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Annals of Tropical Medicine and Parasitology | 1981

Studies on the transmission and prevalence of Bancroftian filariasis in four coastal villages of Tanzania

J. E. McMahon; S. A. Magayuka; Kolstrup N; F. W. Mosha; Frances M. Bushrod; D. E. Abaru; Joan H. Bryan

In surveys of Bancroftian filariasis in four coastal villages in Tanzania, microfilaria rates varied between 28·3 and 15·6% and hydrocoele rates in males over 20 years between 78–5 and 61–3%.Quantitative studies on the intensity of transmission were conducted over a period of 17 months. The estimated potential infective bites per person per year varied from 24 to 189. The number of infective bites was related to filarial endemicity.The vectors in order of importance were Anopheles gambiae s.l., Culex pipiens quinquefasciatus and An. funestus. In all villages An. gambiae s.l. played a role in transmission and in two it was the main vector. Of the total estimated bites by members of the gambiae complex, 16 223 (91·1%) occurred during or following the ‘long rains’ (April to early June). In contrast, transmission by C. p. quinquefasciatus occurred throughout the year. In one village in which C. p. quinquefasciatus was the predominant vector, the biting density of this species was 22 times greater than the bit...


Journal of Medical Internet Research | 2013

The clinical effectiveness of web-based cognitive behavioral therapy with face-to-face therapist support for depressed primary care patients: Randomized controlled trial

Ragnhild Sørensen Høifødt; Kjersti Lillevoll; Kathleen M Griffiths; Tom Wilsgaard; Martin Eisemann; Knut Waterloo; Kolstrup N

Background Most patients with mild to moderate depression receive treatment in primary care, but despite guideline recommendations, structured psychological interventions are infrequently delivered. Research supports the effectiveness of Internet-based treatment for depression; however, few trials have studied the effect of the MoodGYM program plus therapist support. The use of such interventions could improve the delivery of treatment in primary care. Objective To evaluate the effectiveness and acceptability of a guided Web-based intervention for mild to moderate depression, which could be suitable for implementation in general practice. Methods Participants (N=106) aged between 18 and 65 years were recruited from primary care and randomly allocated to a treatment condition comprising 6 weeks of therapist-assisted Web-based cognitive behavioral therapy (CBT), or to a 6-week delayed treatment condition. The intervention included the Norwegian version of the MoodGYM program, brief face-to-face support from a psychologist, and reminder emails. The primary outcome measure, depression symptoms, was measured by the Beck Depression Inventory-II (BDI-II). Secondary outcome measures included the Beck Anxiety Inventory (BAI), the Hospital Anxiety and Depression Scale (HADS), the Satisfaction with Life Scale (SWLS), and the EuroQol Group 5-Dimension Self-Report Questionnaire (EQ-5D). All outcomes were based on self-report and were assessed at baseline, postintervention, and at 6-month follow-up. Results Postintervention measures were completed by 37 (71%) and 47 (87%) of the 52 participants in the intervention and 54 participants in the delayed treatment group, respectively. Linear mixed-models analyses revealed a significant difference in time trends between the groups for the BDI-II, (P=.002), for HADS depression and anxiety subscales (P<.001 and P=.001, respectively), and for the SWLS (P<.001). No differential group effects were found for the BAI and the EQ-5D. In comparison to the control group, significantly more participants in the intervention group experienced recovery from depression as measured by the BDI-II. Of the 52 participants in the treatment program, 31 (60%) adhered to the program, and overall treatment satisfaction was high. The reduction of depression and anxiety symptoms was largely maintained at 6-month follow-up, and positive gains in life satisfaction were partly maintained. Conclusions The intervention combining MoodGYM and brief therapist support can be an effective treatment of depression in a sample of primary care patients. The intervention alleviates depressive symptoms and has a significant positive effect on anxiety symptoms and satisfaction with life. Moderate rates of nonadherence and predominately positive evaluations of the treatment also indicate the acceptability of the intervention. The intervention could potentially be used in a stepped-care approach, but remains to be tested in regular primary health care. Trial Registration Australian New Zealand Clinical Trials Registry: ACTRN12610000257066; http://apps.who.int/trialsearch/trial.aspx?trialid=ACTRN12610000257066 (Archived by WebCite at http://www.webcitation.org/6Ie3YhIZa).


