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Robertson MC, Swartz MC, Basen-Engquist KM, Li Y, Jennings K, Thompson D, Baranowski T, Volpi E, Lyons EJ. A social media game to increase physical activity among older adult women: protocol of a randomized controlled trial to evaluate CHALLENGE. BMC Public Health 2024; 24:2172. [PMID: 39135010 PMCID: PMC11318238 DOI: 10.1186/s12889-024-19662-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 07/31/2024] [Indexed: 08/15/2024] Open
Abstract
BACKGROUND Older adult women often do not engage in sufficient physical activity (PA) and can encounter biological changes that exacerbate the negative effects of inadequate activity. Wearable activity monitors can facilitate PA initiation, but evidence of sustained behavior change is lacking. Supplementing wearable technologies with intervention content that evokes enjoyment, interest, meaning, and personal values associated with PA may support long term adherence. In this paper, we present the protocol of an NIA-funded study designed to evaluate the efficacy of CHALLENGE for increasing step count and motivation for PA in insufficiently active older women (Challenges for Healthy Aging: Leveraging Limits for Engaging Networked Game-based Exercise). CHALLENGE uses social media to supplement wearable activity monitors with the autonomy-supportive frame of a game. We hypothesize that CHALLENGE will engender playful experiences that will improve motivation for exercise and lead to sustained increases in step count. METHODS We will recruit 300 healthy, community dwelling older adult women on a rolling basis and randomize them to receive either the CHALLENGE intervention (experimental arm) or an activity monitor-only intervention (comparison arm). Participants in both groups will receive a wearable activity monitor and personalized weekly feedback emails. In the experimental group, participants will also be added to a private Facebook group, where study staff will post weekly challenges that are designed to elicit playful experiences while walking. Assessments at baseline and 6, 12, and 18 months will measure PA and motivation-related constructs. We will fit linear mixed-effects models to evaluate differences in step count and motivational constructs, and longitudinal mediation models to evaluate if interventional effects are mediated by changes in motivation. We will also conduct thematic content analysis of text and photos posted to Facebook and transcripts from individual interviews. DISCUSSION By taking part in a year-long intervention centered on imbuing walking behaviors with playful and celebratory experiences, participating older adult women may internalize changes to their identity and relationship with PA that facilitate sustained behavior change. Study results will have implications for how we can harness powerful and increasingly ubiquitous technologies for health promotion to the vast and growing population of older adults in the U.S. and abroad. TRIAL REGISTRATION ClinicalTrials.gov Identifier NCT04095923. Registered September 17th, 2019.
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Affiliation(s)
- Michael C Robertson
- Department of Nutrition Sciences and Health Behavior, The University of Texas Medical Branch, 301 University Blvd, Galveston, TX, 77555-0177, USA
- Department of Family and Preventive Medicine, TSET Health Promotion Research Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Maria Chang Swartz
- Department of Pediatrics, Division of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Karen M Basen-Engquist
- Department of Health Disparities, Division of Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Yisheng Li
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kristofer Jennings
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Debbe Thompson
- US Department of Agriculture/Agricultural Research Service, Children's Nutrition Research Center, Baylor College of Medicine, Houston, TX, USA
| | - Tom Baranowski
- US Department of Agriculture/Agricultural Research Service, Children's Nutrition Research Center, Baylor College of Medicine, Houston, TX, USA
| | - Elena Volpi
- Department of Medicine, Division of Geriatrics, Gerontology & Palliative Medicine, UT Health San Antonio, San Antonio, TX, USA
| | - Elizabeth J Lyons
- Department of Nutrition Sciences and Health Behavior, The University of Texas Medical Branch, 301 University Blvd, Galveston, TX, 77555-0177, USA.
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Lockhart E, Turner D, Guastaferro K, Szalacha LA, Alzate HT, Marhefka S, Pittiglio B, Dekker M, Yeh HH, Zelenak L, Toney J, Manogue S, Ahmedani BK. Increasing pre-exposure prophylaxis (PrEP) in primary care: A study protocol for a multi-level intervention using the multiphase optimization strategy (MOST) framework. Contemp Clin Trials 2024; 143:107599. [PMID: 38848935 DOI: 10.1016/j.cct.2024.107599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 05/14/2024] [Accepted: 06/01/2024] [Indexed: 06/09/2024]
Abstract
BACKGROUND In the United States, over 1.2 million people are living with HIV. This disease disproportionately affects men who have sex with men (MSM), people of color, youth and young adults, and transgender individuals. Pre-exposure prophylaxis (PrEP) is an effective HIV prevention method. Barriers exist for both primary care providers (PCPs) to prescribe PrEP and prevent patients from initiating PrEP. METHODS This study, MOST: PrEP, follows the multiphase optimization strategy (MOST) framework. The purpose is to identify a multi-level intervention among patients and PCPs to increase PrEP prescriptions in primary care. First, feedback will be obtained from providers and patients via focus groups, then, suggestions related to the context-specific (provider and individual level) factors of intervention component delivery will be incorporated. Subsequently, a rigorous experiment will be conducted using a 24 factorial design focusing on priority populations for PrEP initiation. Provider components include computer-based simulation training and a best practice alert. Patient components include a tailored PrEP educational video and HIV risk assessment. Finally, the facilitators and barriers to implementing the intervention components will be qualitatively examined. CONCLUSION In this protocol paper, we describe the one of the first known multilevel MOST optimization trial in healthcare. Intervention components are to be delivered to patients and providers in a large healthcare system, based in an HIV Ending the Epidemic priority jurisdiction. If effective, this multi-level approach could be disseminated to providers and patients in other large healthcare systems to make a significant impact on HIV prevention.
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Affiliation(s)
- Elizabeth Lockhart
- Center for Health Policy and Health Services Research, Henry Ford Health, 1 Ford Pl., Detroit, MI 48202, USA.
| | - DeAnne Turner
- College of Nursing, University of South Florida, 12912 USF Health Dr, Tampa, FL 33612, USA.
| | - Kate Guastaferro
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, 708 Broadway, 6th Floor Room 636, New York, NY 10003, USA.
| | | | - Herica Torres Alzate
- College of Nursing, University of South Florida, 12912 USF Health Dr, Tampa, FL 33612, USA.
| | - Stephanie Marhefka
- College of Nursing, University of South Florida, 12912 USF Health Dr, Tampa, FL 33612, USA.
| | - Bianca Pittiglio
- Family Medicine, Henry Ford Health, 110 E 2nd Street, Royal Oak, MI 48067, USA.
| | - Megan Dekker
- Academic Internal Medicine, Henry Ford Health, 2799 W Grand Blvd, Detroit, MI 48202, USA.
| | - Hsueh-Han Yeh
- Center for Health Policy and Health Services Research, Henry Ford Health, 1 Ford Pl., Detroit, MI 48202, USA.
| | - Logan Zelenak
- Center for Health Policy and Health Services Research, Henry Ford Health, 1 Ford Pl., Detroit, MI 48202, USA.
| | - Jeremy Toney
- Center for Health Policy and Health Services Research, Henry Ford Health, 1 Ford Pl., Detroit, MI 48202, USA.
| | - Sean Manogue
- Center for Health Policy and Health Services Research, Henry Ford Health, 1 Ford Pl., Detroit, MI 48202, USA.
| | - Brian K Ahmedani
- Center for Health Policy and Health Services Research, Henry Ford Health, 1 Ford Pl., Detroit, MI 48202, USA.
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Naveed K, Rashidi-Ranjbar N, Kumar S, Zomorrodi R, Blumberger DM, Fischer CE, Sanches M, Mulsant BH, Pollock BG, Voineskos AN, Rajji TK. Effect of dorsolateral prefrontal cortex structural measures on neuroplasticity and response to paired-associative stimulation in Alzheimer's dementia. Philos Trans R Soc Lond B Biol Sci 2024; 379:20230233. [PMID: 38853564 PMCID: PMC11343312 DOI: 10.1098/rstb.2023.0233] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 12/04/2023] [Accepted: 01/15/2024] [Indexed: 06/11/2024] Open
Abstract
Long-term potentiation (LTP)-like activity can be induced by stimulation protocols such as paired associative stimulation (PAS). We aimed to determine whether PAS-induced LTP-like activity (PAS-LTP) of the dorsolateral prefrontal cortex (DLPFC) is associated with cortical thickness and other structural measures impaired in Alzheimer's dementia (AD). We also explored longitudinal relationships between these brain structures and PAS-LTP response after a repetitive PAS (rPAS) intervention. Mediation and regression analyses were conducted using data from randomized controlled trials with AD and healthy control participants. PAS-electroencephalography assessed DLPFC PAS-LTP. DLPFC thickness and surface area were acquired from T1-weighted magnetic resonance imaging. Fractional anisotropy and mean diffusivity (MD) of the superior longitudinal fasciculus (SLF)-a tract important to induce PAS-LTP-were measured with diffusion-weighted imaging. AD participants exhibited reduced DLPFC thickness and increased SLF MD. There was also some evidence that reduction in DLPFC thickness mediates DLPFC PAS-LTP impairment. Longitudinal analyses showed preliminary evidence that SLF MD, and to a lesser extent DLPFC thickness, is associated with DLPFC PAS-LTP response to active rPAS. This study expands our understanding of the relationships between brain structural changes and neuroplasticity. It provides promising evidence for a structural predictor to improving neuroplasticity in AD with neurostimulation. This article is part of a discussion meeting issue 'Long-term potentiation: 50 years on'.
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Affiliation(s)
- K. Naveed
- Temerty Faculty of Medicine, University of Toronto, 1 King’s College Cir, Toronto, OntarioM5S 1A8, Canada
- Toronto Dementia Research Alliance, University of Toronto, 250 College Street, Toronto, OntarioM5T 1R8, Canada
| | - N. Rashidi-Ranjbar
- Temerty Faculty of Medicine, University of Toronto, 1 King’s College Cir, Toronto, OntarioM5S 1A8, Canada
- Toronto Dementia Research Alliance, University of Toronto, 250 College Street, Toronto, OntarioM5T 1R8, Canada
- Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, 209 Victoria Street, Toronto, OntarioM5B 1T8, Canada
| | - S. Kumar
- Temerty Faculty of Medicine, University of Toronto, 1 King’s College Cir, Toronto, OntarioM5S 1A8, Canada
- Toronto Dementia Research Alliance, University of Toronto, 250 College Street, Toronto, OntarioM5T 1R8, Canada
- Campbell Family Mental Health Research Institute, CAMH, 479 Spadina Avenue, Toronto, OntarioM5S 2S1, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, 250 College Street, Toronto, OntarioM5T 1R8, Canada
| | - R. Zomorrodi
- Temerty Faculty of Medicine, University of Toronto, 1 King’s College Cir, Toronto, OntarioM5S 1A8, Canada
- Campbell Family Mental Health Research Institute, CAMH, 479 Spadina Avenue, Toronto, OntarioM5S 2S1, Canada
| | - D. M. Blumberger
- Temerty Faculty of Medicine, University of Toronto, 1 King’s College Cir, Toronto, OntarioM5S 1A8, Canada
- Campbell Family Mental Health Research Institute, CAMH, 479 Spadina Avenue, Toronto, OntarioM5S 2S1, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, 250 College Street, Toronto, OntarioM5T 1R8, Canada
| | - C. E. Fischer
- Temerty Faculty of Medicine, University of Toronto, 1 King’s College Cir, Toronto, OntarioM5S 1A8, Canada
- Toronto Dementia Research Alliance, University of Toronto, 250 College Street, Toronto, OntarioM5T 1R8, Canada
- Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, 209 Victoria Street, Toronto, OntarioM5B 1T8, Canada
| | - M. Sanches
- Biostatistics Core, Centre for Addiction and Mental Health, 60 White Squirrel Way, Toronto, OntarioM6J 1H4, Canada
| | - B. H. Mulsant
- Temerty Faculty of Medicine, University of Toronto, 1 King’s College Cir, Toronto, OntarioM5S 1A8, Canada
- Toronto Dementia Research Alliance, University of Toronto, 250 College Street, Toronto, OntarioM5T 1R8, Canada
- Campbell Family Mental Health Research Institute, CAMH, 479 Spadina Avenue, Toronto, OntarioM5S 2S1, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, 250 College Street, Toronto, OntarioM5T 1R8, Canada
| | - B. G. Pollock
- Temerty Faculty of Medicine, University of Toronto, 1 King’s College Cir, Toronto, OntarioM5S 1A8, Canada
- Campbell Family Mental Health Research Institute, CAMH, 479 Spadina Avenue, Toronto, OntarioM5S 2S1, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, 250 College Street, Toronto, OntarioM5T 1R8, Canada
| | - A. N. Voineskos
- Temerty Faculty of Medicine, University of Toronto, 1 King’s College Cir, Toronto, OntarioM5S 1A8, Canada
- Campbell Family Mental Health Research Institute, CAMH, 479 Spadina Avenue, Toronto, OntarioM5S 2S1, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, 250 College Street, Toronto, OntarioM5T 1R8, Canada
| | - T. K. Rajji
- Temerty Faculty of Medicine, University of Toronto, 1 King’s College Cir, Toronto, OntarioM5S 1A8, Canada
- Toronto Dementia Research Alliance, University of Toronto, 250 College Street, Toronto, OntarioM5T 1R8, Canada
- Campbell Family Mental Health Research Institute, CAMH, 479 Spadina Avenue, Toronto, OntarioM5S 2S1, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, 250 College Street, Toronto, OntarioM5T 1R8, Canada
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Davis EP, Demers CH, Deer L, Gallop RJ, Hoffman MC, Grote N, Hankin BL. Impact of prenatal maternal depression on gestational length: post hoc analysis of a randomized clinical trial. EClinicalMedicine 2024; 72:102601. [PMID: 38680516 PMCID: PMC11053273 DOI: 10.1016/j.eclinm.2024.102601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 03/27/2024] [Accepted: 03/29/2024] [Indexed: 05/01/2024] Open
Abstract
Background Shortened gestation is a leading cause of childhood morbidity and mortality with lifelong consequences for health. There is a need for public health initiatives on increasing gestational age at birth. Prenatal maternal depression is a pervasive health problem robustly linked via correlational and epidemiological studies to shortened gestational length. This proof-of-concept study tests the impact of reducing prenatal maternal depression on gestational length with analysis of a randomized clinical trial (RCT). Methods Participants included 226 pregnant individuals enrolled into an RCT and assigned to receive either interpersonal psychotherapy (IPT) or enhanced usual care (EUC). Recruitment began in July 2017 and participants were enrolled August 10, 2017 to September, 8 2021. Depression diagnosis (Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition; DSM 5) and symptoms (Edinburgh Postnatal Depression Scale and Symptom Checklist) were evaluated at baseline and longitudinally throughout gestation to characterize depression trajectories. Gestational dating was collected based on current guidelines via medical records. The primary outcome was gestational age at birth measured dichotomously (≥39 gestational weeks) and the secondary outcome was gestational age at birth measured continuously. Posthoc analyses were performed to test the effect of reducing prenatal maternal depression on gestational length. This trial is registered with ClinicalTrials.gov (NCT03011801). Findings Steeper decreases in depression trajectories across gestation predicted later gestational age at birth, specifically an increase in the number of full-term babies born ≥39 gestational weeks (EPDS linear slopes: OR = 1.54, 95% CI 1.10-2.16; and SCL-20 linear slopes: OR = 1.67, 95% CI 1.16-2.42). Causal mediation analyses supported the hypothesis that participants assigned to IPT experienced greater reductions in depression symptom trajectories, which in turn, contributed to longer gestation. Supporting mediation, the natural indirect effect (NIE) showed that reduced depression trajectories resulting from intervention were associated with birth ≥39 gestational weeks (EPDS, OR = 1.65, 95% CI 1.02-2.66; SCL-20, OR = 1.85, 95% CI 1.16-2.97). Interpretation We used a RCT design and found that reducing maternal depression across pregnancy was associated with lengthened gestation. Funding This research was supported by the NIH (R01 HL155744, R01 MH109662, R21 MH124026, P50 MH096889).
