1051
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Law YW, Yip PSF, Lai CCS, Kwok CL, Wong PWC, Liu KS, Ng PWL, Liao CWM, Wong TW. A Pilot Study on the Efficacy of Volunteer Mentorship for Young Adults With Self-Harm Behaviors Using a Quasi-Experimental Design. CRISIS 2016; 37:415-426. [PMID: 27278570 DOI: 10.1027/0227-5910/a000393] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Studies have shown that postdischarge care for self-harm patients is effective in reducing repeated suicidal behaviors. Little is known about whether volunteer support can help reduce self-harm repetition and improve psychosocial well-being. AIM This study investigated the efficacy of volunteer support in preventing repetition of self-harm. METHOD This study used a quasi-experimental design by assigning self-harm patients admitted to the emergency departments to an intervention group with volunteer support and treatment as usual (TAU) for 9 months and to a control group of TAU. Outcome measures include repetition of self-harm, suicidal ideation, hopelessness, and level of depressive and anxiety symptoms. RESULTS A total of 74 cases were recruited (38 participants; 36 controls). There were no significant differences in age, gender, and clinical condition between the two groups at the baseline. The intervention group showed significant improvements in hopelessness and depressive symptoms. However, the number of cases of suicide ideation and of repetition of self-harm episodes was similar for both groups at the postintervention period. CONCLUSION Postdischarge care provided by volunteers showed significant improvement in hopelessness and depression. Volunteers have been commonly involved in suicide prevention services. Further research using rigorous methods is recommended for improving service quality in the long term.
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Affiliation(s)
- Yik-Wa Law
- 1 Department of Social Work and Social Administration, The University of Hong Kong, PRC.,2 Centre for Suicide Research and Prevention, The University of Hong Kong, PRC
| | - Paul S F Yip
- 1 Department of Social Work and Social Administration, The University of Hong Kong, PRC.,2 Centre for Suicide Research and Prevention, The University of Hong Kong, PRC
| | - Carmen C S Lai
- 2 Centre for Suicide Research and Prevention, The University of Hong Kong, PRC
| | - Chi Leung Kwok
- 2 Centre for Suicide Research and Prevention, The University of Hong Kong, PRC
| | - Paul W C Wong
- 1 Department of Social Work and Social Administration, The University of Hong Kong, PRC.,2 Centre for Suicide Research and Prevention, The University of Hong Kong, PRC
| | - Kwong-Sun Liu
- 3 Department of Psychiatry, Pamela Youde Nethersole Eastern Hospital, Hong Kong, PRC
| | - Pauline W L Ng
- 3 Department of Psychiatry, Pamela Youde Nethersole Eastern Hospital, Hong Kong, PRC
| | - Carmen W M Liao
- 4 United Christian Hospital, Department of Psychiatry, Hong Kong, PRC
| | - Tai-Wai Wong
- 5 Accident and Emergency Department, Pamela Youde Nethersole Eastern Hospital, Hong Kong, PRC
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1052
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Tanaka EH, Santos PFD, Silva MF, Botelho PFFB, Silva P, Rodrigues NC, Gomes MM, Moraes R, Abreu DCCD. The effect of supervised and home based exercises on balance in elderly subjects: a randomized controlled trial to prevent falls. REVISTA BRASILEIRA DE GERIATRIA E GERONTOLOGIA 2016. [DOI: 10.1590/1809-98232016019.150027] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract Objective: The aim of the present study was to evaluate the influence of a balance training program on the semi-static balance of elderly persons by comparing a supervised group with individual home-based application. Method: A blinded randomized controlled multi-arm trial was conducted. The elderly individuals were randomized into: Supervised Group (SG; n=18); Domiciliary Group (DG; n=20) and Control Group (CG; n=18). The SG and DG participated in twice weekly training sessions for 10 weeks. A posturography evaluation was performed based on velocity, anterior-posterior (AP) and medial-lateral (ML) medial amplitude variables in firm surface with eyes open (FSEO) and closed (FSEC), tandem stance with eyes open (Tandem EO) and closed (Tandem EC), and single-leg stance (SL) situations. Two-way ANOVA and Tukey's post-hoc were used for parametric data, the Friedman and Wilcoxon post-hoc tests were used for intragroup analysis and the Kruskal-Wallis and Mann-Whitney post-hoc tests were used for intergroup analysis. Results: In intergroup analysis, the DG group showed improvement in body sway in the Tandem EC (velocity and medial amplitude AP) and single-leg stance (medial amplitude ML) situations. The SG showed a decline in the Tandem EO situation in all the variables. In intergroup analysis, the DG showed improvement in the FSEO position (medial amplitude ML), in the Tandem EC position (medial velocity ML), and the single-leg stance position (medial amplitude AP and ML). The SG showed improvement in the FSEO position (medial amplitude ML) and the single-leg stance position (medial amplitude AP), but showed a decline in the FSEO (variable medial velocity AP) and Tandem EO position (medial amplitude AP). Conclusion: The exercises were beneficial for the balance of the elderly individuals, with the DG presenting the best results. REBEC: RBR-3S9M65.
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1053
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Beltrán-Barrientos L, Hernández-Mendoza A, Torres-Llanez M, González-Córdova A, Vallejo-Córdoba B. Invited review: Fermented milk as antihypertensive functional food. J Dairy Sci 2016; 99:4099-4110. [DOI: 10.3168/jds.2015-10054] [Citation(s) in RCA: 95] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 12/28/2015] [Indexed: 12/20/2022]
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1054
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Pelekasis P, Zisi G, Koumarianou A, Marioli A, Chrousos G, Syrigos K, Darviri C. Forming a Stress Management and Health Promotion Program for Women Undergoing Chemotherapy for Breast Cancer: A Pilot Randomized Controlled Trial. Integr Cancer Ther 2016; 15:165-74. [PMID: 26242890 PMCID: PMC5736052 DOI: 10.1177/1534735415598225] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE To assess the effects of an 8-week stress management and health promotion program on women undergoing breast cancer chemotherapy treatment. Patients and methods A total of 61 patients were recruited in 2 cancer centers and were randomly assigned to the intervention program (n = 30) or control group (n = 31). The intervention program consisted of different stress management techniques, which were combined with instructions for lifestyle modification. Assessments were carried out through questionnaires and measurement of body mass index (BMI) at baseline and at the end of the 8-week program. RESULTS In all, 25 participants completed the intervention program, whereas 28 participants completed the observational control program. The intervention program resulted in a small effect size on internal dimension of Health Locus of Control (HLC) and a medium effect size on stress, depression, anxiety, night sleep duration, and chance dimension of HLC. A strong effect size was recorded for BMI and sleep onset latency. Self-rated health, spiritual well-being, and powerful others dimension of HLC were not significantly affected. Additionally, some of the participants reported a reduction in the side effects caused by chemotherapy. CONCLUSIONS The intervention resulted in several benefits for the general health status of patients. Therefore, it should be considered as feasible and potentially beneficial for women undergoing breast cancer chemotherapy. However, it is necessary for this intervention to be tested through a randomized controlled trial in a larger sample of patients before adopting this program in standard cancer care.
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Affiliation(s)
- Panagiotis Pelekasis
- Postgraduate Course Science of Stress and Health Promotion, School of Medicine, University of Athens, Athens, Greece
| | - Georgia Zisi
- Postgraduate Course Science of Stress and Health Promotion, School of Medicine, University of Athens, Athens, Greece
| | - Anna Koumarianou
- Postgraduate Course Science of Stress and Health Promotion, School of Medicine, University of Athens, Athens, Greece Fourth Department of Internal Medicine, Attikon University Hospital, Athens, Greece
| | | | - George Chrousos
- Postgraduate Course Science of Stress and Health Promotion, School of Medicine, University of Athens, Athens, Greece
| | - Konstantinos Syrigos
- Postgraduate Course Science of Stress and Health Promotion, School of Medicine, University of Athens, Athens, Greece Oncology Unit GPP, Sotiria General Hospital, Athens, Greece
| | - Christina Darviri
- Postgraduate Course Science of Stress and Health Promotion, School of Medicine, University of Athens, Athens, Greece
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1055
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Milam J, Morris S, Jain S, Sun X, Dubé MP, Daar ES, Jimenez G, Haubrich R. Randomized Controlled Trial of an Internet Application to Reduce HIV Transmission Behavior Among HIV Infected Men Who have Sex with Men. AIDS Behav 2016; 20:1173-1181. [PMID: 26487300 PMCID: PMC4838553 DOI: 10.1007/s10461-015-1215-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We conducted a prospective, randomized controlled trial of an internet-based safer-sex intervention to reduce HIV transmission risk behaviors. HIV-infected men who have sex with men (n = 179) were randomized to receive a monthly internet survey alone or a monthly survey plus tailored risk reduction messages over 12 months. The primary outcome was the cumulative sexually transmitted infection (STI) incidence over 12 months. Secondary outcomes included self-reported unprotected sex with an at risk partner and disclosure of HIV status to partners. In a modified intent to treat analysis, there was no difference in 12-month STI incidence between the intervention and control arms (30 vs. 25 %, respectively; p = 0.5). Unprotected sex decreased and disclosure increased over time in both study arms. These improvements suggest that addition of the risk-reduction messages provided little benefit beyond the self-monitoring of risky behavior via regular self-report risk behavior assessments (as was done in both study arms).
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Affiliation(s)
- Joel Milam
- Keck School of Medicine, University of Southern California, 2001 Soto Building, MC9239, Los Angeles, CA 90032, USA
| | | | - Sonia Jain
- University of California, San Diego, CA, USA
| | | | - Michael P. Dubé
- Keck School of Medicine, University of Southern California, 2001 Soto Building, MC9239, Los Angeles, CA 90032, USA
| | - Eric S. Daar
- Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Long Beach, CA, USA
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1056
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Nam S, Toneatto T. The Influence of Attrition in Evaluating the Efficacy and Effectiveness of Mindfulness-Based Interventions. Int J Ment Health Addict 2016. [DOI: 10.1007/s11469-016-9667-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
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1057
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Guertin KA, Grant RK, Arnold KB, Burwell L, Hartline J, Goodman PJ, Minasian LM, Lippman SM, Klein E, Cassano PA. Effect of long-term vitamin E and selenium supplementation on urine F2-isoprostanes, a biomarker of oxidative stress. Free Radic Biol Med 2016; 95:349-56. [PMID: 27012420 PMCID: PMC4867301 DOI: 10.1016/j.freeradbiomed.2016.03.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Revised: 02/26/2016] [Accepted: 03/11/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND Cigarette smoking generates reactive oxidant species and contributes to systemic oxidative stress, which plays a role in the pathophysiology of chronic diseases. Nutrients with antioxidant properties, including vitamin E and selenium, are proposed to reduce systemic oxidative burden and thus to mitigate the negative health effects of reactive oxidant species. OBJECTIVE Our objective was to determine whether long-term supplementation with vitamin E and/or selenium reduces oxidative stress in smokers, as measured by urine 8-iso-prostaglandin F2-alpha (8-iso-PGF2α). DESIGN We measured urine 8-iso-PGF2α with competitive enzyme linked immunoassay (ELISA) in 312 male current smokers after 36 months of intervention in a randomized placebo-controlled trial of vitamin E (400IU/d all rac-α-tocopheryl acetate) and/or selenium (200µg/d L-selenomethionine). We used linear regression to estimate the effect of intervention on urine 8-iso-PGF2α, with adjustments for age and race. RESULTS Compared to placebo, vitamin E alone lowered urine 8-iso-PGF2α by 21% (p=0.02); there was no effect of combined vitamin E and selenium (intervention arm lower by 9%; p=0.37) or selenium alone (intervention arm higher by 8%; p=0.52). CONCLUSIONS Long-term vitamin E supplementation decreases urine 8-iso-PGF2α among male cigarette smokers, but we observed little to no evidence for an effect of selenium supplementation, alone or combined with vitamin E.
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Affiliation(s)
- Kristin A Guertin
- Division of Nutritional Sciences, Cornell University, 209 Savage Hall, Ithaca, NY 14853, USA
| | - Rachael K Grant
- Division of Nutritional Sciences, Cornell University, 209 Savage Hall, Ithaca, NY 14853, USA
| | | | - Lindsay Burwell
- Division of Nutritional Sciences, Cornell University, 209 Savage Hall, Ithaca, NY 14853, USA
| | | | | | - Lori M Minasian
- Division of Cancer Prevention, National Cancer Institute, Bethesda, MD, USA
| | - Scott M Lippman
- University of California San Diego Cancer Center, San Diego, CA, USA
| | | | - Patricia A Cassano
- Division of Nutritional Sciences, Cornell University, 209 Savage Hall, Ithaca, NY 14853, USA; Department of Healthcare Policy and Research, Division of Biostatistics and Epidemiology, Weill Cornell Medical College, New York, NY, USA.
