This study confirmed the importance for quality of life of core symptoms of SSc, such as pain, fatigue and limitations in hand function. It also identified areas with very little research, such as sleep problems, that appear to play important roles in daily functioning, and that merit more focused study.

Objective. To assess the prevalence, course, and predictors of depression in patients with systemic sclerosis (SSc). Methods. We conducted a comprehensive search in November 2006 of MEDLINE, PsycINFO, and CINAHL databases to identify original research studies published in any language that used a structured interview or validated questionnaire to assess major depressive disorder or clinically significant symptoms of depression in patients with SSc. The search was augmented by hand searching 26 selected journals through December 2006 and references from identified articles and reviews. Studies were excluded if only an abstract was provided or if depression was not measured by a validated method. Results. No studies used a structured clinical interview to assess the prevalence of major depressive disorder. The prevalence of clinically significant depressive symptoms was 51-65% based on 2 studies that used a Beck Depression Inventory (BDI) score >10 and 46 -56% based on 2 studies that used a BDI score >11. These rates and those reported in 4 other studies that used different assessment tools (36 -43%) were consistently high compared with other medical patient groups assessed with the same instruments and cutoffs. Methodologic issues limited the ability to draw strong conclusions from studies of predictors. Conclusion. Symptoms of depression are common among patients with SSc. The high rates reported across studies suggest that routine screening is recommended. There is a need for studies that examine depression at different time points from the diagnosis of SSc and that systematically investigate factors associated with high levels of depressive symptoms.

This paper examines a class of asymmetrical multi-depot vehicle routing problems and location-routing problems, under capacity or maximum cost restrictions. By using an appropriate graph representation, and then a graph extension, the problems are transformed into equivalent constrained assignment problems. Optimal solutions are then found by means of a branch and bound tree. Problems involving up to 80 nodes can be solved without difficulty.