Estimating the economic burden of depression in children and adolescents.

Background: Depression in childhood and adolescence creates significant burden to individuals, families, and societies by increasing morbidity, increasing mortality, and negatively affecting quality of life during times of significantly depressed mood. Several studies have estimated the cost of depression in the United States and elsewhere, but none have included the costs associated with depression in children or younger adolescents. This paper reviews data currently available on the cost of depression in childhood and the cost effectiveness of interventions to treat and prevent depression in this population.

Medical cost-offset following treatment referral for alcohol and other drug use disorders in a group model HMO.

The purpose of this study was to determine whether specialty alcohol and other drug (AOD) treatment is associated with reduced subsequent medical care costs. AOD treatment costs and medical costs in a group model health maintenance organization (HMO) were collected for up to 6 years on 1,472 HMO members who were recommended for specialty AOD treatment, and on 738 members without AOD diagnoses or treatment. Addiction Severity Index measures were also obtained from a sample of 293 of those recommended for treatment.

Substance abuse treatment duration for Medicaid versus commercial clients in a health maintenance organization.

Background: As Medicaid clients have come to be enrolled in managed care, concerns have arisen about the ability of private sector systems to meet the needs of enrollees with substance abuse problems.

Objectives: This project describes treatment initiation and duration for Medicaid and commercial substance abuse treatment clients in a large health maintenance organization (HMO).

Research Design: This study was a prospective secondary analysis of information from HMO databases.

Magnetic resonance elastography of the plantar fat pads: Preliminary study in diabetic patients and asymptomatic volunteers.

Objective: To test the feasibility of applying the magnetic resonance elastography (MRE) technique to map the elastic modulus of the plantar fat pads in diabetic and nondiabetic subjects.

Methods: A prototype MRE imaging apparatus was used to produce quantitative maps of the heel fat pad in a pilot study of 12 volunteers and 4 patients with diabetes with neuropathy. Anatomic images corresponding to MRE maps allowed precise selection of regions of interest in the fat.

Ureterocutaneous fistula and urostomy exclusion with use of a covered wallstent.

The present report describes a case of urostomy breakdown and failed urinary diversion with bilateral nephrostomy drainage treated with transrenal placement of a covered stent. Covered stents can be used successfully for the exclusion of ureterocutaneous fistulas and urostomies with the potential for ureteric occlusion.

The state of cost-effectiveness analysis in American managed care.

In 1996, the US Panel on Cost-Effectiveness in Health and Medicine published detailed recommendations for the conduct and use of cost-effectiveness analyses (CEA) of medical technologies. These recommendations were expected to promote the use of CEA to inform the resource allocation decisions of a diverse audience including, among others, American managed care organizations. Yet, nearly 10 years later, the limited explicit use of CEA in the USA remains a prominent discussion topic, with few signs of resolution.

Adenosine- and hypoxia-induced dilation of human coronary resistance arteries: evidence against the involvement of K(ATP) channels.

1. The ATP-sensitive potassium (K(ATP)) channel may be an important mediator of metabolic dilation in the human coronary circulation. As adenosine and hypoxia are considered to be major mediators of metabolic dilation in the coronary circulation, we investigated the effect of glibenclamide (a K(ATP) channel blocker) on adenosine and hypoxic dilation of human coronary resistance arteries, with myogenic tone, in vitro.

Cost-effectiveness of an intervention to prevent depression in at-risk teens.

Contact: Depression is common in adolescent offspring of depressed parents and can be prevented, but adoption of prevention programs is dependent on the balance of their incremental costs and benefits.

Objective: To examine the incremental cost-effectiveness of a group cognitive behavioral intervention to prevent depression in adolescent offspring of depressed parents.

Design: Cost-effectiveness analysis of a recent randomized controlled trial.

Adenosine and hypoxic dilation of rat coronary small arteries: roles of the ATP-sensitive potassium channel, endothelium, and nitric oxide.

The aims of the study were to examine the roles of the ATP-sensitive potassium (K(ATP)) channel, the endothelium, and nitric oxide (NO) in the responses of rat coronary small arteries to adenosine and hypoxia. Segments of rat coronary vessel were investigated in vitro using pressure myography; all vessels studied developed stable spontaneous myogenic tone during equilibration. Glibenclamide (a K(ATP) channel inhibitor) reversed pinacidil but not 2-deoxyglucose-induced dilation.

A randomized effectiveness trial of brief cognitive-behavioral therapy for depressed adolescents receiving antidepressant medication.

Objective: To test a collaborative-care, cognitive-behavioral therapy (CBT) program adjunctive to selective serotonin reuptake inhibitor (SSRI) treatment in HMO pediatric primary care.

