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  • A Population-Based Study of the Use of Selective Serotonin Reuptake Inhibitors Before and After Introduction of Generic Equivalents
    A Population-Based Study of the Use of Selective Serotonin Reuptake Inhibitors Before and After Introduction of Generic Equivalents

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    From:ProQuest LLC

    Document Overview:
    Generic drugs are less expensive than their branded equivalents, but receive limited promotion. This study sought to examine how user rates of individual selective serotonin reuptake inhibitors (SSRIs) changed after the introduction of their generic equivalents. Administrative health and census data were used to examine the rates of use of all 6 SSRIs from 1996 to 2009 in the province of Manitoba (population of 1.2 million). The primary outcome measure was a comparison of the rates of use in the pre- and post-generic periods, using generalized estimating equations. Secondary analyses were stratified by specialty of physician prescriber. Escalating rates of use of branded SSRIs in the pre-generic period significantly decreased after generic versions became available (all Ps 0.001). Incident use of sertraline and paroxetine continued to decrease throughout the post-generic period (1.5% and 1.9% quarterly decreasing rates, respectively). During the years when generic sertraline, fluoxetine, and fluvoxamine were available, their use declined while branded paroxetine and citalopram use continued to increase. Use of branded citalopram, sertraline, and paroxetine prescribed by general practitioners (GPs) increased at rates significantly higher than when prescribed by psychiatrists (all Ps 0.001). The introduction of cheaper generic alternatives of SSRIs paradoxically resulted in their use diminishing rather than increasing. With the exception of escitalopram, branded SSRIs tended to be preferentially used, compared with available less expensive generic SSRIs. These patterns were more pronounced for prescriptions by GPs.
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  • Factor Structure of Borderline Personality Disorder Symptomatology in Adolescents
    Factor Structure of Borderline Personality Disorder Symptomatology in Adolescents

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    From:ProQuest LLC

    Document Overview:
    To examine the factor structure of the Diagnostic and Statistical Manual of Mental Disorders (DSM), Fourth Edition, criteria for borderline personality disorder (BPD) in a sample of adolescents with a borderline symptomatology. The latent structure of borderline criteria, assessed with the Structured Interview for DSM-IV Personality, was explored with a principal factor analysis in a sample of 107 adolescents with a borderline symptomatology drawn from a European research project on BPDs. The principal component analysis revealed 2 homogeneous factors accounting for 66.8% of the variance. The first factor included internally oriented criteria, such as avoidance of abandonment, identity disturbance, chronic feeling of emptiness, and stress-related paranoid ideation. The second factor included externally oriented criteria, such as unstable relationships, impulsivity, suicidal or self-mutilating behaviours, and inappropriate anger. Affective instability was the only criterion loading on both factors. The results of our study suggests that an internal or external dichotomy may be an appropriate way to conceptualize the structure of borderline criteria in adolescents with a borderline symptomatology, with affective instability being a core feature of BPD at this age.
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  • Stepped Care: A Method to Deliver Increased Access to Psychological Therapies
    Stepped Care: A Method to Deliver Increased Access to Psychological Therapies

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    From:ProQuest LLC

    Document Overview:
    To introduce stepped care as a method of organizing the delivery of treatments, and to consider the factors necessary for implementation. Stepped care is described within the context of strategies such as collaborative care that aim to increase access to mental health care through the improved coordination of care between primary and specialist mental health services. Results from the implementation of stepped care in the United Kingdom and elsewhere are used to highlight the factors required for introducing stepped care into routine services. Issues to address when implementing highvolume services for common mental health problems are derived from this experience. Stepped care sits within the continuum of organizational systems, from situations where responsibility rests almost entirely with primary care clinicians to systems where all patients are managed by specialists for the entire duration of their treatment. Its core principles of delivering low-burden treatments first, followed by careful patient progress monitoring to step patients up to more intensive treatment, are easy to articulate but lead to considerable implementation diversity when services attempt to work in this manner. Services need to ensure they have specific staff competency training, including skills in delivering evidencebased treatments, access to telephony, and smart patient management informatics systems. Stepped care can provide the delivery system for supported self-management. To be successful, health systems need high levels of clinical outcome data and appropriately trained workers. Further attention is required to ensure equity of access and to reduce patient attrition in these systems.
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  • Clinical Course and Personality in Reactive, Compared With Nonreactive, Delusional Disorder
    Clinical Course and Personality in Reactive, Compared With Nonreactive, Delusional Disorder