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Affiliation(s)
- Elysia Poggi Davis
- Department of Psychology, University of Denver, Denver, CO, USA
- Department of Pediatrics, University of California, Irvine, CA, USA
| | - Catherine H. Demers
- Department of Psychology, University of Denver, Denver, CO, USA
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - LillyBelle Deer
- Department of Psychology, University of Denver, Denver, CO, USA
| | - Robert J. Gallop
- Department of Mathematics, West Chester University, West Chester, PA, USA
| | - M. Camille Hoffman
- Department of Obstetrics and Gynecology, Division of Maternal and Fetal Medicine, University of Colorado Denver School of Medicine, Aurora, CO, USA
| | - Nancy Grote
- School of Social Work, University of Washington, Seattle, WA, USA
| | - Benjamin L. Hankin
- Department of Psychology, University of Illinois at Urbana-Champaign, Champaign, IL, USA
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Qin T, Fan C, Liu Q, Wang J, Zhu X. Development and validation of a nomogram for predicting cognitive frailty in patients on maintenance haemodialysis. J Adv Nurs 2024. [PMID: 38807450 DOI: 10.1111/jan.16253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 04/10/2024] [Accepted: 05/10/2024] [Indexed: 05/30/2024]
Abstract
AIMS This study aimed to construct a nomogram for predicting the risk of cognitive frailty in patients on maintenance haemodialysis. DESIGN An explorative cross-sectional design was adopted. METHODS From April 2022 to July 2022, 496 participants were recruited from five haemodialysis centres in Qingdao, Shandong Province, China. Participants with cognitive frailty were screened by Frailty Phenotype scale and Mini-Mental State Examination. Least Absolute Shrinkage and Selection Operator (LASSO) regression and multivariate logistic regression were utilized to determine predictors. The predictive performance of the nomogram was validated by calibration and discrimination. Decision curve analysis was used to assess clinical utility. Internal validation was implemented using 1000 bootstrap samples to mitigate overfitting. RESULTS The prevalence of cognitive frailty was 17.5% (n = 87). Six risk predictors, namely health empowerment, alexithymia, age, educational level, marital status and dialysis vintage, were screened and used to develop a nomogram model. The nomogram had satisfactory discrimination and calibration, and decision curve analysis revealed considerable clinical utility. CONCLUSIONS A nomogram incorporated with the six risk predictors was developed, and it exhibited excellent prediction performance. The nomogram may strengthen the effective screening of patients at high risk of cognitive frailty. IMPACT This study established a tool for healthcare staff to predict cognitive frailty probability and identify risk factors in patients on maintenance haemodialysis. The nomogram can meet the needs of personalized care and precision medicine simultaneously. PATIENT OR PUBLIC CONTRIBUTION Data were collected from patients on maintenance haemodialysis by using questionnaire survey. REPORTING METHOD STROBE checklist was used.
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Affiliation(s)
- Tong Qin
- Nursing department, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Chun Fan
- Department of Pharmacy, Qingdao Municipal Hospital, Qingdao, Shandong, China
| | - Qingwei Liu
- Nursing department, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Jizhe Wang
- Nursing department, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Xiuli Zhu
- School of Nursing, Qingdao University, Qingdao, Shandong, China
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Kucker SC, Schneider JM. Social interactions offset the detrimental effects of digital media use on children's vocabulary. FRONTIERS IN DEVELOPMENTAL PSYCHOLOGY 2024; 2:1401736. [PMID: 38948495 PMCID: PMC11213284 DOI: 10.3389/fdpys.2024.1401736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 07/02/2024]
Abstract
Young children's rapid vocabulary growth during the first few years is supported by input during social interactions with caregivers and, increasingly, from digital media. However, the amount of exposure to both sources can vary substantially across socioeconomic classes, and little is known about how social interactions and digital media use together predict vocabulary in the first few years of life. The current study takes a first step toward examining whether increased social interactions with other individuals may buffer the potentially detrimental effects of digital media use on language among a socioeconomically diverse sample. 305 caregivers of children between 17 and 30-months completed questionnaires about their family demographics, their child's technology use, and the child's daily routines and social interactions. Findings suggest children who experience fewer human interactions and greater technology exposure have smaller vocabularies than their peers who socialize more and use less technology, and this disparity becomes greater as children get older. Moreover, the number of social interactions moderates the link between SES, digital media, and vocabulary such that the negative impact of digital media on vocabulary for children from low SES households can be offset with increased social interactions. Together, this suggests that increasing the amount of human interactions may serve as a protective factor for vocabulary outcomes in a world where digital media use is prominent.
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Affiliation(s)
- Sarah C. Kucker
- Department of Psychology, Southern Methodist University, Dallas, TX, United States
| | - Julie M. Schneider
- Department of Communication Science and Disorders, Louisiana State University, Baton Rouge, LA, United States
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Qin X. Sample size and power calculations for causal mediation analysis: A Tutorial and Shiny App. Behav Res Methods 2024; 56:1738-1769. [PMID: 37231326 DOI: 10.3758/s13428-023-02118-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2023] [Indexed: 05/27/2023]
Abstract
When designing a study for causal mediation analysis, it is crucial to conduct a power analysis to determine the sample size required to detect the causal mediation effects with sufficient power. However, the development of power analysis methods for causal mediation analysis has lagged far behind. To fill the knowledge gap, I proposed a simulation-based method and an easy-to-use web application ( https://xuqin.shinyapps.io/CausalMediationPowerAnalysis/ ) for power and sample size calculations for regression-based causal mediation analysis. By repeatedly drawing samples of a specific size from a population predefined with hypothesized models and parameter values, the method calculates the power to detect a causal mediation effect based on the proportion of the replications with a significant test result. The Monte Carlo confidence interval method is used for testing so that the sampling distributions of causal effect estimates are allowed to be asymmetric, and the power analysis runs faster than if the bootstrapping method is adopted. This also guarantees that the proposed power analysis tool is compatible with the widely used R package for causal mediation analysis, mediation, which is built upon the same estimation and inference method. In addition, users can determine the sample size required for achieving sufficient power based on power values calculated from a range of sample sizes. The method is applicable to a randomized or nonrandomized treatment, a mediator, and an outcome that can be either binary or continuous. I also provided sample size suggestions under various scenarios and a detailed guideline of app implementation to facilitate study designs.
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Affiliation(s)
- Xu Qin
- Department of Health and Human Development at the School of Education, University of Pittsburgh, 5312 Wesley W. Posvar Hall, 230 South Bouquet Street, Pittsburgh, PA, 15260, USA.
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Fuller BM, Driver BE, Roberts MB, Schorr CA, Thompson K, Faine B, Yeary J, Mohr NM, Pappal RD, Stephens RJ, Yan Y, Johnson NJ, Roberts BW. Awareness with paralysis and symptoms of post-traumatic stress disorder among mechanically ventilated emergency department survivors (ED-AWARENESS-2 Trial): study protocol for a pragmatic, multicenter, stepped wedge cluster randomized trial. Trials 2023; 24:753. [PMID: 38001507 PMCID: PMC10675941 DOI: 10.1186/s13063-023-07764-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 10/30/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND Awareness with paralysis (AWP) is memory recall during neuromuscular blockade (NMB) and can cause significant psychological harm. Decades of effort and rigorous trials have been conducted to prevent AWP in the operating room, where prevalence is 0.1-0.2%. By contrast, AWP in mechanically ventilated emergency department (ED) patients is common, with estimated prevalence of 3.3-7.4% among survivors given NMB. Longer-acting NMB use is a critical risk for AWP, and we have shown an association between ED rocuronium use and increased AWP prevalence. As NMB are given to more than 90% of ED patients during tracheal intubation, this trial provides a platform to test an intervention aimed at reducing AWP. The overall objective is to test the hypothesis that limiting ED rocuronium exposure will significantly reduce the proportion of patients experiencing AWP. METHODS This is a pragmatic, stepped wedge cluster randomized trial conducted in five academic EDs, and will enroll 3090 patients. Per the design, all sites begin in a control phase, under observational conditions. At 6-month intervals, sites sequentially enter a 2-month transition phase, during which we will implement the multifaceted intervention, which will rely on use of nudges and defaults to change clinician decisions regarding ED NMB use. During the intervention phase, succinylcholine will be the default NMB over rocuronium. The primary outcome is AWP, assessed with the modified Brice questionnaire, adjudicated by three independent, blinded experts. The secondary outcome is the proportion of patients developing clinically significant symptoms of post-traumatic stress disorder at 30 and 180 days after hospital discharge. We will also assess for symptoms of depression and anxiety, and health-related quality of life. A generalized linear model, adjusted for time and cluster interactions, will be used to compare AWP in control versus intervention phases, analyzed by intention-to-treat. DISCUSSION The ED-AWARENESS-2 Trial will be the first ED-based trial aimed at preventing AWP, a critical threat to patient safety. Results could shape clinical use of NMB in the ED and prevent more than 10,000 annual cases of AWP related to ED care. TRIAL REGISTRATION ClinicalTrials.gov identifier NCT05534243 . Registered 06, September 2022.
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Affiliation(s)
- Brian M Fuller
- Department of Anesthesiology, Division of Critical Care, Department of Emergency Medicine, Washington University in St. Louis School of Medicine, St. Louis, MO, 63110, USA.
| | - Brian E Driver
- Department of Emergency Medicine, Hennepin County Medical Center, 701 Park Avenue, Minneapolis, MN, 55415, USA
| | - Michael B Roberts
- Department of Institutional Research, Department of Psychology, Philadelphia College of Osteopathic Medicine, Rowland Hall, 514B, 4190 City Avenue, Philadelphia, PA, 19131, USA
| | - Christa A Schorr
- Cooper Research Institute, Cooper University Health Care, One Cooper Plaza, Dorrance, Camden, NJ, 08103, USA
| | - Kathryn Thompson
- Department of Emergency Medicine, University of Washington/Harborview Medical Center, 325 9th Avenue, Seattle, WA, 98104, USA
| | - Brett Faine
- Departments of Emergency Medicine and Pharmacy, Roy J. and Lucille A. Carver College of Medicine, University of Iowa College of Pharmacy, 200 Hawkins Drive, 1008 RCP, Iowa City, IA, 52242, USA
| | - Julianne Yeary
- Emergency Department, Charles F. Knight Emergency and Trauma Center, Barnes-Jewish Hospital, 1 Barnes Jewish Hospital Plaza, St. Louis, MO, 63110, USA
| | - Nicholas M Mohr
- Departments of Emergency Medicine and Anesthesiology, Division of Critical Care, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, 200 Hawkins Drive, 1008 RCP, Iowa City, IA, 52242, USA
| | - Ryan D Pappal
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA, 02215, USA
| | - Robert J Stephens
- Department of Medicine, Division of Critical Care Medicine, University of Maryland School of Medicine, 655 W. Baltimore Street, Baltimore, MD, 21201, USA
| | - Yan Yan
- Division of Public Health Sciences, Department of Surgery, Division of Biostatistics, Washington University School of Medicine, 418E, 2Nd Floor, 600 South Taylor Ave., St. Louis, MO, 63110, USA
| | - Nicholas J Johnson
- Departments of Emergency Medicine and Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington/Harborview Medical Center, 325 9th Avenue, Seattle, WA, 98104, USA
| | - Brian W Roberts
- Department of Emergency Medicine, Cooper Medical School of Rowan University, One Cooper Plaza, K152, Camden, NJ, 08103, USA
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Nishi Y, Osumi M, Morioka S. Anticipatory postural adjustments mediate the changes in fear-related behaviors in individuals with chronic low back pain. Scand J Pain 2023; 23:580-587. [PMID: 36437116 DOI: 10.1515/sjpain-2022-0078] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 11/10/2022] [Indexed: 07/21/2023]
Abstract
OBJECTIVES The role(s) of anticipatory postural adjustments (APAs) in changes in subsequent motor and postural controls in response to movement perturbations are unclear in individuals with chronic low back pain (CLBP). This study aimed to clarify the relationships among kinesiophobia, APAs, lumbar kinematic output, and postural control associated with lumbar movement in individuals with CLBP. METHODS CLBP participants (n=48) and healthy controls (HCs) without CLBP (n=22) performed a bend-forward task using their lumbar region on a force platform and returned upright. Each participant's lumbar movements were recorded using an electrogoniometer. We calculated the APA duration, the duration of lumbar direction changes from forward to backward, and the center of pressure (COP) position after lumbar movement tasks completion. RESULTS Compared with the HCs, the duration of direction changes in lumbar movement and the APA duration in CLBP participants were prolonged, and the COP position was shifted forward. The mediation analysis revealed that the duration of lumbar direction changes in the CLBP group was subjected to a significant indirect effect of APAs and a direct effect of kinesiophobia, and the COP position was subjected to a significant indirect effect of kinesiophobia through APAs. CONCLUSIONS APAs partially mediate the relationship between kinesiophobia and changes in lumbar motor control and mediate the relationship between kinesiophobia and postural control in response to movement perturbations. These findings expand our understanding of APAs in altered subsequent movement and postural controls due to kinesiophobia in individuals with CLBP.
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Affiliation(s)
- Yuki Nishi
- Institute of Biomedical Sciences (Health Sciences) , Nagasaki University , Nagasaki, Japan
- Neurorehabilitation Research Center, Kio University, Nara, Japan
| | - Michihiro Osumi
- Neurorehabilitation Research Center, Kio University, Nara, Japan
| | - Shu Morioka
- Neurorehabilitation Research Center, Kio University, Nara, Japan
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10
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Najberg H, Mouthon M, Coppin G, Spierer L. Reduction in sugar drink valuation and consumption with gamified executive control training. Sci Rep 2023; 13:10659. [PMID: 37391448 PMCID: PMC10313656 DOI: 10.1038/s41598-023-36859-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 06/13/2023] [Indexed: 07/02/2023] Open
Abstract
The overvaluation of high-energy, palatable food cues contributes to unhealthy eating and being overweight. Reducing the valuation of unhealthy food may thus constitute a powerful lever to improve eating habits and conditions characterized by unhealthy eating. We conducted a double-blind, placebo-controlled, randomized intervention trial assessing the efficacy of a five to twenty days online cognitive training intervention to reduce sugary drink perceived palatability and consumption. Our intervention involved a recently identified action-to-valuation mechanism of action, in which the repeated inhibition of prepotent motor responses to hedonic food cues in a Go/NoGo (GNG) and an attentional bias modification (ABM) task eventually reduces their valuation and intake. Confirming our hypotheses, the experimental intervention with consistent (100%) mapping between motor inhibition and the targeted unhealthy sugary drinks cues induced a larger decrease in their valuation than the control intervention with inconsistent (50%) mapping (- 27.6% vs. - 19%), and a larger increase of the (water) items associated with response execution (+ 11% vs + 4.2%). Exploratory analyses suggest that the effect of training on unhealthy items valuation may persist for at least one month. Against our hypothesis, we observed equivalent reductions in self-reported consumption of sugary drinks following the two interventions (exp: - 27% vs. ctrl: - 19%, BF01 = 4.7), suggesting a dose-independent effect of motor inhibition on self-reported consumption. Our collective results corroborate the robustness and large size of the devaluation effects induced by response inhibition on palatable items, but challenge the assumption of a linear relationship between such effects and the actual consumption of the target items. PROTOCOL REGISTRATION: The stage 1 protocol for this Registered Report was accepted in principle on 30/03/2021. The protocol, as accepted by the journal, can be found at: https://doi.org/10.17605/OSF.IO/5ESMP .
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Affiliation(s)
- Hugo Najberg
- Laboratory for Neurorehabilitation Science, Medicine Section, Faculty of Science and Medicine, University of Fribourg, 1700, Fribourg, Switzerland
| | - Michael Mouthon
- Laboratory for Neurorehabilitation Science, Medicine Section, Faculty of Science and Medicine, University of Fribourg, 1700, Fribourg, Switzerland
| | - Géraldine Coppin
- UniDistance Suisse, Schinerstrasse 18, 3900, Brigue, Switzerland
- Swiss Center for Affective Sciences, University of Geneva, 1205, Genève, Switzerland
| | - Lucas Spierer
- Laboratory for Neurorehabilitation Science, Medicine Section, Faculty of Science and Medicine, University of Fribourg, 1700, Fribourg, Switzerland.
