A feasibility study of a telephone-supported self-care intervention for depression among adults with a comorbid chronic physical illness in primary care

Objective We assessed the feasibility and acceptability to patients of a telephone-supported self-care intervention for depression among adults aged 40 years or over with one of six targeted chronic physical illnesses and comorbid depressive symptoms in family practice settings.Methods An open, uncontrolled trial (feasibility study) was conducted among patients treated in Montreal family practices. Eligible patients were aged 40 years or over, had one or more of the targeted chronic physical illnesses for at least 6 months (arthritis, hypertension, diabetes, heart disease, asthma and chronic obstructive pulmonary disease) and were evaluated as having at least mild depressive symptoms (a score of ≥ 5 on the 9-item Patient Health Questionnaire, PHQ-9). Participants received a package of six self-care tools (information booklet, video, Internet programme, action plan, workbook and mood-monitoring tool) with telephone support by a lay coach for up to 6 months.Results In total, 63 eligible patients provided written consent and completed the baseline interview; 57 (90%) and 55 (87%) patients completed 2-month and 6-month follow-up interviews, respectively. The mean number of telephone calls made by coaches to participants was 10.5 (SD 4.0), and the average length of these calls was 10.6 minutes. At the 6-month follow-up, 83.6% of the participants reported that one or more of the tools were helpful. Clinically significant improvements were seen in depressive symptoms (as assessed by the PHQ-9) at 6 months, with an effect size of 0.88 (95% CI, 0.55, 1.14).Conclusion A telephone-supported self-care intervention for depression was feasible, was acceptable to patients, and was associated with a significant 6-month improvement in depressive symptoms. A randomised trial of this intervention is justified.     

Arginine Silicate Inositol Complex Accelerates Cutaneous Wound Healing

The objective of this study was to assess the accumulation and depletion of cadmium in the blood, milk, hair, feces, and urine of Holstein cows during and after treatment. Three Holstein cows received daily oral cadmium administrations (as cadmium chloride) of 0.182 mg/kg body weight/day for 21 days followed by a 63-day withdrawal period. Blood, milk, hair, feces, and urine were collected during treatment and withdrawal periods. Cadmium concentrations were measured by inductively coupled plasma mass spectrometry (ICP-MS). Cadmium concentrations in blood (0.61–1.12 μg/L), milk (0.39–1.04 μg/L), and urine (0.41–2.05 μg/L) were low. Comparatively, cadmium concentrations in feces were higher, especially on treatment day 14 (20.11 mg/kg dry matter). Fecal cadmium concentrations decreased to baseline levels (0.12 mg/kg dry matter) on withdrawal day 21. Hair cadmium concentrations increased with treatment, reaching the highest levels on withdrawal day 7 (24.33 μg/kg). Most of the cadmium was excreted via the feces and very little was present in urine or milk. Cadmium residues were detected in blood and milk more than 63 days after cadmium withdrawal. Hair cadmium concentrations may reflect exposure to the metal.