbing cases: health, work, professional skills, equal treatment, legality, diversity, dignity. Men working in unhealthy conditions, mostly due to unhealthy working environments, were forced to leave under the pressure of moral violence. In women, equal treatment and diversity were the main rights that were violated. Co-worker support was absent in all cases. CONCLUSIONS: A civil rights assessment to prevent mobbing is considered. Italian legislation, particularly the Civil Code, can be the legislation key for prevention, with the employer responsible for providing a violence-free environment as indicated in European Directive 626/94.     

Gefitinib induction of in vivo detectable signals by Bcl-2/Bcl-xL modulation of inositol trisphosphate receptor type 3

PURPOSE: To test whether epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKI) induce detectable signals in tumor cells and whether such signals may reveal alterations of the apoptotic program. EXPERIMENTAL DESIGN: Tumor cells were treated with gefitinib or erlotinib and tested for their ability to accumulate 99mTc-Sestamibi, a radiolabeled lipophilic cation that localizes in mitochondria. Then we tested whether Bcl-2 and Bcl-xL alter the pattern of drug-dependent tracer accumulation while reducing tumor cell sensitivity to EGFR TKIs. The mechanism underlying the pattern of tracer accumulation was elucidated. Finally, imaging studies were done in animal models and lung cancer patients before and after treatment with EGFR TKIs using single-photon emission computed tomography and 99mTc-Sestamibi. RESULTS: Gefitinib increases accumulation of 99mTc-Sestamibi in Bcl-2-overexpressing cells and enhances the physical interaction of phosphorylated Bcl-2 with inositol trisphosphate receptor type 3 (IP3R3). Consequently, a relative increase of cytosolic and mitochondrial calcium levels occurs. Similarly, lung cancer cells showed an increase of tracer uptake and an enhanced interaction of Bcl-xL with IP3R3 on exposure to erlotinib concentrations achievable in plasma. The occurrence of these interactions was associated with an enhanced EGFR TKI-induced apoptosis resistance. Posttreatment imaging studies in nude mice bearing control and Bcl-2-overexpressing breast carcinomas showed a high tumor uptake of the tracer whereas baseline studies failed to visualize tumors. Similarly, an enhancement of tracer uptake could be detected in patients with lung cancer treated with erlotinib. CONCLUSION: EGFR TKIs generate detectable signals by Bcl-2/Bcl-xL modulation of IP3R3 in tumor cells.     

Refugee crisis in Macedonia during the Kosovo conflict in 1999

The Kosovo refugee crisis in the Macedonia in 1999 was unique in terms of its unprecedented magnitude against its short duration (sharp increase and sudden decrease in refugee population), its high visibility in the world media, and attention received by donors. In the late March 1999, after the launch of the NATO air campaign against the Federal Republic of Yugoslavia, refugees from Kosovo began to enter Macedonia. Within 9 weeks, the country received 344,500 refugees. Aiming to provide an emergency humanitarian relief, United Nations, and international and national organizations together with the host country, donors, and other concerned parties coordinated and provided immediate assistance to meet the needs of refugees, including shelter in collective centers (camps) and accommodation in host families, nutrition, health care, and water/sanitation. The morbidity and mortality rates remained low due to the effective action undertaken by a great number of humanitarian organizations, backed up by strong governmental support. No significant epidemics developed in the camps, and there were no epidemic outbreaks during the crisis. Mortality rate of refugees was lower than in other emergency situations.     

A comparison of human and porcine acellular dermal tissues in the subcutaneous space of a rat model

The study compared the host response to a human and a porcine acellular dermal tissue implanted in the subcutaneous space of a rat model. The human and porcine acellular grafts were surgically implanted in the subcutaneous tissue of rats (5 rats/group) and the materials were evaluated at 7, 15, 30, 60 and 180 postoperative days (PO). The histological immune response was quantified using a digital image analysis system, which evaluated the number of vessels present in the implants and in the surrounding soft tissue, the area of inflammatory cell infiltration in the grafts, the width of the capsular formation present around the tissues and the area of implants absorbed. The data were submitted to statistical analysis. Light microscopy showed mononuclear cellular infiltration, the presence of a capsular formation surrounding the grafts and the presence of vacuolar structures (optically "empty spaces") inside the implants. The image analysis comparing both materials showed significant inflammatory cells in the human graft at 15 and 30 PO, thicker capsular formation in the porcine tissue at 60 PO, increased number of vessels inside the implants and in the surrounding tissues in the porcine graft and a similar absorption pattern in both materials at 180 PO. The histological findings showed that both tissues were well-tolerated when implanted in the subcutaneous tissue of rats, allowing us to consider the porcine acellular dermal graft as a provisional alternative material for reconstructive plastic surgery.