Method: A randomized effectiveness trial comparing a treatment-as-usual (TAU) control condition consisting primarily of SSRI medication delivered outside the experimental protocol (n = 75) versus TAU SSRI plus brief CBT (n = 77). Participants were identified by a recent dispense of SSRI medication followed by telephone screening.

Patient-based utilities for bipolar disorder-related health states.

Background: Bipolar disorder is a psychiatric disorder which impacts patient functioning and well-being. With increasing interest in cost-effectiveness of treatments, it is necessary to provide estimates of patient's perspectives on treatment outcomes. This study estimated health state utilities for hypothetical bipolar-related health states and patient's current health from bipolar I patients.

Overcoming Depression on the Internet (ODIN) (2): a randomized trial of a self-help depression skills program with reminders.

Background: Guided self-help programs for depression (with associated therapist contact) have been successfully delivered over the Internet. However, previous trials of pure self-help Internet programs for depression (without therapist contact), including an earlier trial conducted by us, have failed to yield positive results. We hypothesized that methods to increase participant usage of the intervention, such as postcard or telephone reminders, might result in significant effects on depression.

Gender-based structural models of health care costs: alcohol use, physical health, mental health, and functioning.

Background: Most models of health services use or costs include gender as a covariate, combining data for men and women in analyses. This strategy may obscure differences in underlying processes producing differential health care use by men and women, particularly in examinations of factors that affect health care use and differ by gender (e.g.

C20orf9-003 (ACI-1), a gene localized on chromosome 20q13.12 encoding for a 49 kD cytoplasmic protein with a putative nucleotide binding site.

Murine NGD5 is a gene identified from NG108-15 cells which is postulated to be involved in opioid receptor function. Here we report the cloning and characterization of a cDNA C20orf9-003 (ACI-1) encoding the human orthologue of the mouse NGD5. Analysis of the genomic structure revealed that C20orf9-003 (ACI-1) contains 13 exons and 12 introns, spanning 52.

Healthcare use by children with attention deficit/hyperactivity disorder with and without psychiatric comorbidities.

This study examined healthcare services used by children with attention-deficit/hyperactivity disorder (ADHD), with and without psychiatric comorbidities. The study was conducted in a large health maintenance organization in the Pacific Northwest on all continuously enrolled children aged 5 to 12 from January 1997 through July 1998. The study measured all outpatient medical care, specialty mental health care services, and prescription drug dispensings from computer records.

Identification and pharmacological characterization of native, functional human urotensin-II receptors in rhabdomyosarcoma cell lines.

1 In an effort to identify endogenous, native mammalian urotensin-II (U-II) receptors (UT), a diverse range of human, primate and rodent cell lines (49 in total) were screened for the presence of detectable [125I]hU-II binding sites. 2 UT mRNA (Northern blot, PCR) and protein (immunocytochemistry) were evident in human skeletal muscle tissue and cells. 3 [(125)I]hU-II bound to a homogenous population of high-affinity, saturable (Kd 67.

Gender differences in outcomes in an HMO-based substance abuse treatment program.

This study examined gender differences in treatment outcomes and outcomes predictors among 155 men and 81 women attending a gender-sensitive substance abuse treatment program. Bivariate analyses indicated women improved more than men in social/family and daily functioning domains, but differences disappeared after controlling for baseline characteristics. Multivariate models predicting treatment outcomes revealed that, across Addiction Severity Index domains, outcomes for men were predicted primarily by mental health and medical conditions, severity of the substance abuse problem, and treatment com- pletion.

Cost-effectiveness of a tailored intervention to increase screening in HMO women overdue for Pap test and mammography services.

Background: Research has established the societal cost-effectiveness of providing breast and cervical cancer screening to women. Less is known about the cost of motivating women significantly overdue for services to receive screening.

Methods: In this intent-to-treat study, a total of 254 women, aged 52-69, who were overdue for both Pap test and mammography, were randomized to two groups, a tailored, motivational outreach or usual care.

Enhancement of luminescence lifetimes of mononuclear ruthenium(II)-terpyridine complexes by manipulation of the sigma-donor strength of ligands.

The synthesis and characterization of mixed ligand 2,2';6',2' '-terpyridine (tpy) ruthenium complexes with 2,6-bis([1,2,4]triazol-3-yl)pyridine, 2,6-bis(5-phenyl-[1,2,4]triazol-3-yl)pyridine, and 2,6-bis([1,2,3,4]tetrazol-5-yl)pyridine are reported. The species are characterized by HPLC, 1H NMR, UV/vis, and emission spectroscopy. The photophysical properties of the complexes are investigated as a function of temperature over the range 80-320 K.