The 'European Alliance Against Depression (EAAD)': a multifaceted, community-based action programme against depression and suicidality.

Action programmes fostering partnerships and bringing together regional and national authorities to promote the care of depressed patients are urgently needed. In 2001 the 'Nuremberg Alliance Against Depression' was initiated as a community-based model project within the large-scale 'German Research Network on Depression and Suicidality' (Kompetenznetz 'Depression, Suizidalität'). The 'Nuremberg Alliance Against Depression' was an action programme, conducted in the city of Nuremberg (500,000 inhabitants) in 2001/2002, addressing four intervention levels (Hegerl et al. Psychol Med 2006;36:1225). Based on the positive results of the Nuremberg project (a significant reduction of suicidal behaviour by more than 20%) 18 international partners representing 16 different European countries established the 'European Alliance Against Depression' (EAAD) in 2004. Based on the four-level approach of the Nuremberg project, all regional partners initiated respective regional intervention programmes addressing depression and suicidality. Evaluation of the activities takes place on regional and international levels. This paper gives a brief overview of the background for and experiences with the EAAD. It describes the components of the programme, provides the rationale for the intervention and outlines the current status of the project. The aim of the paper is to disseminate information about the programme's potential to reduce suicidal behaviour and to provide examples of how European community-based 'best practice' models for improving the care of depressed patients and suicidal persons can be implemented using a bottom-up approach. EAAD is mentioned by the European commission as a best practice example within the Green Paper 'Improving the mental health of the population: Towards a strategy on mental health for the European Union' (European Commission 2005).

[The manner of care, self care and quality of life dialysis patients]. / Behandlungsart, Selbstpflege und das Wohlbefinden von dialysierten Patienten.

BACKGROUND: The aim of this cross-sectional study was to describe specific strategies used by ESRD patients to manage their illness on their own behalf in order to attain their health goals, promote personal development and well-being. METHODS: A representative sample of 178 patients on dialysis of the Swiss German-speaking population was selected. The participants were treated in-centre on hemodialysis (HD) or had ambulatory peritoneal dialysis (CAPD). Data collection procedure for specific self-care activities was structured interviews. Self-care capabilities were measured with the ASA-scale and well-being was rated on the Cantril's ladder. RESULTS: Both patient groups were comparable on demographics, severity of illness except for dialysis duration, social support and general self-care capabilities. Both patient groups scored their subjective well-being 7 or higher on a scale of 10. There was a significant positive correlation between amount of dialysis self-care and subjective well-being. There was no difference in effectiveness of dialysis self-care between in-centre HD and CAPD patients. CONCLUSION: The results demonstrate that patients in this study perform a substantial amount of self-care and perceive their subjective well-being as good. These findings indicate that treatment modalities both of HD and CAPD provide equal opportunities for quality of life if patient selection is based on history of renal disease, available social support and self-care capabilities.

Adequate self-care of dialysed patients: a review of the literature.

The purpose of this article is to clarify the concept: 'adequate self-care of patients treated with hemodialysis (HD) or continuous ambulatory peritoneal dialysis (CAPD)'. This was done by the specification of Orem's general definition of self-care and a review of the literature. Adequate self-care behaviours for preventing and regulating pathological processes and related disabilities e.g. following dialysis and medication prescriptions as well as diet and fluid regimens are well documented. Adequate self-care behaviours aimed to promote personal well-being or development are less well documented. The authors suggest that use of the concept of adequate self-care would enlarge the scope of the disease management of HD and CAPD patients. Further research should focus on systematically investigating self-care activities of dialysed patients and their contribution to health and quality of life outcomes.