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11
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Cachay ER, Moges TS, Qin H, Bamford L, Grelotti DJ, Mathews WC. Effects of drug and hazardous alcohol use on having a detectable HIV viral load: An adherence mediation analysis. Addict Behav Rep 2023; 17:100486. [PMID: 36950716 PMCID: PMC10025983 DOI: 10.1016/j.abrep.2023.100486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 02/27/2023] [Accepted: 03/07/2023] [Indexed: 03/14/2023] Open
Abstract
Objectives People living with HIV (PWH) with substance or alcohol use often have unsuppressed plasma HIV viral loads (pVL). The degree to which substance and alcohol use effects on HIV viral suppression are mediated through medication nonadherence is incompletely understood. Methods We included PWH prescribed antiretroviral therapy and receiving care at an academic HIV clinic between 2014 and 2018 who completed both patient-reported outcomes (PRO) questionnaires and had subsequent pVL measurements. Measures included assessments of alcohol use (AUDIT-C), drug use (NIDA-ASSIST), and self-reported adherence measured using four different methods. Substances found in bivariate analysis to predict detectable pVL were modeled separately for mediation effects through adherence. We report natural direct (NDE) and indirect effect (NIE), marginal total effect (MTE), and percentage mediated. Results Among 3125 PWH who met eligibility criteria, 25.8% reported hazardous alcohol use, 27.1% cannabis, 13.1% amphetamines, 1.9% inhalants, 5.3% cocaine, 4.5% sedative-hypnotics, 2.9% opioids, and 2.3% hallucinogens. Excellent adherence was reported by 58% of PWH, and 10% had detectable pVL. Except for sedatives, using other substances was significantly associated with worse adherence. Bivariate predictors of detectable pVL were [OR (95% CI)]: amphetamine use 2.4 (1.8-3.2) and opioid use 2.3 (1.3-4.0). The percent of marginal total effect mediated by nonadherence varied by substance: 36% for amphetamine use, 27% for opioid use, and 39% for polysubstance use. Conclusion Use of amphetamines, opioids, and multiple substances predicted detectable pVL. Up to 40% of their effects were mediated by self-reported nonadherence. Confirmation using longitudinal measurement models will strengthen causal inference from this cross-sectional analysis.
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Affiliation(s)
- Edward R. Cachay
- Department of Medicine, Division of Infectious Disease and Global Public Health, Owen Clinic, UC San Diego School of Medicine, United States
- Corresponding authors at: University of California San Diego, 200 W Arbor Drive, San Diego, CA 92103-8681, USA (E. Cachay). 4168 Front St., 3rd floor, San Diego, CA 92103, USA (W.C. Mathews).
| | - Tesfaye S. Moges
- Department of Medicine, Division of Infectious Disease and Global Public Health, Owen Clinic, UC San Diego School of Medicine, United States
| | - Huifang Qin
- Department of Medicine, Division of Infectious Disease and Global Public Health, Owen Clinic, UC San Diego School of Medicine, United States
| | - Laura Bamford
- Department of Medicine, Division of Infectious Disease and Global Public Health, Owen Clinic, UC San Diego School of Medicine, United States
| | - David J. Grelotti
- HIV Neurobehavioral Research Program, Department of Psychiatry, UC San Diego School of Medicine, United States
| | - Wm. Christopher Mathews
- Department of Medicine, Division of Infectious Disease and Global Public Health, Owen Clinic, UC San Diego School of Medicine, United States
- Corresponding authors at: University of California San Diego, 200 W Arbor Drive, San Diego, CA 92103-8681, USA (E. Cachay). 4168 Front St., 3rd floor, San Diego, CA 92103, USA (W.C. Mathews).
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12
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van Houwelingen G, van Dijke M. Investing to gain others' trust: Cognitive abstraction increases prosocial behavior and trust received from others. PLoS One 2023; 18:e0284500. [PMID: 37058512 PMCID: PMC10104375 DOI: 10.1371/journal.pone.0284500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 04/03/2023] [Indexed: 04/15/2023] Open
Abstract
Being trusted has many positive implications for one's wellbeing (e.g., a better career, more satisfying interpersonal relationships). Scholars have suggested that people actively attempt to earn trust. However, it is not clear what makes people invest in actions that may earn them trust. We propose that cognitive abstraction (more than concreteness) facilitates seeing the long-term benefits of performing behaviors (i.e., prosocial behaviors) for gaining trust. We conducted a survey among employees and their supervisors and two yoked experiments-total N = 1098 or 549 pairs. In support of our claim, we find that cognitive abstraction leads to more prosocial behavior, which subsequently increases trust received. Furthermore, the effect of abstraction on the performance of prosocial behavior is limited to situations where such behavior can be observed by others (and thus be a basis for gaining observers' trust). Our research shows when and why people decide to act in ways that may gain them trust and clarifies how cognitive abstraction influences the display of prosocial behavior and the subsequent trust received from fellow organization members.
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Affiliation(s)
- Gijs van Houwelingen
- Faculty of Economics and Business, University of Amsterdam, Amsterdam, the Netherlands
| | - Marius van Dijke
- Rotterdam School of Management, Erasmus University Rotterdam, Rotterdam, the Netherlands & Nottingham Business School, Nottingham Trent University, Nottingham, United Kingdom
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13
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Lina M, Yang L, Qing G. The mediating effect of achievement motivation on mindfulness and procrastination behavior of nursing students: A correlational study. Medicine (Baltimore) 2023; 102:e33327. [PMID: 36961165 PMCID: PMC10035994 DOI: 10.1097/md.0000000000033327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 02/28/2023] [Indexed: 03/25/2023] Open
Abstract
Procrastination behavior is prevalent among nursing students in China. However, little research has examined how mindfulness is associated with procrastination behavior, via achievement motivation among nursing students. The aims of this study were to investigate the relationship between procrastination behavior, mindfulness and achievement motivation, and explore the mediating effect of achievement motivation on mindfulness and procrastination behavior of nursing students. A correlational cross-sectional study was performed using an online questionnaire. The study was conducted from January to March 2022 among 632 students from 1 university. A general information questionnaire, Achievement Motivation Scale, Five Facet Mindfulness Questionnaire and General Procrastination Scale (GPS) were used for investigation. Calculations were performed using SPSS Statistics, version 25. Descriptive statistics, correlation, and process plug-in mediation effect analyses were used to analyze the data. A total of 640 questionnaires were issued and 632 valid questionnaires were finally recovered, with an effective recovery rate of 98.75%. The GPS score of 632 nursing undergraduates was (55.80 ± 6.57), achievement motivation scale score was (-2.49 ± 8.73), Five Facet Mindfulness Questionnaire score was (118.21 ± 18.39). Achievement motivation and psychological capital were all negatively correlated with procrastination behavior (r = -0.291, -0.483; P < .01). Achievement motivation played a partial mediating role between mindfulness and procrastination behavior, and the mediating effect accounted for 59.82% of the total effect. The procrastination behavior of nursing undergraduates is at the middle level. Mindfulness can influence procrastination behavior through achievement motivation. Measures are needed to decrease the procrastination behavior by developing mindfulness programs to increase their achievement motivation.
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Affiliation(s)
- Meng Lina
- Department of Nursing, Harbin Medical University, Daqing, China
| | - Li Yang
- Department of Nursing, Harbin Medical University, Daqing, China
| | - Guan Qing
- Department of Education, Harbin Medical University, Daqing, China
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14
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Spivak-Lavi Z, Latzer Y, Katz R. The role of mothers' involvement in their daughters' self-esteem and dieting behaviors. Health Care Women Int 2023; 45:512-536. [PMID: 36947584 DOI: 10.1080/07399332.2023.2183205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 02/17/2023] [Indexed: 03/23/2023]
Abstract
This study presents an initial effort to develop disordered eating pathology (DEP) prevention program with an emphasis on maternal involvement. Disordered eating pathology representing a range of behaviors and attitudes, from negative body image to full-blown eating disorder. It appears mainly in adolescent females and related to psychological and familial factors, including maternal modeling of thinness. A sample of 118 Israeli girls (11-12) was divided into three groups: participants in the program in parallel with their mothers, participants without their mothers, and control. Participants completed self-report questionnaires. Groups were tested three times: pre-intervention, post-intervention, and follow-up. For those girls who participated in parallel with their mothers, higher self-esteem was associated with fewer pathological diet behaviors. Findings deepen understanding of the risk factors involved in the development of DEP. The main study contribution is the important role mothers play in preventing DEP among their daughters.
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Affiliation(s)
- Zohar Spivak-Lavi
- Department of Social Work, Yezreel Valley College, Emek Yezreel, Israel
| | - Yael Latzer
- Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
- Eating Disorders Institution, Psychiatric Division, Rambam Health Care Campus, Haifa, Israel
| | - Ruth Katz
- Department of Human Services, Yezreel Valley College, Emek Yezreel, Israel
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15
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YuYu L, Shan Z, JingJun P. The mediating effect of mindfulness on demoralization syndrome and quality of life of thyroid cancer patients: A correlational study. Medicine (Baltimore) 2023; 102:e32719. [PMID: 36800585 PMCID: PMC9936027 DOI: 10.1097/md.0000000000032719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/19/2023] Open
Abstract
Demoralization syndrome is prevalence among cancer patients in China. However, little research has examined how demoralization syndrome is associated with quality of life (QOL). The aims of this study were to investigate the relationship between mindfulness state, demoralization syndrome and QOL of thyroid cancer patients, and explore the mediating effect of mindfulness on demoralization syndrome and QOL. A correlational cross-sectional study was performed using an online questionnaire. The study was conducted from July to October 2022 among 310 thyroid cancer patients. General information questionnaire, the Demoralization Scale, Five Facet Mindfulness Questionnaire, short form health survey questionnaire were used for investigation. Calculations were performed using SPSS Statistics, version 25. Descriptive statistics, correlation, and process plug-in mediation effect analyses were used to analyze the data. A total of 310 valid questionnaires were finally recovered. The Five Facet Mindfulness Questionnaire score of 310 patients was (120.80 ± 16.57), Demoralization Scale score was (12.49 ± 4.73), short form health survey questionnaire score was (146.15 ± 28.46). Mindfulness played a partial mediating role between demoralization syndrome and QOL of thyroid cancer patients, and the mediating effect accounted for 68.57% of the total effect. Demoralization syndrome can influence QOL through mindfulness state. Measures are needed to increase the QOL of thyroid cancer patients by developing mindfulness programs to decrease their demoralization syndrome.
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Affiliation(s)
- Li YuYu
- Department of Thyroid, Guangzhou Hospital, Guangdong, China
| | - Zhao Shan
- Department of Thyroid, Guangzhou Hospital, Guangdong, China
| | - Peng JingJun
- Department of Thyroid, Guangzhou Hospital, Guangdong, China
- * Correspondence: Peng JingJun, Department of Thyroid, Guangzhou Hospital, No.106 Zhongshan Second Road, Yuexiu District, Guangzhou, Guangdong Province 150000, China (e-mail: )
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Contribution of intraoperative electroencephalogram suppression to frailty-associated postoperative delirium: mediation analysis of a prospective surgical cohort. Br J Anaesth 2023; 130:e263-e271. [PMID: 36503826 DOI: 10.1016/j.bja.2022.11.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 11/02/2022] [Accepted: 11/04/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Frailty is a risk factor for postoperative delirium (POD), and has led to preoperative interventions that have reduced, but not eliminated, the risk. We hypothesised that EEG suppression, another risk factor for POD, mediates some of the frailty risk for POD. METHODS A prospective cohort study enrolled patients aged 65 yr or older, scheduled for noncardiac surgery under total intravenous anaesthesia. Frailty was assessed using the FRAIL scale. Cumulative duration of EEG suppression, defined as an amplitude between -5 and 5 μV for >0.5 s during anaesthesia, was measured. POD was diagnosed by either confusion assessment method (CAM), CAM-ICU, or medical records. The severity of POD was assessed using the Delirium Rating Scale - Revised-98 (DRS). Mediation analysis was used to estimate the relationships between frailty, EEG suppression, and severity of POD. RESULTS Among 252 enrolled patients, 51 were robust, 129 were prefrail, and 72 were frail. Patients classified as frail had higher duration of EEG suppression than either the robust (19 vs 0.57 s, P<0.001) or prefrail groups (19 vs 3.22 s, P<0.001). Peak delirium score was higher in the frail group than either the robust (17 vs 15, P<0.001) or prefrail groups (17 vs 16, P=0.007). EEG suppression time mediated 24.2% of the frailty-DRS scores association. CONCLUSION EEG suppression time mediated a statistically significant portion of the frailty-POD association in older noncardiac surgery patients. Trials directed at reducing EEG suppression time could result in intraoperative interventions to reduce POD in frail patients. CLINICAL TRIAL REGISTRATION ChiCTR2000041092 (Chinese Clinical Trial Registry).
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17
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Ma JH, Liu YF, Hong H, Li CJ, Cui F, Mu DL, Wang DX. Effect of acute pain on the association between preoperative cognitive impairment and postoperative delirium: a secondary analysis of three trials. Br J Anaesth 2023; 130:e272-e280. [PMID: 35933172 DOI: 10.1016/j.bja.2022.06.033] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 05/25/2022] [Accepted: 06/18/2022] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The association between preoperative cognitive impairment, postoperative pain, and postoperative delirium in older patients after noncardiac surgery is not known. METHODS This was a secondary analysis of datasets from three previous studies. Patients aged ≥55 yr who underwent elective noncardiac surgery were enrolled. Preoperative cognitive impairment was defined as Mini-Mental State Examination <27. Pain intensity with movement was assessed using an 11-point numeric rating scale at 12-h intervals during the first 72 h after surgery; time-weighted average (TWA) pain score was calculated. Primary outcome was the occurrence of delirium within the first 5 postoperative days. Mediation analysis was used to investigate the relationships between cognitive impairment, pain score, and delirium. RESULTS A total of 1497 patients were included. Prevalence of preoperative cognitive impairment was 40.3% (603/1497). Patients with cognitive impairment suffered higher TWA pain score within 72 h (4 [3-5] vs 3 [2-5], P=0.004) and more delirium within 5 days (12.9% [78/603] vs 4.9% [44/894], P<0.001) when compared with those without. Total and direct associations between cognitive impairment and delirium were (adjusted β) 8.3% (95% confidence interval [CI], 4.8-12.0%; P<0.001) and 7.8% (95% CI, 4.4-12.0%; P<0.001), respectively. A significant indirect association with acute pain was observed between cognitive impairment and delirium (adjusted β=0.4%; 95% CI, 0.1-1.0%; P=0.006), accounting for 4.9% of the total effect. CONCLUSIONS The association between preoperative cognitive impairment and delirium is significantly mediated by acute pain in patients after noncardiac surgery. Considering the small effect size, clinical significance of this mediation effect requires further investigation.
