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Van Norman ER, Forcht ER. Accuracy of progress monitoring decision rules to evaluate response to instruction with two computer adaptive tests. J Sch Psychol 2024; 105:101319. [PMID: 38876546 DOI: 10.1016/j.jsp.2024.101319] [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: 10/07/2021] [Revised: 08/30/2023] [Accepted: 04/17/2024] [Indexed: 06/16/2024]
Abstract
Computer adaptive tests have become popular assessments to screen students for academic risk. Research is emerging regarding their use as progress monitoring tools to measure response to instruction. We evaluated the accuracy of the trend-line decision rule when applied to outcomes from a frequently used reading computer adaptive test (i.e., Star Reading [SR]) and frequently used math computer adaptive test (i.e., Star Math [SM]). Analyses of extant SR and SM data were conducted to inform conditions for simulations to determine the number of assessments required to yield sufficient sensitivity (i.e., probability of recommending an instructional change when a change was warranted) and specificity (i.e., probability of recommending maintaining an intervention when a change was not warranted) when comparing performance to goal lines based upon a future target score (i.e., benchmark) as well as normative comparisons (50th and 75th percentiles). The extant dataset of SR outcomes consisted of monthly progress monitoring data from 993 Grade 3, 804 Grade 4, and 709 Grade 5 students from multiple states in the United States northwest. Data for SM were also drawn from the northwest and contained outcomes from 518 Grade 3, 474 Grade 4, and 391 Grade 5 students. Grade level samples were predominately White (range = 59.89%-67.72%) followed by Latinx (range = 9.65%-15.94%). Results of simulations suggest that when data were collected once a month, seven, eight, and nine observations were required to support low-stakes decisions with SR for Grades 3, 4, and 5, respectively. For SM, nine, ten, and eight observations were required for Grades, 3, 4, and 5, respectively. Given the length of time required to support reasonably accurate decisions, recommendations to consider other types of assessments and decision-making frameworks for academic progress monitoring are provided.
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Affiliation(s)
- Ethan R Van Norman
- Center for Promoting Research to Practice, Lehigh University, United States of America.
| | - Emily R Forcht
- Center for Promoting Research to Practice, Lehigh University, United States of America
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Anaby DR, Avery L, Palisano RJ, Levin MF, Khayargoli P, Hsieh YH, Gorter JW, Teplicky R. Environment-based approaches to improve participation of young people with physical disabilities during COVID-19. Dev Med Child Neurol 2024; 66:931-938. [PMID: 38140720 DOI: 10.1111/dmcn.15822] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 10/30/2023] [Accepted: 11/07/2023] [Indexed: 12/24/2023]
Abstract
AIM To examine the effects of the Pathways and Resources for Engagement and Participation (PREP) intervention during the COVID-19 pandemic on (1) activity performance and satisfaction, and (2) motor, cognitive, and affective body functions. METHOD An interrupted time-series design with multiple baselines across 21 young people (13 females, eight males) aged 16 to 25 years (median = 21 years 5 months) with physical disabilities was employed. The young people engaged in an 8-week self-chosen leisure activity (e.g. football, piano, photography) at their home or community. The Canadian Occupational Performance Measure (COPM) assessed activity performance and satisfaction weekly. Mental health problems, including affective and cognitive outcomes, were assessed weekly using the Behavior Assessment System for Children, Third Edition. Motor functions (e.g. trunk control, reaching, strength) were assessed biweekly. Linear mixed-effects models were used. RESULTS The intervention had large effects on activity performance (0.78) and satisfaction (0.88) with clinically significant change in COPM scores (2.6 [95% confidence interval {CI}: 2.0-3.2] and 3.2 points [95% CI: 2.4-3.9] respectively). Young people without mental health problems at baseline benefited more from the intervention (p = 0.028). Improvements in at least one domain of body function occurred in 10 young people especially for motor outcomes. INTERPRETATION Results demonstrate the effectiveness of PREP during adverse times and suggest benefits going beyond participation, involving outcomes at the body-function level. WHAT THIS PAPER ADDS Environmental-based interventions can improve participation even during adverse times such as the COVID-19 pandemic. Significant improvement with large effect sizes occurred in both activity performance and satisfaction. Intervention was effective for all; those without mental health problems benefited more. Improvements in body-function outcomes were partially observed, especially in motor-related outcomes. Body functions may improve through participation even if not targeted by the intervention.
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Affiliation(s)
- Dana R Anaby
- School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
| | - Lisa Avery
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Avery Information Services Ltd., Ontario, Canada
| | - Robert J Palisano
- Department of Physical Therapy and Rehabilitation Science, Drexel University, Philadelphia, USA
| | - Mindy F Levin
- School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
| | - Pranamika Khayargoli
- School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
| | - Yu-Hsin Hsieh
- School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
| | - Jan Willem Gorter
- CanChild Centre for Childhood Disability Research, Hamilton, Ontario, Canada
- Department of Rehabilitation, Physical Therapy Science and Sports, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Rachel Teplicky
- CanChild Centre for Childhood Disability Research, Hamilton, Ontario, Canada
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Casey MB, Takemasa S, O'Reilly T, Leamy M, Mc Kearney E, Buckley M, Smart KM, Segurado R, Lowry D, Flanagan D, Gopal H, Hearty C, Doody C. Exercise combined with Acceptance and Commitment Therapy for chronic pain: One-year follow-up from a randomized controlled trial. Eur J Pain 2024; 28:913-928. [PMID: 38348557 DOI: 10.1002/ejp.2229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 11/23/2023] [Accepted: 12/12/2023] [Indexed: 02/24/2024]
Abstract
BACKGROUND Acceptance and Commitment Therapy (ACT) is a type of Cognitive Behavioural Therapy, which has demonstrated positive outcomes in individuals with chronic pain. The purpose of this study was to compare the effect of an 8-week programme combining Exercise with Acceptance and Commitment Therapy (ExACT) with a standalone supervised exercise programme at 1-year follow-up. METHODS One hundred and seventy-five people with chronic pain were randomly assigned to ExACT or supervised exercise only. The primary outcome was pain interference measured with the Brief Pain Inventory-Interference Scale. Secondary and treatment process outcomes included pain severity, depression, anxiety, pain catastrophizing, pain self-efficacy, fear avoidance, pain acceptance, committed action, healthcare utilization, patient satisfaction, and global impression of change. Estimates of treatment effects at 1-year follow-up were based on intention-to-treat analyses, implemented using a linear mixed-effects model. RESULTS Eighty-three participants (47.4%) returned the outcome measures at 1-year follow-up. No significant difference was observed between the groups for the primary outcome, pain interference. There was a statistically significant difference between the groups, in favour of ExACT for pain catastrophizing. Within group improvements that were observed within both groups at earlier timepoints were maintained at 1-year follow-up for many of the secondary and treatment process outcomes. ExACT group participants reported higher levels of satisfaction with treatment and global perceived change. CONCLUSIONS The study results showed no significant difference between the two groups for the primary outcome pain interference at 1-year follow-up. Future research could investigate factors that may predict and optimize outcomes from these types of intervention for people living with chronic pain. SIGNIFICANCE Few previous randomized controlled trials investigating ACT for chronic pain have included long-term follow-up. This study found that Exercise combined with ACT was not superior to supervised exercise alone for reducing pain interference at 1-year follow-up. Further research is necessary to identify key processes of therapeutic change and to explore how interventions may be modified to enhance clinical outcomes for people with chronic pain.
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Affiliation(s)
- M B Casey
- Department of Public Health & Primary Care, Institute of Population Health, School of Medicine, Trinity College Dublin, The University of Dublin, Dublin, Ireland
| | - S Takemasa
- School of Public Health, Physiotherapy & Sports Science, University College Dublin, Dublin, Ireland
- Clinical Development, Clinical Development Centre, Asahi Kasei Pharma Corporation, Tokyo, Japan
| | - T O'Reilly
- School of Public Health, Physiotherapy & Sports Science, University College Dublin, Dublin, Ireland
| | - M Leamy
- School of Public Health, Physiotherapy & Sports Science, University College Dublin, Dublin, Ireland
| | - E Mc Kearney
- School of Public Health, Physiotherapy & Sports Science, University College Dublin, Dublin, Ireland
| | - M Buckley
- School of Public Health, Physiotherapy & Sports Science, University College Dublin, Dublin, Ireland
| | - K M Smart
- School of Public Health, Physiotherapy & Sports Science, University College Dublin, Dublin, Ireland
| | - R Segurado
- School of Public Health, Physiotherapy & Sports Science, University College Dublin, Dublin, Ireland
| | - D Lowry
- Department of Pain Medicine, Mater Misericordiae University Hospital, Dublin, Ireland
| | - D Flanagan
- Department of Pain Medicine, Mater Misericordiae University Hospital, Dublin, Ireland
| | - H Gopal
- Department of Pain Medicine, Mater Misericordiae University Hospital, Dublin, Ireland
| | - C Hearty
- Department of Pain Medicine, Mater Misericordiae University Hospital, Dublin, Ireland
| | - C Doody
- School of Public Health, Physiotherapy & Sports Science, University College Dublin, Dublin, Ireland
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Bache-Mathiesen LK, Bahr R, Sattler T, Fagerland MW, Whiteley R, Skazalski C. Causal inference did not detect any effect of jump load on knee complaints in elite men's volleyball. Scand J Med Sci Sports 2024; 34:e14635. [PMID: 38671558 DOI: 10.1111/sms.14635] [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: 07/26/2023] [Revised: 04/10/2024] [Accepted: 04/11/2024] [Indexed: 04/28/2024]
Abstract
The aim was to determine how jump load affects knee complaints in elite men's volleyball. We collected data from four men's premier league volleyball teams through three seasons in a prospective cohort study (65 players, 102 player-seasons). Vert inertial measurement devices captured the jump load (jump frequency and jump height) from 21 088 daily player sessions, and knee complaints were reported in 3568 weekly OSTRC-O questionnaires. Mixed complementary log-log regression models described the probability of (i) experiencing symptoms if players were currently asymptomatic, (ii) worsening symptoms if players had symptoms, and (iii) recovery from knee complaints. Based on our causal assumptions, weekly jump load was modeled as the independent variable, adjusted for age (years), weight (kg), position on volleyball team, and past jump load. No certain evidence of an association was found between weekly jump load and probability of (i) knee complaints (p from 0.10 to 0.32 for three restricted cubic splines of load), (ii) worsening symptoms if the player already had symptoms (p from 0.11 to 0.97), (iii) recovery (p from 0.36 to 0.63). The probability of knee complaints was highest for above-average weekly jump load (~1.2% for an outside hitter with mean age and height) compared with low loads (~1%) and very high loads (→ ~ 0%). The association between jump load and knee complaints risk remains unclear. Small differences in risk across observed jump load levels were observed. It would likely require substantially increased sample sizes to detect this association with certainty.