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1058
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Liu W, Ding J. A novel complete-case analysis to determine statistical significance between treatments in an intention-to-treat population of randomized clinical trials involving missing data. Stat Methods Med Res 2016; 27:1067-1075. [PMID: 27230128 DOI: 10.1177/0962280216651307] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The application of the principle of the intention-to-treat (ITT) to the analysis of clinical trials is challenged in the presence of missing outcome data. The consequences of stopping an assigned treatment in a withdrawn subject are unknown. It is difficult to make a single assumption about missing mechanisms for all clinical trials because there are complicated reactions in the human body to drugs due to the presence of complex biological networks, leading to data missing randomly or non-randomly. Currently there is no statistical method that can tell whether a difference between two treatments in the ITT population of a randomized clinical trial with missing data is significant at a pre-specified level. Making no assumptions about the missing mechanisms, we propose a generalized complete-case (GCC) analysis based on the data of completers. An evaluation of the impact of missing data on the ITT analysis reveals that a statistically significant GCC result implies a significant treatment effect in the ITT population at a pre-specified significance level unless, relative to the comparator, the test drug is poisonous to the non-completers as documented in their medical records. Applications of the GCC analysis are illustrated using literature data, and its properties and limits are discussed.
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Affiliation(s)
| | - Jinhui Ding
- 2 Bioinformatics Core, Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, MD, USA
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1059
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Ha AY, Shalvoy RM, Voisinet A, Racine J, Aaron RK. Controversial role of arthroscopic meniscectomy of the knee: A review. World J Orthop 2016; 7:287-92. [PMID: 27190756 PMCID: PMC4865718 DOI: 10.5312/wjo.v7.i5.287] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 01/13/2016] [Accepted: 01/27/2016] [Indexed: 02/06/2023] Open
Abstract
The role of arthroscopic partial meniscectomy (APM) in reducing pain and improving function in patients with meniscal tears remains controversial. Five recent high-quality randomized controlled trials (RCTs) compared non-operative management of meniscal tears to APM, with four showing no difference and one demonstrating superiority of APM. In this review, we examined the strengths and weaknesses of each of these RCTs, with particular attention to the occurrence of inadvertent biases. We also completed a quantitative analysis that compares treatment successes in each treatment arm, considering crossovers as treatment failures. Our analysis revealed that each study was an excellent attempt to compare APM with non-surgical treatment but suffered from selection, performance, detection, and/or transfer biases that reduce confidence in its conclusions. While the RCT remains the methodological gold standard for establishing treatment efficacy, the use of an RCT design does not in itself ensure internal or external validity. Furthermore, under our alternative analysis of treatment successes, two studies had significantly more treatment successes in the APM arm than the non-operative arm although original intention-to-treat analyses showed no difference between these two groups. Crossovers remain an important problem in surgical trials with no perfect analytical solution. With the studies available at present, no conclusion can be drawn concerning the optimal treatment modality for meniscal tears. Further work that minimizes significant biases and crossovers and incorporates sub-group and cost-benefit analyses may clarify therapeutic indications.
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1060
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Ruggenenti P, Gentile G, Perico N, Perna A, Barcella L, Trillini M, Cortinovis M, Ferrer Siles CP, Reyes Loaeza JA, Aparicio MC, Fasolini G, Gaspari F, Martinetti D, Carrara F, Rubis N, Prandini S, Caroli A, Sharma K, Antiga L, Remuzzi A, Remuzzi G. Effect of Sirolimus on Disease Progression in Patients with Autosomal Dominant Polycystic Kidney Disease and CKD Stages 3b-4. Clin J Am Soc Nephrol 2016; 11:785-794. [PMID: 26912555 PMCID: PMC4858487 DOI: 10.2215/cjn.09900915] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 01/26/2016] [Indexed: 01/13/2023]
Abstract
BACKGROUND AND OBJECTIVES The effect of mammalian target of rapamycin (mTOR) inhibitors has never been tested in patients with autosomal dominant polycystic kidney disease (ADPKD) and severe renal insufficiency. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS In this academic, prospective, randomized, open label, blinded end point, parallel group trial (ClinicalTrials.gov no. NCT01223755), 41 adults with ADPKD, CKD stage 3b or 4, and proteinuria ≤0.5 g/24 h were randomized between September of 2010 and March of 2012 to sirolimus (3 mg/d; serum target levels of 5-10 ng/ml) added on to conventional therapy (n=21) or conventional treatment alone (n=20). Primary outcome was GFR (iohexol plasma clearance) change at 1 and 3 years versus baseline. RESULTS At the 1-year preplanned interim analysis, GFR fell from 26.7±5.8 to 21.3±6.3 ml/min per 1.73 m(2) (P<0.001) and from 29.6±5.6 to 24.9±6.2 ml/min per 1.73 m(2) (P<0.001) in the sirolimus and conventional treatment groups, respectively. Albuminuria (73.8±81.8 versus 154.9±152.9 μg/min; P=0.02) and proteinuria (0.3±0.2 versus 06±0.4 g/24 h; P<0.01) increased with sirolimus. Seven patients on sirolimus versus one control had de novo proteinuria (P=0.04), ten versus three patients doubled proteinuria (P=0.02), 18 versus 11 patients had peripheral edema (P=0.04), and 14 versus six patients had upper respiratory tract infections (P=0.03). Three patients on sirolimus had angioedema, 14 patients had aphthous stomatitis, and seven patients had acne (P<0.01 for both versus controls). Two patients progressed to ESRD, and two patients withdrew because of worsening of proteinuria. These events were not observed in controls. Thus, the independent data and safety monitoring board recommend early trial termination for safety reasons. At 1 year, total kidney volume (assessed by contrast-enhanced computed tomography imaging) increased by 9.0% from 2857.7±1447.3 to 3094.6±1519.5 ml on sirolimus and 4.3% from 3123.4±1695.3 to 3222.6±1651.4 ml on conventional therapy (P=0.12). On follow-up, 37% and 7% of serum sirolimus levels fell below or exceeded the therapeutic range, respectively. CONCLUSIONS Finding that sirolimus was unsafe and ineffective in patients with ADPKD and renal insufficiency suggests that mTOR inhibitor therapy may be contraindicated in this context.
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Affiliation(s)
- Piero Ruggenenti
- Clinical Research Center for Rare Diseases “Aldo e Cele Daccò,” IRCCS—Istituto di Ricerche Farmacologiche “Mario Negri,” Bergamo, Italy
- Units of Nephrology and Dialysis
| | - Giorgio Gentile
- Clinical Research Center for Rare Diseases “Aldo e Cele Daccò,” IRCCS—Istituto di Ricerche Farmacologiche “Mario Negri,” Bergamo, Italy
- Units of Nephrology and Dialysis
| | - Norberto Perico
- Clinical Research Center for Rare Diseases “Aldo e Cele Daccò,” IRCCS—Istituto di Ricerche Farmacologiche “Mario Negri,” Bergamo, Italy
| | - Annalisa Perna
- Clinical Research Center for Rare Diseases “Aldo e Cele Daccò,” IRCCS—Istituto di Ricerche Farmacologiche “Mario Negri,” Bergamo, Italy
| | | | - Matias Trillini
- Clinical Research Center for Rare Diseases “Aldo e Cele Daccò,” IRCCS—Istituto di Ricerche Farmacologiche “Mario Negri,” Bergamo, Italy
| | - Monica Cortinovis
- Clinical Research Center for Rare Diseases “Aldo e Cele Daccò,” IRCCS—Istituto di Ricerche Farmacologiche “Mario Negri,” Bergamo, Italy
| | - Claudia Patricia Ferrer Siles
- Clinical Research Center for Rare Diseases “Aldo e Cele Daccò,” IRCCS—Istituto di Ricerche Farmacologiche “Mario Negri,” Bergamo, Italy
| | - Jorge Arturo Reyes Loaeza
- Clinical Research Center for Rare Diseases “Aldo e Cele Daccò,” IRCCS—Istituto di Ricerche Farmacologiche “Mario Negri,” Bergamo, Italy
| | - Maria Carolina Aparicio
- Clinical Research Center for Rare Diseases “Aldo e Cele Daccò,” IRCCS—Istituto di Ricerche Farmacologiche “Mario Negri,” Bergamo, Italy
| | - Giorgio Fasolini
- Radiology, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy; and
| | - Flavio Gaspari
- Clinical Research Center for Rare Diseases “Aldo e Cele Daccò,” IRCCS—Istituto di Ricerche Farmacologiche “Mario Negri,” Bergamo, Italy
| | - Davide Martinetti
- Clinical Research Center for Rare Diseases “Aldo e Cele Daccò,” IRCCS—Istituto di Ricerche Farmacologiche “Mario Negri,” Bergamo, Italy
| | - Fabiola Carrara
- Clinical Research Center for Rare Diseases “Aldo e Cele Daccò,” IRCCS—Istituto di Ricerche Farmacologiche “Mario Negri,” Bergamo, Italy
| | - Nadia Rubis
- Clinical Research Center for Rare Diseases “Aldo e Cele Daccò,” IRCCS—Istituto di Ricerche Farmacologiche “Mario Negri,” Bergamo, Italy
| | - Silvia Prandini
- Clinical Research Center for Rare Diseases “Aldo e Cele Daccò,” IRCCS—Istituto di Ricerche Farmacologiche “Mario Negri,” Bergamo, Italy
| | - Anna Caroli
- Clinical Research Center for Rare Diseases “Aldo e Cele Daccò,” IRCCS—Istituto di Ricerche Farmacologiche “Mario Negri,” Bergamo, Italy
| | - Kanishka Sharma
- Clinical Research Center for Rare Diseases “Aldo e Cele Daccò,” IRCCS—Istituto di Ricerche Farmacologiche “Mario Negri,” Bergamo, Italy
| | - Luca Antiga
- Clinical Research Center for Rare Diseases “Aldo e Cele Daccò,” IRCCS—Istituto di Ricerche Farmacologiche “Mario Negri,” Bergamo, Italy
| | - Andrea Remuzzi
- Clinical Research Center for Rare Diseases “Aldo e Cele Daccò,” IRCCS—Istituto di Ricerche Farmacologiche “Mario Negri,” Bergamo, Italy
| | - Giuseppe Remuzzi
- Clinical Research Center for Rare Diseases “Aldo e Cele Daccò,” IRCCS—Istituto di Ricerche Farmacologiche “Mario Negri,” Bergamo, Italy
- Units of Nephrology and Dialysis
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
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1061
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Hu T, Decker SL, Chou SY. Medicaid Pay for Performance Programs and Childhood Immunization Status. Am J Prev Med 2016; 50:S51-S57. [PMID: 27102859 PMCID: PMC7375194 DOI: 10.1016/j.amepre.2016.01.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 01/07/2016] [Accepted: 01/21/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Although pay for performance (P4P) programs are being increasingly used by state Medicaid programs to provide incentives for managed care plans to provide high-quality care, no national study has examined the effects of these plans on commonly targeted outcomes such as childhood immunization rates. METHODS Information from the 1999-2011 National Immunization Survey combined with information on state Medicaid P4P programs from the Centers for Medicare and Medicaid Services was used to study the effect of Medicaid P4P programs on the immunization status of children aged 19-35 months. Difference-in-difference-in-difference models were used to study whether adoption of Medicaid P4P programs was associated with higher immunization rates among Medicaid-eligible children relative to non-Medicaid eligible children within states that adopted Medicaid P4P programs compared with states that did not. Linear probability models were used in all estimations, and models controlled for demographic factors. RESULTS The study found no overall effect of Medicaid P4P on the chance that children aged 19-35 months had completed the 4:3:1:3:3:1 vaccination series. However, there was a 4 percentage point increase in the chance that a child 19-23 months had completed the series. CONCLUSIONS This study provides some evidence that Medicaid P4P programs may be helpful in improving childhood vaccination rates. Further study of the effects on other targeted outcomes as well as the effects of different P4P program designs may increase understanding of the potential role of these programs in improving the quality of health care.