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Affiliation(s)
- Jia-Hui Ma
- Department of Anesthesiology, Peking University First Hospital, Beijing, China
| | - Ya-Fei Liu
- Department of Anesthesiology, Peking University First Hospital, Beijing, China
| | - Hong Hong
- Department of Anesthesiology, Peking University First Hospital, Beijing, China
| | - Chun-Jing Li
- Department of Anesthesiology, Peking University First Hospital, Beijing, China
| | - Fan Cui
- Department of Anesthesiology, Peking University First Hospital, Beijing, China
| | - Dong-Liang Mu
- Department of Anesthesiology, Peking University First Hospital, Beijing, China.
| | - Dong-Xin Wang
- Department of Anesthesiology, Peking University First Hospital, Beijing, China; Outcomes Research Consortium, Cleveland, OH, USA
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AIM2ACT: Randomized controlled trial protocol for a mobile health intervention for early adolescents with asthma. Contemp Clin Trials 2022; 123:107011. [PMID: 36396068 PMCID: PMC10071332 DOI: 10.1016/j.cct.2022.107011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 11/10/2022] [Accepted: 11/11/2022] [Indexed: 11/16/2022]
Abstract
Early adolescents diagnosed with asthma have difficulties consistently performing disease self-management behaviors, placing them at-risk for poor asthma control, morbidity, and reduced quality of life. Helpful caregiver support is pivotal in determining whether early adolescents develop and master asthma self-management behaviors. We developed Applying Interactive Mobile health to Asthma Care in Teens (AIM2ACT), a mobile health intervention to facilitate helpful caregiver support in early adolescents (12-15 year-olds) with poorly controlled asthma. AIM2ACT is a dyadic smartphone intervention that contains three components: 1) ecological momentary assessment to identify personalized strengths and weaknesses in asthma self-management behaviors; 2) collaborative identification and tracking of goals that help early adolescents to become increasingly independent in managing their asthma; and 3) a suite of skills training videos. This paper describes our plans to test the efficacy of AIM2ACT and evaluate long-term maintenance of treatment effects in a fully powered randomized controlled trial with 160 early adolescents with poorly controlled persistent asthma, ages 12-15 years, and a caregiver. Families will be randomly assigned to receive AIM2ACT (n = 80) or a mHealth attention control condition (n = 80) that accounts for attention and novelty of a technology-based intervention for 6 months. Assessments will occur at baseline, post-intervention, and 3-, 6-, and 12-month follow-up time points. We will collect patient-reported and objectively monitored (e.g., spirometry, adherence) outcomes. Given the timing of the trial, a secondary exploratory goal is to evaluate the perceived impact of COVID-19 on family functioning and parental control of their adolescent's asthma in the context of our intervention.
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Huizar YP, Cundiff JM, Schmidt AT, Cribbet MR. Risky Early Family Environment and Genetic Associations with Adult Metabolic Dysregulation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14032. [PMID: 36360915 PMCID: PMC9656925 DOI: 10.3390/ijerph192114032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 10/19/2022] [Accepted: 10/22/2022] [Indexed: 06/16/2023]
Abstract
Growing up in a family environment characterized by neglectful parenting, overt conflict, and unsupportive relationships is associated with poor health in adulthood. A risky early family environment may also be associated with obesity in adulthood, likely through the activation of the HPA axis. Likewise, the GABAergic (gamma-aminobutyric acid) T>C single nucleotide polymorphism in the 1519 nucleotide position of the GABAAα6 receptor subunit gene has been associated with a predisposition to a higher body mass index and a larger waist circumference. Participants (n = 213, Mage = 30.13 years, SD = 10.85; 57.7% men) from the Pittsburgh Cold Study 3 completed a demographic questionnaire, the Risky Families Questionnaire (RFQ) and had their height, weight, and waist circumference measured during a physical exam. Participant DNA was recovered from buccal swabs and genotyped for the various allelic types of the SNP according to published protocols. In secondary data analyses, we tested the hypothesis that early family environment and GABRA6 would be positively associated with body mass index and waist circumference. We also examined diurnal cortisol as a mechanism linking both early risky family environment and GABRA6 to metabolic outcomes. The findings provide evidence that a risky early family environment may exert more influence than genetic predisposition when determining the indices of metabolic health in adulthood.
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Affiliation(s)
- Yazmine P. Huizar
- Department of Psychology, Texas Tech University, Lubbock, TX 79409, USA
| | - Jenny M. Cundiff
- Department of Psychology, University of Alabama, 348 Gordon Palmer Hall, Box 870348, Tuscaloosa, AL 35487, USA
| | - Adam T. Schmidt
- Department of Psychology, Texas Tech University, Lubbock, TX 79409, USA
| | - Matthew R. Cribbet
- Department of Psychology, University of Alabama, 348 Gordon Palmer Hall, Box 870348, Tuscaloosa, AL 35487, USA
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Ackerman A. The effect of combat exposure on sexually transmitted diseases. ECONOMICS AND HUMAN BIOLOGY 2022; 46:101142. [PMID: 35525101 DOI: 10.1016/j.ehb.2022.101142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 04/14/2022] [Accepted: 04/19/2022] [Indexed: 06/14/2023]
Abstract
Traumatic exposures can affect beliefs and behaviors related to the spread of sexually transmitted diseases (STDs), a persistent public health problem. I leverage a natural experiment created by variation in US military deployment location assignments to estimate how combat exposure changes a surviving deployed male veteran's probability of acquiring a sexually transmitted disease. I analyze longitudinal data from 1994 to 2008 on 485 deployed veterans with information theoretic methods to reduce the sensitivity of estimates to small samples, an infrequently observed outcome, and highly correlated covariates. For veterans assigned to a combat zone, I estimate combat exposure results in a 5.4 percentage point increase in the probability of acquiring an STD. Additional estimations provide evidence suggesting risky behaviors involving substance use or multiple sexual partners may serve as pathways from combat exposure to STDs. My results are relevant to discussions regarding STD screening and care needs for trauma exposed individuals.
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Affiliation(s)
- Adam Ackerman
- American University, Department of Economics, Kreeger Building, Washington DC 20016, USA.
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Hyer S, Hu W, Hu M, Davis JW, Xie R, Giurgescu C. Relationship with the Father of the Baby and Pregnancy-Related Anxiety among Pregnant Black Women. MCN Am J Matern Child Nurs 2022; 47:213-219. [PMID: 35352688 PMCID: PMC9232922 DOI: 10.1097/nmc.0000000000000830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
PURPOSE Pregnancy-related anxiety may increase the risk of preterm birth. Effective coping strategies and social support may help minimize pregnancy-related anxiety. STUDY DESIGN Secondary analysis of cross-sectional data. METHODS A sample of 408 pregnant non-Hispanic Black women completed questionnaires between 19 and 31 weeks gestation. Mediation analysis with structural equation modeling was used to explore effects of the relationship with the father of the baby on pregnancy-related anxiety. RESULTS Support from the father of the baby was negatively associated with avoidance coping ( r = -.22, p < .001) and pregnancy-related anxiety ( r = - .17, p < .001), whereas conflict with the father of the baby was positively associated with avoidance coping ( r = .37, p < .001) and pregnancy-related anxiety ( r = .29, p < .001). Avoidance coping was positively associated with pregnancy-related anxiety ( r = .34, p < .001). After adjustment, avoidance coping partially mediated the effect of conflict with the father of the baby on pregnancy-related anxiety. CLINICAL IMPLICATIONS Discussions with women about management of pregnancy-related anxiety should consider her current social support and coping mechanisms. Providers should offer support and resources on adaptive coping strategies.
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22
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Gwadz M, Cleland CM, Lizardo M, Hawkins RL, Bangser G, Parameswaran L, Stanhope V, Robinson JA, Karim S, Hollaway T, Ramirez PG, Filippone PL, Ritchie AS, Banfield A, Silverman E. Using the multiphase optimization strategy (MOST) framework to optimize an intervention to increase COVID-19 testing for Black and Latino/Hispanic frontline essential workers: A study protocol. BMC Public Health 2022; 22:1235. [PMID: 35729622 PMCID: PMC9210062 DOI: 10.1186/s12889-022-13576-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 06/02/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Among those at highest risk for COVID-19 exposure is the large population of frontline essential workers in occupations such food service, retail, personal care, and in-home health services, among whom Black and Latino/Hispanic persons are over-represented. For those not vaccinated and at risk for exposure to COVID-19, including frontline essential workers, regular (approximately weekly) COVID-19 testing is recommended. However, Black and Latino/Hispanic frontline essential workers in these occupations experience serious impediments to COVID-19 testing at individual/attitudinal- (e.g., lack of knowledge of guidelines), social- (e.g., social norms), and structural-levels of influence (e.g., poor access), and rates of testing for COVID-19 are insufficient. METHODS/DESIGN The proposed community-engaged study uses the multiphase optimization strategy (MOST) framework and an efficient factorial design to test four candidate behavioral intervention components informed by an integrated conceptual model that combines critical race theory, harm reduction, and self-determination theory. They are A) motivational interview counseling, B) text messaging grounded in behavioral economics, C) peer education, and D) access to testing (via navigation to an appointment vs. a self-test kit). All participants receive health education on COVID-19. The specific aims are to: identify which components contribute meaningfully to improvement in the primary outcome, COVID-19 testing confirmed with documentary evidence, with the most effective combination of components comprising an "optimized" intervention that strategically balances effectiveness against affordability, scalability, and efficiency (Aim 1); identify mediators and moderators of the effects of components (Aim 2); and use a mixed-methods approach to explore relationships among COVID-19 testing and vaccination (Aim 3). Participants will be N = 448 Black and Latino/Hispanic frontline essential workers not tested for COVID-19 in the past six months and not fully vaccinated for COVID-19, randomly assigned to one of 16 intervention conditions, and assessed at 6- and 12-weeks post-baseline. Last, N = 50 participants will engage in qualitative in-depth interviews. DISCUSSION This optimization trial is designed to yield an effective, affordable, and efficient behavioral intervention that can be rapidly scaled in community settings. Further, it will advance the literature on intervention approaches for social inequities such as those evident in the COVID-19 pandemic. TRIAL REGISTRATION ClinicalTrials.gov: NCT05139927 ; Registered on 11/29/2021. Protocol version 1.0. May 2, 2022, Version 1.0.
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Affiliation(s)
- Marya Gwadz
- Intervention Innovations Team Lab (IIT-Lab), NYU Silver School of Social Work, 1 Washington Square North, New York, NY, 10003, USA.
- Center for Drug Use and HIV Research (CDUHR), NYU School of Global Public Health, 708 Broadway, New York, NY, 10003, USA.
| | - Charles M Cleland
- Center for Drug Use and HIV Research (CDUHR), NYU School of Global Public Health, 708 Broadway, New York, NY, 10003, USA
- Division of Biostatistics, Department of Population Health at NYU Grossman School of Medicine, 180 Madison Ave, New York, NY, 10016, USA
| | - Maria Lizardo
- Northern Manhattan Improvement Corporation (NMIC), 45 Wadsworth Avenue, New York, NY, 10033, USA
| | - Robert L Hawkins
- Intervention Innovations Team Lab (IIT-Lab), NYU Silver School of Social Work, 1 Washington Square North, New York, NY, 10003, USA
| | - Greg Bangser
- Northern Manhattan Improvement Corporation (NMIC), 45 Wadsworth Avenue, New York, NY, 10033, USA
| | - Lalitha Parameswaran
- Department of Medicine, NYU Grossman School of Medicine, New York, NY, 10016, USA
| | - Victoria Stanhope
- Intervention Innovations Team Lab (IIT-Lab), NYU Silver School of Social Work, 1 Washington Square North, New York, NY, 10003, USA
| | - Jennifer A Robinson
- Intervention Innovations Team Lab (IIT-Lab), NYU Silver School of Social Work, 1 Washington Square North, New York, NY, 10003, USA
| | - Shristi Karim
- Intervention Innovations Team Lab (IIT-Lab), NYU Silver School of Social Work, 1 Washington Square North, New York, NY, 10003, USA
| | - Tierra Hollaway
- Intervention Innovations Team Lab (IIT-Lab), NYU Silver School of Social Work, 1 Washington Square North, New York, NY, 10003, USA
| | - Paola G Ramirez
- Intervention Innovations Team Lab (IIT-Lab), NYU Silver School of Social Work, 1 Washington Square North, New York, NY, 10003, USA
| | - Prema L Filippone
- Intervention Innovations Team Lab (IIT-Lab), NYU Silver School of Social Work, 1 Washington Square North, New York, NY, 10003, USA
| | - Amanda S Ritchie
- Intervention Innovations Team Lab (IIT-Lab), NYU Silver School of Social Work, 1 Washington Square North, New York, NY, 10003, USA
| | | | - Elizabeth Silverman
- SUNY Research Foundation, Downstate Medical Center, 450 Clarkson Ave, Brooklyn, NY, 11203, USA
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23
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Schneider JM, Abel AD, Maguire MJ. Vocabulary knowledge and reading comprehension account for SES-differences in how school-aged children infer word meanings from sentences. LANGUAGE LEARNING AND DEVELOPMENT : THE OFFICIAL JOURNAL OF THE SOCIETY FOR LANGUAGE DEVELOPMENT 2022; 19:369-385. [PMID: 37771762 PMCID: PMC10530852 DOI: 10.1080/15475441.2022.2081573] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/30/2023]
Abstract
Socioeconomic status (SES)-related language gaps are known to widen throughout the course of the school years; however, not all children from lower SES homes perform worse than their higher SES peers on measures of language. The current study uses mediation and moderated mediation to examine how cognitive and language abilities (vocabulary, reading, phonological processing, working memory) account for individual differences in a children's ability to infer a novel word's meaning, a key component in word learning, in school-aged children from varying SES backgrounds. Vocabulary and reading comprehension mediated the relationship between SES and accuracy when inferring word meanings. The relationship between SES, vocabulary, and inferring word meaning was moderated by age, such that the influence of vocabulary on task performance was strongest in young children. The reading pathway did not interact with age effects, indicating reading is an important contributor to SES-related differences in how children infer a word's meaning throughout grade school. These findings highlight different paths by which children's trajectories for inferring word meanings may be impacted.
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Affiliation(s)
- J M Schneider
- Louisiana State University, 217 Thomas Boyd Hall, Baton Rouge, LA 70803
| | - A D Abel
- San Diego State University, 5500 Campanile Dr, San Diego, CA 92182 United States
| | - M J Maguire
- The University of Texas at Dallas, 1966 Inwood Rd., Dallas, TX 75235, United States
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24
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McCleary N, Ivers NM, Schwalm JD, Witteman HO, Taljaard M, Desveaux L, Bouck Z, Grace SL, Grimshaw JM, Presseau J. Impacts of two behavior change interventions on determinants of medication adherence: process evaluation applying the health action process approach and habit theory alongside a randomized controlled trial. J Behav Med 2022; 45:659-673. [PMID: 35596020 DOI: 10.1007/s10865-022-00327-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 04/22/2022] [Indexed: 10/18/2022]
Abstract
Investigating the mechanisms of behavior change interventions provides a more fulsome understanding of how and why interventions work (or don't work). We assessed mechanisms of two interventions (mailouts alone, and mailouts plus telephone support, informed by the Health Action Process Approach (HAPA) and Habit Theory), designed to increase medication adherence after myocardial infarction. We conducted a process evaluation alongside a pragmatic trial. Medication adherence was assessed via self-report at 12-months in the trial, and participants in all trial groups were invited to contemporaneously complete an additional questionnaire assessing targeted mechanisms (HAPA constructs and automaticity). We used multiple regression-based mediation models to investigate indirect effects. Of 589 respondents, 497 were analyzed (92 excluded due to missing data). Mailouts plus telephone support had statistically significant but small effects on intention, social support, action planning, coping planning, and automaticity. There were no indirect effects of interventions on medication adherence via these constructs. Therefore, while this intervention led to changes in proposed mechanisms, these changes were not great enough to lead to behavior change. Refinements (and subsequent evaluation) of the interventions are warranted, and our findings indicate that this could involve offering more intensive support to form plans and identify cues for taking medications, in addition to providing physical supports to encourage self-monitoring, feedback, and habit formation. Trial registration: ClinicalTrials.gov: NCT02382731.