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Affiliation(s)
- Lena Kristin Bache-Mathiesen
- Oslo Sports Trauma Research Centre, Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | - Roald Bahr
- Oslo Sports Trauma Research Centre, Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Tine Sattler
- Faculty of Sport, University of Ljubljana, Ljubljana, Slovenia
| | - Morten Wang Fagerland
- Oslo Sports Trauma Research Centre, Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
- Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway
| | - Rod Whiteley
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Christopher Skazalski
- Oslo Sports Trauma Research Centre, Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
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Liu Y, Liu K, Zhang X, Guo Q. Does digital infrastructure improve public Health? A quasi-natural experiment based on China's Broadband policy. Soc Sci Med 2024; 344:116624. [PMID: 38290184 DOI: 10.1016/j.socscimed.2024.116624] [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: 10/13/2023] [Revised: 12/28/2023] [Accepted: 01/19/2024] [Indexed: 02/01/2024]
Abstract
This study proposed a scheme for improving people's health from the perspective of digital infrastructure construction. We used the China Family Panel Studies conducted between 2010 and 2020 and the digital infrastructure construction marked by the Broadband China policy between 2014 and 2016 as a quasi-natural experiment. We adopted the multi-time difference-in-differences method to identify the causal relationship between digital infrastructure and people's health. We found that digital infrastructure construction significantly improved people's health, and the effect was more prominent among young and middle-aged residents and those with less than a university education. Moreover, digital infrastructure construction improved the utilization of medical services, helped residents develop healthy lifestyles, and increased people's health investments. Additionally, digital infrastructure reduced health inequality among people and promoted health equity. The findings could guide future policies to improve people's health and well-being.
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Affiliation(s)
- Yiwei Liu
- School of Government, Central University of Finance and Economics, 39 South College Road, Haidian District, Beijing 100081, China
| | - Keshan Liu
- School of Government, Central University of Finance and Economics, 39 South College Road, Haidian District, Beijing 100081, China
| | - XiangLin Zhang
- School of Government, Central University of Finance and Economics, 39 South College Road, Haidian District, Beijing 100081, China
| | - Qiuyue Guo
- School of Government, Central University of Finance and Economics, 39 South College Road, Haidian District, Beijing 100081, China.
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Schlegl S, Maier J, Dieffenbacher A, Voderholzer U. Efficacy of a therapist-guided smartphone-based intervention to support recovery from bulimia nervosa: Study protocol of a randomized controlled multi-centre trial. EUROPEAN EATING DISORDERS REVIEW 2024; 32:350-362. [PMID: 37936300 DOI: 10.1002/erv.3047] [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: 03/14/2023] [Revised: 10/23/2023] [Accepted: 10/24/2023] [Indexed: 11/09/2023]
Abstract
OBJECTIVE Although inpatient treatment is highly effective for patients with bulimia nervosa (BN), some patients show a resurgence of symptoms and relapse after discharge. Therefore, the aim of this study is to evaluate the efficacy of a guided smartphone-based aftercare intervention following inpatient treatment to support recovery. METHOD 172 female patients with BN (DSM-5: 307.51) will be randomized to receive a 16-week smartphone-based aftercare intervention (German version of 'Recovery Record') with therapist feedback as an add-on element to treatment as usual (TAU) or TAU alone. Assessments will take place at baseline (discharge, T0), during the intervention (after 4 weeks, T1), post-intervention (after 16 weeks, T2) and at 6-month follow-up (T3). Primary outcome will be remission at T2. Moderator and mediator analyses will investigate for whom the aftercare intervention suits best and how it works. CONCLUSIONS This is the first randomized controlled trial to examine a guided smartphone-based aftercare intervention following inpatient treatment of patients with BN. We expect that this innovative aftercare intervention is highly accepted by the patients and that it has the potential to support recovery after inpatient treatment and thereby could contribute to improving aftercare for patients with BN.
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Affiliation(s)
- Sandra Schlegl
- Department of Psychiatry and Psychotherapy (LMU), University Hospital of Munich (LMU), Munich, Germany
| | - Julia Maier
- Department of Psychiatry and Psychotherapy (LMU), University Hospital of Munich (LMU), Munich, Germany
| | - Anna Dieffenbacher
- Department of Psychiatry and Psychotherapy (LMU), University Hospital of Munich (LMU), Munich, Germany
| | - Ulrich Voderholzer
- Department of Psychiatry and Psychotherapy (LMU), University Hospital of Munich (LMU), Munich, Germany
- Department of Psychiatry and Psychotherapy, University Hospital of Freiburg, Freiburg, Germany
- Schoen Clinic Roseneck, Prien am Chiemsee, Germany
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Rosenbloom BN, Slepian PM, Azam MA, Aternali A, Birnie KA, Curtis K, Thaker S, Ladak S, Waisman A, Clarke H, Katz J, Weinrib AZ. A Randomized Controlled Trial of Clinical Hypnosis as an Opioid-Sparing Adjunct Treatment for Pain Relief in Adults Undergoing Major Oncologic Surgery. J Pain Res 2024; 17:45-59. [PMID: 38196969 PMCID: PMC10775151 DOI: 10.2147/jpr.s424639] [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: 06/07/2023] [Accepted: 11/27/2023] [Indexed: 01/11/2024] Open
Abstract
Clinical hypnosis is an effective strategy for managing acute pain in the surgical setting. However, the opioid sparing effects of clinical hypnosis are not as well understood. This pre-registered (NCT03730350) randomized, controlled trial (RCT) examined the impact of clinical hypnosis, pre- and post-surgery, on opioid consumption during hospitalization as well as on measures of pain intensity, pain interference, depressed mood, anxiety, sleep, and pain catastrophizing. Participants (M = 57.6 years; SD = 10.9) awaiting oncologic surgery were randomized to treatment-as-usual (n = 47) or hypnosis (n = 45). Intent-to-treat analyses were conducted using linear mixed effects modeling. A significant Group × Time interaction, F(6, 323.34) = 3.32, p = 0.003, indicated an opioid sparing effect of clinical hypnosis during the acute postoperative period. Hypnosis also protected against increases in pain catastrophizing at one-week after surgery, F (1, 75.26) = 4.04, p = 0.048. A perioperative clinical hypnosis intervention had a sparing effect on opioid consumption in-hospital after major oncologic surgery. These findings extend the efficacy of clinical hypnosis as an adjunct tool for perioperative pain management.
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Affiliation(s)
- Brittany N Rosenbloom
- Department of Psychology, York University, Toronto, ON, Canada
- Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, Toronto, ON, Canada
- Toronto Academic Pain Medicine Institute, Women’s College Hospital, Toronto, ON, Canada
| | - P Maxwell Slepian
- Department of Psychology, York University, Toronto, ON, Canada
- Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, Toronto, ON, Canada
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada
| | - Muhammed Abid Azam
- Department of Psychology, York University, Toronto, ON, Canada
- Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, Toronto, ON, Canada
| | - Andrea Aternali
- Department of Psychology, York University, Toronto, ON, Canada
| | - Kathryn A Birnie
- Department of Anesthesiology, Perioperative and Pain Medicine, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Kathryn Curtis
- Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, Toronto, ON, Canada
| | - Sonal Thaker
- Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, Toronto, ON, Canada
| | - Salima Ladak
- Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, Toronto, ON, Canada
| | - Anna Waisman
- Department of Psychology, York University, Toronto, ON, Canada
| | - Hance Clarke
- Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, Toronto, ON, Canada
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada
| | - Joel Katz
- Department of Psychology, York University, Toronto, ON, Canada
- Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, Toronto, ON, Canada
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada
| | - Aliza Z Weinrib
- Department of Psychology, York University, Toronto, ON, Canada
- Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, Toronto, ON, Canada
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Vernooij LM, van Waes JAR, Grobben RB, van Lier F, Feng S, Machina M, McKenny M, Nathoe HM, Wijeysundera DN, van Klei WA, Beattie WS. Postoperative myocardial injury phenotypes and self-reported disability in patients undergoing noncardiac surgery: a multicentre observational study. Br J Anaesth 2024; 132:35-44. [PMID: 38057252 DOI: 10.1016/j.bja.2023.10.012] [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: 06/06/2023] [Revised: 10/10/2023] [Accepted: 10/13/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND Postoperative myocardial injury (PMI) comprises a spectrum of mechanisms resulting in troponin release. The impact of different PMI phenotypes on postoperative disability remains unknown. METHODS This was a multicentre prospective cohort study including patients aged ≥50 yr undergoing elective major noncardiac surgery. Patients were stratified in five groups based on the occurrence of PMI and clinical information on postoperative adverse events: PMI classified as myocardial infarction (MI; according to fourth definition), PMI plus adverse event other than MI, clinically silent PMI (PMI without adverse events), adverse events without PMI, and neither PMI nor an adverse event (reference). The primary endpoint was 6-month self-reported disability (assessed by WHO Disability Assessment Schedule 2.0 [WHODAS]). Disability-free survival was defined as WHODAS ≤16%. RESULTS We included 888 patients of mean age 69 (range 53-91) yr, of which 356 (40%) were women; 151 (17%) patients experienced PMI, and 625 (71%) experienced 6-month disability-free survival. Patients with PMI, regardless of its phenotype, had higher preoperative disability scores than patients without PMI (difference in WHODAS; β: 3.3, 95% confidence interval [CI]: 0.5-6.2), but scores remained stable after surgery (β: 1.2, 95% CI: -3.2-5.6). Before surgery, patients with MI (n=36, 4%) were more disabled compared with patients without PMI and no adverse events (β: 5.5, 95% CI: 0.3-10.8). At 6 months, patients with MI and patients without PMI but with adverse events worsened in disability score (β: 11.2, 95% CI: 2.3-20.2; β: 8.1, 95% CI: 3.0-13.2, respectively). Patients with clinically silent PMI did not change in disability score at 6 months (β: 1.39, 95% CI: -4.50-7.29, P=0.642). CONCLUSIONS Although patients with postoperative myocardial injury had higher preoperative self-reported disability, disability scores did not change at 6 months after surgery. However, patients experiencing myocardial infarction worsened in disability score after surgery.