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Affiliation(s)
- Tianyan Hu
- Department of Health Policy and Management, Florida International University, Miami, Florida
| | - Sandra L Decker
- Center for Financing, Access and Cost Trends, Agency for Health Research Quality, Rockville, Maryland.
| | - Shin-Yi Chou
- Department of Economics, Lehigh University, Bethlehem, Pennsylvania
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1062
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Helpman L, Papini S, Chhetry BT, Shvil E, Rubin M, Sullivan GM, Markowitz JC, Mann JJ, Neria Y. PTSD REMISSION AFTER PROLONGED EXPOSURE TREATMENT IS ASSOCIATED WITH ANTERIOR CINGULATE CORTEX THINNING AND VOLUME REDUCTION. Depress Anxiety 2016; 33:384-91. [PMID: 26864570 PMCID: PMC4846556 DOI: 10.1002/da.22471] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Revised: 12/30/2015] [Accepted: 01/02/2016] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Brain structures underlying posttraumatic stress disorder (PTSD) have been a focus of imaging studies, but associations between treatment outcome and alterations in brain structures remain largely unexamined. We longitudinally examined the relation of structural changes in the rostral anterior cingulate cortex (rACC), a previously identified key region in the PTSD fear network, to outcome of prolonged exposure (PE) treatment. METHOD The sample included 78 adults (53 women): 41 patients with PTSD and 37 trauma-exposed healthy volunteers (TE-HCs). Patients underwent a 10-week course of PE treatment and completed pre- and posttreatment assessments and magnetic resonance imaging (MRI) structural scans. TE-HCs also underwent assessment and MRI at baseline and 10 weeks later. PE remitters (n = 11), nonremitters (n = 14), and TE-HCs, were compared at baseline on demographic and clinical characteristics and ACC structure. Remitters, nonremitters, and TE-HCs were compared for pre- to posttreatment clinical and structural ACC change, controlling for potential confounding variables. RESULTS There were no baseline differences in structure between PTSD and TE-HCs or remitters and nonremitters. Following treatment, PTSD remitters exhibited cortical thinning and volume decrease in the left rACC compared with PTSD nonremitters and TE-HCs. CONCLUSIONS These results, while in need of replication, suggest that PE treatment for PTSD, by extinguishing maladaptive trauma associations, may promote synaptic plasticity and structure change in rACC. Future research should explore possible underlying mechanisms.
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Affiliation(s)
- Liat Helpman
- Department of Psychiatry, Columbia University Medical Center, New York State Psychiatric Institute, New York, New York
| | - Santiago Papini
- Department of Psychiatry, Columbia University Medical Center, New York State Psychiatric Institute, New York, New York
| | - Binod T Chhetry
- Department of Psychiatry, Columbia University Medical Center, New York State Psychiatric Institute, New York, New York
| | - Erel Shvil
- Department of Psychiatry, Columbia University Medical Center, New York State Psychiatric Institute, New York, New York
| | - Mikael Rubin
- Department of Psychiatry, Columbia University Medical Center, New York State Psychiatric Institute, New York, New York
| | - Gregory M Sullivan
- Department of Psychiatry, Columbia University Medical Center, New York State Psychiatric Institute, New York, New York
| | - John C Markowitz
- Department of Psychiatry, Columbia University Medical Center, New York State Psychiatric Institute, New York, New York
| | - J John Mann
- Department of Psychiatry, Columbia University Medical Center, New York State Psychiatric Institute, New York, New York
| | - Yuval Neria
- Department of Psychiatry, Columbia University Medical Center, New York State Psychiatric Institute, New York, New York
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1063
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Theodoros DG, Hill AJ, Russell TG. Clinical and Quality of Life Outcomes of Speech Treatment for Parkinson's Disease Delivered to the Home Via Telerehabilitation: A Noninferiority Randomized Controlled Trial. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2016; 25:214-232. [PMID: 27145396 DOI: 10.1044/2015_ajslp-15-0005] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 11/30/2015] [Indexed: 06/05/2023]
Abstract
PURPOSE This study investigated the noninferiority and validity of an intensive speech treatment for people with Parkinson's disease (PD) delivered via telerehabilitation to the home. The effect of location on online delivery was also investigated. METHOD In this single-blinded, randomized controlled noninferiority trial, 31 participants with dysarthria associated with PD from a metropolitan area were randomly assigned to either face-to-face or online Lee Silverman Voice Treatment (LSVT LOUD). A cohort of 21 participants from nonmetropolitan areas was also recruited and treated online. Outcomes were assessed using acoustic, perceptual, and quality of life measures. RESULTS Noninferiority of online treatment was confirmed through comparable clinical and quality of life outcomes for the metropolitan online and face-to-face treatment groups. Significant improvements posttreatment were achieved for several acoustic, perceptual, and quality of life measures across the groups. No significant effect of online treatment location was identified. CONCLUSIONS Clinical and quality of life outcomes supported the noninferiority and validity of online delivery of intensive speech treatment to people with PD in the home. Future research should address the implementation of online treatment in a clinical service, cost analyses, and potentially technology-enabled clinical pathways for people with PD in order to maintain optimal communication and quality of life.
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1064
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Maheu C, Lebel S, Courbasson C, Lefebvre M, Singh M, Bernstein LJ, Muraca L, Benea A, Jolicoeur L, Harris C, Ramanakumar AV, Ferguson S, Sidani S. Protocol of a randomized controlled trial of the fear of recurrence therapy (FORT) intervention for women with breast or gynecological cancer. BMC Cancer 2016; 16:291. [PMID: 27112319 PMCID: PMC4845394 DOI: 10.1186/s12885-016-2326-x] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 04/20/2016] [Indexed: 01/31/2023] Open
Abstract
Background Clinically significant levels of fear of cancer recurrence (FCR) affect up to 49 % of cancer survivors and are more prevalent among women. FCR is associated with psychological distress, lower quality of life, and increased use of medical resources. Despite its prevalence, FCR is poorly addressed in clinical care. To address this problem, we first developed, and pilot tested a 6-week, 2 h, Cognitive-existential group intervention therapy that targeted FCR in survivors of breast or gynecological cancer. Following the positive outcome of the pilot, we are now testing this approach in a randomized clinical trial (RCT). Goal and hypotheses: This multicenter, prospective RCT aims to test the efficacy of the intervention. The study hypotheses are that, compared to a control group, cancer survivors participating in the intervention (1) will have less FCR, (2) will show more favorable outcomes on the following measures: cancer-specific distress, quality of life, illness uncertainty, intolerance of uncertainty, perceived risk of cancer recurrence, and coping skills. We further postulate that the between-group differences will persist three and 6 months post-intervention. Methods Sixteen groups of seven to nine women are being allocated to the intervention or the control group. The control group receives a 6-week, 2 h, structurally equivalent support group. We are recruiting 144 cancer survivors from four hospital sites in three Canadian cities. The sample size was based on the moderate pre/post-test changes found in our pilot study and adjusted to the drop-out rates. Measurements: The primary outcome, FCR, is measured by the Fear of Cancer Recurrence Inventory. Secondary outcomes measured include cancer-specific distress, perceived risk of cancer recurrence, illness uncertainty, intolerance of uncertainty, coping, and quality of life. We use reliable and recognized valid scales. Participants are to complete the questionnaire package at four times: before the first group session (baseline), immediately after the sixth session, and 3 and 6 months post-intervention. Analysis: In the descriptive analysis, comparison of group equivalent baseline variables, identification of confounding/intermediate variables and univariate analysis are planned. Each participant’s trajectory is calculated using Generalized Estimating Equation models to determine the time and group effects, after considering the correlation structures of the groups. An intent-to-treat analysis approach may be adopted. Discussion Our Fear of Recurrence Therapy (FORT) intervention has direct implications for clinical service development to improve the quality of life for patients with breast (BC) and gynecological cancer (GC). Based on our pilot data, we are confident that the FORT intervention can guide the development of effective psychosocial cancer survivorship interventions to reduce FCR and improve psychological functioning among women with BC or GC. Trial registration Dr. Christine Maheu registered the trial with ISRCTN registry (Registration number: ISRCTN83539618, date assigned 03/09/2014).
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Affiliation(s)
- Christine Maheu
- Ingram School of Nursing, McGill University, Montreal, Quebec, J7V 0E2, Canada. .,Cancer Survivorship Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, M5G 2C4, Canada.
| | - Sophie Lebel
- School of Psychology, University of Ottawa, Ottawa, Ontario, K1N 6N5, Canada
| | - Christine Courbasson
- Centre for Addition and Mental Health, CB, DB Therapy & H Therapy Centre, Toronto, Ontario, M4T 1Z2, Canada
| | - Monique Lefebvre
- Department of Psychology and Psychosocial Oncology Program, The Ottawa Hospital Cancer Centre, Ottawa, Ontario, K1H 8L6, Canada
| | - Mina Singh
- School of Nursing, York University, Toronto, Ontario, M3J 1P3, Canada
| | - Lori J Bernstein
- Cancer Survivorship Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, M5G 2C4, Canada
| | - Linda Muraca
- Auxiliary Breast Health Program, Joseph and Wolf Lebovic Health Complex, Mount Sinai Hospital, Toronto, Ontario, M5G 1X5, Canada
| | - Aronela Benea
- After Cancer Treatment Transition Clinic, Women's College Hospital, Toronto, Ontario, M5S 1B2, Canada
| | - Lynne Jolicoeur
- Integrated Cancer Program, The Ottawa Hospital, Ottawa, Ontario, K1H 8L6, Canada
| | - Cheryl Harris
- Centre for Addition and Mental Health, CB, DB Therapy & H Therapy Centre, Toronto, Ontario, M4T 1Z2, Canada
| | | | - Sarah Ferguson
- Obstetrics and Gynecology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, M5G 2M9, Canada
| | - Souraya Sidani
- Daphne Cockwell School of Nursing, Ryerson University, Toronto, Ontario, M5B 2K3, Canada
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1065
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Bennich G, Rudnicki M, Wilken-Jensen C, Lousen T, Lassen PD, Wøjdemann K. Impact of adding a second layer to a single unlocked closure of a Cesarean uterine incision: randomized controlled trial. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2016; 47:417-422. [PMID: 26489989 DOI: 10.1002/uog.15792] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 10/06/2015] [Accepted: 10/11/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To investigate short- and long-term effects on residual myometrial thickness (RMT) of adding a second layer to a single unlocked closure of a Cesarean uterine incision. METHODS This was a randomized double-blind controlled trial. Healthy nulliparous women scheduled for first-time elective Cesarean delivery were operated on using a modified version of the Misgav Ladach surgical technique. The women were examined by transabdominal ultrasound before discharge from the maternity ward and by transvaginal saline contrast sonohysterography at a minimum of 5 months postpartum. RESULTS Seventy-six nulliparae met the criteria and agreed to participate in the study. Thirty-five women were assigned to the single-layer technique and 38 to the double-layer unlocked closure technique. Groups were comparable regarding gestational age at delivery, duration of surgery and perioperative blood loss. There was no difference in RMT between the two groups, both at time of discharge (mean ± SD, 20.2 ± 8.0 mm vs 21.0 ± 9.7 mm) and after 5 months postpartum (mean, 5.7 ± 2.9 mm vs 5.7 ± 2.2 mm). RMT was approximately half that of the normal myometrium at both examinations. CONCLUSION The results of this study suggest that double-layer closure of a Cesarean uterine incision does not increase RMT compared with single-layer closure when an unlocked technique is used.
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Affiliation(s)
- G Bennich
- Department of Obstetrics and Gynecology, Roskilde University Hospital, Roskilde, Denmark
| | - M Rudnicki
- Department of Obstetrics and Gynecology, Odense University Hospital, Odense, Denmark
| | - C Wilken-Jensen
- Department of Obstetrics and Gynecology, Hvidovre University Hospital, Hvidovre, Denmark
| | - T Lousen
- Department of Obstetrics and Gynecology, Roskilde University Hospital, Roskilde, Denmark
| | - P D Lassen
- Department of Obstetrics and Gynecology, Roskilde University Hospital, Roskilde, Denmark
| | - K Wøjdemann
- Department of Surgery, Bornholms Hospital, Roenne, Denmark
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1066
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Wurz A, Brunet J. A Systematic Review Protocol to Assess the Effects of Physical Activity on Health and Quality of Life Outcomes in Adolescent Cancer Survivors. JMIR Res Protoc 2016; 5:e54. [PMID: 27030210 PMCID: PMC4830903 DOI: 10.2196/resprot.5383] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Revised: 12/21/2015] [Accepted: 01/07/2016] [Indexed: 01/03/2023] Open
Abstract
Background The benefits of physical activity for child and adult cancer survivors have been summarized in previous systematic reviews. However, no review has summarized the evidence for adolescent cancer survivors. Objective This paper describes the design of a protocol to conduct a systematic review of published studies examining the effects of physical activity on health and quality of life outcomes for adolescent cancer survivors.