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Affiliation(s)
- Nicola McCleary
- Centre for Implementation Research, Clinical Epidemiology Program, Ottawa Hospital Research Institute, The Ottawa Hospital - General Campus, 501 Smyth Road, K1H 8L6, Ottawa, Ontario, Canada. .,School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada.
| | - Noah M Ivers
- Department of Family and Community Medicine, Women's College Hospital, Toronto, ON, Canada.,Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,ICES, Toronto, ON, Canada.,Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
| | - J-D Schwalm
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, ON, Canada.,Department of Medicine, Division of Cardiology, Hamilton Health Sciences and McMaster University, Hamilton, ON, Canada
| | - Holly O Witteman
- Centre for Implementation Research, Clinical Epidemiology Program, Ottawa Hospital Research Institute, The Ottawa Hospital - General Campus, 501 Smyth Road, K1H 8L6, Ottawa, Ontario, Canada.,Department of Family and Emergency Medicine, Laval University, Québec City, QC, Canada
| | - Monica Taljaard
- Centre for Implementation Research, Clinical Epidemiology Program, Ottawa Hospital Research Institute, The Ottawa Hospital - General Campus, 501 Smyth Road, K1H 8L6, Ottawa, Ontario, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Laura Desveaux
- Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada.,Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada
| | - Zachary Bouck
- Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
| | - Sherry L Grace
- Faculty of Health, York University, Toronto, ON, Canada.,KITE Research Institute, University Health Network, Toronto, ON, Canada
| | - Jeremy M Grimshaw
- Centre for Implementation Research, Clinical Epidemiology Program, Ottawa Hospital Research Institute, The Ottawa Hospital - General Campus, 501 Smyth Road, K1H 8L6, Ottawa, Ontario, Canada.,Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Justin Presseau
- Centre for Implementation Research, Clinical Epidemiology Program, Ottawa Hospital Research Institute, The Ottawa Hospital - General Campus, 501 Smyth Road, K1H 8L6, Ottawa, Ontario, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada.,School of Psychology, University of Ottawa, Ottawa, ON, Canada
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25
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Chrisman SPD, Bollinger BJ, Mendoza JA, Palermo TM, Zhou C, Brooks MA, Rivara FP. Mobile Subthreshold Exercise Program (MSTEP) for concussion: study protocol for a randomized controlled trial. Trials 2022; 23:355. [PMID: 35473570 PMCID: PMC9040347 DOI: 10.1186/s13063-022-06239-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 03/27/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Subthreshold exercise, defined as aerobic exercise below the level that causes symptoms, has been utilized as a treatment for youth with persistent postconcussive symptoms (PPCS), but there is currently little evidence to guide use. In addition, prior studies of exercise for PPCS have all required multiple in-person visits. We developed a virtual approach for delivering subthreshold exercise to youth with PPCS called the Mobile Subthreshold Exercise Program (MSTEP), and we have now been funded to conduct a large national randomized controlled trial (RCT) to test its efficacy for reducing concussive symptoms and improving health-related quality of life. METHODS This investigation is an RCT comparing MSTEP to an active control. We will recruit 200 adolescents 11-18 years old with postconcussive symptoms persisting for at least 1 week but less than 1 year. Youth will be randomized to receive either 6 weeks of subthreshold exercise (MSTEP) or a stretching condition (control). Youth and parents will complete surveys of concussive symptoms at baseline, weekly during the intervention, and at 3 and 6 months. The primary outcomes will be trajectory of concussive symptoms and health-related quality of life over the 6 months of the study. Secondary outcomes will include depression, anxiety, and sleep quality. We will also assess potential mediators of treatment effects including moderate-vigorous physical activity and fear avoidance of concussive symptoms. DISCUSSION This multisite RCT of MSTEP will provide vital information regarding the efficacy of a virtually delivered subthreshold exercise program for youth with PPCS, and insight regarding potential mediators of treatment effects, including objectively measured physical activity and fear avoidance of concussive symptoms. TRIAL REGISTRATION ClinicalTrials.gov NCT04688255. Registered on December 29, 2020.
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Affiliation(s)
- Sara P D Chrisman
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, PO Box 5371, CURE-03, Seattle, WA, 98145, USA. .,Department of Pediatrics, University of Washington, Seattle, USA.
| | - Beth J Bollinger
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, PO Box 5371, CURE-03, Seattle, WA, 98145, USA
| | - Jason A Mendoza
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, PO Box 5371, CURE-03, Seattle, WA, 98145, USA.,Department of Pediatrics, University of Washington, Seattle, USA.,Fred Hutchinson Cancer Research Center, Seattle, USA
| | - Tonya M Palermo
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, PO Box 5371, CURE-03, Seattle, WA, 98145, USA.,Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, USA
| | - Chuan Zhou
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, PO Box 5371, CURE-03, Seattle, WA, 98145, USA
| | | | - Frederick P Rivara
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, PO Box 5371, CURE-03, Seattle, WA, 98145, USA.,Department of Pediatrics, University of Washington, Seattle, USA
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26
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Pham C, Vryer R, O’Hely M, Mansell T, Burgner D, Collier F, Symeonides C, Tang MLK, Vuillermin P, Gray L, Saffery R, Ponsonby AL. Shortened Infant Telomere Length Is Associated with Attention Deficit/Hyperactivity Disorder Symptoms in Children at Age Two Years: A Birth Cohort Study. Int J Mol Sci 2022; 23:ijms23094601. [PMID: 35562991 PMCID: PMC9104809 DOI: 10.3390/ijms23094601] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 04/11/2022] [Accepted: 04/14/2022] [Indexed: 12/13/2022] Open
Abstract
Environmental factors can accelerate telomere length (TL) attrition. Shortened TL is linked to attention deficit/hyperactivity disorder (ADHD) symptoms in school-aged children. The onset of ADHD occurs as early as preschool-age, but the TL-ADHD association in younger children is unknown. We investigated associations between infant TL and ADHD symptoms in children and assessed environmental factors as potential confounders and/or mediators of this association. Relative TL was measured by quantitative polymerase chain reaction in cord and 12-month blood in the birth cohort study, the Barwon Infant Study. Early life environmental factors collected antenatally to two years were used to measure confounding. ADHD symptoms at age two years were evaluated by the Child Behavior Checklist Attention Problems (AP) and the Attention Deficit/Hyperactivity Problems (ADHP). Associations between early life environmental factors on TL or ADHD symptoms were assessed using multivariable regression models adjusted for relevant factors. Telomere length at 12 months (TL12), but not at birth, was inversely associated with AP (β = −0.56; 95% CI (−1.13, 0.006); p = 0.05) and ADHP (β = −0.66; 95% CI (−1.11, −0.21); p = 0.004). Infant secondhand smoke exposure at one month was independently associated with shorter TL12 and also higher ADHD symptoms. Further work is needed to elucidate the mechanisms that influence TL attrition and early neurodevelopment.
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Affiliation(s)
- Cindy Pham
- Murdoch Children’s Research Institute, Royal Children’s Hospital, Parkville, VIC 3052, Australia; (C.P.); (R.V.); (M.O.); (T.M.); (D.B.); (C.S.); (M.L.K.T.); (P.V.); (R.S.)
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC 3052, Australia
- Melbourne School of Population and Global Health, University of Melbourne, Parkville, VIC 3052, Australia
- Child Health Research Unit, Barwon Health, Geelong, VIC 3220, Australia; (F.C.); (L.G.)
| | - Regan Vryer
- Murdoch Children’s Research Institute, Royal Children’s Hospital, Parkville, VIC 3052, Australia; (C.P.); (R.V.); (M.O.); (T.M.); (D.B.); (C.S.); (M.L.K.T.); (P.V.); (R.S.)
- Child Health Research Unit, Barwon Health, Geelong, VIC 3220, Australia; (F.C.); (L.G.)
- Department of Paediatrics, University of Melbourne, Parkville, VIC 3052, Australia
| | - Martin O’Hely
- Murdoch Children’s Research Institute, Royal Children’s Hospital, Parkville, VIC 3052, Australia; (C.P.); (R.V.); (M.O.); (T.M.); (D.B.); (C.S.); (M.L.K.T.); (P.V.); (R.S.)
- Child Health Research Unit, Barwon Health, Geelong, VIC 3220, Australia; (F.C.); (L.G.)
- School of Medicine, Deakin University, Geelong, VIC 3220, Australia
| | - Toby Mansell
- Murdoch Children’s Research Institute, Royal Children’s Hospital, Parkville, VIC 3052, Australia; (C.P.); (R.V.); (M.O.); (T.M.); (D.B.); (C.S.); (M.L.K.T.); (P.V.); (R.S.)
- Child Health Research Unit, Barwon Health, Geelong, VIC 3220, Australia; (F.C.); (L.G.)
- Department of Paediatrics, University of Melbourne, Parkville, VIC 3052, Australia
| | - David Burgner
- Murdoch Children’s Research Institute, Royal Children’s Hospital, Parkville, VIC 3052, Australia; (C.P.); (R.V.); (M.O.); (T.M.); (D.B.); (C.S.); (M.L.K.T.); (P.V.); (R.S.)
- Child Health Research Unit, Barwon Health, Geelong, VIC 3220, Australia; (F.C.); (L.G.)
- Department of Paediatrics, University of Melbourne, Parkville, VIC 3052, Australia
| | - Fiona Collier
- Child Health Research Unit, Barwon Health, Geelong, VIC 3220, Australia; (F.C.); (L.G.)
- School of Medicine, Deakin University, Geelong, VIC 3220, Australia
| | - Christos Symeonides
- Murdoch Children’s Research Institute, Royal Children’s Hospital, Parkville, VIC 3052, Australia; (C.P.); (R.V.); (M.O.); (T.M.); (D.B.); (C.S.); (M.L.K.T.); (P.V.); (R.S.)
- Department of Paediatrics, University of Melbourne, Parkville, VIC 3052, Australia
| | - Mimi L. K. Tang
- Murdoch Children’s Research Institute, Royal Children’s Hospital, Parkville, VIC 3052, Australia; (C.P.); (R.V.); (M.O.); (T.M.); (D.B.); (C.S.); (M.L.K.T.); (P.V.); (R.S.)
- Department of Paediatrics, University of Melbourne, Parkville, VIC 3052, Australia
| | - Peter Vuillermin
- Murdoch Children’s Research Institute, Royal Children’s Hospital, Parkville, VIC 3052, Australia; (C.P.); (R.V.); (M.O.); (T.M.); (D.B.); (C.S.); (M.L.K.T.); (P.V.); (R.S.)
- Child Health Research Unit, Barwon Health, Geelong, VIC 3220, Australia; (F.C.); (L.G.)
- School of Medicine, Deakin University, Geelong, VIC 3220, Australia
| | - Lawrence Gray
- Child Health Research Unit, Barwon Health, Geelong, VIC 3220, Australia; (F.C.); (L.G.)
- School of Medicine, Deakin University, Geelong, VIC 3220, Australia
| | - Richard Saffery
- Murdoch Children’s Research Institute, Royal Children’s Hospital, Parkville, VIC 3052, Australia; (C.P.); (R.V.); (M.O.); (T.M.); (D.B.); (C.S.); (M.L.K.T.); (P.V.); (R.S.)
- Child Health Research Unit, Barwon Health, Geelong, VIC 3220, Australia; (F.C.); (L.G.)
- Department of Paediatrics, University of Melbourne, Parkville, VIC 3052, Australia
| | - Anne-Louise Ponsonby
- Murdoch Children’s Research Institute, Royal Children’s Hospital, Parkville, VIC 3052, Australia; (C.P.); (R.V.); (M.O.); (T.M.); (D.B.); (C.S.); (M.L.K.T.); (P.V.); (R.S.)
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC 3052, Australia
- Melbourne School of Population and Global Health, University of Melbourne, Parkville, VIC 3052, Australia
- Child Health Research Unit, Barwon Health, Geelong, VIC 3220, Australia; (F.C.); (L.G.)
- Correspondence:
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27
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A principled approach to mediation analysis in perinatal epidemiology. Am J Obstet Gynecol 2022; 226:24-32.e6. [PMID: 34991898 PMCID: PMC9204564 DOI: 10.1016/j.ajog.2021.10.028] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 10/21/2021] [Accepted: 10/21/2021] [Indexed: 01/03/2023]
Abstract
For many research questions in perinatal epidemiology, gestational age is a mediator that features the causal pathway between exposure and outcome. A mediator is an intermediate variable between an exposure and outcome, which is influenced by the exposure on the causal pathway to the outcome. Therefore, conventional analyses that adjust, stratify, or match for gestational age or its proxy (eg, preterm vs term deliveries) are problematic. This practice, which is entrenched in perinatal research, induces an overadjustment bias. Depending on the causal question, it may be inappropriate to adjust (or condition) for a mediator, such as gestational age, by either design or statistical analysis, but its effect can be quantified through causal mediation analysis. In an exposition of such methods, we demonstrated the relationship between the exposure and outcome and provided a formal analytical framework to quantify the extent to which a causal effect is influenced by a mediator. We reviewed concepts of confounding and causal inference, introduced the concept of a mediator and illustrated the perils of adjusting for a mediator in an exposure-outcome paradigm for a given causal question, adopted causal methods that call for an evaluation of a mediator in a causal exposure effect on the outcome, and discussed unmeasured confounding assumptions in mediation analysis. Furthermore, we reviewed other developments in the causal mediation analysis literature, including decomposition of a total effect when the mediator interacts with the exposure (4-way decomposition), methods for multiple mediators, mediation methods for case-control studies, mediation methods for time-to-event outcomes, sample size and power analysis for mediation analysis, and available software to apply these methods. To illustrate these methods, we provided a clinical example to estimate the risk of perinatal mortality (outcome) concerning placental abruption (exposure) and to determine the extent to which preterm delivery (mediator; a proxy for gestational age) plays a role in this causal effect. We hoped that the adoption of mediation methods described in this review will move research in perinatal epidemiology away from biased adjustments of mediators toward a more nuanced quantification of effects that pose unique challenges and provide unique insights in our field.
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28
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Wong A, Lam BYK, Mak MKY, Lam LCW, Au LWC, Yiu BKF, Wong C, Tong HY, Yeung SK, Chu WCW, Shi L, Leung TWH, Soo YOY, Lau AYL, Ip BYM, Kwok TCY, Ko H, Mok VCT. Aerobic exercise in older people with subclinical sporadic cerebral small vessel disease: A randomized clinical trial. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2021; 7:e12224. [PMID: 35005205 PMCID: PMC8719349 DOI: 10.1002/trc2.12224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 10/22/2021] [Accepted: 11/02/2021] [Indexed: 11/10/2022]
Abstract
INTRODUCTION The benefit and risk of aerobic exercise among older people harboring advanced cerebral small vessel disease (CSVD) upon cognition, mood, and motor functions are unknown. METHODS This rater-blind randomized trial examined effects of a 24-week aerobic exercise training (60 min/session, twice/week) upon clinical (cognition, mood, motor functions) and hemodynamic (pulse pressure [PP], blood pressure [BP], pulsatility index) measures in older people harboring moderate to severe CSVD, as evidenced by confluent white matter hyperintensity and/or ≥2 lacunes on magnetic resonance imaging. We further investigated interactions between treatment conditions and hemodynamics measures. RESULTS Fifty-three and 54 subjects were randomized into the active and control group, respectively. There was no between-group difference in any of the clinical outcomes. The active group had a greater between-group reduction in systolic BP and PP than the control group. Within-group comparison showed that global cognition of the active group remained similar at end of the study compared to baseline, whereas it declined significantly in the control group. We observed "diverging" interaction effects in that greater reduction in systolic BP/PP was associated with greater improvement in memory functions and global cognition but worsening in processing speed in the active group. Side effects were comparable between the two groups. DISCUSSION Future study should investigate the mechanisms of the diverging impacts of aerobic exercise upon different cognitive domains so that the benefit-risk ratio of aerobic exercise in older people harboring more advanced CSVD can be better defined.