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Affiliation(s)
- Lisette M Vernooij
- Department of Anesthesiology and Intensive Care Medicine, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands; Department of Anesthesiology, Intensive Care and Pain Medicine, St Antonius Hospital, Nieuwegein, The Netherlands.
| | - Judith A R van Waes
- Department of Anesthesiology and Intensive Care Medicine, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands
| | - Remco B Grobben
- Department of Cardiology, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands
| | - Felix van Lier
- Department of Anesthesiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Simon Feng
- Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network Toronto, Toronto, ON, Canada; Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Matthew Machina
- Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network Toronto, Toronto, ON, Canada; Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, ON, Canada
| | - Michael McKenny
- Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network Toronto, Toronto, ON, Canada; Department of Anesthesiology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Hendrik M Nathoe
- Department of Cardiology, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands
| | - Duminda N Wijeysundera
- Department of Anesthesia, St. Michael's Hospital - Unity Health Toronto, Toronto, ON, Canada; Department of Anesthesiology and Pain Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Wilton A van Klei
- Department of Anesthesiology and Intensive Care Medicine, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands; Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network Toronto, Toronto, ON, Canada; Department of Anesthesiology and Pain Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Toronto General Hospital Research Institute, Toronto, ON, Canada
| | - W Scott Beattie
- Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network Toronto, Toronto, ON, Canada
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Koch M, Matzke I, Huhn S, Sié A, Boudo V, Compaoré G, Maggioni MA, Bunker A, Bärnighausen T, Dambach P, Barteit S. Assessing the Effect of Extreme Weather on Population Health Using Consumer-Grade Wearables in Rural Burkina Faso: Observational Panel Study. JMIR Mhealth Uhealth 2023; 11:e46980. [PMID: 37938879 PMCID: PMC10666008 DOI: 10.2196/46980] [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: 03/04/2023] [Revised: 08/25/2023] [Accepted: 09/15/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND Extreme weather, including heat and extreme rainfall, is projected to increase owing to climate change, which can have adverse impacts on human health. In particular, rural populations in sub-Saharan Africa are at risk because of a high burden of climate-sensitive diseases and low adaptive capacities. However, there is a lack of data on the regions that are anticipated to be most exposed to climate change. Improved public health surveillance is essential for better decision-making and health prioritization and to identify risk groups and suitable adaptation measures. Digital technologies such as consumer-grade wearable devices (wearables) may generate objective measurements to guide data-driven decision-making. OBJECTIVE The main objective of this observational study was to examine the impact of weather exposure on population health in rural Burkina Faso using wearables. Specifically, this study aimed to assess the relationship between individual daily activity (steps), sleep duration, and heart rate (HR), as estimated by wearables, and exposure to heat and heavy rainfall. METHODS Overall, 143 participants from the Nouna health and demographic surveillance system in Burkina Faso wore the Withings Pulse HR wearable 24/7 for 11 months. We collected continuous weather data using 5 weather stations throughout the study region. The heat index and wet-bulb globe temperature (WBGT) were calculated as measures of heat. We used linear mixed-effects models to quantify the relationship between exposure to heat and rainfall and the wearable parameters. Participants kept activity journals and completed a questionnaire on their perception of and adaptation to heat and other weather exposure. RESULTS Sleep duration decreased significantly (P<.001) with higher heat exposure, with approximately 15 minutes shorter sleep duration during heat stress nights with a heat index value of ≥25 °C. Many participants (55/137, 40.1%) reported that heat affected them the most at night. During the day, most participants (133/137, 97.1%) engaged in outdoor physical work such as farming, housework, or fetching water. During the rainy season, when WBGT was highest, daily activity was highest and increased when the daily maximum WBGT surpassed 30 °C during the rainiest month. In the hottest month, daily activity decreased per degree increase in WBGT for values >30 °C. Nighttime HR showed no significant correlation with heat exposure. Daytime HR data were insufficient for analysis. We found no negative health impact associated with heavy rainfall. With increasing rainfall, sleep duration increased, average nightly HR decreased, and activity decreased. CONCLUSIONS During the study period, participants were frequently exposed to heat and heavy rainfall. Heat was particularly associated with impaired sleep and daily activity. Essential tasks such as harvesting, fetching water, and caring for livestock expose this population to weather that likely has an adverse impact on their health. Further research is essential to guide interventions safeguarding vulnerable communities.
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Affiliation(s)
- Mara Koch
- Heidelberg Institute of Global Health, Faculty of Medicine, University Hospital, Heidelberg University, Heidelberg, Germany
| | - Ina Matzke
- Heidelberg Institute of Global Health, Faculty of Medicine, University Hospital, Heidelberg University, Heidelberg, Germany
| | - Sophie Huhn
- Heidelberg Institute of Global Health, Faculty of Medicine, University Hospital, Heidelberg University, Heidelberg, Germany
| | - Ali Sié
- Heidelberg Institute of Global Health, Faculty of Medicine, University Hospital, Heidelberg University, Heidelberg, Germany
- Centre de Recherche en Santé, Nouna, Burkina Faso
| | | | | | - Martina Anna Maggioni
- Charité - Universitätsmedizin Berlin, Institute of Physiology, Center for Space Medicine and Extreme Environments Berlin, Berlin, Germany
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| | - Aditi Bunker
- Heidelberg Institute of Global Health, Faculty of Medicine, University Hospital, Heidelberg University, Heidelberg, Germany
- Center for Climate, Health, and the Global Environment, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Till Bärnighausen
- Heidelberg Institute of Global Health, Faculty of Medicine, University Hospital, Heidelberg University, Heidelberg, Germany
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, United States
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Peter Dambach
- Heidelberg Institute of Global Health, Faculty of Medicine, University Hospital, Heidelberg University, Heidelberg, Germany
| | - Sandra Barteit
- Heidelberg Institute of Global Health, Faculty of Medicine, University Hospital, Heidelberg University, Heidelberg, Germany
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10
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Kopczak A, Stringer MS, van den Brink H, Kerkhofs D, Blair GW, van Dinther M, Reyes CA, Garcia DJ, Onkenhout L, Wartolowska KA, Thrippleton MJ, Kampaite A, Duering M, Staals J, Lesnik-Oberstein S, Muir KW, Middeke M, Norrving B, Bousser MG, Mansmann U, Rothwell PM, Doubal FN, van Oostenbrugge R, Biessels GJ, Webb AJS, Wardlaw JM, Dichgans M. Effect of blood pressure-lowering agents on microvascular function in people with small vessel diseases (TREAT-SVDs): a multicentre, open-label, randomised, crossover trial. Lancet Neurol 2023; 22:991-1004. [PMID: 37863608 DOI: 10.1016/s1474-4422(23)00293-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 06/15/2023] [Accepted: 08/01/2023] [Indexed: 10/22/2023]
Abstract
BACKGROUND Hypertension is the leading risk factor for cerebral small vessel disease. We aimed to determine whether antihypertensive drug classes differentially affect microvascular function in people with small vessel disease. METHODS We did a multicentre, open-label, randomised crossover trial with blinded endpoint assessment at five specialist centres in Europe. We included participants aged 18 years or older with symptomatic sporadic small vessel disease or cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) and an indication for antihypertensive treatment. Participants were randomly assigned (1:1:1) to one of three sequences of antihypertensive treatment using a computer-generated multiblock randomisation, stratified by study site and patient group. A 2-week washout period was followed by three 4-week periods of oral monotherapy with amlodipine, losartan, or atenolol at approved doses. The primary endpoint was change in cerebrovascular reactivity (CVR) determined by blood oxygen level-dependent MRI response to hypercapnic challenge in normal-appearing white matter from the end of washout to the end of each treatment period. Efficacy analyses were done by intention-to-treat principles in all randomly assigned participants who had at least one valid assessment for the primary endpoint, and analyses were done separately for participants with sporadic small vessel disease and CADASIL. This trial is registered at ClinicalTrials.gov, NCT03082014, and EudraCT, 2016-002920-10, and is terminated. FINDINGS Between Feb 22, 2018, and April 28, 2022, 75 participants with sporadic small vessel disease (mean age 64·9 years [SD 9·9]) and 26 with CADASIL (53·1 years [7·0]) were enrolled and randomly assigned to treatment. 79 participants (62 with sporadic small vessel disease and 17 with CADASIL) entered the primary efficacy analysis. Change in CVR did not differ between study drugs in participants with sporadic small vessel disease (mean change in CVR 1·8 × 10-4%/mm Hg [SE 20·1; 95% CI -37·6 to 41·2] for amlodipine; 16·7 × 10-4%/mm Hg [20·0; -22·3 to 55·8] for losartan; -7·1 × 10-4%/mm Hg [19·6; -45·5 to 31·1] for atenolol; poverall=0·39) but did differ in patients with CADASIL (15·7 × 10-4%/mm Hg [SE 27·5; 95% CI -38·3 to 69·7] for amlodipine; 19·4 × 10-4%/mm Hg [27·9; -35·3 to 74·2] for losartan; -23·9 × 10-4%/mm Hg [27·5; -77·7 to 30·0] for atenolol; poverall=0·019). In patients with CADASIL, pairwise comparisons showed that CVR improved with amlodipine compared with atenolol (-39·6 × 10-4%/mm Hg [95% CI -72·5 to -6·6; p=0·019) and with losartan compared with atenolol (-43·3 × 10-4%/mm Hg [-74·3 to -12·3]; p=0·0061). No deaths occurred. Two serious adverse events were recorded, one while taking amlodipine (diarrhoea with dehydration) and one while taking atenolol (fall with fracture), neither of which was related to study drug intake. INTERPRETATION 4 weeks of treatment with amlodipine, losartan, or atenolol did not differ in their effects on cerebrovascular reactivity in people with sporadic small vessel disease but did result in differential treatment effects in patients with CADASIL. Whether antihypertensive drug classes differentially affect clinical outcomes in people with small vessel diseases requires further research. FUNDING EU Horizon 2020 programme.