Methods Several guidelines informed the development of this protocol. The Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols guidelines provided the structure by which to conduct and report the protocol; though some adaptations were made with regards to search terms, data synthesis, and evaluating the risk of bias. The Cochrane Handbook for Systematic Reviews of Interventions was used to guide research question development, search term selection, and the data extraction form. The Consolidated Standards of Reporting Trials guidelines helped inform the data extraction form. Lastly, the Guidance on the Conduct of Narrative Synthesis in Systematic Reviews informed the data synthesis. Ten electronic databases were identified and a search strategy was developed using a combination of Medical Subject Headings terms and keywords that were developed by the authors and peer reviewed by a university librarian. Both authors independently screened eligible studies for final inclusion, and data were abstracted using a form developed by the research team. A decision was made to synthesize all data narratively. Results The review has now been completed, peer-reviewed, and accepted for publication in a forthcoming issue of JMIR Cancer.
Conclusions As this will be the first systematic review on this topic, outlining the protocol ensures transparency for the completed review. Further, this protocol illustrates how elements from several guidelines were incorporated to answer the research question (ie, what is the effect of physical activity on health and quality of life outcomes in adolescent cancer survivors). This flexible approach was necessary as a function of the paucity of available research on this topic.
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Affiliation(s)
- Amanda Wurz
- University of Ottawa, Faculty of Health Sciences, School of Human Kinetics, Ottawa, ON, Canada
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1067
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Bonander C, Gustavsson J, Nilson F. Can the provision of a home help service for the elderly population reduce the incidence of fall-related injuries? A quasi-experimental study of the community-level effects on hospital admissions in Swedish municipalities. Inj Prev 2016; 22:412-419. [PMID: 27016460 DOI: 10.1136/injuryprev-2015-041848] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Revised: 01/25/2016] [Accepted: 03/02/2016] [Indexed: 11/03/2022]
Abstract
BACKGROUND Fall-related injuries are a global public health problem, especially in elderly populations. The effect of an intervention aimed at reducing the risk of falls in the homes of community-dwelling elderly persons was evaluated. The intervention mainly involves the performance of complicated tasks and hazards assessment by a trained assessor, and has been adopted gradually over the last decade by 191 of 290 Swedish municipalities. METHODS A quasi-experimental design was used where intention-to-treat effect estimates were derived using panel regression analysis and a regression discontinuity (RD) design. The outcome measure was the incidence of fall-related hospitalisations in the treatment population, the age of which varied by municipality (≥65 years, ≥67 years, ≥70 years or ≥75 years). RESULTS We found no statistically significant reductions in injury incidence in the panel regression (IRR 1.01 (95% CI 0.98 to 1.05)) or RD (IRR 1.00 (95% CI 0.97 to 1.03)) analyses. The results are robust to several different model specifications, including segmented panel regression analysis with linear trend change and community fixed effects parameters. CONCLUSIONS It is unclear whether the absence of an effect is due to a low efficacy of the services provided, or a result of low adherence. Additional studies of the effects on other quality-of-life measures are recommended before conclusions are drawn regarding the cost-effectiveness of the provision of home help service programmes.
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Affiliation(s)
- Carl Bonander
- Division of Risk Management, Department of Environmental and Life Sciences, Karlstad University, Sweden.,Centre for Public Safety, Karlstad University, Karlstad, Sweden
| | - Johanna Gustavsson
- Division of Risk Management, Department of Environmental and Life Sciences, Karlstad University, Sweden.,Centre for Public Safety, Karlstad University, Karlstad, Sweden
| | - Finn Nilson
- Division of Risk Management, Department of Environmental and Life Sciences, Karlstad University, Sweden.,Centre for Public Safety, Karlstad University, Karlstad, Sweden
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1068
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Kuss DJ, Lopez-Fernandez O. Internet addiction and problematic Internet use: A systematic review of clinical research. World J Psychiatry 2016; 6:143-76. [PMID: 27014605 PMCID: PMC4804263 DOI: 10.5498/wjp.v6.i1.143] [Citation(s) in RCA: 254] [Impact Index Per Article: 31.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2015] [Revised: 11/19/2015] [Accepted: 01/05/2016] [Indexed: 02/05/2023] Open
Abstract
AIM To provide a comprehensive overview of clinical studies on the clinical picture of Internet-use related addictions from a holistic perspective. A literature search was conducted using the database Web of Science. METHODS Over the last 15 years, the number of Internet users has increased by 1000%, and at the same time, research on addictive Internet use has proliferated. Internet addiction has not yet been understood very well, and research on its etiology and natural history is still in its infancy. In 2013, the American Psychiatric Association included Internet Gaming Disorder in the appendix of the updated version of the Diagnostic and Statistical Manual for Mental Disorders (DSM-5) as condition that requires further research prior to official inclusion in the main manual, with important repercussions for research and treatment. To date, reviews have focused on clinical and treatment studies of Internet addiction and Internet Gaming Disorder. This arguably limits the analysis to a specific diagnosis of a potential disorder that has not yet been officially recognised in the Western world, rather than a comprehensive and inclusive investigation of Internet-use related addictions (including problematic Internet use) more generally. RESULTS The systematic literature review identified a total of 46 relevant studies. The included studies used clinical samples, and focused on characteristics of treatment seekers and online addiction treatment. Four main types of clinical research studies were identified, namely research involving (1) treatment seeker characteristics; (2) psychopharmacotherapy; (3) psychological therapy; and (4) combined treatment. CONCLUSION A consensus regarding diagnostic criteria and measures is needed to improve reliability across studies and to develop effective and efficient treatment approaches for treatment seekers.
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1069
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Murray EJ, Hernán MA. Adherence adjustment in the Coronary Drug Project: A call for better per-protocol effect estimates in randomized trials. Clin Trials 2016; 13:372-8. [PMID: 26951361 DOI: 10.1177/1740774516634335] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND In many randomized controlled trials, patients and doctors are more interested in the per-protocol effect than in the intention-to-treat effect. However, valid estimation of the per-protocol effect generally requires adjustment for prognostic factors associated with adherence. These adherence adjustments have been strongly questioned in the clinical trials community, especially after 1980 when the Coronary Drug Project team found that adherers to placebo had lower 5-year mortality than non-adherers to placebo. METHODS We replicated the original Coronary Drug Project findings from 1980 and re-analyzed the Coronary Drug Project data using technical and conceptual developments that have become established since 1980. Specifically, we used logistic models for binary outcomes, decoupled the definition of adherence from loss to follow-up, and adjusted for pre-randomization covariates via standardization and for post-randomization covariates via inverse probability weighting. RESULTS The original Coronary Drug Project analysis reported a difference in 5-year mortality between adherers and non-adherers in the placebo arm of 9.4 percentage points. Using modern approaches, we found that this difference was reduced to 2.5 (95% confidence interval: -2.1 to 7.0). CONCLUSION Valid estimation of per-protocol effects may be possible in randomized clinical trials when analysts use appropriate methods to adjust for post-randomization variables.
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Affiliation(s)
- Eleanor J Murray
- Departments of Epidemiology and Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Miguel A Hernán
- Departments of Epidemiology and Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA Harvard-MIT Division of Health Sciences and Technology, Boston, MA, USA
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1070
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Nordgreen T, Haug T, Öst LG, Andersson G, Carlbring P, Kvale G, Tangen T, Heiervang E, Havik OE. Stepped Care Versus Direct Face-to-Face Cognitive Behavior Therapy for Social Anxiety Disorder and Panic Disorder: A Randomized Effectiveness Trial. Behav Ther 2016; 47:166-83. [PMID: 26956650 DOI: 10.1016/j.beth.2015.10.004] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Revised: 10/07/2015] [Accepted: 10/08/2015] [Indexed: 11/15/2022]
Abstract
The aim of this study was to assess the effectiveness of a cognitive behavioral therapy (CBT) stepped care model (psychoeducation, guided Internet treatment, and face-to-face CBT) compared with direct face-to-face (FtF) CBT. Patients with panic disorder or social anxiety disorder were randomized to either stepped care (n=85) or direct FtF CBT (n=88). Recovery was defined as meeting two of the following three criteria: loss of diagnosis, below cut-off for self-reported symptoms, and functional improvement. No significant differences in intention-to-treat recovery rates were identified between stepped care (40.0%) and direct FtF CBT (43.2%). The majority of the patients who recovered in the stepped care did so at the less therapist-demanding steps (26/34, 76.5%). Moderate to large within-groups effect sizes were identified at posttreatment and 1-year follow-up. The attrition rates were high: 41.2% in the stepped care condition and 27.3% in the direct FtF CBT condition. These findings indicate that the outcome of a stepped care model for anxiety disorders is comparable to that of direct FtF CBT. The rates of improvement at the two less therapist-demanding steps indicate that stepped care models might be useful for increasing patients' access to evidence-based psychological treatments for anxiety disorders. However, attrition in the stepped care condition was high, and research regarding the factors that can improve adherence should be prioritized.
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Affiliation(s)
- Tine Nordgreen
- Anxiety Disorders Research Network, Haukeland University Hospital; University of Bergen.
| | - Thomas Haug
- Anxiety Disorders Research Network, Haukeland University Hospital
| | - Lars-Göran Öst
- Anxiety Disorders Research Network, Haukeland University Hospital; University of Bergen; Stockholm University; Karolinska Institutet
| | | | | | - Gerd Kvale
- Anxiety Disorders Research Network, Haukeland University Hospital; University of Bergen
| | - Tone Tangen
- Anxiety Disorders Research Network, Haukeland University Hospital; University of Bergen
| | - Einar Heiervang
- Anxiety Disorders Research Network, Haukeland University Hospital; Institute of Clinical Medicine, University of Oslo
| | - Odd E Havik
- Anxiety Disorders Research Network, Haukeland University Hospital; University of Bergen
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1071
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Braden BB, Pipe TB, Smith R, Glaspy TK, Deatherage BR, Baxter LC. Brain and behavior changes associated with an abbreviated 4-week mindfulness-based stress reduction course in back pain patients. Brain Behav 2016; 6:e00443. [PMID: 26925304 PMCID: PMC4754498 DOI: 10.1002/brb3.443] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 12/17/2015] [Accepted: 12/19/2015] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Mindfulness-based stress reduction (MBSR) reduces depression, anxiety, and pain for people suffering from a variety of illnesses, and there is a growing need to understand the neurobiological networks implicated in self-reported psychological change as a result of training. Combining complementary and alternative treatments such as MBSR with other therapies is helpful; however, the time commitment of the traditional 8-week course may impede accessibility. This pilot study aimed to (1) determine if an abbreviated MBSR course improves symptoms in chronic back pain patients and (2) examine the neural and behavioral correlates of MBSR treatment. METHODS Participants were assigned to 4 weeks of weekly MBSR training (n = 12) or a control group (stress reduction reading; n = 11). Self-report ratings and task-based functional MRI were obtained prior to, and after, MBSR training, or at a yoked time point in the control group. RESULTS While both groups showed significant improvement in total depression symptoms, only the MBSR group significantly improved in back pain and somatic-affective depression symptoms. The MBSR group also uniquely showed significant increases in regional frontal lobe hemodynamic activity associated with gaining awareness to changes in one's emotional state. CONCLUSIONS An abbreviated MBSR course may be an effective complementary intervention that specifically improves back pain symptoms and frontal lobe regulation of emotional awareness, while the traditional 8-week course may be necessary to detect unique improvements in total anxiety and cognitive aspects of depression.
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Affiliation(s)
- B Blair Braden
- Department of Neuroimaging Barrow Neurological Institute St. Joseph's Hospital and Medical Center Phoenix Arizona
| | - Teri B Pipe
- College of Nursing and Health Innovation Arizona State University Phoenix Arizona
| | - Ryan Smith
- Department of Neuroimaging Barrow Neurological Institute St. Joseph's Hospital and Medical Center Phoenix Arizona; Departments of Psychiatry and Psychology University of Arizona Tucson Arizona
| | - Tyler K Glaspy
- Department of Neuroimaging Barrow Neurological Institute St. Joseph's Hospital and Medical Center Phoenix Arizona
| | - Brandon R Deatherage
- Department of Neuroimaging Barrow Neurological Institute St. Joseph's Hospital and Medical Center Phoenix Arizona
| | - Leslie C Baxter
- Department of Neuroimaging Barrow Neurological Institute St. Joseph's Hospital and Medical Center Phoenix Arizona
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1072
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Diaz J, Sternberg CN, Mehmud F, Delea TE, Latimer N, Pandite L, Motzer RJ. Overall Survival Endpoint in Oncology Clinical Trials: Addressing the Effect of Crossover--The Case of Pazopanib in Advanced Renal Cell Carcinoma. Oncology 2016; 90:119-26. [PMID: 26901053 DOI: 10.1159/000443647] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 12/23/2015] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To identify the issues of using overall survival (OS) as a primary endpoint in the presence of crossover and the statistical analyses available to adjust for confounded OS due to crossover in oncology clinical trials. METHODS An indirect comparison was conducted between pazopanib and sunitinib in advanced renal cell carcinoma. Statistical adjustment methods were used to estimate the true comparative effectiveness of these treatments. Recently, a head-to-head trial comparing pazopanib and sunitinib was completed. This provided the opportunity to compare the OS treatment effect estimated for pazopanib versus sunitinib using indirect comparison and statistical adjustment techniques with that observed in the head-to-head trial. RESULTS Using a rank-preserving structural failure time model to adjust for crossover in the pazopanib registration trial, the indirect comparison of pazopanib versus sunitinib resulted in an OS hazard ratio (HR) of 0.97, while an unadjusted analysis resulted in an OS HR of 1.96. The head-to-head trial reported a final OS HR of 0.92 for pazopanib versus sunitinib. CONCLUSION This case study supports the need to adjust for confounded OS due to crossover, which enables trials to meet ethical standards and provides decision makers with a more accurate estimate of treatment benefit.
