Search

Introduction: The Veterans Health Administration (VA) Primary Care-Mental Health Integration (PC-MHI) initiative targets depression (MDD), anxiety/posttraumatic stress disorder (PTSD) and alcohol misuse (AM) for care improvement. In primary care, case finding often relies on depression screening. Whereas clinical practice guidelines solely inform management of depression, minimal information exists to guide treatment when psychiatric symptom clusters coexist. We provide descriptive clinical information for care planners about VA PC patients with depression alone, depression plus alcohol misuse, and depression with complex psychiatric comorbidities (PTSD and/or probable bipolar disorder). Method: We examined data from a VA study that used a visit-based sampling procedure to screen 10,929 VA PC patients for depression: 761 patients with probable major depression completed baseline measures of health and care engagement. Follow-up assessments were completed at 7 months. Results: At baseline, 53% of patients evidenced mental health conditions in addition to depression; 10% had concurrent AM, and 43% had psychiatrically complex depression (either with or without AM). Compared with patients with depression alone or depression with AM, those with psychiatrically complex depression evinced longer standing and more severe mood disturbance, higher likelihood of suicidal ideation, higher unemployment, and higher levels of polypharmacy. Baseline depression complexity predicted worse mental health status and functioning at follow-up. Discussion: A substantial proportion of VA primary care patients with depression presented with high medical multimorbidity and elevated safety concerns. Psychiatrically complex depression predicted lower treatment effectiveness, suggesting that PC-MHI interventions should co-ordinate and individualize care for these patients. Public Significance Statement Limited evidence exists to guide primary care-based management of psychiatrically complex depression. This study's findings demonstrate a prospective relationship between complexity and treatment outcomes and provide descriptive information that will be useful to care planners and providers when psychiatric symptom clusters coexist. Keywords: depression complexity, primary care, integrated behavioral health, collaborative care, Depression is common and debilitating. Twelvemonth prevalence estimates approach 7% of the United States general population, and nearly 17% of persons will experience a major depressive episode in their lifetimes [...]

Aims: Tirzepatide is a first‐in‐class combination glucose‐dependent insulinotropic polypeptide (GIP) receptor agonist and glucagon‐like peptide 1 receptor agonist (GLP1‐RA) approved for treatment of adults with type 2 diabetes mellitus (T2DM) and chronic weight management. The aim of this analysis was to assess the real‐world efficacy of tirzepatide in patients with T2DM. Methods: This retrospective observational study evaluated patients with T2DM from a large urban academic medical centre who received at least 3 months of continuous tirzepatide treatment. The primary outcome was change in A1C from following tirzepatide treatment. Secondary outcomes included change in body weight and body mass index (BMI) after tirzepatide was initiated. Results: A total of 1896 patient charts were reviewed, and 612 patients were evaluated for the primary outcome. Over a median time period of 10.4 months, treatment with tirzepatide resulted in a mean A1C reduction of 1.02 ± 1.48% (p < 0.001). A total of 570 patients were evaluated for the secondary outcomes. Tirzepatide was associated with a mean reduction in body weight of 7.3 ± 9.3 kg (p < 0.001) and a mean reduction in BMI of 2.5 kg/m2. Greater A1C lowering and weight loss was observed in patients without prior GLP1‐RA treatment compared to those switched to tirzepatide from GLP1‐RA. Conclusions: In a real‐world population of US patients with T2DM, tirzepatide was associated with clinically and statistically significant reductions in A1C and body weight. Greater reductions in both A1C and body weight were observed among patients who were GLP1‐RA naïve compared to patients switched from GLP1‐RA to tirzepatide. [ABSTRACT FROM AUTHOR]

The Eurasian woodcock prefers habitats where its main prey, earthworms, can be found in higher densities. Although they are forest‐dwelling birds, they regularly visit pastures and natural grasslands at night, where earthworm abundance is generally higher. However, there is little information on fine‐scale habitat use in relation to variation in habitat characteristics and prey availability, particularly beyond the breeding season. In our study, we investigated if the nocturnal occurrence of woodcocks during migratory stopover periods differed between two neighbouring fields, or management units, with similar vegetation structure, and if within‐field variation in the spatial patterns of woodcock sightings were associated with fine‐scale earthworm densities and soil parameters. Specifically, we used GPS tracking data of two tagged woodcocks and direct observation data to study patterns of occurrence of birds in a mixed forest‐pasture landscape in Hungary during pre‐ and post‐breeding periods. We compared these patterns with fine‐scale soil characteristics and earthworm abundance, acquired by field sampling. We found that the field with higher earthworm abundance was visited by woodcocks more frequently, and this correlation was similarly observed at the intra‐field level. Our results demonstrate that woodcocks select foraging sites with higher earthworm densities at multiple spatial scales, both between fields (coarse scale), and within fields (fine‐scale). Considering that woodcocks tended to return to the same field to forage at night, the strong associations between occupancy and resources provide a basis for developing habitat management strategies at the field level for conservation. As earthworm densities and soil parameters are good indicators of woodcock foraging habitat, measuring those variables, at least at a coarse scale, could aid in predicting important habitats for the species across the landscape. [ABSTRACT FROM AUTHOR]