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    From:ProQuest LLC

    Document Overview:
    Reactive delusional disorder (DD) (with a precipitating factor) has been postulated to differ clinically from nonreactive DD and to show a better prognosis. Our study tests this hypothesis in a sample of patients with persistent DD (International Classification of Diseases, 10th Revision) or DD (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) followed during a period of more than 10 years. As part of a long-term study on DD, 19 patients with DD and a stressful life event preceding the onset of the disorder were compared with 24 DD patients without such a life event. Diagnoses, social and biographical data, life events, and outcome were assessed by a semistructured interview and validated rating scales. Personality features were assessed by the NEO Five-Factor Inventory and by the Inventory of Clinical Personality Accentuations. Patients with reactive DD tended to be somewhat younger but showed otherwise little differences to patients with nonreactive DD. In particular, there were no differences in the course of the disorder. However, patients with reactive DD were significantly more often in a stable relationship and showed higher values on neuroticism and more pronounced dependent and borderline personality accentuations in dimensional personality measures. Reactive DD was not found to have a better prognosis than nonreactive DD. However, the results suggest an increased vulnerability for interpersonal conflicts in these patients.
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  • And Now for Something Completely Different . . . Self-Management
    And Now for Something Completely Different . . . Self-Management

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    From:ProQuest LLC

    Document Overview:
    The Canadian Mental Health Association, British Columbia Division, has developed BounceBack, a program funded by the BC Ministry of Health that provides people living with anxiety and depression, instructional DVDs, workbooks, and telephone coaching based on cognitive behavioural strategies in partnership with primary health care providers. Since BounceBack's inception in 2008, there have been 1 1 500 referrals to telephone coaching by physicians and 59 000 DVDs have been distributed.
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  • Supported Self-Management: A Simple, Effective Way to Improve Depression Care
    Supported Self-Management: A Simple, Effective Way to Improve Depression Care

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    From:ProQuest LLC

    Document Overview:
    To introduce supported self-management (SSM) for depression, examine it through the use of a quality assessment framework, and show its potential for enhancing the Canadian health care system. SSM is examined in terms of quality criteria: relevance, effectiveness, appropriateness, efficiency, safety, acceptability, and sustainability. Critical research is highlighted, and a case study is presented to illustrate the use of SSM with depressed patients. SSM is defined by access to a self-management guide (workbook or website) plus encouragement and coaching by health care provider, family member, or other supporter. It has high relevance to depression care in Canada, high cost-effectiveness, high appropriateness for most people with depression, and high safety. Acceptability of this intervention is more problematic: many providers remain doubtful of its acceptability to their poorly motivated patients. Sustainability of SSM as a component of mental health care will require ongoing knowledge exchange among policy-makers, health care providers, and researchers. The introduction of SSM represents a unique opportunity to enhance the delivery of depression care in Canada. Actively engaging the distressed individual in changing depressive patterns can improve outcomes without mobilizing substantial new resources. Over time, we will learn more about making SSM compatible with constraints on provider time, increasing access to self-management tools, and evaluating the benefit to everyday clinical work.
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  • STAYING GROUNDED WITH KERRY WASHINGTON
    STAYING GROUNDED WITH KERRY WASHINGTON

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    From:ProQuest LLC

    Document Overview:
    The actress often travels from her home in New York City to Los Angeles, where she shoots ABC's new political drama, Scandal, and she's currently in Louisiana making Quentin Tarantino's preCivil War western, Django Unchained.
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  • Travel Well
    Travel Well

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    From:ProQuest LLC

    Document Overview:
    (The flight attendant can provide hot water to prepare it.) "When you have to dine at an airport or a rest stop, choose a salad- but ditch the cheese and croutons and go light on the dressing," says Elizabeth Somer, R.D., a SHAPE advisory board member. 4.WVSHAWAY Like Boeing 747s, germs travel fast. Once you land, log on to the jet tag calculator at britishairways.com; using your usual wake-up time, sleep habits, and home time zone, it recommends when to bask in sunlight and when to hibernate in your hotel room. 8.
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  • thanks a brunch!
    thanks a brunch!