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Affiliation(s)
- Anna Kopczak
- Institute for Stroke and Dementia Research, University Hospital, LMU Munich, Munich, Germany
| | - Michael S Stringer
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK; UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK
| | - Hilde van den Brink
- Department of Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, Netherlands
| | - Danielle Kerkhofs
- Department of Neurology and School for Cardiovascular Diseases, Maastricht University Medical Center+, Maastricht, Netherlands
| | - Gordon W Blair
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Maud van Dinther
- Department of Neurology and School for Cardiovascular Diseases, Maastricht University Medical Center+, Maastricht, Netherlands
| | - Carmen Arteaga Reyes
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK; UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK
| | - Daniela Jaime Garcia
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK; UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK
| | - Laurien Onkenhout
- Department of Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, Netherlands
| | - Karolina A Wartolowska
- Wolfson Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Michael J Thrippleton
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK; UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK
| | - Agniete Kampaite
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK; UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK
| | - Marco Duering
- Institute for Stroke and Dementia Research, University Hospital, LMU Munich, Munich, Germany; Medical Image Analysis Center and Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Julie Staals
- Department of Neurology and School for Cardiovascular Diseases, Maastricht University Medical Center+, Maastricht, Netherlands
| | | | - Keith W Muir
- School of Psychology and Neuroscience, University of Glasgow, Queen Elizabeth University Hospital, Glasgow, UK
| | - Martin Middeke
- Hypertoniezentrum München, Excellence Centre of the European Society of Hypertension, Munich, Germany
| | - Bo Norrving
- Department of Clinical Sciences Lund, Neurology, Skåne University Hospital, Lund University, Lund, Sweden
| | | | - Ulrich Mansmann
- Institute for Medical Information Processing, Biometry, and Epidemiology, LMU Munich, Munich, Germany
| | - Peter M Rothwell
- Wolfson Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Fergus N Doubal
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK; UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK
| | - Robert van Oostenbrugge
- Department of Neurology and School for Cardiovascular Diseases, Maastricht University Medical Center+, Maastricht, Netherlands
| | - Geert Jan Biessels
- Department of Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, Netherlands
| | - Alastair J S Webb
- Wolfson Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Joanna M Wardlaw
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK; UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK
| | - Martin Dichgans
- Institute for Stroke and Dementia Research, University Hospital, LMU Munich, Munich, Germany; Munich Cluster for Systems Neurology, Munich, Germany; German Center for Neurodegenerative Diseases, Munich, Germany; German Centre for Cardiovascular Research, Munich, Germany.
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11
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Tryggedsson JSJ, Andersen K, Behrendt S, Bilberg R, Bogenschutz MP, Buehringer G, Søgaard Nielsen A. Improvement in quality of life among women and men aged 60 years and older following treatment for alcohol use disorder. ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2023; 47:1952-1963. [PMID: 37864528 DOI: 10.1111/acer.15170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 07/14/2023] [Accepted: 08/07/2023] [Indexed: 10/23/2023]
Abstract
BACKGROUND Previous studies have yielded mixed results on the association between gender and alcohol use disorder (AUD) treatment outcomes. Thus, additional research is needed to determine the effect of gender on AUD treatment outcomes, including quality of life (QoL), particularly among older adults. AIMS In a clinical sample of older adults with DSM-5 AUD, we examined changes in QoL from the beginning of AUD treatment through 1 year of follow-ups. We also examined the effect of gender and explored interaction effects with gender on QoL. METHODS We utilized data from the "Elderly Study," a multi-national, single-blind, randomized, controlled trial of 693 adults aged 60+ with DSM-5 AUD. Alcohol use was assessed with the Form-90, and QoL with the brief version of the World Health Organization QoL measure. Information was collected at treatment initiation and at 4-, 12-, 26-, and 52-week follow-ups. Multilevel mixed-effects logistic and linear regression models were used to examine QoL changes and the effect of gender on changes in QoL. RESULTS Following treatment, small, but significant improvements were seen over time in overall perceived health (p < 0.05). Improvements that persisted over the 1-year follow-up period were seen in the QoL domains of physical health (β: 2.6, 95% CI: 1.4-3.9), psychological health (β: 3.5, 95% CI: 3.3-3.8), social relationships (β: 4.0, 95% CI: 2.5-5.6), and environmental health (β: 1.4, 95% CI: 0.4-2.4). No significant changes were seen over time in overall perceived QoL (p = 0.58). Gender was not associated with changes in any of the QoL outcome measures (all p ≥ 0.05). CONCLUSIONS Among 60+ year-old adults receiving treatment for DSM-5 AUD, improvements in QoL were achievable and maintained over time, but were not associated with gender.
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Affiliation(s)
- Jeppe Sig Juelsgaard Tryggedsson
- Unit of Clinical Alcohol Research (UCAR), Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Mental Health Odense, Region of Southern Denmark, Odense, Denmark
- OPEN, Odense Patient Data Explorative Network, Odense University Hospital, Odense, Denmark
| | - Kjeld Andersen
- Unit of Clinical Alcohol Research (UCAR), Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Mental Health Odense, Region of Southern Denmark, Odense, Denmark
- OPEN, Odense Patient Data Explorative Network, Odense University Hospital, Odense, Denmark
| | - Silke Behrendt
- Unit of Clinical Alcohol Research (UCAR), Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - Randi Bilberg
- Unit of Clinical Alcohol Research (UCAR), Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Michael P Bogenschutz
- NYU Langone Medical Center, New York, New York, USA
- Health Sciences Center, University of New Mexico, Albuquerque, New Mexico, USA
| | - Gerhard Buehringer
- Unit of Clinical Alcohol Research (UCAR), Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
- IFT Institut für Therapieforschung, Munich, Germany
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - Anette Søgaard Nielsen
- Unit of Clinical Alcohol Research (UCAR), Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Mental Health Odense, Region of Southern Denmark, Odense, Denmark
- OPEN, Odense Patient Data Explorative Network, Odense University Hospital, Odense, Denmark
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12
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Verwijmeren L, Noordzij PG, Daeter EJ, Emmelot-Vonk MH, Vernooij LM, van Klei WA, van Dongen EPA. Preoperative frailty and one-year functional recovery in elderly cardiac surgery patients. J Thorac Cardiovasc Surg 2023; 166:870-878.e6. [PMID: 35272845 DOI: 10.1016/j.jtcvs.2022.01.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 12/27/2021] [Accepted: 01/18/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Frailty increases risk for morbidity and mortality after cardiac surgery. Its influence on functional outcome is largely unknown. We studied the association of frailty with health-related quality of life and disability after cardiac surgery. METHODS A prospective 2-center observational cohort of 555 patients aged 70 years or more undergoing cardiac surgery. A comprehensive frailty assessment was performed before surgery based on 11 individual assessments in physical, mental, and social domains. Frailty was defined as at least 1 positive test in each domain. The primary outcome was health-related quality of life over 1 year, and the secondary outcomes were severe in-hospital complications and disability over 1 year. Adverse functional outcome was defined as the composite of a decreased health-related quality of life and disability. RESULTS Physical frailty was most common (91%) compared with mental (39%) or social frailty (42%). Adverse functional outcome occurred in 257 patients (46%) and consisted of decreased physical health-related quality of life in 134 (24%), decreased mental health-related quality of life in 141 (25%), and disability in 120 (22%). Frailty was more common in patients with adverse functional outcome (29%) compared with patients without adverse functional outcome (16%, P < .001). Poor mobility, malnutrition, and polypharmacy were associated with a decreased health-related quality of life over time, whereas impaired physical functioning and higher self-rated health were related to increased health-related quality of life. Disability after cardiac surgery was associated with poor mobility, polypharmacy, dependent living, living alone, and lower self-rated mental health before surgery. CONCLUSIONS Mobility, nutrition, medication use, physical functioning, and self-rated health before surgery are associated with health-related quality of life in elderly patients 1 year after cardiac surgery.