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Affiliation(s)
- Adrian Wong
- Division of NeurologyDepartment of Medicine and TherapeuticsFaculty of MedicineThe Chinese University of Hong KongHong Kong SARChina
- Margaret K.L. Cheung Research Centre for Management of ParkinsonismTherese Pei Fong Chow Research Centre for Prevention of DementiaLui Che Woo Institute of Innovative MedicineGerald Choa Neuroscience CentreThe Chinese University of Hong KongHong Kong SARChina
| | - Bonnie Yin Ka Lam
- Division of NeurologyDepartment of Medicine and TherapeuticsFaculty of MedicineThe Chinese University of Hong KongHong Kong SARChina
- Margaret K.L. Cheung Research Centre for Management of ParkinsonismTherese Pei Fong Chow Research Centre for Prevention of DementiaLui Che Woo Institute of Innovative MedicineGerald Choa Neuroscience CentreThe Chinese University of Hong KongHong Kong SARChina
| | - Margaret Kit Yi Mak
- Department of Rehabilitation SciencesThe Hong Kong Polytechnic UniversityHong Kong SARChina
| | - Linda Chiu Wa Lam
- Department of PsychiatryFaculty of MedicineThe Chinese University of Hong KongHong Kong SARChina
| | - Lisa Wing Chi Au
- Division of NeurologyDepartment of Medicine and TherapeuticsFaculty of MedicineThe Chinese University of Hong KongHong Kong SARChina
- Margaret K.L. Cheung Research Centre for Management of ParkinsonismTherese Pei Fong Chow Research Centre for Prevention of DementiaLui Che Woo Institute of Innovative MedicineGerald Choa Neuroscience CentreThe Chinese University of Hong KongHong Kong SARChina
| | - Brian Ka Fung Yiu
- Division of NeurologyDepartment of Medicine and TherapeuticsFaculty of MedicineThe Chinese University of Hong KongHong Kong SARChina
- Margaret K.L. Cheung Research Centre for Management of ParkinsonismTherese Pei Fong Chow Research Centre for Prevention of DementiaLui Che Woo Institute of Innovative MedicineGerald Choa Neuroscience CentreThe Chinese University of Hong KongHong Kong SARChina
| | - Chun Wong
- Division of NeurologyDepartment of Medicine and TherapeuticsFaculty of MedicineThe Chinese University of Hong KongHong Kong SARChina
| | - Hor Yee Tong
- Division of NeurologyDepartment of Medicine and TherapeuticsFaculty of MedicineThe Chinese University of Hong KongHong Kong SARChina
| | - Sin Ki Yeung
- Division of NeurologyDepartment of Medicine and TherapeuticsFaculty of MedicineThe Chinese University of Hong KongHong Kong SARChina
| | - Winnie Chiu Wing Chu
- Department of Imaging and Interventional RadiologyFaculty of MedicineThe Chinese University of Hong KongShatin, New TerritoriesHong Kong SARChina
| | - Lin Shi
- Department of Imaging and Interventional RadiologyFaculty of MedicineThe Chinese University of Hong KongShatin, New TerritoriesHong Kong SARChina
- BrainNow Research InstituteShenzhenGuangdong ProvinceChina
| | - Thomas Wai Hong Leung
- Division of NeurologyDepartment of Medicine and TherapeuticsFaculty of MedicineThe Chinese University of Hong KongHong Kong SARChina
| | - Yannie Oi Yan Soo
- Division of NeurologyDepartment of Medicine and TherapeuticsFaculty of MedicineThe Chinese University of Hong KongHong Kong SARChina
| | - Alexander Yuk Lun Lau
- Division of NeurologyDepartment of Medicine and TherapeuticsFaculty of MedicineThe Chinese University of Hong KongHong Kong SARChina
- Margaret K.L. Cheung Research Centre for Management of ParkinsonismTherese Pei Fong Chow Research Centre for Prevention of DementiaLui Che Woo Institute of Innovative MedicineGerald Choa Neuroscience CentreThe Chinese University of Hong KongHong Kong SARChina
| | - Bonaventure Yiu Ming Ip
- Division of NeurologyDepartment of Medicine and TherapeuticsFaculty of MedicineThe Chinese University of Hong KongHong Kong SARChina
| | - Timothy Chi Yui Kwok
- Division of NeurologyDepartment of Medicine and TherapeuticsFaculty of MedicineThe Chinese University of Hong KongHong Kong SARChina
| | - Ho Ko
- Division of NeurologyDepartment of Medicine and TherapeuticsFaculty of MedicineThe Chinese University of Hong KongHong Kong SARChina
- Margaret K.L. Cheung Research Centre for Management of ParkinsonismTherese Pei Fong Chow Research Centre for Prevention of DementiaLui Che Woo Institute of Innovative MedicineGerald Choa Neuroscience CentreThe Chinese University of Hong KongHong Kong SARChina
- Li Ka Shing Institute of Health SciencesFaculty of MedicineThe Chinese University of Hong KongHong Kong SARChina
| | - Vincent Chung Tong Mok
- Division of NeurologyDepartment of Medicine and TherapeuticsFaculty of MedicineThe Chinese University of Hong KongHong Kong SARChina
- Margaret K.L. Cheung Research Centre for Management of ParkinsonismTherese Pei Fong Chow Research Centre for Prevention of DementiaLui Che Woo Institute of Innovative MedicineGerald Choa Neuroscience CentreThe Chinese University of Hong KongHong Kong SARChina
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Feng Q, Yang Z, May M, Tsoi KK, Ingle S, Lee EK, Wong SY, Kim JH. The role of body mass index in the association between dietary sodium intake and blood pressure: A mediation analysis with NHANES. Nutr Metab Cardiovasc Dis 2021; 31:3335-3344. [PMID: 34629246 DOI: 10.1016/j.numecd.2021.08.051] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 08/19/2021] [Accepted: 08/31/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND AIMS Recent research demonstrated that obesity and high dietary sodium intake, the two established risk factors for hypertension, were associated with each other. The objective was to investigate the potential indirect effect of sodium intake on blood pressure via body mass index (BMI). METHODS AND RESULTS Using ten years data from US NHANES (2007-2016), the study included adult participants (>20 years old) who were not taking antihypertensive medications and without baseline diseases (n = 12,262). BMI was modelled as the mediator of sodium intake on systolic and diastolic blood pressure, adjusted for age, sex, socioeconomic status, smoking, drinking, physical activity, calorie intake, fluid intake and potassium intake. Mediation analysis was performed to evaluate total effect, direct effect and indirect effect via BMI. Subgroup analyses based on three age subgroups (20-40, 41-60 and ≥61 years old) were performed. The mean age was 39.29 (13.4) years and 53.1 (0.45) % were males. The mean BMI was 27.8 (6.20) kg/m2. Overall, 1 g/d increase in sodium intake was associated with an increased systolic blood pressure by 0.36 (95% confidence interval 0.14 to 0.58) mmHg, with a direct effect (0.14 (0.09-0.19)) and an indirect effect via BMI (0.23 (0.02-0.44)). The indirect effect was mainly observed in participants ≤60 years old. CONCLUSION Sodium intake showed both direct effect and indirect effect (via BMI) on systolic blood pressure in US NHANES. The findings provide evidence for combining sodium restriction and weight reduction measures for prevention of hypertension. Cautions should be taken when generalizing the findings to other populations with lower average BMI.
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Affiliation(s)
- Qi Feng
- School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China; Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Zuyao Yang
- School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Margaret May
- Population Health Sciences, University of Bristol, UK
| | - Kelvin K Tsoi
- School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Suzanne Ingle
- Population Health Sciences, University of Bristol, UK
| | - Eric K Lee
- School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Samuel Y Wong
- School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Jean H Kim
- School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.
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Sevelius JM, Neilands TB, Reback CJ, Castro D, Dilworth SE, Kaplan RL, Johnson MO. An Intervention by and for Transgender Women Living With HIV: Study Protocol for a Two-Arm Randomized Controlled Trial Testing the Efficacy of “Healthy Divas” to Improve HIV Care Outcomes. FRONTIERS IN REPRODUCTIVE HEALTH 2021; 3:665723. [PMID: 36304034 PMCID: PMC9580739 DOI: 10.3389/frph.2021.665723] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 09/16/2021] [Indexed: 01/22/2023] Open
Abstract
Introduction: Transgender women (assigned “male” at birth but who do not identify as male) are disproportionately impacted by HIV and experience unique barriers and facilitators to HIV care engagement. In formative work, we identified culturally specific and modifiable barriers to HIV treatment engagement among transgender women living with HIV (TWH), including prioritizing transition-related healthcare over HIV treatment, avoiding HIV care settings due to gender-related and HIV stigma, concerns about potential drug interactions with hormones, and inadequate social support. Grounded in the investigators' Models of Gender Affirmation and Health Care Empowerment, we developed the Healthy Divas intervention to optimize engagement in HIV care among TWH at risk for treatment failure and consequential morbidity, mortality, and onward transmission of HIV. Methods and Analysis: We conducted a 2-arm randomized controlled trial (RCT) of the intervention's efficacy in Los Angeles and San Francisco to improve engagement in care among TWH (N = 278). The primary outcome was virologic control indicated by undetectable HIV-1 level (undetectability = < 20 copies/mL), at baseline and follow-up assessment for 12 months at 3-month intervals. Ethics and Dissemination: This study was approved by University of California, San Francisco Institutional Review Board (15-17910) and Western Institutional Review Board (20181370). Participants provided informed consent before enrolment in the study. We are committed to collaboration with National Institutes of Health officials, other researchers, and health and social services communities for rapid dissemination of data and sharing of materials. The results will be published in peer-reviewed academic journals and scientific presentations. We will make our results available to researchers interested in transgender health to avoid unintentional duplication of research, as well as to others in health and social services communities, including HIV clinics, LGBT community-based organizations, and AIDS service organizations. Clinical Trial Registration:Clinicaltrials.gov, identifier NCT03081559.
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Affiliation(s)
- Jae M. Sevelius
- Department of Medicine, Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, CA, United States
- Department of Medicine, Center of Excellence for Transgender Health, University of California, San Francisco, San Francisco, CA, United States
- *Correspondence: Jae M. Sevelius
| | - Torsten B. Neilands
- Department of Medicine, Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, CA, United States
| | - Cathy J. Reback
- Friends Research Institute, Los Angeles, CA, United States
- Center for HIV Identification, Prevention and Treatment Services, University of California, Los Angeles, Los Angeles, CA, United States
| | - Danielle Castro
- Department of Medicine, Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, CA, United States
- Department of Medicine, Center of Excellence for Transgender Health, University of California, San Francisco, San Francisco, CA, United States
| | - Samantha E. Dilworth
- Department of Medicine, Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, CA, United States
| | - Rachel L. Kaplan
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Bixby Center for Global Reproductive Health, University of California, San Francisco, San Francisco, CA, United States
| | - Mallory O. Johnson
- Department of Medicine, Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, CA, United States
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Najberg H, Rigamonti M, Mouthon M, Spierer L. Modifying food items valuation and weight with gamified executive control training. ROYAL SOCIETY OPEN SCIENCE 2021; 8:191288. [PMID: 34084536 PMCID: PMC8150012 DOI: 10.1098/rsos.191288] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 05/07/2021] [Indexed: 05/16/2023]
Abstract
Recent lines of research suggest that repeated executive control of motor responses to food items modifies their perceived value and in turn their consumption. Cognitive interventions involving the practice of motor control and attentional tasks have thus been advanced as potential approach to improve eating habits. Yet, their efficacy remains debated, notably due to a lack of proper control for the effects of expectations. We examined whether a one-month intervention combining the practice of Go/NoGo and Cue approach training modified the perceived palatability of food items (i.e. decrease in unhealthy and increase in healthy food items' palatability ratings), and in turn participants' weights. We assessed our hypotheses with a parallel, double-blind, randomized controlled trial. Motivation and adherence to the intervention were maximized by a professional-level gamification of the training tasks. The control intervention differed from the experimental intervention only in the biasing of the stimulus-response mapping rules, enabling to balance expectations between the two groups and thus to conclude on the causal influence of motoric control on items valuation. We found a larger decrease of the unhealthy items' palatability ratings in the experimental (20.6%) than control group (13.1%). However, we did not find any increase of the healthy items' ratings or weight loss. Overall, the present registered report confirms that the repeated inhibition of motor responses to food cues, together with the development of attentional biases away from these cues, reduces their perceived value.
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Affiliation(s)
- Hugo Najberg
- Neurology Unit, Medicine Section, Faculty of Science and Medicine, University of Fribourg, PER 09, Chemin du Musée 5, 1700 Fribourg, Switzerland
| | - Maurizio Rigamonti
- Neurology Unit, Medicine Section, Faculty of Science and Medicine, University of Fribourg, PER 09, Chemin du Musée 5, 1700 Fribourg, Switzerland
| | - Michael Mouthon
- Neurology Unit, Medicine Section, Faculty of Science and Medicine, University of Fribourg, PER 09, Chemin du Musée 5, 1700 Fribourg, Switzerland
| | - Lucas Spierer
- Neurology Unit, Medicine Section, Faculty of Science and Medicine, University of Fribourg, PER 09, Chemin du Musée 5, 1700 Fribourg, Switzerland
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Alter S, Wilson C, Sun S, Harris RE, Wang Z, Vitale A, Hazlett EA, Goodman M, Ge Y, Yehuda R, Galfalvy H, Haghighi F. The association of childhood trauma with sleep disturbances and risk of suicide in US veterans. J Psychiatr Res 2021; 136:54-62. [PMID: 33561736 DOI: 10.1016/j.jpsychires.2021.01.030] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 12/14/2020] [Accepted: 01/16/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Sleep dysregulation is prevalent among veterans and is associated with increased risk of suicidal ideation and behaviors. A confluence of risk factors have been identified to date that contribute to increase risk for suicidal behavior. How these risk factors including childhood trauma, comorbid psychopathology, impulsivity, and hostility together with sleep disturbance contribute to suicide risk remains an open question. These factors have never been examined simultaneously in a unified mediation model, as investigated in the present study, to determine their relative contribution to suicide risk. METHODS Veterans (N = 105) were recruited across 3-groups, including Major Depressive Disorder (MDD) with/without a history of a suicide attempt (n = 35 and n = 37, respectively), and non-psychiatric controls, who had no history of mental illness or suicidal behavior (n = 33). The participants were assessed using validated self-report assessments with in-depth phenotyping for relevant risk factors associated with suicidal behavior including childhood adversity, depression severity, impulsivity, hostility, and sleep quality. These factors were included in mediation models using path analysis. RESULTS Across all subjects including those with MDD and non-psychiatric controls, mediation analysis showed that higher levels of childhood trauma had an indirect effect on poor sleep quality (p = 0.001). This effect was orthogonal, being independently mediated by both MDD psychopathology (p = 0.003), and higher traits of impulsivity (p = 0.001) and hostility (p = 0.015). Amongst MDD veterans, childhood trauma was directly associated with increased suicide risk (p = 0.034), irrespective of their severity of depression, or their degree of hostility and impulsivity. LIMITATIONS include use of self-report data, and the inability to establish causal inferences with cross-sectional design. CONCLUSION Childhood adversity as a significant pre-deployment risk factor for disturbed sleep and elevated suicide risk, potentially important for incorporation in clinical practice for suicide.
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Affiliation(s)
| | | | - Shengnan Sun
- Icahn School of Medicine at Mount Sinai, New York, USA
| | | | - Zhaoyu Wang
- Icahn School of Medicine at Mount Sinai, New York, USA
| | - Amanda Vitale
- Icahn School of Medicine at Mount Sinai, New York, USA
| | - Erin A Hazlett
- James J. Peters VA Medical Center, Bronx, USA; Icahn School of Medicine at Mount Sinai, New York, USA
| | - Marianne Goodman
- James J. Peters VA Medical Center, Bronx, USA; Icahn School of Medicine at Mount Sinai, New York, USA
| | - Yongchao Ge
- Icahn School of Medicine at Mount Sinai, New York, USA
| | - Rachel Yehuda
- James J. Peters VA Medical Center, Bronx, USA; Icahn School of Medicine at Mount Sinai, New York, USA
| | | | - Fatemeh Haghighi
- James J. Peters VA Medical Center, Bronx, USA; Icahn School of Medicine at Mount Sinai, New York, USA.