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    From:ProQuest LLC

    Document Overview:
    Since she always wants these waffles on weekdays' too I make a douille batch on Sunday and save some halter lor later- so we'bolh have something to look forward Lo on Monday morning." Nutrition score per serving: 240 calories, 1Og fat (3g saturated), 27g carbs, 13g protein, 3g fiber, 47mg calcium, 2mg iron,45Qmg sodium Mushroom, Gruyre, and Onion Quiche With Oat Crust SERVES 6 PREP TIME: 18 MINUTES CPLUSlHOURCHILLING) COOK TIME: 1 HOUR 40 MINUTES FOR THE CRUST cup old-fashioned rolled oats cup all-purpose flour teaspoon salt 3 tablespoons cold unsalted butter, cut into small pieces 3 tablespoons lowfat buttermilk cooking spray FOR THE FILLING 4 teaspoons olive oil 1 medium onion, thinly sliced into half-moons pound mixed mushrooms (such as cremini, oyster, or shiitake), coarsely chopped teaspoon salt teaspoon freshly ground black pepper teaspoon dry mustard 1 tablespoon chopped fresh thyme (or 1 teaspoon dried) 1 cups 1% milk 3 tablespoons all-purpose flour 3 large eggs 2 large egg whites cup grated Gruyre cheese (about 2 ounces) 1. Nutrition score per serving (1 tomato cup): 240 calories, 11g fat (4g saturated), 23g carbs, 17g protein, 6g fiber, 271mg calcium, 3mg iron, 420mg sodium Buttermilk Waffles With Strawberry Topping SERVES 4 PREP TIME: 12 MINUTES COOK TIME: 17 MINUTES FOR THE STRAWBERRY TOPPING 2 cups fresh or frozen (unsweetened) strawberries, stems removed 2 tablespoons maple syrup 2 teaspoons fresh lemon juice FOR THE WAFFLES cup all-purpose flour cup whole-wheat flour 2 tablespoons toasted wheat germ 1 teaspoons baking powder teaspoon baking soda teaspoon salt 1 cups lowfat buttermilk 1 tablespoon cala oil 1 tablespoon honey 1 large egg teaspoon vanilla extract cooking spray confectioners' sugar (optional) 1.
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  • WHAT YOU'RE NOT TELLING YOUR DOC
    WHAT YOU'RE NOT TELLING YOUR DOC

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    From:ProQuest LLC

    Document Overview:
    According to a Columbia University survey, more than half of women ages 25 to 49 routinely withhold information from their physicians. [...]research has shown that puffing just one to four cigarettes per day raises your odds of having a major heart -related event nearly threefold.
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  • PRIMAL INSTINCT
    PRIMAL INSTINCT

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    From:ProQuest LLC

    Document Overview:
    BenAmun resin bangles (from $35; ben-amun.com). beauty tip To get sun-kissed skin the safe way, use a gradual selftanner, like Jergens Natural GlowS Protect Daily Moisturizer SPF 20 ($9; drugstores). Wildlife by HeidiKlum for QVC gold-plated necklace ($79; qvc.com). beauty tip Give lips a dose of moisture and just a hint of tint with Yes to Carrots Color Balm in Peachy Keen ($6; drugstores). Pebble London resin bangle ($95; pebb1elondon.com). beauty tip For extra-active days, swipe on a hardworking antiperspirant like Degree Women Clinical Protection With MotionSense in Cotton Fresh (from $8; drugstores).
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  • fit in a flash
    fit in a flash

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    From:ProQuest LLC

    Document Overview:
    [...]stuff the Spanx back in the drawer-you do have time to slim down! WORKOUT CALENDAR MONDAY 24-Minute Blast, Core Challenge (page 137) TUESDAY Burn & FiRM Cardio (page 139) WEDNESDAY 24-Minute Blast, Core Challenge THURSDAY Burn & Firm CardIo 24-Minute 24-Minute Blast, Core Challenge SATURDAY 60-minute cardio session (any activity) SUNDAY off 24-MINUTE BLAST This four-move routine sculpts every major muscle group and burns 9 calories a minute. [...]raise arms to shoulder height in front of you [C]. Switch legs after 15 seconds. 4| PICK-UP Stand with feet shoulder-width apart, holding a dumbbell in each hand at sides, palms facing thighs.
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  • Keeping Cyber Success in Site
    Keeping Cyber Success in Site

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    From:ProQuest LLC

    Document Overview:
    Today, the bubbly 23-yearold and recent college grad is a cofounder of Miss O & Friends (missoandfriends.com), an online community for tweens and young teens.
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  • No More Swimsuit Drama
    No More Swimsuit Drama

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    From:ProQuest LLC

    Document Overview:
    [...]this season, I decided, would be different. Since I was on my way to transforming my body, it was time for a new bathing suit - and an attitude to match.
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  • Sound Check
    Sound Check

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    From:ProQuest LLC

    Document Overview:
    According to recent research from Johns Hopkins University, one in five Americans age 12 and older has already suffered some hearing loss.
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