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Affiliation(s)
- Lisa Verwijmeren
- Department of Anesthesiology, Intensive Care, and Pain Medicine, St Antonius Hospital, Nieuwegein, The Netherlands
| | - Peter G Noordzij
- Department of Anesthesiology, Intensive Care, and Pain Medicine, St Antonius Hospital, Nieuwegein, The Netherlands.
| | - Edgar J Daeter
- Department of Cardiothoracic Surgery, St Antonius Hospital, Nieuwegein, The Netherlands
| | - Marielle H Emmelot-Vonk
- Department of Geriatric Medicine, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Lisette M Vernooij
- Department of Anesthesiology, Intensive Care, and Pain Medicine, St Antonius Hospital, Nieuwegein, The Netherlands; Department of Anesthesiology, Intensive Care and Emergency Medicine, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Wilton A van Klei
- Department of Anesthesiology, Intensive Care and Emergency Medicine, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Eric P A van Dongen
- Department of Anesthesiology, Intensive Care, and Pain Medicine, St Antonius Hospital, Nieuwegein, The Netherlands
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13
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Stapleton JR, Ard JD, Beavers DP, Cogdill LS, Fernandez AZ, Howard MJ, Justice JN, Lynch SD, Newman JJ, Weaver AA, Beavers KM. Strategies to reduce the onset of sleeve gastrectomy associated bone loss (STRONG BONES): Trial design and methods. Contemp Clin Trials Commun 2023; 34:101181. [PMID: 37456507 PMCID: PMC10344650 DOI: 10.1016/j.conctc.2023.101181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 06/05/2023] [Accepted: 07/02/2023] [Indexed: 07/18/2023] Open
Abstract
Background Despite recognized improvements in obesity-related comorbidities, mounting evidence implicates surgical weight loss in the onset of skeletal fragility. Sleeve gastrectomy (SG) is the most commonly performed bariatric procedure and is associated with 3-7% axial bone loss in the year following surgery. Bisphosphonates are FDA-approved medications for the prevention and treatment of age-related bone loss and may represent a strategy to reduce bone loss following SG surgery. Methods The Strategies to Reduce the Onset of Sleeve Gastrectomy Associated Bone Loss (STRONG BONES) trial (NCT04922333) is designed to definitively test whether monthly administration of the bisphosphonate, risedronate, for six months can effectively counter SG-associated bone loss. Approximately 120 middle-aged and older (≥40 years) SG patients will be randomized to six months of risedronate or placebo treatment, with skeletal outcomes assessed at baseline, six, and 12-months post-surgery. The primary outcome of the trial is 12-month change in total hip areal bone mineral density (aBMD), measured by dual energy x-ray absorptiometry (DXA). This will be complemented by DXA-acquired aBMD assessment at other skeletal sites and quantitative computed tomography (QCT) derived changes in bone quality. Change in muscle mass and function will also be assessed, as well as biomarkers of bone health, turnover, and crosstalk, providing mechanistic insight into intervention-related changes to the bone-muscle unit. Discussion Results from the STRONG BONES trial have the potential to influence current clinical practice by determining the ability of bisphosphonate use to mitigate bone loss and concomitant fracture risk in middle-aged and older SG patients.
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Affiliation(s)
- Joshua R. Stapleton
- Department of Biomedical Engineering, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Jamy D. Ard
- Weight Management Center, Atrium Health Wake Forest Baptist, Winston-Salem, NC, USA
- Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Daniel P. Beavers
- Department of Statistical Sciences, Wake Forest University, Winston-Salem, NC, USA
| | - Lori S. Cogdill
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, USA
| | - Adolfo Z. Fernandez
- Weight Management Center, Atrium Health Wake Forest Baptist, Winston-Salem, NC, USA
| | - Marjorie J. Howard
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Jamie N. Justice
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - S. Delanie Lynch
- Department of Biomedical Engineering, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Jovita J. Newman
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, USA
| | - Ashley A. Weaver
- Department of Biomedical Engineering, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Kristen M. Beavers
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, USA
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14
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Laupsa-Borge J, Grytten E, Bohov P, Bjørndal B, Strand E, Skorve J, Nordrehaug JE, Berge RK, Rostrup E, Mellgren G, Dankel SN, Nygård OK. Sex-specific responses in glucose-insulin homeostasis and lipoprotein-lipid components after high-dose supplementation with marine n-3 PUFAs in abdominal obesity: a randomized double-blind crossover study. Front Nutr 2023; 10:1020678. [PMID: 37404855 PMCID: PMC10315503 DOI: 10.3389/fnut.2023.1020678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 06/01/2023] [Indexed: 07/06/2023] Open
Abstract
Background Clinical studies on effects of marine-derived omega-3 (n-3) polyunsaturated fatty acids (PUFAs), mainly eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), and the plant-derived omega-6 (n-6) PUFA linoleic acid (LA) on lipoprotein-lipid components and glucose-insulin homeostasis have shown conflicting results, which may partly be explained by differential responses in females and males. However, we have lacked data on sexual dimorphism in the response of cardiometabolic risk markers following increased consumption of n-3 or n-6 PUFAs. Objective To explore sex-specific responses after n-3 (EPA + DHA) or n-6 (LA) PUFA supplementation on circulating lipoprotein subfractions, standard lipids, apolipoproteins, fatty acids in red blood cell membranes, and markers of glycemic control/insulin sensitivity among people with abdominal obesity. Methods This was a randomized double-blind crossover study with two 7-week intervention periods separated by a 9-week washout phase. Females (n = 16) were supplemented with 3 g/d of EPA + DHA (fish oil) or 15 g/d of LA (safflower oil), while males (n = 23) received a dose of 4 g/d of EPA + DHA or 20 g/d of LA. In fasting blood samples, we measured lipoprotein particle subclasses, standard lipids, apolipoproteins, fatty acid profiles, and markers of glycemic control/insulin sensitivity. Results The between-sex difference in relative change scores was significant after n-3 for total high-density lipoproteins (females/males: -11%*/-3.3%, p = 0.036; *: significant within-sex change), high-density lipoprotein particle size (+2.1%*/-0.1%, p = 0.045), and arachidonic acid (-8.3%*/-12%*, p = 0.012), and after n-6 for total (+37%*/+2.1%, p = 0.041) and small very-low-density lipoproteins (+97%*/+14%, p = 0.021), and lipoprotein (a) (-16%*/+0.1%, p = 0.028). Circulating markers of glucose-insulin homeostasis differed significantly after n-3 for glucose (females/males: -2.1%/+3.9%*, p = 0.029), insulin (-31%*/+16%, p < 0.001), insulin C-peptide (-12%*/+13%*, p = 0.001), homeostasis model assessment of insulin resistance index 2 (-12%*/+14%*, p = 0.001) and insulin sensitivity index 2 (+14%*/-12%*, p = 0.001), and quantitative insulin sensitivity check index (+4.9%*/-3.4%*, p < 0.001). Conclusion We found sex-specific responses after high-dose n-3 (but not n-6) supplementation in circulating markers of glycemic control/insulin sensitivity, which improved in females but worsened in males. This may partly be related to the sex differences we observed in several components of the lipoprotein-lipid profile following the n-3 intervention. Clinical trial registration https://clinicaltrials.gov/, identifier [NCT02647333].
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Affiliation(s)
- Johnny Laupsa-Borge
- Hormone Laboratory, Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway
- Mohn Nutrition Research Laboratory, Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Elise Grytten
- Hormone Laboratory, Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway
- Mohn Nutrition Research Laboratory, Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Pavol Bohov
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Bodil Bjørndal
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Elin Strand
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Jon Skorve
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Jan Erik Nordrehaug
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Rolf K. Berge
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Espen Rostrup
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Gunnar Mellgren
- Hormone Laboratory, Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway
- Mohn Nutrition Research Laboratory, Department of Clinical Science, University of Bergen, Bergen, Norway
- Mohn Research Center for Diabetes Precision Medicine, Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Simon N. Dankel
- Hormone Laboratory, Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway
- Mohn Nutrition Research Laboratory, Department of Clinical Science, University of Bergen, Bergen, Norway
- Mohn Research Center for Diabetes Precision Medicine, Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Ottar K. Nygård
- Mohn Nutrition Research Laboratory, Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
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15
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Barends H, Dekker J, van Dessel NC, Twisk JWR, van der Horst HE, van der Wouden JC. Exploring maladaptive cognitions and behaviors as perpetuating factors in patients with persistent somatic symptoms: a longitudinal study. J Psychosom Res 2023; 170:111343. [PMID: 37201294 DOI: 10.1016/j.jpsychores.2023.111343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 04/18/2023] [Accepted: 04/29/2023] [Indexed: 05/20/2023]
Abstract
OBJECTIVE Maladaptive cognitions and behaviors may influence symptoms and impairment in patients with persistent somatic symptoms (PSS). Aims of this study were to examine: (i) whether maladaptive cognitions and behaviors are associated with symptom severity and functional health over time; (ii) if these associations are the result of changes within individuals over time or of differences between individuals; (iii) directions of changes within individuals over time. METHODS Longitudinal data of a heterogeneous sample of patients with PSS were analyzed (n = 322 patients enrolled in the PROSPECTS cohort study). Cognitive and behavioral responses to symptoms (CBRQ), symptom severity (PHQ-15) and physical and mental functioning (RAND-36 PCS and MCS) were assessed seven times over a five-year period (0, 6 months, 1, 2, 3, 4, 5 year). Longitudinal mixed model and hybrid model analysis with and without time-lag were applied. RESULTS Maladaptive cognitions and behaviors were associated with more severe symptoms and reduced physical and mental functioning over time. Both changes within individuals over time and differences between individuals were associated with higher symptom severity and reduced physical and mental functioning. The between-subject component was about twice the effect size of the within-subject component. Changes in several specific maladaptive cognitions and behaviors were associated with more severe symptoms and reduced physical and mental functioning later in time and vice versa. CONCLUSION This study shows that maladaptive cognitions and behaviors are associated with symptom severity and reduced physical and mental functioning over time in patients with PSS.
