Background
Depression is common in patients with inflammatory bowel disease (IBD) and contributes to poor quality of life (QoL). The use of information technology for the remote management of patients with IBD is growing, but little is known about its impact on depressive symptoms (DS) and QoL. We aimed to evaluate the impact of telemedicine on DS and generic QoL in IBD patients.
Methods
We analyzed data from the Telemedicine for Patients with IBD (TELE-IBD) study. During this 12-month clinical trial, patients were randomized to receive text message-based telemedicine weekly (TELE-IBD W), every other week (TELE-IBD EOW), or to standard care. Depressive symptoms and QoL were assessed over time with the Mental Health Inventory 5 (MHI-5) and the Short Form 12 (SF-12), respectively. We compared the change in MHI-5 and SF-12 (with separate physical (PCS) and mental component summary (MCS) scores) between the study arms.
Results
A total of 217 participants were included in this analysis. After 1 year, there was no significant difference in the change in MHI-5 (TELE-IBD W +3.0 vs TELE-IBD EOW +0.7 vs standard care +3.4; P = 0.70), MCS (TELE-IBD W +1.4 vs TELE-IBD EOW +1.0 vs standard care +2.5; P = 0.89), and PCS scores (TELE-IBD W +0.4 vs TELE-IBD EOW +0.6 vs standard care +3.7; P = 0.06) between the groups.
Conclusions
Text message-based telemedicine does not improve DS or QoL when compared with standard care in IBD patients treated at tertiary referral centers. Further studies are needed to determine whether telemedicine improves DS or QoL in settings with few resources.
Citation: Bilkovic, D. M., M. M. Mitchell, R. E. Isdell, M. Schliep, and A. R. Smyth. 2017. Mutualism between ribbed mussels and cordgrass enhances salt marsh nitrogen removal. Ecosphere 8(4):e01795. 10.1002/ecs2.1795Abstract. Salt marsh ecosystems have declined globally and are increasingly threatened by erosion, sea level rise, and urban development. These highly productive, physically demanding ecosystems are populated by core species groups that often have strong trophic interactions with implications for ecosystem function and service provision. Positive interactions occur between ribbed mussels (Geukensia demissa) and cordgrass (Spartina alterniflora). Mussels transfer particulate nitrogen from the water column to the marsh sediments, which stimulates cordgrass growth, and cordgrass provides predator and/or heat stress refuge for mussels. Here, we test mussel facilitation of two functions in salt marshes that relate to N removal: microbial denitrification and water filtration. Microcosm experiments revealed that the highest rates of N 2 production and nitrification occurred when mussels were present with marsh vegetation, suggesting that mussels enhanced coupling of the nitrification-denitrification. Surveys spanning the York River Estuary, Chesapeake Bay, showed that the highest densities of mussels occurred in the first meter for all marsh types with mainstem fringing (1207 AE 265 mussels/m 2 ) being the most densely populated. The mussel population was estimated to be~197 million animals with a water filtration potential of 90-135 million L/hr. Erosion simulation models demonstrated that suitable marsh habitat for ribbed mussels along the York River Estuary would be reduced by 11.8% after 50 years. This reduction in mussel habitat resulted in a projected 15% reduction in ribbed mussel abundance and filtration capacity. Denitrification potential was reduced in conjunction with projected marsh loss (35,536 m 2 ) by 205 g N/hr, a 16% reduction. Because of the predominant occurrence of ribbed mussels at the marsh seaward edge and because the highest proportional loss will occur for fringing marshes (20%), shoreline management practices that restore or create fringing marsh may help offset these projected losses.
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