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Affiliation(s)
- Jose Diaz
- GlaxoSmithKline, Stockley Park West, Uxbridge, UK
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1073
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Forster DA, McLachlan HL, Davey MA, Biro MA, Farrell T, Gold L, Flood M, Shafiei T, Waldenström U. Continuity of care by a primary midwife (caseload midwifery) increases women's satisfaction with antenatal, intrapartum and postpartum care: results from the COSMOS randomised controlled trial. BMC Pregnancy Childbirth 2016; 16:28. [PMID: 26841782 PMCID: PMC4739100 DOI: 10.1186/s12884-016-0798-y] [Citation(s) in RCA: 129] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 01/05/2016] [Indexed: 12/15/2022] Open
Abstract
Background Continuity of care by a primary midwife during the antenatal, intrapartum and postpartum periods has been recommended in Australia and many hospitals have introduced a caseload midwifery model of care. The aim of this paper is to evaluate the effect of caseload midwifery on women’s satisfaction with care across the maternity continuum. Methods Pregnant women at low risk of complications, booking for care at a tertiary hospital in Melbourne, Australia, were recruited to a randomised controlled trial between September 2007 and June 2010. Women were randomised to caseload midwifery or standard care. The caseload model included antenatal, intrapartum and postpartum care from a primary midwife with back-up provided by another known midwife when necessary. Women allocated to standard care received midwife-led care with varying levels of continuity, junior obstetric care, or community-based general practitioner care. Data for this paper were collected by background questionnaire prior to randomisation and a follow-up questionnaire sent at two months postpartum. The primary analysis was by intention to treat. A secondary analysis explored the effect of intrapartum continuity of carer on overall satisfaction rating. Results Two thousand, three hundred fourteen women were randomised: 1,156 to caseload care and 1,158 to standard care. The response rate to the two month survey was 88 % in the caseload group and 74 % in the standard care group. Compared with standard care, caseload care was associated with higher overall ratings of satisfaction with antenatal care (OR 3.35; 95 % CI 2.79, 4.03), intrapartum care (OR 2.14; 95 % CI 1.78, 2.57), hospital postpartum care (OR 1.56, 95 % CI 1.32, 1.85) and home-based postpartum care (OR 3.19; 95 % CI 2.64, 3.85). Conclusion For women at low risk of medical complications, caseload midwifery increases women’s satisfaction with antenatal, intrapartum and postpartum care. Trial registration Australian New Zealand Clinical Trials Registry ACTRN012607000073404 (registration complete 23rd January 2007).
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Affiliation(s)
- Della A Forster
- Judith Lumley Centre, La Trobe University, 215 Franklin St., Melbourne, 3000, Australia. .,The Royal Women's Hospital, Locked Bag 300, Cnr Grattan St and Flemington Rd, Parkville, 3052, Australia.
| | - Helen L McLachlan
- Judith Lumley Centre, La Trobe University, 215 Franklin St., Melbourne, 3000, Australia. .,School of Nursing and Midwifery, La Trobe University, Bundoora, 3086, Australia.
| | - Mary-Ann Davey
- Judith Lumley Centre, La Trobe University, 215 Franklin St., Melbourne, 3000, Australia.
| | - Mary Anne Biro
- School of Nursing and Midwifery, Monash University, Clayton, 3800, Australia.
| | - Tanya Farrell
- The Royal Women's Hospital, Locked Bag 300, Cnr Grattan St and Flemington Rd, Parkville, 3052, Australia.
| | - Lisa Gold
- Deakin Health Economics, Deakin University, Burwood, 3125, Australia.
| | - Maggie Flood
- Judith Lumley Centre, La Trobe University, 215 Franklin St., Melbourne, 3000, Australia.
| | - Touran Shafiei
- Judith Lumley Centre, La Trobe University, 215 Franklin St., Melbourne, 3000, Australia.
| | - Ulla Waldenström
- Department of Women's and Children's Health, Division of Reproductive and Perinatal Health, Karolinska Institutet, Stockholm, Sweden.
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1074
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Kogan SM, Lei MK, Brody GH, Futris TG, Sperr M, Anderson T. Implementing Family-Centered Prevention in Rural African American Communities: a Randomized Effectiveness Trial of the Strong African American Families Program. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2016; 17:248-58. [PMID: 26459373 PMCID: PMC5911919 DOI: 10.1007/s11121-015-0614-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Efforts to disseminate evidence-based prevention programs are hampered by a lack of real-world effectiveness trials undertaken with community providers. The Strong African American Families (SAAF) program is an empirically validated intervention designed to prevent problem behavior among rural African American youth. To evaluate the effectiveness of SAAF and its implementation protocols when delivered by a community provider, we conducted a randomized, wait-list-controlled trial with outcome measurements assessed longitudinally at baseline and 6 months after baseline. A total of 465 African American youth and their parents were recruited randomly from public school lists of fifth- and sixth-grade students in eight rural counties in south Georgia. Youth and parents assessed targeted outcomes in their homes. The main outcome, problem behavior vulnerability, was operationalized as a latent construct comprising three indicators: tolerance for deviance, intentions to engage in risky behavior, and affiliations with risk-taking peers. SAAF was implemented with uniformly high levels of adherence (85.5%; SD = 10.8) and attendance (M = 4.1, SD = 2.9, range = 0-7). Intent-to-treat and complier average causal effect analyses revealed significant program effects on intervention-targeted parenting practices, youth self-regulatory processes, and problem behavior vulnerability. SAAF influenced problem behavior vulnerability indirectly via effects on targeted parenting and youth processes. This study supported the effectiveness of SAAF in a community setting when a systematic implementation model supports participant engagement and intervention adherence.
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Affiliation(s)
- Steven M Kogan
- Department of Human Development and Family Science, University of Georgia, 305 Sanford Drive, Athens, GA, 30602, USA.
- Center for Family Research, University of Georgia, Athens, GA, USA.
| | - Man-Kit Lei
- Center for Family Research, University of Georgia, Athens, GA, USA
| | - Gene H Brody
- Center for Family Research, University of Georgia, Athens, GA, USA
| | - Ted G Futris
- Department of Human Development and Family Science, University of Georgia, 305 Sanford Drive, Athens, GA, 30602, USA
| | - Megan Sperr
- Center for Family Research, University of Georgia, Athens, GA, USA
| | - Tracy Anderson
- Center for Family Research, University of Georgia, Athens, GA, USA
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1075
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Lai AY, Mui MW, Wan A, Stewart SM, Yew C, Lam TH, Chan SS. Development and Two-Year Follow-Up Evaluation of a Training Workshop for the Large Preventive Positive Psychology Happy Family Kitchen Project in Hong Kong. PLoS One 2016; 11:e0147712. [PMID: 26808541 PMCID: PMC4726595 DOI: 10.1371/journal.pone.0147712] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 01/07/2016] [Indexed: 11/18/2022] Open
Abstract
Evidence-based practice and capacity-building approaches are essential for large-scale health promotion interventions. However, there are few models in the literature to guide and evaluate training of social service workers in community settings. This paper presents the development and evaluation of the “train-the-trainer” workshop (TTT) for the first large scale, community-based, family intervention projects, entitled “Happy Family Kitchen Project” (HFK) under the FAMILY project, a Hong Kong Jockey Club Initiative for a Harmonious Society. The workshop aimed to enhance social workers’ competence and performance in applying positive psychology constructs in their family interventions under HFK to improve family well-being of the community they served. The two-day TTT was developed and implemented by a multidisciplinary team in partnership with community agencies to 50 social workers (64% women). It focused on the enhancement of knowledge, attitude, and practice of five specific positive psychology themes, which were the basis for the subsequent development of the 23 family interventions for 1419 participants. Acceptability and applicability were enhanced by completing a needs assessment prior to the training. The TTT was evaluated by trainees’ reactions to the training content and design, changes in learners (trainees) and benefits to the service organizations. Focus group interviews to evaluate the workshop at three months after the training, and questionnaire survey at pre-training, immediately after, six months, one year and two years after training were conducted. There were statistically significant increases with large to moderate effect size in perceived knowledge, self-efficacy and practice after training, which sustained to 2-year follow-up. Furthermore, there were statistically significant improvements in family communication and well-being of the participants in the HFK interventions they implemented after training. This paper offers a practical example of development, implementation and model-based evaluation of training programs, which may be helpful to others seeking to develop such programs in diverse communities.
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Affiliation(s)
- Agnes Y. Lai
- School of Public Health, The University of Hong Kong, Hong Kong, SAR, China
| | - Moses W. Mui
- The Hong Kong Council of Social Service, Hong Kong, SAR, China
| | - Alice Wan
- School of Public Health, The University of Hong Kong, Hong Kong, SAR, China
| | - Sunita M. Stewart
- Department of Psychiatry, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, United States of America
| | - Carol Yew
- United Centre of Emotional Health and Positive Living, United Christian Nethersole Community Health Service, Hong Kong, SAR, China
| | - Tai-hing Lam
- School of Public Health, The University of Hong Kong, Hong Kong, SAR, China
- * E-mail:
| | - Sophia S. Chan
- School of Nursing, The University of Hong Kong, Hong Kong, SAR, China
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1076
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Allavena C, Katlama C, Cotte L, Roger PM, Delobel P, Cheret A, Duvivier C, Poizot-Martin I, Hoen B, Cabie A, Cheret A, Lahoulou R, Raffi F, Pugliese P. Long-term efficacy and safety of etravirine-containing regimens in a real-life cohort of treatment-experienced HIV-1-infected patients. Infect Dis (Lond) 2016; 48:392-8. [PMID: 26757613 DOI: 10.3109/23744235.2015.1133927] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Etravirine (ETR) was approved in France in September 2008 and is used in combination with a boosted protease inhibitor (bPI) and other anti-retrovirals (ART) in HIV-infected pre-treated patients. This study aimed to report in a real-life setting the efficacy and tolerability of ETR-based regimens and factors associated with virological response. METHODS The study population included all treatment-experienced patients who initiated an ETR-based regimen between September 2008 and July 2013 from the French Dat'AIDS cohort. Analyses were performed in ART-experienced patients starting ETR after virological failure (VF) or as a maintenance therapy (MT), with or without bPI. RESULTS A total of 2006 patients (VF, n = 1014 (51%); MT, n = 992 (49%)) were included. At M12, the proportion of patients with HIV RNA < 50 copies/ml was 71.7% (72.0% and 71.1% with or without bPI) in the VF group and 90.5% (85.0% and 92.3% with or without bPI) in the MT group, without significant differences regarding the use of bPI. ETR was discontinued in 8.8% of patients for adverse events in 23.9% of cases (21.5% in VF, 29.5% in MT), treatment failure in 15.2% (16.2% in VF, 7.4% in MT) or simplification in 5.4% (4.6% in VF, 7.4% in MT). In the VF group, factors associated with virological response were a longer duration of HIV infection (OR = 2.7; p < 0.001) and baseline HIV RNA < 5 log10 copies/mL (OR = 2.1; p = 0.002). CONCLUSION This study shows that in ART-experienced patients ETR is well tolerated with a high efficacy when combined with other active drugs, even when the regimen does not include a bPI.