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Affiliation(s)
- Hieke Barends
- Department of General Practice, Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, Amsterdam, the Netherlands.
| | - Joost Dekker
- Amsterdam Public Health Research Institute, Amsterdam, the Netherlands; Department of Rehabilitation Medicine and Department of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands
| | - Nikki Claassen- van Dessel
- Department of General Practice, Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Jos W R Twisk
- Amsterdam Public Health Research Institute, Amsterdam, the Netherlands; Department of Epidemiology and Data Science, Amsterdam UMC, the Netherlands
| | - Henriëtte E van der Horst
- Department of General Practice, Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Johannes C van der Wouden
- Department of General Practice, Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
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16
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Zhang XL, Zhang M, Lei N, Ouyang WW, Chen HF, Lao BN, Xu YM, Tang F, Fu LZ, Liu XS, Wu YF. An investigation of low-protein diets' qualification rates and an analysis of their short-term effects for patients with CKD stages 3-5: a single-center retrospective cohort study from China. Int Urol Nephrol 2023; 55:1059-1070. [PMID: 36310191 PMCID: PMC10030416 DOI: 10.1007/s11255-022-03390-3] [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: 02/21/2022] [Accepted: 10/15/2022] [Indexed: 03/22/2023]
Abstract
BACKGROUND The feasibility and efficacy of low-protein diets (LPD) treatment in chronic kidney disease (CKD) is controversial. Based on the characteristics of the Chinese diet, we observe the qualification rates and short-term clinical effects of LPD for CKD patients in our center. METHODS This is a retrospective cohort study. CKD stages 3-5 patients who were regularly followed up 5 times (over 2 years) and treated with LPD were included. We collected clinical data to observe the changes in LPD qualification rates and divided patients into LPD and non-LPD group according to the average dietary protein intake (DPI) of 5 follow-up time points and compared the changes in primary and secondary outcome measures between the two groups. RESULTS We analyzed data from 161 eligible CKD stages 3-5 patients. From baseline to the 5th follow-up time point, the LPD qualification rates of all patients were 11.80%, 35.40%, 47.82%, 53.43% and 54.04%, respectively. For primary outcome measures, the urine protein/creatinine ratio (UPCR) decreased more in the LPD group than in the non-LPD group [Median (interquartile range, IQR) of the difference between the 5th follow-up time point and baseline: 0.19 (- 0.01-0.73) vs. 0.10 (- 0.08-0.27), P < 0.001]. We constructed three classes of mixed linear models (model I, II, III). The UPCR slopes were all negative in the LPD group and positive in the non-LPD group (P < 0.001). Meanwhile, in model I, the estimate glomerular filtration rate(eGFR) decline slope in the LPD group was lower than that in the non-LPD group [slope (standard error): - 1.32 (0.37) vs. - 2.35 (0.33), P = 0.036]. For secondary outcome measures, body mass index (BMI) triglycerides (TG), body weight, and fat free mass (FFM) showed stable statistical differences in the comparison of LPD and non-LPD groups, with greater declines in the former. CONCLUSION The results of this study suggest that LPD treatment can reduce UPCR in patients with CKD stages 3-5, and may also delay the decline in eGFR. Meanwhile, it also reduces BMI, TG, body weight, and FFM, thus the need to prevent malnutrition in clinical implementation.
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Affiliation(s)
- Xian-Long Zhang
- Renal Division, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou, Guangdong, China
| | - Min Zhang
- The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Nuo Lei
- The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Wen-Wei Ouyang
- Key Unit of Methodology in Clinical Research, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou, China
| | - Hui-Fen Chen
- The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Bei-Ni Lao
- The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yan-Min Xu
- The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Fang Tang
- Chronic Disease Management Outpatient, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou, China
| | - Li-Zhe Fu
- Chronic Disease Management Outpatient, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou, China
| | - Xu-Sheng Liu
- Renal Division, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou, Guangdong, China
| | - Yi-Fan Wu
- Renal Division, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou, Guangdong, China.
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17
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Griffiths SL, Bogatsu T, Longhi M, Butler E, Alexander B, Bandawar M, Everard L, Jones PB, Fowler D, Hodgekins J, Amos T, Freemantle N, McCrone P, Singh SP, Birchwood M, Upthegrove R. Five-year illness trajectories across racial groups in the UK following a first episode psychosis. Soc Psychiatry Psychiatr Epidemiol 2023; 58:569-579. [PMID: 36717434 PMCID: PMC10066114 DOI: 10.1007/s00127-023-02428-w] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 01/12/2023] [Indexed: 02/01/2023]
Abstract
PURPOSE Psychosis disproportionally affects ethnic minority groups in high-income countries, yet evidence of disparities in outcomes following intensive early intervention service (EIS) for First Episode Psychosis (FEP) is less conclusive. We investigated 5-year clinical and social outcomes of young people with FEP from different racial groups following EIS care. METHOD Data were analysed from the UK-wide NIHR SUPEREDEN study. The sample at baseline (n = 978) included White (n = 750), Black (n = 71), and Asian (n = 157) individuals, assessed during the 3 years of EIS, and up to 2 years post-discharge (n = 296; Black [n = 23]; Asian [n = 52] and White [n = 221]). Outcome trajectories were modelled for psychosis symptoms (positive, negative, and general), functioning, and depression, using linear mixed effect models (with random intercept and slopes), whilst controlling for social deprivation. Discharge service was also explored across racial groups, 2 years following EIS. RESULTS Variation in linear growth over time was accounted for by racial group status for psychosis symptoms-positive (95% CI [0.679, 1.235]), negative (95% CI [0.315, 0.783]), and general (95% CI [1.961, 3.428])-as well as for functioning (95% CI [11.212, 17.677]) and depressive symptoms (95% CI [0.261, 0.648]). Social deprivation contributed to this variance. Black individuals experienced greater levels of deprivation (p < 0.001, 95% CI [0.187, 0.624]). Finally, there was a greater likelihood for Asian (OR = 3.04; 95% CI [2.050, 4.498]) and Black individuals (OR = 2.47; 95% CI [1.354, 4.520]) to remain in secondary care by follow-up. CONCLUSION Findings suggest variations in long-term clinical and social outcomes following EIS across racial groups; social deprivation contributed to this variance. Black and Asian individuals appear to make less improvement in long-term recovery and are less likely to be discharged from mental health services. Replication is needed in large, complete data, to fully understand disparities and blind spots to care.
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Affiliation(s)
- Siân Lowri Griffiths
- Institute for Mental Health, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
| | - Tumelo Bogatsu
- Institute for Mental Health, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Mia Longhi
- Institute for Mental Health, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Emily Butler
- Institute for Mental Health, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Beel Alexander
- Institute for Mental Health, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Mrunal Bandawar
- Institute for Mental Health, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Linda Everard
- Birmingham and Solihull Mental Health Foundation Trust, Birmingham, UK
| | - Peter B Jones
- Department of Psychiatry, University of Cambridge and CAMEO, Cambridge and Peterborough NHS Foundation Trust, Fulbourn, UK
| | - David Fowler
- Department of Psychology, University of Sussex, Brighton, UK
| | | | - Tim Amos
- Academic Unit of Psychiatry, University of Bristol, Bristol, UK
| | - Nick Freemantle
- Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Paul McCrone
- Institute for Life Course Development, University of Greenwich, London, UK
| | - Swaran P Singh
- Mental Health and Wellbeing Warwick Medical School, University of Warwick, Coventry, UK
| | - Max Birchwood
- Mental Health and Wellbeing Warwick Medical School, University of Warwick, Coventry, UK
| | - Rachel Upthegrove
- Institute for Mental Health, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
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18
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Lynch S, Lowry D, Finnerty C, O’Meara Y, Brennan D. The COMFORT trial: a randomised control trial comparing group-based COMpassion-FOcussed therapy and breathing pattern ReTraining with treatment as usual on the psychological functioning of patients diagnosed with cancer recurrence during COVID. Trials 2023; 24:89. [PMID: 36747246 PMCID: PMC9901386 DOI: 10.1186/s13063-023-07088-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 01/10/2023] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND A cancer diagnosis is a known precipitant of psychological distress, with fear of recurrence being a well-documented distressing consequence of cancer. Cancer recurrence often results in an additional psychological burden, which may exacerbate as a result of the COVID-19 pandemic. METHODS This is a single-centre, prospective, randomised controlled trial. Patients identified as having experienced cancer recurrence since March 2020 (the onset of the COVID-19 pandemic in Ireland) will be screened for participation. Eligible, consenting candidates who score 4 or higher on the Distress Thermometer will be enrolled in the study. Participants will be randomly allocated to receive either a 6-week, group-based, online, compassion-focussed therapy and breathing pattern retraining intervention or the control arm. Those in the control arm will all be offered the group intervention after the 18-week study period. The primary outcome is the Distress Thermometer score at 18 weeks post-baseline though secondary outcomes will include measures of mood, traumatic distress and mental adjustment to cancer. DISCUSSION To our knowledge, this protocol describes the first RCT which directly examines the effect of a group-based psychological intervention on Irish patients experiencing cancer recurrence in the context of COVID-19. The outcome of this trial is likely to be twofold: It will determine if the psychological intervention achieves its primary objective of distress amelioration 3 months post-intervention and to establish the feasibility of delivering this intervention in a virtual format. TRIAL REGISTRATION ClinicalTrials.gov NCT05518591. Registered on 25 August 2022. All items from the World Health Organization Trial Registration Data set have been included.