Family Practice | 2011

Effectiveness of cognitive behavioural therapy in primary health care: a review

Ragnhild Sørensen Høifødt; Christine Strøm; Kolstrup N; Martin Eisemann; Knut Waterloo

BACKGROUND Depression and anxiety are highly prevalent disorders causing substantial impairment in daily life. Cognitive behavioural therapy (CBT) delivered face-to-face or as self-help has shown to be an effective treatment for these disorders. Such treatments may be suitable for delivery in primary health care. AIM The aim of the article was to review research on the effectiveness of CBT for depression and anxiety disorders delivered in primary care by primary care therapists. METHODS A literature search of quantitative studies of the effectiveness of CBT delivered in primary care was conducted on multiple electronic databases. A total of 17 studies were included in the review. RESULTS Eight studies of supported Internet- or computer-based CBT, six of which were randomized controlled trials (RCTs), indicate that this treatment is effective for mild to moderate depression and anxiety. Five studies suggest that this treatment may be more effective than usual care for mild to moderate but not for more severe symptoms. Results of four RCTs of brief therapies using written self-help material suggest that while such interventions are effective, no particular approach outperformed any other, including usual care. Five RCTs of CBT delivered face-to-face show that this treatment can be effective when delivered by therapists highly educated in the mental health field. However, many primary care therapists may find such interventions too time consuming. CONCLUSIONS CBT delivered in primary care, especially including computer- or Internet-based self-help programs, is potentially more effective than usual care and could be delivered effectively by primary care therapists.


Transactions of The Royal Society of Tropical Medicine and Hygiene | 1978

The lethal effects of the cibarial and pharyngeal armatures of mosquitoes on microfilariae

P.B. McGreevy; Joan H. Bryan; P. Oothuman; Kolstrup N

Microfilariae of Wuchereria bancrofti and Brugia pahangi were killed by the chewing action of the cibarial and pharyngeal armatures and other papillae and spines in the fore-gut of mosquitoes. The proportion of ingested microfilariae that were killed was largely dependent on the presence and shape of the cibarial armature. Anopheles farauti No. 1 and Anopheles gambiae species A and B have well developed cibarial armatures and killed 36 to 96% of the ingested microfilariae. Culex pipiens fatigans has a poorly developed cibarial armature and killed only 6% of the microfilariae. Aedes aegypti and Aedes togoi lack cibarial armatures but have the remaining fore-gut structures. They killed only 2 to 22% of the microfilariae. The significance of these observations in relation to the control of filariasis with diethylcarbamazine is discussed.


BMC Psychiatry | 2013

Motivation to persist with internet-based cognitive behavioural treatment using blended care: a qualitative study.

Maja Wilhelmsen; Kjersti Lillevoll; Mette Bech Risør; Ragnhild Sørensen Høifødt; May-Lill Johansen; Knut Waterloo; Martin Eisemann; Kolstrup N

BackgroundThe prevalence of depression is high and results in huge costs for society. Internet-based cognitive behavioural treatment (ICBT) has been suggested for use in primary care and has been shown to be more effective when combined with human support. However, non-completion rates remain a challenge. Current recommendations state that steps to improve persistence with ICBT should be determined and the impact of therapist support on persistence explored. A few earlier studies have explored motivations to persist with ICBT without face-to-face therapist support. The present study explored the motivation to persist as experienced by a group of patients who sought help in primary care and used “blended care”, i.e. ICBT supported by short face-to-face consultations.MethodsTo elucidate motivation in an everyday context and the meaning of patients’ experiences we chose a phenomenological hermeneutical approach. We interviewed participants in the intervention group of a randomized controlled trial that evaluated the efficacy of an ICBT programme called MoodGYM, an eHealth intervention used to treat depression. Fourteen participants, both completers and non-completers, went through individual, semi-structured interviews after they ended their treatment.ResultsHope of recovery and a desire to gain control of one’s life were identified as intrinsic motivators. The feeling of being able to freely choose how, when and where to complete the ICBT modules was identified as an important supporting condition and satisfied the participants’ need for autonomy. Furthermore, the importance of a sense of belonging towards partners, friends or family was essential for motivation as was the ability to identify with ICBT content. Another supporting condition was the experience of connectedness when met with acknowledgement, flexibility and feedback from a qualified therapist in the face-to-face consultations.ConclusionsA key finding was that participants were motivated to persist with ICBT when their overall need for relatedness was satisfied. This was achieved through a sense of belonging towards partners, friends and family. Connectedness with the therapist and the participant’s ability to identify with the ICBT modules also gave a sense of relatedness. Improving these motivational aspects may increase patients’ persistence with ICBT.