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Cherrington AL, Krause-Steinrauf H, Bebu I, Naik AD, Walker E, Golden SH, Gonzalez JS. Study of emotional distress in a comparative effectiveness trial of diabetes treatments: Rationale and design. Contemp Clin Trials 2021; 107:106366. [PMID: 33766761 DOI: 10.1016/j.cct.2021.106366] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 03/10/2021] [Accepted: 03/16/2021] [Indexed: 11/18/2022]
Abstract
Emotional distress, including depression and diabetes-specific distress (e.g., feeling overwhelmed by living with diabetes, feelings of failure related to diabetes self-care), is a significant and prevalent problem for patients with type 2 diabetes. Both depression and diabetes distress have been associated with metabolic/glycemic control, diabetes complications, mortality, and quality of life. Recent findings further suggest that risk for emotional distress is influenced by diabetes treatment. The GRADE Study (Glycemia Reduction Approaches in Diabetes: A Comparative Effectiveness Study) is generating prospective data that will provide a unique opportunity to examine the relationships between emotional distress, diabetes treatment, and outcomes in an experimental design. The GRADE study is a randomized clinical trial that will compare the metabolic effects of four common anti-hyperglycemic drugs when combined with metformin. This sub-study recruited a subset (n = 1739) of GRADE participants and will examine patient-level variation in baseline emotional distress as a predictor of glycemic control and other health outcomes, independent of treatment effects. The study will also provide an experimental examination of treatment regimen effects on emotional distress over time as part of the overall evaluation of comparative effectiveness. Evaluation of emotional distress using validated measures will allow us to disentangle the roles of depressive symptoms and diabetes distress, factors that share significant overlap but require distinct approaches to screening and treatment. Study findings may directly influence practice decisions regarding screening and treatment for emotional distress as part of diabetes care. ClinicalTrials.gov Identifier: NCT01794143.
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Affiliation(s)
- Andrea L Cherrington
- Department of Medicine (General Internal and Preventive Medicine), University of Alabama, Birmingham, Birmingham, AL, United States of America.
| | - Heidi Krause-Steinrauf
- The Biostatistics Center, Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, The George Washington University, Rockville, MD, United States of America
| | - Ionut Bebu
- The Biostatistics Center, Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, The George Washington University, Rockville, MD, United States of America
| | - Aanand D Naik
- Department of Medicine (Geriatrics and Palliative Medicine Section), Baylor College of Medicine, Houston, Texas, United States of America; Houston Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, United States of America
| | - Elizabeth Walker
- Departments of Medicine (Endocrinology) and Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, United States of America
| | - Sherita H Golden
- School of Medicine, Johns Hopkins University, Baltimore, MD, United States of America
| | - Jeffrey S Gonzalez
- Departments of Medicine (Endocrinology) and Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, United States of America; Ferkauf Graduate School of Psychology, Yeshiva University, New York, NY, United States of America
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Childhood environment, sense of control and hoarding among Chinese college students. CURRENT PSYCHOLOGY 2021. [DOI: 10.1007/s12144-021-01624-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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VanderWeele TJ. Invited Commentary: Frontiers of Power Assessment in Mediation Analysis. Am J Epidemiol 2020; 189:1568-1570. [PMID: 32415833 DOI: 10.1093/aje/kwaa081] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 04/08/2020] [Accepted: 04/15/2020] [Indexed: 12/16/2022] Open
Abstract
The development of tools for power and sample-size calculations for mediation analysis has lagged far behind the development of methods. The accompanying paper by Rudolph et al. (Am J Epidemiol. 2020;189(12):1559-1567) is a helpful contribution in using simulations as a tool for power calculations for more complex methods and settings. Much work remains to be done in the development of easy-to-use packages and simple online websites for carrying out power and sample-size calculations for mediation analysis. Much remains to be learned with respect to the relative power of different methods in different settings. There will likely be feedback between these 2 important frontiers of the tools we have available and of our understanding of power when conducting mediation analysis.
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Rudolph KE, Goin DE, Stuart EA. The Peril of Power: A Tutorial on Using Simulation to Better Understand When and How We Can Estimate Mediating Effects. Am J Epidemiol 2020; 189:1559-1567. [PMID: 32415839 DOI: 10.1093/aje/kwaa083] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 03/27/2020] [Accepted: 03/30/2020] [Indexed: 02/06/2023] Open
Abstract
Mediation analyses are valuable for examining mechanisms underlying an association, investigating possible explanations for nonintuitive results, or identifying interventions that can improve health in the context of nonmanipulable exposures. However, designing a study for the purpose of answering a mediation-related research question remains challenging because sample size and power calculations for mediation analyses are typically not conducted or are crude approximations. Consequently, many studies are probably conducted without first establishing that they have the statistical power required to detect a meaningful effect, potentially resulting in wasted resources. In an effort to advance more accurate power calculations for estimating direct and indirect effects, we present a tutorial demonstrating how to conduct a flexible, simulation-based power analysis. In this tutorial, we compare power to estimate direct and indirect effects across various estimators (the Baron and Kenny estimator (J Pers Soc Psychol. 1986;51(6):1173-1182), inverse odds ratio weighting, and targeted maximum likelihood estimation) using various data structures designed to mimic important features of real data. We include step-by-step commented R code (R Foundation for Statistical Computing, Vienna, Austria) in an effort to lower implementation barriers to ultimately improving power assessment in mediation studies.
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Babu GR, Deepa R, Lewis MG, Lobo E, Krishnan A, Ana Y, Katon JG, Enquobahrie DA, Arah OA, Kinra S, Murthy G. Do Gestational Obesity and Gestational Diabetes Have an Independent Effect on Neonatal Adiposity? Results of Mediation Analysis from a Cohort Study in South India. Clin Epidemiol 2019; 11:1067-1080. [PMID: 31920399 PMCID: PMC6938184 DOI: 10.2147/clep.s222726] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 12/12/2019] [Indexed: 12/20/2022] Open
Abstract
Purpose Neonates born to mothers with obesity or gestational diabetes mellitus (GDM) have an increased chance of various metabolic disorders later in life. In India, it is unclear whether maternal obesity or GDM is related to offspring adiposity. We aimed to understand the independent effect of maternal obesity and GDM with neonatal adiposity and whether GDM has a mediating effect between maternal obesity and neonatal adiposity. Methods We recruited a cohort of 1120 women (between April 2016 and February 2019) from the public hospitals in Bangalore, India, who voluntarily agreed to participate and provided written informed consent. The primary outcome was neonatal adiposity, defined as the sum of skinfold thickness >85th percentile. Exposure included maternal obesity, defined as >90th percentile of skinfold thickness. GDM, the potential mediator, was classified using the World Health Organization criteria by oral glucose tolerance test. Binary logistic regression was applied to test the effect of maternal obesity and GDM on neonatal adiposity, adjusting for potential confounders. We used Paramed command in STATA version 14 for analyzing mediating effects. Results We found that maternal obesity (odds ratio (OR)=2.16, 95% CI 1.46, 3.18) and GDM (OR=2.21, 95% CI1.38, 3.52) have an independent effect on neonatal adiposity. GDM significantly mediates 25.2% of the total effect between maternal obesity and neonatal adiposity, (natural direct effect OR = 1.16 95% CI 1.04, 1.30) with significant direct effect of maternal obesity (natural direct effect OR = 1.90 95% CI 1.16, 3.10) and significant total effect (OR=2.20 95% CI 1.35, 3.58). Conclusion We showed that maternal obesity and GDM are independently associated with offspring adiposity. Also, GDM mediates the association of maternal obesity on adiposity in children. Interventions focused on obesity prevention in women, and effective screening and management of GDM may contribute to reducing childhood obesity in India.
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Affiliation(s)
- Giridhara R Babu
- Indian Institute of Public Health-Bangalore, Public Health Foundation of India (PHFI), Bangalore, India
| | - R Deepa
- Indian Institute of Public Health-Bangalore, Public Health Foundation of India (PHFI), Bangalore, India
| | - Melissa Glenda Lewis
- Indian Institute of Public Health-Hyderabad, Public Health Foundation of India (PHFI), Hyderabad, India
| | - Eunice Lobo
- Indian Institute of Public Health-Bangalore, Public Health Foundation of India (PHFI), Bangalore, India
| | - Anjaly Krishnan
- Indian Institute of Public Health-Bangalore, Public Health Foundation of India (PHFI), Bangalore, India
| | - Yamuna Ana
- Indian Institute of Public Health-Bangalore, Public Health Foundation of India (PHFI), Bangalore, India
| | - Jodie G Katon
- Health Services Research and Development Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, WA, USA.,Department of Health Services, University of Washington, Seattle, WA, USA
| | - Daniel A Enquobahrie
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA
| | - Onyebuchi A Arah
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles (UCLA), Los Angeles, CA, USA.,California Center for Population Research, University of California, Los Angeles (UCLA), Los Angeles, CA, USA.,UCLA Center for Health Policy Research, Los Angeles, CA, USA
| | - Sanjay Kinra
- Non-communicable Disease Epidemiology , London School of Hygiene & Tropical Medicine and, University College London Hospital, London, UK
| | - Gvs Murthy
- Indian Institute of Public Health-Hyderabad, Public Health Foundation of India (PHFI), Hyderabad, India.,International Centre for Eye Health, Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
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Abstract
Suicide is a leading cause of death in patients with schizophrenia. Previous studies have mostly investigated the association between suicide and sociodemographics, positive and negative symptoms, and depressive symptoms. This study evaluated psychache and alexithymia in patients with schizophrenia, which have both been associated with suicide attempts and thoughts in patients with other psychiatric disorders. Positive and Negative Syndrome Scale (PANSS), Psychache Scale (PAS), Beck Scale for Suicidal Ideation (BSSI), Calgary Depression Scale for Schizophrenia (CDSS), and Toronto Alexithymia Scale (TAS) scores were obtained in 113 patients with schizophrenia, including 50 with suicide attempts. PANSS positive symptoms and general psychopathology subscale, CDSS, BSSI, TAS, and PAS scores were significantly higher in patients with suicide attempts. In multivariate logistic regression analysis, only the PAS score was an independent predictor of attempted suicide. Mediation analysis demonstrated that psychache (both directly and indirectly) and alexithymia (indirectly) might be associated with the risk of suicide in these patients.
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Bellavia A, Centorrino F, Jackson JW, Fitzmaurice G, Valeri L. The role of weight gain in explaining the effects of antipsychotic drugs on positive and negative symptoms: An analysis of the CATIE schizophrenia trial. Schizophr Res 2019; 206:96-102. [PMID: 30584025 DOI: 10.1016/j.schres.2018.12.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Revised: 12/04/2018] [Accepted: 12/05/2018] [Indexed: 10/27/2022]
Abstract
Second-generation antipsychotics are associated with moderate benefits in terms of improved schizophrenia symptoms, but also with higher rates of side-effects such as excessive weight gain (WG); a consensus on their efficacy has not been reached. To date, no study has evaluated the interplay of treatments and side-effects in a single framework, which is a critical step to clarify the role of side-effects in explaining the efficacy of these antipsychotics. We used recent methods for mediation and interaction to clarify the role of WG in explaining the effects of second-generation drugs on schizophrenia symptoms. We used data from 1460 participants in the CATIE trial, assigned to either perphenazine (first-generation comparison drug), olanzapine, quetiapine, risperidone, or ziprasidone. The primary outcome was an individual's score on the Positive and Negative Syndrome Scale (PANSS) for symptoms of schizophrenia after 9 months, separately evaluated as positive (PANSS+), negative (PANSS-), and total PANSS score. WG after 6 months was investigated as a potential mediator and effect modifier. Results showed that, by limiting WG, patients would benefit of a considerably better improvement in terms of PANSS symptoms. In the scenario of weight change being controlled between -2% and 1% for all participants, patients assigned to olanzapine would experience the highest significant improvements in both PANSS+ (-2.66 points; 95% CI: -4.98, -0.35), PANSS- (-1.59; 95% CI: -4.31, 1.14), and total PANSS (-6.11; 95% CI: -13.13, 0.92). In conclusion, occurrence of excessive WG hampers the potentially beneficial effects of second-generation antipsychotics, thus suggesting future directions for treatment and interventions.
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Affiliation(s)
- Andrea Bellavia
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America; Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
| | - Franca Centorrino
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States of America
| | - John W Jackson
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Garrett Fitzmaurice
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America; Department of Psychiatry, Harvard Medical School, Boston, MA, United States of America; Laboratory for Psychiatric Biostatistics, McLean Hospital, Belmont, MA, United States of America
| | - Linda Valeri
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, NY, United States of America.
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Prado G, Estrada Y, Rojas LM, Bahamon M, Pantin H, Nagarsheth M, Gwynn L, Ofir AY, Forster LQ, Torres N, Brown CH. Rationale and design for eHealth Familias Unidas Primary Care: A drug use, sexual risk behavior, and STI preventive intervention for hispanic youth in pediatric primary care clinics. Contemp Clin Trials 2019; 76:64-71. [PMID: 30453076 PMCID: PMC6331011 DOI: 10.1016/j.cct.2018.11.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 10/25/2018] [Accepted: 11/04/2018] [Indexed: 11/24/2022]
Abstract
Family-based behavioral interventions are efficacious and effective in preventing drug use and sexual risk behaviors; unfortunately, they have not been evaluated and disseminated in pediatric primary care practice, where they can have a significant impact. There is an increased focus on integrating parenting interventions into primary care to reduce health disparities among ethnic minorities such as Hispanics. Although Hispanic youth demonstrate higher levels of drug use and sexual risk behaviors than their non-Hispanic counterparts, few parenting interventions are available for Hispanic youth, and none have been delivered specifically to Hispanic adolescents in primary care. Therefore, this manuscript describes the rationale and design of an Internet-based, family-centered, Hispanic-specific, evidence-based prevention intervention, eHealth Familias Unidas Primary Care. Hispanic adolescents (n = 456) and their care givers will be recruited from pediatric primary care clinics in South Florida and randomized to: eHealth Familias Unidas Primary Care or prevention as usual. The intervention will be delivered by trained interns, clinic volunteers, social workers, mental health counselors, students, and nurses. Outcomes will be measured at baseline and 6, 12, 24, and 36 months post-baseline. This study will determine whether the intervention, compared to prevention as usual, is effective in reducing drug use, unprotected sex, and STI incidence in Hispanic youth through the improvement of family functioning. Additionally, we will determine the cost effectiveness of delivering eHealth Familias Unidas within primary care settings. The effectiveness of eHealth Familias Unidas Primary Care will further inform the need to integrate effective behavioral health interventions into primary care settings.
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Affiliation(s)
- Guillermo Prado
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, FL, USA.
| | - Yannine Estrada
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Lourdes M Rojas
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Monica Bahamon
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Hilda Pantin
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Meera Nagarsheth
- Department of Medicine, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Lisa Gwynn
- Department of Pediatrics, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Audrey Y Ofir
- Department of Pediatrics, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Lourdes Q Forster
- Department of Pediatrics, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Nicole Torres
- Department of Pediatrics, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - C Hendricks Brown
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA; Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA; Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA; Center for Prevention Implementation Methodology (Ce-PIM), Northwestern University, Chicago, IL, USA
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41
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Lapointe-Shaw L, Bouck Z, Howell NA, Lange T, Orchanian-Cheff A, Austin PC, Ivers NM, Redelmeier DA, Bell CM. Mediation analysis with a time-to-event outcome: a review of use and reporting in healthcare research. BMC Med Res Methodol 2018; 18:118. [PMID: 30373524 PMCID: PMC6206666 DOI: 10.1186/s12874-018-0578-7] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 10/16/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Mediation analysis tests whether the relationship between two variables is explained by a third intermediate variable. We sought to describe the usage and reporting of mediation analysis with time-to-event outcomes in published healthcare research. METHODS A systematic search of Medline, Embase, and Web of Science was executed in December 2016 to identify applications of mediation analysis to healthcare research involving a clinically relevant time-to-event outcome. We summarized usage over time and reporting of important methodological characteristics. RESULTS We included 149 primary studies, published from 1997 to 2016. Most studies were published after 2011 (n = 110, 74%), and the annual number of studies nearly doubled in the last year (from n = 21 to n = 40). A traditional approach (causal steps or change in coefficient) was most commonly taken (n = 87, 58%), and the majority of studies (n = 114, 77%) used a Cox Proportional Hazards regression for the outcome. Few studies (n = 52, 35%) mentioned any of the assumptions or limitations fundamental to a causal interpretation of mediation analysis. CONCLUSION There is increasing use of mediation analysis with time-to-event outcomes. Current usage is limited by reliance on traditional methods and the Cox Proportional Hazards model, as well as low rates of reporting of underlying assumptions. There is a need for formal criteria to aid authors, reviewers, and readers reporting or appraising such studies.