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Affiliation(s)
- Sinead Lynch
- grid.411596.e0000 0004 0488 8430Department of Psychology, Mater Misericordiae University Hospital, Dublin, Ireland ,grid.411596.e0000 0004 0488 8430Department of Psycho-Oncology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Damien Lowry
- grid.411596.e0000 0004 0488 8430Department of Psychology, Mater Misericordiae University Hospital, Dublin, Ireland ,grid.411596.e0000 0004 0488 8430Department of Pain Medicine, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Clodagh Finnerty
- grid.7886.10000 0001 0768 2743COMFORT Trial, University College Dublin, Dublin, Ireland
| | - Yvonne O’Meara
- grid.7886.10000 0001 0768 2743Women’s Cancer Survivorship Research Coordinator, School of Medicine, University College Dublin, Dublin, Ireland
| | - Donal Brennan
- grid.411596.e0000 0004 0488 8430Mater Misericordiae University Hospital, Dublin, Ireland ,grid.7886.10000 0001 0768 2743School of Medicine, University College Dublin, Dublin, Ireland
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19
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Hyland K, Hammarberg A, Hedman-Lagerlöf E, Johansson M, Lindner P, Andreasson S. The efficacy of an internet-based cognitive behavioral program added to treatment-as-usual for alcohol-dependent patients in primary care: a randomized controlled trial. Addiction 2023. [PMID: 36739528 DOI: 10.1111/add.16157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 01/16/2023] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIMS Most alcohol-dependent people have a moderate level of dependence. General practitioners (GPs) hesitate to engage in this area, and need to have access to treatment they find applicable and feasible to use. The aim of this present study was to test if an open-ended internet-based cognitive-behavioral therapy (iCBT) program added to treatment-as-usual (TAU) is more effective than TAU-only for alcohol-dependent patients in primary care. DESIGN, SETTING AND PARTICIPANTS The present study was a two-group, parallel, randomized controlled superiority trial comparing iCBT+TAU versus TAU-only at 3- and 12-month follow-ups. TAU was delivered at 14 primary care centers in Stockholm, Sweden. A total of 264 patients (mean age 51 years, of whom 148 were female and 116 were male) with alcohol dependence and hazardous alcohol consumption were enrolled between September 2017 and November 2019. MEASUREMENTS Participants were randomized at a ratio of 1:1 to iCBT, as a self-help intervention added to TAU (n = 132) or to TAU-only (n = 132). The GPs gave participants in both treatment arms feedback on the assessments and biomarkers and offered TAU at the primary care center. Primary outcome was weekly alcohol consumption in g/week at 12-month follow-up, analyzed according to intention-to-treat (n = 132 + 132). The per-protocol analysis included participants who completed at least one module of iCBT (n = 102 + 132). FINDINGS There was no significant difference in weekly alcohol consumption between iCBT+TAU and TAU in the intention-to-treat (ITT) analysis at 12-month follow-up [iCBT+TAU = 133.56 (95% confidence interval, CI = 100.94-166.19) and TAU = 176.20 (95% CI = 144.04-208.35), P = 0.068, d = 0.23]. In the per-protocol analysis, including only those who initiated iCBT, the iCBT+TAU group showed lower mean weekly alcohol consumption compared with TAU [iCBT+TAU = 107.46 (95% CI = 71.17-143.74), TAU = 176.00 (95% CI = 144.21-207.80), P = 0.010, d = 0.42]. CONCLUSIONS In Sweden, an internet-based cognitive-behavioral program added to treatment-as-usual to reduce alcohol consumption showed weak evidence of a benefit at 12 months in the intention-to-treat analysis and good evidence of a benefit in the per-protocol analysis.
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Affiliation(s)
- Karin Hyland
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Centre for Dependency Disorders, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Anders Hammarberg
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Centre for Dependency Disorders, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Erik Hedman-Lagerlöf
- Department of Clinical Neuroscience, Gustavsberg Primary Care Center, Region Stockholm, Stockholm, Sweden
| | - Magnus Johansson
- Centre for Dependency Disorders, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden.,Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Philip Lindner
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Centre for Dependency Disorders, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Sven Andreasson
- Centre for Dependency Disorders, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden.,Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
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20
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Sommersten CH, Gjerde ES, Laupsa-Borge J, Andersen AI, Lawrence-Archer L, McCann A, Hansson P, Raza GS, Herzig KH, Lied GA, Martins C, Mellgren G, Dierkes J, Dankel SN. Relationship between Ketones, Ghrelin, and, Appetite on Isocaloric Diets with Varying Carbohydrate Quality and Amount: Results from a Randomized Controlled Trial in People with Obesity (CARBFUNC). J Nutr 2023; 153:459-469. [PMID: 36894239 PMCID: PMC10127526 DOI: 10.1016/j.tjnut.2022.12.030] [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: 09/29/2022] [Revised: 12/23/2022] [Accepted: 12/28/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Low-carbohydrate high-fat (LCHF) diets may suppress the increase in appetite otherwise seen after diet-induced fat loss. However, studies of diets without severe energy restriction are lacking, and the effects of carbohydrate quality relative to quantity have not been directly compared. OBJECTIVES To evaluated short- (3 mo) and long-term (12 mo) changes in fasting plasma concentrations of total ghrelin, β-hydroxybutyrate (βHB), and subjective feelings of appetite on 3 isocaloric eating patterns within a moderate caloric range (2000-2500 kcal/d) and with varying carbohydrate quality or quantity. METHODS We performed a randomized controlled trial of 193 adults with obesity, comparing eating patterns based on "acellular" carbohydrate sources (e.g., flour-based whole-grain products; comparator arm), "cellular" carbohydrate sources (minimally processed foods with intact cellular structures), or LCHF principles. Outcomes were compared by an intention-to-treat analysis using constrained linear mixed modeling. This trial was registered at clinicaltrials.gov as NCT03401970. RESULTS Of the 193 adults, 118 (61%) and 57 (30%) completed 3 and 12 mo of follow-up. Throughout the intervention, intakes of protein and energy were similar with all 3 eating patterns, with comparable reductions in body weight (5%-7%) and visceral fat volume (12%-17%) after 12 mo. After 3 mo, ghrelin increased significantly with the acellular (mean: 46 pg/mL; 95% CI: 11, 81) and cellular (mean: 54 pg/mL; 95% CI: 21, 88) diets but not with the LCHF diet (mean: 11 pg/mL; 95% CI: -16, 38). Although βHB increased significantly more with the LCHF diet than with the acellular diet after 3 m (mean: 0.16 mmol/L; 95% CI: 0.09, 0.24), this did not correspond to a significant group difference in ghrelin (unless the 2 high-carbohydrate groups were combined [mean: -39.6 pg/mL; 95% CI: -76, -3.3]). No significant between-group differences were seen in feelings of hunger. CONCLUSIONS Modestly energy-restricted isocaloric diets differing in carbohydrate cellularity and amount showed no significant differences in fasting total ghrelin or subjective hunger feelings. An increase in ketones with the LCHF diet to 0.3-0.4 mmol/L was insufficient to substantially curb increases in fasting ghrelin during fat loss.
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Affiliation(s)
- Cathrine Horn Sommersten
- Mohn Nutrition Research Laboratory, Centre for Nutrition, Department of Clinical Science, University of Bergen, Bergen, Norway; Mohn Nutrition Research Laboratory, Centre for Nutrition, Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Eirin Semb Gjerde
- Mohn Nutrition Research Laboratory, Centre for Nutrition, Department of Clinical Science, University of Bergen, Bergen, Norway; Mohn Nutrition Research Laboratory, Centre for Nutrition, Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Johnny Laupsa-Borge
- Mohn Nutrition Research Laboratory, Centre for Nutrition, Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Amanda Io Andersen
- Mohn Nutrition Research Laboratory, Centre for Nutrition, Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Laurence Lawrence-Archer
- Hormone Laboratory, Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway
| | | | - Patrik Hansson
- Department of Clinical Medicine, Faculty of Health Sciences, the Arctic University of Norway, Tromsø, Norway
| | - Ghulam S Raza
- Research Unit of Biomedicine, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Karl Heinz Herzig
- Research Unit of Biomedicine, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Gülen Arslan Lied
- Mohn Nutrition Research Laboratory, Centre for Nutrition, Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Catia Martins
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Sciences and Technology, Trondheim, Norway; Centre for Obesity and Innovation, Clinic of Surgery, St. Olav University Hospital, Trondheim, Norway
| | - Gunnar Mellgren
- Mohn Nutrition Research Laboratory, Centre for Nutrition, Department of Clinical Science, University of Bergen, Bergen, Norway; Hormone Laboratory, Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway
| | - Jutta Dierkes
- Mohn Nutrition Research Laboratory, Centre for Nutrition, Department of Clinical Medicine, University of Bergen, Bergen, Norway; Hormone Laboratory, Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway
| | - Simon N Dankel
- Mohn Nutrition Research Laboratory, Centre for Nutrition, Department of Clinical Science, University of Bergen, Bergen, Norway; Hormone Laboratory, Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway.