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Affiliation(s)
- Clotilde Allavena
- a Infectious Diseases, CHU Hôtel Dieu University Hospital , Nantes , France
| | - Christine Katlama
- b Infectious Diseases, AP-HP Pitié Salpétrière Hospital , Paris , France
| | - Laurent Cotte
- c Infectious Diseases, Hôpital Croix-Rousse, Hospices Civils de Lyon , Lyon , France
| | | | | | | | - Claudine Duvivier
- g Infectious Diseases, AP-HP, Necker-Enfants Malades Hospital, Necker-Pasteur Infectious Diseases Center, Descartes University, Sorbonne Paris Cité , EA7327 , IHU Imagine , Paris , France
| | - Isabelle Poizot-Martin
- h Infectious Diseases, Aix-Marseille University , APHM Sainte-Marguerite, Department of Immuno-hematology , Inserm U912 (SESSTIM) , Marseille , France
| | - Bruno Hoen
- i Infectious Diseases, CHU Besançon , Besancon , France
| | - André Cabie
- j Infectious Diseases, CHU de Martinique , Inserm CIC1424 , France
| | | | | | - François Raffi
- a Infectious Diseases, CHU Hôtel Dieu University Hospital , Nantes , France
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1077
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A Randomized Controlled Trial of the Effectiveness of Traditional and Mobile Public Health Communications With Health Care Providers. Disaster Med Public Health Prep 2015; 10:98-107. [DOI: 10.1017/dmp.2015.139] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
AbstractObjectivesHealth care providers play an essential role in public health emergency preparedness and response. We conducted a 4-year randomized controlled trial to systematically compare the effectiveness of traditional and mobile communication strategies for sending time-sensitive public health messages to providers.MethodsSubjects (N=848) included providers who might be leveraged to assist with emergency preparedness and response activities, such as physicians, pharmacists, nurse practitioners, physician’s assistants, and veterinarians. Providers were randomly assigned to a group that received time-sensitive quarterly messages via e-mail, fax, or cell phone text messaging (SMS) or to a no-message control group. Follow-up phone interviews elicited information about message receipt, topic recall, and perceived credibility and trustworthiness of message and source.ResultsOur main outcome measures were awareness and recall of message content, which was compared across delivery methods. Per-protocol analysis revealed that e-mail messages were recalled at a higher rate than were messaged delivered by fax or SMS, whereas the as-treated analysis found that e-mail and fax groups had similar recall rates and both had higher recall rates than the SMS group.ConclusionsThis is the first study to systematically evaluate the relative effectiveness of public health message delivery systems. Our findings provide guidance to improve public health agency communications with providers before, during, and after a public health emergency. (Disaster Med Public Health Preparedness. 2016;10:98–107)
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1078
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Barrows JL, Fleury J. Systematic Review of Yoga Interventions to Promote Cardiovascular Health in Older Adults. West J Nurs Res 2015; 38:753-81. [PMID: 26689218 DOI: 10.1177/0193945915618610] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The benefits of physical activity are well established, yet few older adults engage in adequate physical activity to optimize health. While yoga may reduce the risk of cardiovascular disease, few studies have focused on the efficacy of yoga-based physical activity to promote cardiovascular health in older adults. The objective of this review is to provide an evaluation of yoga interventions to reduce cardiovascular risk in older adults. Four databases were searched for randomized controlled trials of yoga interventions in older adults. Studies with cardiovascular outcomes were included. Literature searches identified nine articles eligible for review. Significant health benefits were reported, including favorable changes in blood pressure, body composition, glucose, and lipids. Yoga practices, participant characteristics, and outcome measures were variable. There was limited use of theory. Yoga is safe and feasible in older adults; additional research is warranted to examine the specific components of yoga interventions essential to reducing cardiovascular risk.
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1079
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Endres J, Breuer MM, Stemmler M. „Intention to treat“ oder „treatment as received“ – Umgang mit Abbrechern in der Forschung zur Straftäterbehandlung. FORENSISCHE PSYCHIATRIE PSYCHOLOGIE KRIMINOLOGIE 2015. [DOI: 10.1007/s11757-015-0348-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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1080
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Figueira J, Silva R, Henriques J, Caldeira Rosa P, Laíns I, Melo P, Gonçalves Nunes S, Cunha-Vaz J. Ranibizumab for High-Risk Proliferative Diabetic Retinopathy: An Exploratory Randomized Controlled Trial. Ophthalmologica 2015; 235:34-41. [DOI: 10.1159/000442026] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 10/28/2015] [Indexed: 11/19/2022]
Abstract
Purpose: To compare the efficacy and safety of intravitreal ranibizumab (IVR) in monotherapy or associated with panretinal photocoagulation (PRP) versus conventional PRP, for high-risk proliferative diabetic retinopathy (PDR) without vitreoretinal traction. Procedures: Multicenter randomized trial, with 3 treatment arms: PRP versus IVR alone and PRP + IVR combined treatment. Follow-up was performed at months 3, 6 and 12. Results: Thirty-five subjects were randomized and 32 used for analysis. Complete regression of neovessels elsewhere occurred in 100% (PRP + IVR), 75% (IVR) and 69.2% (PRP) and for neovessels of the disk in 44.4% (PRP + IVR), 37.5% (IVR) and 30.8% (PRP). During the 1-year duration of treatment, there was no need for laser rescue treatment in IVR-treated eyes. Conclusions: This trial suggests that the use of IVR is safe and may have a beneficial effect in the treatment of eyes with high-risk PDR. Message: Ranibizumab appears to have a place in the treatment of PDR.
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1081
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Phang CK, Mukhtar F, Ibrahim N, Keng SL, Mohd Sidik S. Effects of a brief mindfulness-based intervention program for stress management among medical students: the Mindful-Gym randomized controlled study. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2015; 20:1115-34. [PMID: 25697124 DOI: 10.1007/s10459-015-9591-3] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Accepted: 02/07/2015] [Indexed: 05/23/2023]
Abstract
Pursuing undergraduate medical training can be very stressful and academically challenging experience. A 5-week mindfulness-based stress management (MBSM/Mindful-Gym) program was developed to help medical students cope with stress. The aim of this study was to evaluate the effectiveness of the intervention in reducing stress among students in a medical school in Malaysia. Seventy-five medical students participated in the program. They were stratified according to years of studies and randomly allocated to intervention (N = 37) and control groups (N = 38). The following outcome variables were measured at pre- and post-intervention: mindfulness (with Mindful Awareness Attention Scale); perceived stress (with Perceived Stress Scale); mental distress (with General Health Questionnaire), and self-efficacy (with General Self-efficacy Scale). Hierarchical multiple regressions were used to analyse the effect of group (intervention vs. control) on changes in the outcome variables. There were significant improvements at one week post-intervention in all outcome variables: mindfulness (β = 0.19, ΔR2 = 0.04, p = .040, f (2) = 0.05), perceived stress (β = -0.26, ΔR2 = 0.07, p = .009, f (2) = 0.10); mental distress (β = -0.28, ΔR2 = 0.10, p = .003, f (2) = 0.15); and self-efficacy (β = 0.30, ΔR2 = 0.09, p < .001, f (2) = 0.21). Six months after the intervention, those who had joined the program reported higher self-efficacy compared to those in the control group (β = 0.24, ΔR2 = 0.06, p = .020, f (2) = 0.08); but there was no difference in other outcome measures. More than 90% of the participants found the program applicable in helping patients and all reported that they would recommend it to others. This study indicates that the program is potentially an effective stress management program for medical students in Malaysia.
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Affiliation(s)
- Cheng Kar Phang
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia (UPM), 43400, Serdang, Selangor, Malaysia.
| | - Firdaus Mukhtar
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia (UPM), 43400, Serdang, Selangor, Malaysia
| | - Normala Ibrahim
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia (UPM), 43400, Serdang, Selangor, Malaysia
| | - Shian-Ling Keng
- Department of Psychology, National University of Singapore, Singapore, Singapore
| | - Sherina Mohd Sidik
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia (UPM), 43400, Serdang, Selangor, Malaysia
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1082
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Rhoades GK. The Effectiveness of the Within Our Reach Relationship Education Program for Couples: Findings from a Federal Randomized Trial. FAMILY PROCESS 2015; 54:672-85. [PMID: 25787758 DOI: 10.1111/famp.12148] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
This study examined the effectiveness of a couple-based relationship education program, Within Our Reach. Secondary data (n = 3,609) were analyzed from the federal Supporting Healthy Marriage project. Couples were randomly assigned to receive Within Our Reach and associated services or to a no-treatment (treatment-as-usual) control group. Those assigned to Within Our Reach reported better couple and individual outcomes on 8 of 12 outcomes measured (M ES = .15) at the 12-month follow-up and 6 of 10 outcomes measured at the 30-month follow-up (M ES = .14), including higher relationship happiness, more warmth and support, more positive communication, less negative behavior and emotion, less psychological abuse, less physical assault (for men), lower psychological distress (for women), and less infidelity. They were also less likely to report that their marriage was in trouble. These effects were generally small in size and many were replicated across the two follow-ups. There were no significant differences between those assigned to Within Our Reach versus control on cooperative parenting, severe psychological assault, or percent married. Implications for future research, programming, and policy are discussed.
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1083
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Jiang H, Xiong X, Buekens P, Su Y, Qian X. Use of mouth rinse during pregnancy to improve birth and neonatal outcomes: a randomized controlled trial. BMC Pregnancy Childbirth 2015; 15:311. [PMID: 26608342 PMCID: PMC4660817 DOI: 10.1186/s12884-015-0761-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 11/23/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Poor oral health, such as periodontal (gum) disease, has been found to be associated with an increased risk of adverse pregnancy outcomes including preterm birth, low birth weight, and neonatal and infant mortality, especially in low-and middle-income countries. However, there is little or no access to preventive dental care in most low-and middle-income countries. We propose to develop and test a "Mouth Rinse Intervention" among pregnant women to prevent the progression of periodontal disease during pregnancy and reduce adverse birth and neonatal outcomes in a rural county of China. METHODS/DESIGN This is a randomized controlled clinical trial. A sample of 468 (234 in each arm of the study) women in early pregnancy with periodontal disease will be recruited for the study. Periodontal disease will be diagnosed through the methods of Periodontal Screening and Recording. All women diagnosed with periodontal disease will be randomly allocated into the intervention or control group. Women assigned in the intervention group will be provided with non-alcohol antimicrobial mouth rinse containing cetylpyridinium chloride throughout the pregnancy and oral health education. Women in the control group will receive a package of tooth brush and paste, plus oral hygiene education. Women will be followed-up to childbirth until the 42nd day postpartum. The main outcomes include mean birthweight (gram) and mean gestational age (week). DISCUSSION Compared with conventional mechanical 'scaling and root planning' periodontal treatment during pregnancy, our proposed mouth rinse intervention could be a simple, cost-effective, and sustainable solution to improve both mother's oral health and neonate outcomes. If the mouth rinse is confirmed to be effective, it would demonstrate great potential for the application in other low- or middle-income countries to prevent adverse birth outcomes such as preterm birth and low birth weight and to reduce neonatal and infant mortality. TRIAL REGISTRATION This trial was registered with Chinese Clinical Trial Registry (ChiCTR): ( #ChiCTR-TRC-13003768 ) on November 06, 2013.
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Affiliation(s)
- Hong Jiang
- School of Public Health; Global Health Institute, Fudan University, Mailbox 175, No. 138 Yixueyuan Road, Shanghai, 200032, China. .,Key Laboratory of Public Health Safety, Ministry of Education, Fudan University, Shanghai, China.
| | - Xu Xiong
- School of Public Health and Tropical Medicine, Tulane University, 1440 Canal Street, Suite 2022, New Orleans, LA, 70112, USA.
| | - Pierre Buekens
- School of Public Health and Tropical Medicine, Tulane University, 1440 Canal Street, Suite 2022, New Orleans, LA, 70112, USA.
| | - Yi Su
- Eye & ENT Hospital of Fudan University, Shanghai, China.
| | - Xu Qian
- School of Public Health; Global Health Institute, Fudan University, Mailbox 175, No. 138 Yixueyuan Road, Shanghai, 200032, China. .,Key Laboratory of Public Health Safety, Ministry of Education, Fudan University, Shanghai, China.
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1084
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Hakestad KA, Torstveit MK, Nordsletten L, Risberg MA. Effect of exercises with weight vests and a patient education programme for women with osteopenia and a healed wrist fracture: a randomized, controlled trial of the OsteoACTIVE programme. BMC Musculoskelet Disord 2015; 16:352. [PMID: 26578370 PMCID: PMC4650105 DOI: 10.1186/s12891-015-0811-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 11/10/2015] [Indexed: 12/22/2022] Open
Abstract
Background Exercise programmes have shown to be important for the prevention of fractures in patients with established osteoporosis. However, few studies have evaluated the effect of such programmes for women with low bone mineral density (BMD) (osteoporosis or osteopenia) who have already suffered a fracture. Studies have indicated that exercise programmes concentrating on muscular strength and dynamic balance have a positive effect on significant risk factors for falls such as quadriceps strength and balance. The aim of the present study was to assess the effect of a 6-month exercise programme and a patient education component (OsteoACTIVE) on quadriceps strength, BMD, dynamic balance, walking capacity, physical activity level and quality of life in postmenopausal women with osteopenia and a previous wrist fracture. Methods Eighty postmenopausal women with low BMD and a healed wrist fracture were randomized to OsteoACTIVE (n = 42) (age 65.5, range 51.2–79.2 years) or patient education only (control group) (n = 38) (age 63.9, range 52.7–86.8 years). Follow-up was conducted after 6 months (end of intervention) and 1 year. Outcome measures included quadriceps strength, BMD, dynamic balance, walking capacity, physical activity level and quality of life. Results Thirty-five participants (83 %) completed the OsteoACTIVE programme. Mean adherence to OsteoACTIVE was 87 % (range 48–100 %). Twenty-five participants (72 %) met the a priori goal of 80 % adherence to the program. No adverse events were reported. There were no significant differences between the two groups over the 1-year follow-up for any of the outcome measures. Conclusion The OsteoACTIVE rehabilitation programme revealed no significant effect on quadriceps strength, BMD, dynamic balance, walking capacity or self-reported functional outcomes over the 1-year follow-up. Trial registration NCT01357278 at ClinicalTrials.gov (date of registration2010-04-21).