Transactions of The Royal Society of Tropical Medicine and Hygiene | 1982

Ingestion and development of Wuchereria bancrofti in Culex quinquefasciatus, Anopheles gambiae and Aedes aegypti after feeding on humans with varying densities of microfilariae in Tanzania.

P.B. McGreevy; Kolstrup N; J. Tao; M.M. McGreevy; T.F. de C. Marshall

Abstract Laboratory observations were made on the transmission of Wuchereria bancrofti by Culex quinquefasciatus and Anopheles gambiae, natural vectors in East Africa, and by Aedes aegypti, an experimental vector. Mosquitoes were fed on human carriers with one to 2,667 microfilariae (mff/ml) of peripheral blood and the numbers of mff ingested were determined. The mosquitoes demonstrated a ‘concentrating effect’ and ingested 8.6 to 12-fold more mff than the expected number based on the density of mff in the carrier and the size of the blood meal. Studies on Culex showed that only 2.7 to 13% of the ingested mff developed into infective larvae (L3s). Emphasis was given to the transmission of Wuchereria from low density carriers with less than 10 mff/ml of peripheral blood—a value that approximates the threshold level of microfilaraemia detectable with conventional diagnostic techniques. By combining our laboratory data with published field data on the biting rates and longevity of mosquitoes in East Africa, we estimate that each low density carrier could serve as a source for nil to 15 L3s/year in Cx quinquefasciatus and 0.3 to 8 L3s/year in An. gambiae depending on the particular community. These estimates are relevant when formulating strategy to control bancroftian filariasis by mass chemotherapy with diethylcarbamazine. Experience with this drug has shown that a proportion of the carriers in a community continue to circulate mff at low levels after treatment. The present data demonstrate that these carriers serve as a reservoir of infection for mosquitoes.


BMJ | 1979

Praziquantel: a new schistosomicide against Schistosoma haematobium.

J. E. McMahon; Kolstrup N

The effectiveness of the new schistosomicide praziquantel was assessed in African schoolchildren infected with Schistosoma haematobium. They were stratified according to the severity of their infection and were then randomly allocated to treatment with two single-dose regimens (30 and 40 mg/kg) and a split regimen of two doses of 20 mg/kg given four hours apart. All three regimens were highly effective and produced few side effects. Children who initially had very high pretreatment egg loads showed a poorer therapeutic response at all dose levels, and further investigations are necessary to find the optimum dose. Because of its effectiveness in a single dose and lack of toxicity, praziquantel may prove to be the ideal schistosomicide.


Journal of Medical Internet Research | 2013

Patients’ Experiences of Helpfulness in Guided Internet-Based Treatment for Depression: Qualitative Study of Integrated Therapeutic Dimensions

Kjersti Lillevoll; Maja Wilhelmsen; Kolstrup N; Ragnhild Sørensen Høifødt; Knut Waterloo; Martin Eisemann; Mette Bech Risør

Background Quantitative research on Internet-based cognitive behavioral therapy (ICBT) has collected substantial evidence for the effectiveness of this treatment approach on health outcomes. Less is known about how patients find ICBT to be generally meaningful and helpful for treating depression. Objective To explore patients’ experiences of being in ICBT treatment with a focus on the treatment dimensions that they considered helpful. Methods Choosing a phenomenological-hermeneutical approach, 14 patients were interviewed with semistructured qualitative interviews to elicit their understanding of using ICBT. The patients took part in a clinical trial using ICBT with MoodGYM, which also featured brief consultations with a clinical psychologist. The interviews were transcribed and analyzed according to the chosen methodology and organized into significant themes. Results The phenomenological-hermeneutical analysis identified 5 themes relating overall to the meaning of this mode of treatment in terms of helpfulness. Two related to treatment in general: (1) taking action to address one’s problems and (2) the value of talking to a professional. The next two themes specifically addressed guided self-help using the MoodGYM program: (3) acquiring relevant knowledge, and (4) restructuring the new knowledge acquired through ICBT. A fifth theme concerned (5) actual changes in patients’ perceptions and interactions, related to either the self-help material or the face-to-face consultations with the therapist. Conclusions Three important dimensions were made explicit: the active engagement of the patient, the guidance of the therapist, and the content of the treatment program. The findings pointed to (1) the role of MoodGYM as a source of new knowledge providing patients with a structured approach to work with their depression, (2) the patient’s role as the primary agent of change through adapting relevant knowledge from MoodGYM to their situation, and (3) the dialogue with the therapist as a trusting relationship in which to share thoughts and feelings, receive feedback and advice, and to assist the patient in making use of the MoodGYM content.