A decline in rainfall as a source of agricultural water has affected and will continue to affect sustainable crop production globally including in Hungary. Conservation of the greatest water reservoir is important for the sustainable development of agriculture in Hungary. The objective of this study was to evaluate the effects of the different tillage methods on soil moisture content, grain yield, and root weight of wheat (Triticum aestivum) and sunflower (Helianthus annuus) under rainfed conditions. A field study was conducted at the Józsefmajor Experimental and Training Farm (JM) of the Hungarian University of Agriculture and Life Sciences near Hatvan. The experiment consisted of six tillage treatments: disking (D, 16 cm), shallow cultivation (SC, 20 cm), no-till (NT), deep cultivation (DC, 25 cm), loosening (L, 45 cm), and plowing (P, 30 cm). Soil moisture content (SMC) was measured monthly, and grain yield and root weight were measured at the end of the cropping period. Our results showed no significant difference in SMC between conservation and conventional tillage methods in 2018. However, in 2021, greater SMC was significantly conserved under NT compared to P. Regarding the sampling date, a significant increase in moisture with time was observed. A significantly lower SMC was observed on 3 June 2019 between L and D. while on the 9 September 2020, SMC significantly differed between P and all the other treatments (D, SC, NT, DC, and L). Interestingly in 2018, SMC was significantly lower at 10–20 cm depth between L and D. Notably the effect of depth on SMC was observed as moisture significantly increased with increasing depth in all tillage treatments. Root weight was greatest at DC (1.54 t ha−1) in 2018 and under L (3.89 t ha−1) in 2021. Similarly, wheat grain yield was greatest at DC (2.48 t ha−1) in 2018, while sunflower yield in 2021 was greatest at L (3.86 t ha−1). It is comprehensible that conservation tillage methods such as L and NT can increase SMC and grain yield. [ABSTRACT FROM AUTHOR]

Abstract Background Meta-analyses show collaborative care models (CCMs) with nurse care management are effective for improving primary care for depression. This study aimed to develop CCM approaches that could be sustained and spread within Veterans Affairs (VA). Evidence-based quality improvement (EBQI) uses QI approaches within a research/clinical partnership to redesign care. The study used EBQI methods for CCM redesign, tested the effectiveness of the locally adapted model as implemented, and assessed the contextual factors shaping intervention effectiveness. Methods The study intervention is EBQI as applied to CCM implementation. The study uses a cluster randomized design as a formative evaluation tool to test and improve the effectiveness of the redesign process, with seven intervention and three non-intervention VA primary care practices in five different states. The primary study outcome is patient antidepressant use. The context evaluation is descriptive and uses subgroup analysis. The primary context evaluation measure is naturalistic primary care clinician (PCC) predilection to adopt CCM. For the randomized evaluation, trained telephone research interviewers enrolled consecutive primary care patients with major depression in the evaluation, referred enrolled patients in intervention practices to the implemented CCM, and re-surveyed at seven months. Results Interviewers enrolled 288 CCM site and 258 non-CCM site patients. Enrolled intervention site patients were more likely to receive appropriate antidepressant care (66% versus 43%, p = 0.01), but showed no significant difference in symptom improvement compared to usual care. In terms of context, only 40% of enrolled patients received complete care management per protocol. PCC predilection to adopt CCM had substantial effects on patient participation, with patients belonging to early adopter clinicians completing adequate care manager follow-up significantly more often than patients of clinicians with low predilection to adopt CCM (74% versus 48%%, p = 0.003). Conclusions Depression CCM designed and implemented by primary care practices using EBQI improved antidepressant initiation. Combining QI methods with a randomized evaluation proved challenging, but enabled new insights into the process of translating research-based CCM into practice. Future research on the effects of PCC attitudes and skills on CCM results, as well as on enhancing the link between improved antidepressant use and symptom outcomes, is needed. Trial Registration ClinicalTrials.gov: NCT00105820