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Affiliation(s)
- K A Hakestad
- Department of Orthopaedic Surgery, Norwegian Research Center for Active Rehabilitation (NAR), Oslo University Hospital, Trondheimsveien 235, 0514, Oslo, Norway.
| | - M K Torstveit
- Faculty of Health and Sport Sciences, University of Agder, Kristiansand and Grimstand, Norway.
| | - L Nordsletten
- Department of Orthopaedic Surgery, Norwegian Research Center for Active Rehabilitation (NAR), Oslo University Hospital, Trondheimsveien 235, 0514, Oslo, Norway. .,University of Oslo, Oslo, Norway.
| | - M A Risberg
- Department of Orthopaedic Surgery, Norwegian Research Center for Active Rehabilitation (NAR), Oslo University Hospital, Trondheimsveien 235, 0514, Oslo, Norway. .,Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway.
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1085
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Labetoulle M, Findl O, Malecaze F, Alió J, Cochener B, Lobo C, Lazreg S, Hartani D, Colin J, Tassignon MJ, Behndig A. Evaluation of the efficacy and safety of a standardised intracameral combination of mydriatics and anaesthetics for cataract surgery. Br J Ophthalmol 2015; 100:976-985. [PMID: 26531052 PMCID: PMC4941138 DOI: 10.1136/bjophthalmol-2015-307587] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 09/24/2015] [Accepted: 10/10/2015] [Indexed: 11/12/2022]
Abstract
Background/aims To compare the efficacy and safety of intracameral (IC) administration at the beginning of cataract surgery, of Mydrane, a standardised ophthalmic combination of tropicamide 0.02%, phenylephrine 0.31% and lidocaine 1%, to a standard topical regimen. Methods In this international phase III, prospective, randomised study, the selected eye of 555 patients undergoing phacoemulsification with intraocular lens (IOL) implantation received 200 μL of Mydrane (Mydrane group) just after the first incision or a topical regimen of one drop each of tropicamide 0.5% and phenylephrine 10% repeated three times (reference group). The primary efficacy variable was achievement of capsulorhexis without additional mydriatics. The non-inferiority of Mydrane to the topical regimen was tested. The main outcome measures were pupil size, patient perception of ocular discomfort and safety. Results Capsulorhexis without additional mydriatics was performed in 98.9% of patients and 94.7% in the Mydrane and reference groups, respectively. Both groups achieved adequate mydriasis (>7 mm) during capsulorhexis, phacoemulsification and IOL insertion. IOL insertion was classified as ‘routine’ in a statistically greater number of eyes in the Mydrane group compared with the reference group (p=0.047). Patients in the Mydrane group reported statistically greater comfort than the reference group before IOL insertion (p=0.034). Safety data were similar between groups. Conclusions Mydrane is an effective and safe alternative to standard eye drops for initiating and maintaining intraoperative mydriasis and analgesia. Patients who received IC Mydrane were significantly more comfortable before IOL insertion than the reference group. Surgeons found IOL insertion less technically challenging with IC Mydrane. Trial registration number NCT02101359; Results.
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Affiliation(s)
- Marc Labetoulle
- Hôpital Bicêtre, APHP, South Paris University, Ophtalmology, Le Kremlin-Bicêtre, France.,Institute for Integrative Biology of the Cell (I2BC), Département de Virologie, CNRS, Gif/Yvette, France
| | - Oliver Findl
- Vienna Institute for Research in Ocular Surgery (VIROS), Hanusch Hospital, Vienna, Austria
| | | | - Jorge Alió
- Instituto Oftalmologico de Alicante, Alicante, Spain
| | | | - Conceição Lobo
- Association for Innovation and Biomedical Research on Light and Image (AIBILI), Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
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1086
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Klaperski S, von Dawans B, Heinrichs M, Fuchs R. Effects of a 12-week endurance training program on the physiological response to psychosocial stress in men: a randomized controlled trial. J Behav Med 2015; 37:1118-33. [PMID: 24659155 DOI: 10.1007/s10865-014-9562-9] [Citation(s) in RCA: 85] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Accepted: 03/10/2014] [Indexed: 10/25/2022]
Abstract
The present study experimentally tested the cross-stressor adaptation hypothesis by examining whether endurance exercise training leads to reductions in the physiological stress response to a psychosocial stressor. We randomly assigned 149 healthy men to a 12-week exercise training, relaxation training, or a wait list control group. Before and after intervention we assessed the groups' physical fitness (lactate testing) and compared their physiological stress responses to the Trier Social Stress Test for Groups in terms of salivary free cortisol, heart rate (HR) and heart rate variability (HRV); the final sample consisted of 96 subjects. As hypothesized, the exercise training significantly improved fitness and reduced stress reactivity in all three parameters; however, it only improved stress recovery in terms of HR. The relaxation program reduced only cortisol, but not HR or HRV reactivity; no changes emerged for the control group. The findings suggest that the cross-stressor adaptation hypothesis is valid for cardiovascular as well as endocrine stress reactivity.
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1087
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Evaluation of a hybrid treatment for Veterans with comorbid traumatic brain injury and posttraumatic stress disorder: Study protocol for a randomized controlled trial. Contemp Clin Trials 2015; 45:210-216. [DOI: 10.1016/j.cct.2015.10.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 10/14/2015] [Accepted: 10/17/2015] [Indexed: 11/23/2022]
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1088
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Gray RM, Bourke F. Remediation of intrusive symptoms of PTSD in fewer than five sessions: a 30-person pre-pilot study of the RTM Protocol. JOURNAL OF MILITARY VETERAN AND FAMILY HEALTH 2015. [DOI: 10.3138/jmvfh.2996] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Introduction: The Reconsolidation of Traumatic Memories (RTM) Protocol is a brief non-traumatizing intervention for the intrusive symptoms of post-traumatic stress disorder (PTSD). It is supported by nearly 25 years of anecdotal and clinical reports. This study reports the first scientific evaluation of the protocol. Methods: A 30-person pilot study using male Veterans with a pre-existing diagnosis of PTSD. Intake criteria included interviews and confirmatory re-diagnosis using the PTSD Checklist–Military version (PCL-M). Of 33 people who met the inclusion criteria, 26 completed treatment using the RTM protocol. A small ( n = 5) wait-list control group was included. All participants were reassessed following treatment using the PCL-M. Results: Of 26 program completers, 25 (96%) were symptom free at 6-week follow-up. Mean PCL-M score at intake was 61 points. At the 6-week follow-up, the mean PCL-M score was 28.8, with a mean reduction in scores of 33 points. Hedges’ g was computed for 6-week follow-up and showed a 2.9 SD difference from intake to follow-up. A wait-list control analysis indicated non-significant symptom changes during the 2-week wait period. Discussion: Results suggest that RTM is a promising intervention worthy of further investigation.
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Affiliation(s)
- Richard M. Gray
- The Research and Recognition Project, Corning, New York, USA
| | - Frank Bourke
- The Research and Recognition Project, Corning, New York, USA
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1089
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Intervention Mapping to Adapt Evidence-Based Interventions for Use in Practice: Increasing Mammography among African American Women. BIOMED RESEARCH INTERNATIONAL 2015; 2015:160103. [PMID: 26587531 PMCID: PMC4637430 DOI: 10.1155/2015/160103] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 09/15/2015] [Accepted: 09/20/2015] [Indexed: 12/03/2022]
Abstract
This paper describes and demonstrates the use of the systematic planning process, Intervention Mapping, to adapt an evidence-based public health intervention (EBI). We used a simplified version of Intervention Mapping (IM Adapt) to increase an intervention's fit with a new setting and population. IM Adapt guides researchers and practitioners in selecting an EBI, making decisions about whether and what to adapt, and executing the adaptation while guarding the EBI's essential elements (those responsible for effectiveness). We present a case study of a project in which we used IM Adapt to find, adapt, implement, and evaluate an EBI to improve mammography adherence for African American women in a new practice setting in Houston, Texas. IM Adapt includes the following (1) assess needs and organizational capacity; (2) find EBIs; (3) plan adaptations based on fit assessments; (4) make adaptations; (5) plan for implementation; and (6) plan for evaluation of the adapted EBI. The case study shows an example of how public health researchers and practitioners can use the tool to make it easier to find and use EBIs, thus encouraging greater uptake. IM Adapt adds to existing dissemination and adaptation models by providing detailed guidance on how to decide on effective adaptation, while maintaining the essential elements of the EBI.
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1090
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McLachlan HL, Forster DA, Davey MA, Farrell T, Flood M, Shafiei T, Waldenström U. The effect of primary midwife-led care on women's experience of childbirth: results from the COSMOS randomised controlled trial. BJOG 2015; 123:465-74. [DOI: 10.1111/1471-0528.13713] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2015] [Indexed: 11/30/2022]
Affiliation(s)
- HL McLachlan
- Judith Lumley Centre and School of Nursing and Midwifery; La Trobe University; Melbourne Vic. Australia
| | - DA Forster
- Judith Lumley Centre and School of Nursing and Midwifery; La Trobe University; Melbourne Vic. Australia
- The Royal Women's Hospital; Parkville Vic. Australia
| | - M-A Davey
- Judith Lumley Centre and School of Nursing and Midwifery; La Trobe University; Melbourne Vic. Australia
- Consultative Council on Obstetric and Paediatric Mortality and Morbidity; Department of Health; Melbourne Vic. Australia
| | - T Farrell
- The Royal Women's Hospital; Parkville Vic. Australia
| | - M Flood
- Judith Lumley Centre and School of Nursing and Midwifery; La Trobe University; Melbourne Vic. Australia
| | - T Shafiei
- Judith Lumley Centre and School of Nursing and Midwifery; La Trobe University; Melbourne Vic. Australia
| | - U Waldenström
- Department of Women's and Children's Health; Division of Reproductive and Perinatal Health; Karolinska Institutet; Stockholm Sweden
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1091
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Evaluation of the Effectiveness and Implementation of an Adapted Evidence-Based Mammography Intervention for African American Women. BIOMED RESEARCH INTERNATIONAL 2015; 2015:240240. [PMID: 26504790 PMCID: PMC4609333 DOI: 10.1155/2015/240240] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 08/10/2015] [Accepted: 08/18/2015] [Indexed: 11/19/2022]
Abstract
Breast cancer mortality disparities continue, particularly for uninsured and minority women. A number of effective evidence-based interventions (EBIs) exist for addressing barriers to mammography screening; however, their uptake and use in community has been limited. Few cancer-specific studies have evaluated adapted EBIs in new contexts, and fewer still have considered implementation. This study sought to (1) evaluate the effectiveness of an adapted mammography EBI in improving appointment keeping in African American women and (2) describe processes of implementation in a new practice setting. We used the type 1 hybrid design to test effectiveness and implementation using a quasi-experimental design. Logistic regression and intent-to-treat analysis were used to evaluate mammography appointment attendance. The no-show rate was 44% (comparison) versus 19% (intervention). The adjusted odds of a woman in the intervention group attending her appointment were 3.88 (p < 0.001). The adjusted odds of a woman attending her appointment in the intent-to-treat analysis were 2.31 (p < 0.05). Adapted EBI effectiveness was 3.88 (adjusted OR) versus 2.10 (OR) for the original program, indicating enhanced program effect. A number of implementation barriers and facilitators were identified. Our findings support previous studies noting that sequentially measuring EBI efficacy and effectiveness, followed by implementation, may be missing important contextual information.