Annals of Tropical Medicine and Parasitology | 1981

Control measures against bancroftian filariasis in coastal villages in Tanzania.

Kolstrup N; J. E. McMahon; S. A. Magayuka; F. W. Mosha; Frances M. Bushrod; Joan H. Bryan

Control measures against Bancroftian filariasis were implemented in four coastal villages in Tanzania.In two villages the mass administration of diethylcarbamazine in spaced doses over six months (total dose 54 to 72 mg kg−1 per person), reduced the infective bites per person per year from 189 to 13 and 41 to nil, respectively, despite a persistent microfilaraemia in the villagers of 3·8%. In a third village, larviciding with chlorpyrifos against Culex pipiens quinquefasciatus in pit latrines reduced the infective bites from 187 to 12. The corresponding reduction was from 24 to nine in a fourth village, where the control procedures integrated simple environmental measures with the use of larvicides (chlorpyrifos in pit-latrines and temephos to control Anopheles gambiae s.l. larvae in temporary pools).Because of the wide variation in transmission patterns within the same geographical area and even in the same locality in that area at different times a flexible approach to filariasis control is necessary. I...


Journal of Medical Internet Research | 2014

Norwegian general practitioners' perspectives on implementation of a guided web-based cognitive behavioral therapy for depression: a qualitative study.

Maja Wilhelmsen; Ragnhild Sørensen Høifødt; Kolstrup N; Knut Waterloo; Martin Eisemann; Richard Chenhall; Mette Bech Risør

Background Previous research suggests that Internet-based cognitive behavioral therapy (ICBT) has a positive effect on symptoms of depression. ICBT appears to be more effective with therapist support, but it is unclear what this support should comprise. General practitioners (GPs) have positive attitudes toward ICBT. However, ICBT is rarely used in regular care in general practice. More research is warranted to integrate the potential of ICBT as part of regular care. Objective The aim of this study was to explore aspects perceived by GPs to affect the implementation of guided ICBT in daily practice. Understanding their perspectives may contribute to improving the treatment of depression in the context of general practice. Methods A training package (3-day course) introducing a Norwegian translation of the ICBT program MoodGYM was developed and presented to GPs in Norway. Following training, GPs were asked to include guided ICBT in their regular care of patients with symptoms of depression by providing brief, face-to-face follow-up consultations between modules. We interviewed 11 GPs who had taken the course. Our interview guide comprised open questions that encouraged GPs to frame their responses using examples from their experiences when implementing ICBT. Thematic analysis was chosen to explore patterns across the data. Results An overall belief that ICBT would benefit both the patients’ health and the GPs’ own work satisfaction prompted the GPs to take the ICBT course. ICBT motivated them to invest time and effort in improving treatment. The most important motivating aspects in MoodGYM were that a program based on cognitive behavioral therapy could add a structured agenda to their consultations and empower depressed patients. Organizational aspects, such as a lack of time and varied practice, inhibited the use of ICBT. Inadequate knowledge, recalling the program, and changing own habits were also challenging. The GPs were ambivalent about whether ICBT had a negative impact on the doctor–patient interaction in the module follow-ups. Generally, GPs made an effort to recommend MoodGYM, but the expected module follow-ups were often not provided to patients and instead the GPs returned to standard treatment. Conclusions GPs’ feedback in the present study contribute to our understanding of the challenges of changing treatment for depression. Our findings indicated that recommending ICBT could add to the GP’s toolkit. Offering training and highlighting the following aspects may increase recommendation of ICBT by GPs: (1) ICBT is theory-based and credible, (2) ICBT increases the GPs’ work satisfaction by having a tool to offer, and (3) ICBT facilitates empowerment of patients in their own health. In addition, the present study also indicated that complex aspects must be accommodated before module follow-ups can be incorporated into GPs’ treatment of depression.

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Joan H. Bryan

University of Queensland

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