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Affiliation(s)
- Lauren Lapointe-Shaw
- Department of Medicine, University of Toronto, Toronto, Canada. .,Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada. .,Institute for Clinical Evaluative Sciences, Toronto, Canada.
| | - Zachary Bouck
- Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, Canada
| | - Nicholas A Howell
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Canada.,Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Canada
| | - Theis Lange
- Section of Biostatistics, University of Copenhagen, Copenhagen, Denmark.,Center for Statistical Science, Peking University, Beijing, China
| | - Ani Orchanian-Cheff
- Library and Information Services, University Health Network, Toronto, Canada
| | - Peter C Austin
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Canada
| | - Noah M Ivers
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Canada.,Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, Canada
| | - Donald A Redelmeier
- Department of Medicine, University of Toronto, Toronto, Canada.,Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Canada
| | - Chaim M Bell
- Department of Medicine, University of Toronto, Toronto, Canada.,Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Canada.,Department of Medicine, Mount Sinai Health System, Toronto, Canada
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42
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Zou X, Zhu Y, Jackson JW, Bellavia A, Fitzmaurice GM, Centorrino F, Valeri L. The role of PANSS symptoms and adverse events in explaining the effects of paliperidone on social functioning: a causal mediation analysis approach. NPJ SCHIZOPHRENIA 2018; 4:13. [PMID: 29950691 PMCID: PMC6021395 DOI: 10.1038/s41537-018-0054-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 03/24/2018] [Accepted: 05/14/2018] [Indexed: 11/09/2022]
Abstract
To date, no study has evaluated the joint role of symptoms and adverse events as mediators of the effect of second-generation antipsychotics on patients' social functioning. We used recently developed methods for mediation analysis with multiple mediators to clarify the interplay of adverse events and symptoms in explaining the effects of paliperidone (R code for implementing the mediation analysis for multiple mediators is provided). We used data from 490 participants in a 6-week randomized dose-response trial that assigned three fixed dosages of ER OROS paliperidone (3, 9, and 15 mg/day). The primary outcome was an individual's score on the social performance scale assessed after 6 weeks. The sum of Positive and Negative Syndrome Scale (PANSS), weight gain, and extrapyramidal symptoms measured via the Simpson-Angus Scale after 5 weeks were investigated as potential mediators and effect modifiers of treatment effects. Results from mediation analyses showed that the improvements in social functioning are partly explained by reduction in PANSS symptoms. Suggestive evidence that adverse events could play a role as mediators was found. In particular, weight gain displayed a non-linear relationship with social functioning, whereby beneficial effects observed at small levels of weight gain were reduced in the presence of excessive weight gain. In conclusion, we found that the short-term effects of paliperidone on social functioning were dependent on the successful reduction in PANSS symptoms and possibly the occurrence of excessive weight gain, thus suggesting future directions for treatment and interventions.
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Affiliation(s)
- Xue Zou
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Yiwen Zhu
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - John W Jackson
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Andrea Bellavia
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Garrett M Fitzmaurice
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Laboratory for Psychiatric Biostatistics, McLean Hospital, Belmont, MA, USA
| | | | - Linda Valeri
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
- Laboratory for Psychiatric Biostatistics, McLean Hospital, Belmont, MA, USA.
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Okereke OI, Reynolds CF, Mischoulon D, Chang G, Cook NR, Copeland T, Friedenberg G, Buring JE, Manson JE. The VITamin D and OmegA-3 TriaL-Depression Endpoint Prevention (VITAL-DEP): Rationale and design of a large-scale ancillary study evaluating vitamin D and marine omega-3 fatty acid supplements for prevention of late-life depression. Contemp Clin Trials 2018; 68:133-145. [PMID: 29526608 PMCID: PMC5899680 DOI: 10.1016/j.cct.2018.02.017] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 02/19/2018] [Accepted: 02/27/2018] [Indexed: 02/07/2023]
Abstract
RATIONALE Depression is a leading cause of disease burden and disability for older adults; thus, prevention is a priority. Biologic and observational data support potential mental health benefits of vitamin D and omega-3 fatty acids; however, it is unclear whether these supplements can prevent late-life depression. DESIGN We describe the novel methodology of a large-scale study: VITAL-DEP (VITamin D and OmegA-3 TriaL-Depression Endpoint Prevention), an ancillary to the VITAL trial. Primary Aims of VITAL-DEP are to determine effects on prevention of depression and on trajectory of mood symptoms of long-term (mean=5years) supplementation with vitamin D (vitamin D3 [cholecalciferol], 2000IU/day) and marine omega-3 fatty-acids (eicosapentaenoic acid + docosahexaenoic acid, 1g/day), in a 2×2 factorial design, among 25,874 older adults. Secondary Aims will evaluate: vitamin D's effects among African-Americans (an at-risk group for vitamin D deficiency); both agents' effects among those with high-risk factors or sub-syndromal depression in a sub-set of ~1000 participants with detailed examinations at baseline and 2-year follow-up; whether baseline nutrient levels influence depression risk and/or modify agents' effects. Additional planned analyses will use pre-randomization blood samples available in ~17,000 participants to address whether key biomarkers and factors influence long-term mood and depression risk and/or the agents' effects. CONCLUSION VITAL-DEP applies all modalities of state-of-the-art prevention research - universal, selective and indicated. VITAL-DEP will clarify effects of supplemental vitamin D and/or omega-3 on mood, and inform clinical care and public health guidelines on the use of these agents for prevention of depression in mid-life and older adults.
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Affiliation(s)
- Olivia I Okereke
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA; Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA.
| | - Charles F Reynolds
- Department of Psychiatry, UPMC and University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - David Mischoulon
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Grace Chang
- VA Boston Healthcare System, Brockton, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Nancy R Cook
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA; Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Trisha Copeland
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Georgina Friedenberg
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Julie E Buring
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA; Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - JoAnn E Manson
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA; Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
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44
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Harmelink KEM, Zeegers AVCM, Hullegie W, Hoogeboom TJ, Nijhuis-van der Sanden MWG, Staal JB. Are There Prognostic Factors for One-Year Outcome After Total Knee Arthroplasty? A Systematic Review. J Arthroplasty 2017; 32:3840-3853.e1. [PMID: 28927646 DOI: 10.1016/j.arth.2017.07.011] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 06/09/2017] [Accepted: 07/07/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Preoperative factors predicting outcome for pain, physical function and quality of life after total knee arthroplasty (TKA) have not been clearly identified. METHODS Embase and MEDLINE were searched for relevant studies. A study was considered for inclusion if the study aimed to identify preoperative prognostic factors for pain, physical function, and/or quality of life after a follow-up period of at least 1 year; included at least 200 adults suffering from osteoarthritis and undergoing TKA; and analyzed data using multivariable modeling. The quality of the evidence per prognostic factor was determined using the Grading of Recommendations, Assessment, Development and Evaluation framework for prognosis studies. RESULTS A total of 18 studies were included. There is very low-quality evidence that preoperative more pain, presence of social support, absence of anxiety, and presence of more radiographic damage are prognostic factors for lower pain levels after TKA. There is very low-quality evidence that low preoperative physical function, less comorbidity, absence of anxiety, presence of social support, higher income, normal body mass index, and more radiographic damage are prognostic factors for better physical function. There is very low-quality evidence that female sex and less comorbidity are prognostic factors for better quality of life. CONCLUSION Only very low-quality evidence was found for a number of prognostic factors of long-term outcome after TKA. More studies that seek to generate understanding of the underlying process for the prognosis of outcome in TKA are needed to understand and test prognostic pathways, and it might be more valuable to look at recovery curves rather than at recovery points. Systematic review registration number: CRD42015026814.
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Affiliation(s)
- Karen E M Harmelink
- FysioHolland Twente, Enschede, The Netherlands; Research Institute for Health Sciences, Radboud University Medical Center, IQ Healthcare, Nijmegen, The Netherlands
| | - Adelgunde V C M Zeegers
- Department of Orthopaedic Surgery, Medisch Spectrum Twente (MST), Haaksbergen, The Netherlands
| | - Wim Hullegie
- Fysiotherapie Hullegie & Richter, Enschede, The Netherlands
| | - Thomas J Hoogeboom
- Research Institute for Health Sciences, Radboud University Medical Center, IQ Healthcare, Nijmegen, The Netherlands
| | | | - J Bart Staal
- Research Institute for Health Sciences, Radboud University Medical Center, IQ Healthcare, Nijmegen, The Netherlands; Faculty of Health and Social Studies, Research Group Musculoskeletal Rehabilitation, HAN University of Applied Sciences, Nijmegen, The Netherlands
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45
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Sample Size for Joint Testing of Indirect Effects. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2016; 16:1128-35. [PMID: 25418811 DOI: 10.1007/s11121-014-0528-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
This paper presents methods to calculate sample size for evaluating mediation by joint testing of both links in an indirect pathway from exposure to mediator to outcome. Calculations rely on simulations of the underlying data structure, with testing of the two links performed under the simplifying assumption that the two test statistics are asymptotically independent. Simulations show that the proposed methods are accurate. Continuous and binary exposures and mediators, as well as continuous, binary, count, and survival outcomes are accommodated, along with over-dispersion of count outcomes, design effects, and confounding of the exposure-mediator and mediator-outcome relationships. An illustrative example is provided, and a documented R program implementing the calculations is available online.
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Kapellas K, Mejia G, Bartold PM, Skilton MR, Maple-Brown LJ, Slade GD, O'Dea K, Brown A, Celermajer DS, Jamieson LM. Periodontal therapy and glycaemic control among individuals with type 2 diabetes: reflections from the PerioCardio study. Int J Dent Hyg 2016; 15:e42-e51. [PMID: 27245786 DOI: 10.1111/idh.12234] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2016] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Diabetes mellitus and periodontal disease are highly prevalent among Indigenous Australian adults. Untreated periodontitis impacts glycaemic control in people with diabetes. The aim of this study was to report on the effect of periodontal therapy on glycaemic control among people with obesity. METHODS This subgroup analysis is limited to 62 participants with diabetes from the original 273 Aboriginal Australian adults enrolled into the PerioCardio study. Intervention participants received full-mouth non-surgical periodontal scaling during a single, untimed session while controls were untreated. Endpoints of interest included change in glycated haemoglobin (HbA1c), C-reactive protein (CRP) and periodontal status at 3 months post-intervention. RESULTS There were more females randomized to the treatment group (n = 17) than control (n = 10) while the control group had a higher overall body mass index (BMI) [mean (SD)] 33.1 (9.7 kg m-2 ) versus 29.9 (6.0 kg m-2 ). A greater proportion of males were followed up at 3 months compared to females, P = 0.05. Periodontal therapy did not significantly reduce HbA1c: ancova difference in means 0.22 mmol mol-1 (95% CI -6.25 to 6.69), CRP: ancova difference in means 0.64 (95% CI -1.08, 2.37) or periodontal status at 3 months. CONCLUSIONS Non-surgical periodontal therapy did not significantly reduce glycated haemoglobin in participants with type 2 diabetes. Reasons are likely to be multifactorial and may be influenced by persistent periodontal inflammation at the follow-up appointments. Alternatively, the BMI of study participants may impact glycaemic control via alternative mechanisms involving the interplay between inflammation and adiposity meaning HbA1c may not be amenable to periodontal therapy in these individuals.
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Affiliation(s)
- K Kapellas
- Australian Research Centre for Population Oral Health, School of Dentistry, University of Adelaide, Adelaide, SA, Australia.,Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - G Mejia
- Australian Research Centre for Population Oral Health, School of Dentistry, University of Adelaide, Adelaide, SA, Australia.,School of Dental Medicine, East Carolina University, Greenville, NC, USA
| | - P M Bartold
- Colgate Australian Clinical Dental Research Centre, School of Dentistry, University of Adelaide, Adelaide, SA, Australia
| | - M R Skilton
- Boden Institute of Obesity, Nutrition, Exercise and Eating Disorders, University of Sydney, Sydney, NSW, Australia
| | - L J Maple-Brown
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia.,Division of Medicine, Royal Darwin Hospital, Darwin, NT, Australia
| | - G D Slade
- Department of Dental Ecology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - K O'Dea
- Sansom Institute for Health Research, UniSA, Adelaide, SA, Australia
| | - A Brown
- Aboriginal Research Unit, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | - D S Celermajer
- Department of Medicine, University of Sydney, Sydney, NSW, Australia
| | - L M Jamieson
- Australian Research Centre for Population Oral Health, School of Dentistry, University of Adelaide, Adelaide, SA, Australia
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Smith LE, Prendergast AJ, Turner PC, Mbuya MNN, Mutasa K, Kembo G, Stoltzfus RJ. The Potential Role of Mycotoxins as a Contributor to Stunting in the SHINE Trial. Clin Infect Dis 2015; 61 Suppl 7:S733-7. [PMID: 26602301 PMCID: PMC4657594 DOI: 10.1093/cid/civ849] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Children in developing countries experience multiple exposures that are harmful to their growth and development. An emerging concern is frequent exposure to mycotoxins that contaminate a wide range of staple foods, including maize and groundnuts. Three mycotoxins are suspected to contribute to poor child health and development: aflatoxin, fumonisin, and deoxynivalenol. We summarize the evidence that mycotoxin exposure is associated with stunting, and propose that the causal pathway may be through environmental enteric dysfunction (EED) and disturbance of the insulin-like growth factor 1 (IGF-1) axis. The objectives of this substudy are to assess the relationship between agricultural and harvest practices and mycotoxin exposure; to evaluate associations between mycotoxin exposure and child stunting; and to investigate EED as a potential pathway linking mycotoxin exposure to child stunting, to inform potential areas for intervention.
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Affiliation(s)
- Laura E. Smith
- Division of Nutritional Sciences, Cornell University, Ithaca, New York
| | - Andrew J. Prendergast
- Blizard Institute, Queen Mary University of London, United Kingdom
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Paul C. Turner
- Maryland Institute for Applied Environmental Health, School of Public Health, University of Maryland, College Park
| | - Mduduzi N. N. Mbuya
- Division of Nutritional Sciences, Cornell University, Ithaca, New York
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Kuda Mutasa
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
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Richey JA, White BA, Valdespino A, Ghane M, Schmidt NB. Attentional control mediates fearful responding to an ecologically valid stressor. ANXIETY STRESS AND COPING 2015; 29:60-79. [DOI: 10.1080/10615806.2015.1015424] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Steinman BA, Allen SM, Chen J, Pynoos J. Functional limitations as potential mediators of the effects of self-reported vision status on fall risk of older adults. J Aging Health 2014; 27:158-76. [PMID: 25047163 DOI: 10.1177/0898264314543473] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To test whether limitations in mobility and large-muscle functioning mediate self-reported vision status to increase fall risk among respondents age 65 and above. METHOD This study used two waves from the Health and Retirement Study. We conducted binary logistic and negative binomial regression analyses to test indirect paths leading from self-reported vision status to falls, via indices of mobility and large-muscle functioning. RESULTS Limited evidence was found for a mediating effect among women; however, large-muscle groups were implicated as partially mediating risk factors for falls among men with fair self-reported vision status. DISCUSSION Implications of these findings are discussed including the need for prioritizing improved muscle strength of older men and women with poor vision as a preventive measure against falls.
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Affiliation(s)
| | | | - Jie Chen
- University of Massachusetts, Boston, USA
| | - Jon Pynoos
- University of Southern California, Los Angeles, USA
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50
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Monte Carlo based statistical power analysis for mediation models: methods and software. Behav Res Methods 2013; 46:1184-98. [DOI: 10.3758/s13428-013-0424-0] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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