Background-The safety and predictability of refractive surgery for all degrees of myopia is now becoming established. It is therefore appropriate to evaluate whether there is a patient driven demand for such treatments and, if so, to establish guidelines for its provision within the National Health Service (NHS). Methods-A comparative study was designed to assess the eVect of degree of myopia on quality of life ("high" (n = 30) -10.00D, worse eye; "moderate" (n = 40) -4.00 to -9.75D, worse eye; "low" (n = 42) <-4.00D, worse eye) compared with a group of patients with keratoconus (n = 30) treated by optical correction. Data collection included binocular logMAR visual acuity, Pelli-Robson low contrast letter sensitivity, questionnaires to assess subjective visual function (VF-14) and eVect on quality of life (VQOL), and semistructured interviews. Results-There were no significant diVerences in any of the measures between patients with a high degree of myopia and those with keratoconus, or between those with a low and those with a moderate degree of myopia. However, those with a high degree of myopia had highly significantly poorer logMAR, VF-14, and VQOL scores than those with low and moderate myopia (p<0.001). Interview data supported these findings with patients with a high degree of myopia and those with keratoconus reporting that psychological, cosmetic, practical, and financial factors aVected their quality of life. Conclusion-Compared with low and moderate myopia, patients with a high degree of myopia experience impaired quality of life similar to that of patients with keratoconus. Criteria should therefore be identified to enable those in suYcient need to obtain refractive surgical treatment under the NHS. (Br J Ophthalmol 2000;84:1031-1034 Myopia aVects 25% of the population in western industrialised societies and has a potentially negative eVect on self-esteem, career choice, and ocular health.

Training GPs with the reattribution training package appears to be extremely cost-effective.

Combination therapy is likely to be a cost-effective first-line secondary care treatment for severe depression. Its cost-effectiveness for moderate depression is more uncertain from current evidence. Targeted combination therapy could improve resource utilisation.

PURPOSE. Examine the efficacy of a computer-tailored intervention (CTI) based on the transtheoretical model (TTM) for reducing depression, an increasingly important component of health promotion programs. DESIGN. Pretest-posttest randomized trial. Setting . Participants were recruited and treated at home after being identified in two primary care clinics in Eastern Massachusetts and Chicago, Illinois. SUBJECTS. A total of 350 adults experiencing at least mild symptoms of depression but not involved in or planning to seek treatment for depression. INTERVENTION. A print manual and three CTI reports tailored to stage of change for using effective methods to prevent or reduce depression, other TTM variables, level of depression, and behavior. . Pre-post changes and reliable and clinically significant change on the Beck Depression scale II and pre-post changes on the 20-item Medical Outcomes Study Short Form survey-based measure of physical functioning at 9 months' follow-up. ANALYSIS. t-tests and χ(2) tests. Complete-case analysis and two intention-to-treat analyses-assumption of no change and multiple imputation (MI)-are reported. Exploratory analyses examined whether the effects of the intervention on depression were moderated by five subject characteristics: baseline level of depression, baseline level of physical functioning, baseline stage of change for preventing or managing depression, age, and education. RESULTS. Complete-case and intention-to-treat analyses showed that the intervention group experienced significantly greater improvements in depression (d  =  .220-.355); results for physical functioning were weaker (d  =  .150-.309) and did not reach statistical significance in the MI analysis. The effects of the intervention on reliable and clinically significant change in depression were largest among participants who were experiencing moderate depression (d  =  .363-.519) or severe depression (d  =  .603-.718) or who were in the precontemplation or contemplation stage (d  =  .573-.856) at baseline.