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1092
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Waters AM, Zimmer-Gembeck MJ, Craske MG, Pine DS, Bradley BP, Mogg K. Look for good and never give up: A novel attention training treatment for childhood anxiety disorders. Behav Res Ther 2015; 73:111-23. [DOI: 10.1016/j.brat.2015.08.005] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Revised: 06/25/2015] [Accepted: 08/14/2015] [Indexed: 11/26/2022]
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1093
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Pavlou M, Acheson J, Nicolaou D, Fraser CL, Bronstein AM, Davies RA. Effect of Developmental Binocular Vision Abnormalities on Visual Vertigo Symptoms and Treatment Outcome. J Neurol Phys Ther 2015; 39:215-24. [DOI: 10.1097/npt.0000000000000105] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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1094
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Who responds to financial incentives for weight loss? Evidence from a randomized controlled trial. Soc Sci Med 2015; 145:44-52. [PMID: 26448164 DOI: 10.1016/j.socscimed.2015.09.034] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Revised: 09/16/2015] [Accepted: 09/25/2015] [Indexed: 11/22/2022]
Abstract
There is a paucity of evidence on the heterogeneous impacts of financial incentives on weight loss. Between March 2010 and January 2012, in a randomized controlled trial, we assigned 700 obese persons to three experimental arms. We test whether particular subgroups react differently to financial incentives for weight loss. Two treatment groups obtained a cash reward (€150 and €300 with 237 and 229 participants, respectively) for achieving an individually-assigned target weight within four months; the control group (234 participants) was not incentivized. Participants and administrators were not blinded to the intervention. We find that monetary rewards effectively induced obese individuals to reduce weight across all subgroups. However, there is no evidence for treatment-effect heterogeneity for those groups that were incentivized. Among those who were in the €300 group, statistically significant and large weight losses were observed for women, singles, and those who are not working (all above 4 kg in four months). In addition, the magnitude of the reward matters only for women and migrants. The effectiveness of financial incentives to reduce weight nevertheless raises sensitive ethical issues that should be taken into consideration by policymakers.
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1095
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Lover AA. Considerations for Comprehensive Analyses of Sporozoite-Based Controlled Human Malaria Infection Studies. Am J Trop Med Hyg 2015; 93:1130-1133. [PMID: 26392161 PMCID: PMC4674223 DOI: 10.4269/ajtmh.15-0327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Accepted: 08/12/2015] [Indexed: 11/30/2022] Open
Abstract
There has been renewed interest in the use of sporozoite-based approaches for controlled human malaria infections (CHMIs), and several sets of human challenge studies have recently completed. A study undertaken in Tanzania and published in 2014 found dose dependence between 10,000 and 25,000 sporozoite doses, as well as divergent times-to-parasitemia relative to earlier studies in European volunteers, with important implications for planning future studies. Analysis of time-to-event data has had extensive development in recent years, but these methods have had limited exposure outside biostatistics. Expansion of the published analyses to include recent methodological approaches optimized for the types of data used could provide a richer analysis of these studies and may result in alternative findings. Specifically, in a re-analysis of these data using survival analysis techniques, the differences recorded in prepatent periods between the two dosing regimens do not reach statistical significance, and there is no evidence for statistically significant differences in prepatent periods between the Dutch and Tanzanian study sites. Although these findings do not impact the reported safety and tolerability of challange with cryopreserved Plasmodium falciparum sporozoites (PfSPZ), or invalidate the authors' hypotheses regarding naturally acquired immunity and its effect on parasite growth rates and prepatent periods, they highlight important opportunities to more fully use datasets from these trials and related CHMI experiments in the planning of future challenge studies.
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Affiliation(s)
- Andrew A. Lover
- *Address correspondence to Andrew A. Lover, Malaria Elimination Initiative, University of California, 550 16th Street, 3F, San Francisco, CA 94158. E-mails: or
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1096
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Effect of the probiotic strain Bifidobacterium animalis subsp. lactis, BB-12®, on defecation frequency in healthy subjects with low defecation frequency and abdominal discomfort: a randomised, double-blind, placebo-controlled, parallel-group trial. Br J Nutr 2015; 114:1638-46. [PMID: 26382580 PMCID: PMC4657032 DOI: 10.1017/s0007114515003347] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The aim of the present study was to investigate the effect of Bifidobacterium
animalis subsp. lactis, BB-12®, on two primary end
points – defecation frequency and gastrointestinal (GI) well-being – in healthy adults
with low defecation frequency and abdominal discomfort. A total of 1248 subjects were
included in a randomised, double-blind, placebo-controlled trial. After a 2-week run-in
period, subjects were randomised to 1 or 10 billion colony-forming units/d of the
probiotic strain BB-12® or a matching placebo capsule once daily for 4 weeks.
Subjects completed a diary on bowel habits, relief of abdominal discomfort and symptoms.
GI well-being, defined as global relief of abdominal discomfort, did not show significant
differences. The OR for having a defecation frequency above baseline for ≥50 % of the time
was 1·31 (95 % CI 0·98, 1·75), P=0·071, for probiotic treatment overall.
Tightening the criteria for being a responder to an increase of ≥1 d/week for ≥50 % of the
time resulted in an OR of 1·55 (95 % CI 1·22, 1·96), P=0·0003, for
treatment overall. A treatment effect on average defecation frequency was found
(P=0·0065), with the frequency being significantly higher compared with
placebo at all weeks for probiotic treatment overall (all P<0·05).
Effects on defecation frequency were similar for the two doses tested, suggesting that a
ceiling effect was reached with the one billion dose. Overall, 4 weeks’ supplementation
with the probiotic strain BB-12® resulted in a clinically relevant benefit on
defecation frequency. The results suggest that consumption of BB-12® improves
the GI health of individuals whose symptoms are not sufficiently severe to consult a
doctor (ISRCTN18128385).
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1097
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Cuperus N, Hoogeboom TJ, Kersten CC, den Broeder AA, Vlieland TPMV, van den Ende CHM. Randomized trial of the effectiveness of a non-pharmacological multidisciplinary face-to-face treatment program on daily function compared to a telephone-based treatment program in patients with generalized osteoarthritis. Osteoarthritis Cartilage 2015; 23:1267-75. [PMID: 25887365 DOI: 10.1016/j.joca.2015.04.007] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Revised: 03/10/2015] [Accepted: 04/02/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To compare the effectiveness of a non-pharmacological multidisciplinary face-to-face self-management treatment program with a telephone-based program on daily function in patients with generalized osteoarthritis (GOA). DESIGN A pragmatic single-blind randomized clinical superiority trial involving 147 patients clinically diagnosed with GOA, randomly allocated to either a 6 week non-pharmacological multidisciplinary face-to-face treatment program comprising seven group sessions or a 6 week telephone-based treatment program comprising two group sessions combined with four telephone contacts. Both programs aimed to improve daily function and to enhance self-management to control the disease. The programs critically differed in mode of delivery and intensity. Daily function (primary outcome) and secondary outcomes were assessed at baseline, 6, 26 and 52 weeks. Data were analyzed using linear or logistic multilevel regression models corrected for baseline, sex and group-wise treatment. RESULTS No differences in effectiveness between both treatment programs were observed on the primary outcome (group difference (95% CI): -0.03 (-0.14, 0.07)) or on secondary outcome measures, except for a larger improvement in pain in the face-to-face treatment group (group difference (95% CI): 1.61 (0.01, 3.21)). Within groups, significant improvements were observed on several domains, especially in the face-to-face group. However, these benefits are relatively small and unlikely to be of clinical importance. CONCLUSIONS We found no differences in treatment effect between patients with GOA who followed a non-pharmacological multidisciplinary face-to-face self-management program and those who received a telephone-delivered program. Besides, our findings demonstrated limited benefits of a self-management program for individuals with GOA. Dutch Trial Register trial number: NTR2137.
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Affiliation(s)
- N Cuperus
- Department of Rheumatology, Sint Maartenskliniek, Nijmegen, The Netherlands.
| | - T J Hoogeboom
- Department of Epidemiology, CAPHRI School for Public Health and Primary Care, CCTR Centre for Care Technology Research, Maastricht University, The Netherlands.
| | - C C Kersten
- Department of Rheumatology, Sint Maartenskliniek, Nijmegen, The Netherlands.
| | - A A den Broeder
- Department of Rheumatology, Sint Maartenskliniek, Nijmegen, The Netherlands.
| | - T P M Vliet Vlieland
- Department of Orthopaedics, Leiden University Medical Centre, Leiden, The Netherlands.
| | - C H M van den Ende
- Department of Rheumatology, Sint Maartenskliniek, Nijmegen, The Netherlands.
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1098
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McMahon S, Winter SC, Palmer JE, Postmus JL, Peterson NA, Zucker S, Koenick R. A randomized controlled trial of a multi-dose bystander intervention program using peer education theater. HEALTH EDUCATION RESEARCH 2015; 30:554-68. [PMID: 26135957 DOI: 10.1093/her/cyv022] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Accepted: 05/26/2015] [Indexed: 06/04/2023]
Abstract
This article reports findings from a longitudinal, experimental evaluation of a peer education theater program, Students Challenging Realities and Educating Against Myths (SCREAM) Theater. This study examines the impact of SCREAM Theater on a range of bystander-related outcomes (i.e. bystander intentions, bystander efficacy, perception of friend norms and bystander behaviors) in situations involving sexual violence and whether there was a differential impact of the program by participant sex. First-year college students completed three waves of surveys (pretest, first post-test and second post-test). All participants received one dose of the intervention during summer orientation after the pretest. After the first post-test, participants were randomly assigned to receive two additional doses, or to a control condition, in which they received no additional doses. Students in both one- and three-dose groups reported a number of positive increases. Overall, an intent-to-treat analysis (n = 1390) indicated three doses of the intervention during the first semester of college resulted in better outcomes than the one-time intervention during summer orientation alone. Although both male and female students' scores increased during the study period, female students consistently scored higher than male students on each outcome. The findings suggest that peer education theater holds promise for bystander intervention education on college campuses.
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1099
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Abstract
Although the standard recommendation is to exclude person-time not at risk (ie, time during which the outcome could not have occurred) from the denominators of disease rates, there are scenarios where person-time not at risk should be included. In particular, we draw an analogy between including person-time not at risk and intention-to-treat (ITT) analyses of randomized trials, and excluding person-time not at risk and compliance-corrected analysis of these same trials. Excluding person-time not at risk is appropriate when addressing questions of the biologic or mechanistic effects of an exposure, whereas the ITT-type approach typically addresses questions regarding the effect of an exposure under observed compliance patterns. The choice of approach directly affects the causal question being addressed and subsequent inference, with potential implications for public health. When interested in estimating treatment effects that allow and account for potential noncompliance, or where the exposure may be associated with the time at risk, we argue that person-time not at risk should be included. In the case of time to pregnancy, although the ITT-type analysis may underestimate the biological fecundity of the population, it may also yield an answer to a question that is of more interest to couples trying to become pregnant.
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1100
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Ferrarello F, Deluca G, Pizzi A, Baldini C, Iori F, Marchionni N, Di Bari M. Passive standing as an adjunct rehabilitation intervention after stroke: a randomized controlled trial. Arch Physiother 2015; 5:2. [PMID: 29340171 PMCID: PMC5721723 DOI: 10.1186/s40945-015-0002-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2015] [Accepted: 04/09/2015] [Indexed: 11/21/2022] Open
Abstract
Background Early physical rehabilitation enhances functional recovery in stroke survivors. Supported standing is a common adjunctive therapeutic practice in subjects with several central nervous diseases who are unable to stand actively. Data on the effect of supported positioning on standing frames in individuals with recent stroke are scarce and contradictory. Objectives To verify if the addition of supported standing practice (SSP), delivered by means of a standing frame in two durations, to conventional physical therapy (CPT), may improve motor function, autonomy, and mobility in individuals with disability due to recent stroke. Methods After baseline assessment, 75 participants with severe disability due to stroke, all receiving CPT, were randomly assigned to adjunctive 20 or 40 min of SSP, or CPT only (control). Motor function, autonomy, and mobility were assessed before and after training, and three months later. Results All participants assessed received the planned dose of intervention. No adverse events of SSP were detected. Most outcome measures improved from baseline through the end of treatment and in the follow-up in all groups; the extent of change was comparable across the three randomization groups. Conclusions In this randomized trial, SSP was unable to provide any sizeable adjunctive benefit, above and beyond CPT, in subjects with recent stroke.
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Affiliation(s)
- Francesco Ferrarello
- Functional Rehabilitation Unit, Azienda USL 4, Via Cavour 118/120, 59100 Prato, Italy
| | | | - Assunta Pizzi
- Fondazione Don Carlo Gnocchi ONLUS-IRCCS, Florence, Italy
| | - Carlo Baldini
- Fondazione Don Carlo Gnocchi ONLUS-IRCCS, Florence, Italy
| | - Francesca Iori
- Fondazione Don Carlo Gnocchi ONLUS-IRCCS, Florence, Italy
| | - Niccolò Marchionni
- Research Unit of Medicine of Aging, Department of Experimental and Clinical Medicine, University of Florence, and Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Mauro Di Bari
- Research Unit of Medicine of Aging, Department of Experimental and Clinical Medicine, University of Florence, and Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
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