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21
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Ditzel FL, van Montfort SJT, Vernooij LM, Kant IMJ, Aarts E, Spies CD, Hendrikse J, Slooter AJC, van Dellen E. Functional brain network and trail making test changes following major surgery and postoperative delirium: a prospective, multicentre, observational cohort study. Br J Anaesth 2023; 130:e281-e288. [PMID: 36261307 DOI: 10.1016/j.bja.2022.07.054] [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: 02/15/2022] [Revised: 07/22/2022] [Accepted: 07/31/2022] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Delirium is a frequent complication after surgery in older adults and is associated with an increased risk of long-term cognitive impairment and dementia. Disturbances in functional brain networks were previously reported during delirium. We hypothesised that alterations in functional brain networks persist after remission of postoperative delirium and that functional brain network alterations are associated with long-term cognitive impairment. METHODS In this prospective, multicentre, observational cohort study, we included older patients who underwent clinical assessments (including the Trail Making Test B [TMT-B]) and resting-state functional MRI (rs-fMRI) before and 3 months after elective surgery. Delirium was assessed on the first seven postoperative days. RESULTS Of the 554 enrolled patients, 246 remained after strict motion correction, of whom 38 (16%) developed postoperative delirium. The rs-fMRI functional connectivity strength increased 3 months after surgery in the total study population (β=0.006; 95% confidence interval [CI]: 0.001-0.011; P=0.013), but it decreased after postoperative delirium (β=-0.015; 95% CI: -0.028 to 0.002; P=0.023). No difference in TMT-B scores was found at follow-up between patients with and without postoperative delirium. Patients with decreased functional connectivity strength declined in TMT-B scores compared with those who did not (β=11.04; 95% CI: 0.85-21.2; P=0.034). CONCLUSIONS Postoperative delirium was associated with decreased brain functional connectivity strength after 3 months, suggesting that delirium has a long-lasting impact on brain networks. The decreased connectivity strength was associated with significant cognitive deterioration after major surgery. CLINICAL TRIAL REGISTRATION NCT02265263.
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Affiliation(s)
- Fienke L Ditzel
- Department of Intensive Care Medicine and University Medical Center Utrecht Brain Center, Utrecht University, Utrecht, the Netherlands.
| | - Simone J T van Montfort
- Department of Intensive Care Medicine and University Medical Center Utrecht Brain Center, Utrecht University, Utrecht, the Netherlands
| | - Lisette M Vernooij
- Department of Intensive Care Medicine and University Medical Center Utrecht Brain Center, Utrecht University, Utrecht, the Netherlands; Department of Anesthesiology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Ilse M J Kant
- Department of Intensive Care Medicine and University Medical Center Utrecht Brain Center, Utrecht University, Utrecht, the Netherlands
| | - Ellen Aarts
- Department of Intensive Care Medicine and University Medical Center Utrecht Brain Center, Utrecht University, Utrecht, the Netherlands; Faculty of Psychology, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Claudia D Spies
- Department of Anaesthesiology, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Jeroen Hendrikse
- Department of Radiology, University Medical Center Utrecht Brain Center, Utrecht University, Utrecht, the Netherlands
| | - Arjen J C Slooter
- Department of Intensive Care Medicine and University Medical Center Utrecht Brain Center, Utrecht University, Utrecht, the Netherlands; Department of Neurology, UZ Brussel and Vrije Universiteit Brussel, Brussels, Belgium
| | - Edwin van Dellen
- Department of Intensive Care Medicine and University Medical Center Utrecht Brain Center, Utrecht University, Utrecht, the Netherlands; Department of Psychiatry and UMC University Medical Center Utrecht Brain Center, Utrecht University, Utrecht, the Netherlands
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22
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Sabiston CM, Doré I, Lucibello KM, Pila E, Brunet J, Thibault V, Bélanger M. Body image self-conscious emotions get worse throughout adolescence and relate to physical activity behavior in girls and boys. Soc Sci Med 2022; 315:115543. [PMID: 36413860 DOI: 10.1016/j.socscimed.2022.115543] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 10/28/2022] [Accepted: 11/12/2022] [Indexed: 11/16/2022]
Abstract
Body image is a commonly-reported factor perpetuating declines in physical activity levels during adolescence. However, the evidence is predominantly qualitative, cross-sectional, and focused on girls. Furthermore, the affective dimension of body image has been overlooked compared to the perceptual (e.g., misrepresentations of body size) and cognitive (e.g., dissatisfaction) dimensions. Affective body image includes a range of self-conscious emotions including guilt, shame, envy, embarrassment, and authentic and hubristic pride. This study examined (i) body-related self-conscious emotions over time, and (ii) associations between body-related emotions and physical activity over five years during early-to-mid adolescence. Potential gender differences were also explored. Self-report data for this study were collected once a year over 5 years as part of the MATCH study. The main analyses involved mixed-effects modeling. Participants (n = 776, 55.8% girls) initially aged 12.6 (SD = 0.6) years who provided data on at least one occasion were included in the analysis. Girls reported higher body-related guilt, shame, envy, and embarrassment than boys, and boys reported higher hubristic pride than girls. Over five years from early to mid-adolescence, body-related shame, guilt, envy, and embarrassment significantly increased for boys and girls, authentic pride did not change, and hubristic pride increased for girls only. Controlling for gender and puberty status, body-related guilt, shame, and embarrassment were negatively, and body-related authentic and hubristic pride were positively, associated with physical activity over time. Body-related envy was not significantly related to physical activity. These findings suggest that adolescents express greater negative body-related self-conscious emotions over time. Since these were negatively related to physical activity, interventions focused on reducing negative body-related emotions and enhancing positive body-related emotions may be valuable in adolescence to help curb declining physical activity.
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Affiliation(s)
| | - Isabelle Doré
- Université de Montréal, Montréal, Québec, CHUM Research Centre, Montréal, Québec, Canada.
| | | | - Eva Pila
- Western University, London, ON, Canada.
| | | | | | - Mathieu Bélanger
- Université de Sherbrooke, Moncton, New Brunswick, Canada; Centre de Formation Médicale Du Nouveau-Brunswick, Moncton, New Brunswick, Research Services, Vitalité Health Network, Moncton, New Brunswick, Canada.
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23
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El Alili M, van Dongen JM, Esser JL, Heymans MW, van Tulder MW, Bosmans JE. A scoping review of statistical methods for trial-based economic evaluations: The current state of play. HEALTH ECONOMICS 2022; 31:2680-2699. [PMID: 36089775 PMCID: PMC9826466 DOI: 10.1002/hec.4603] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 06/21/2022] [Accepted: 08/11/2022] [Indexed: 06/06/2023]
Abstract
The statistical quality of trial-based economic evaluations is often suboptimal, while a comprehensive overview of available statistical methods is lacking. Therefore, this review summarized and critically appraised available statistical methods for trial-based economic evaluations. A literature search was performed to identify studies on statistical methods for dealing with baseline imbalances, skewed costs and/or effects, correlated costs and effects, clustered data, longitudinal data, missing data and censoring in trial-based economic evaluations. Data was extracted on the statistical methods described, their advantages, disadvantages, relative performance and recommendations of the study. Sixty-eight studies were included. Of them, 27 (40%) assessed methods for baseline imbalances, 39 (57%) assessed methods for skewed costs and/or effects, 27 (40%) assessed methods for correlated costs and effects, 18 (26%) assessed methods for clustered data, 7 (10%) assessed methods for longitudinal data, 26 (38%) assessed methods for missing data and 10 (15%) assessed methods for censoring. All identified methods were narratively described. This review provides a comprehensive overview of available statistical methods for dealing with the most common statistical complexities in trial-based economic evaluations. Herewith, it can provide valuable input for researchers when deciding which statistical methods to use in a trial-based economic evaluation.
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Affiliation(s)
- Mohamed El Alili
- Department of Health SciencesFaculty of ScienceVrije Universiteit AmsterdamAmsterdam Public Health Research InstituteAmsterdamthe Netherlands
| | - Johanna M. van Dongen
- Department of Health SciencesFaculty of ScienceVrije Universiteit AmsterdamAmsterdam Public Health Research InstituteAmsterdamthe Netherlands
- Department of Health SciencesFaculty of ScienceVrije Universiteit AmsterdamAmsterdam Movement Sciences Research InstituteAmsterdamthe Netherlands
| | - Jonas L. Esser
- Department of Health SciencesFaculty of ScienceVrije Universiteit AmsterdamAmsterdam Public Health Research InstituteAmsterdamthe Netherlands
| | - Martijn W. Heymans
- Department of Epidemiology and BiostatisticsAmsterdam UMC, Location VUmcAmsterdam Public Health Research InstituteAmsterdamthe Netherlands
| | - Maurits W. van Tulder
- Department of Health SciencesFaculty of ScienceVrije Universiteit AmsterdamAmsterdam Public Health Research InstituteAmsterdamthe Netherlands
- Department of Health SciencesFaculty of ScienceVrije Universiteit AmsterdamAmsterdam Movement Sciences Research InstituteAmsterdamthe Netherlands
- Department of Physiotherapy & Occupational TherapyAarhus University HospitalAarhusDenmark
| | - Judith E. Bosmans
- Department of Health SciencesFaculty of ScienceVrije Universiteit AmsterdamAmsterdam Public Health Research InstituteAmsterdamthe Netherlands
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24
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Duan MJ, Dekker LH, Carrero JJ, Navis G. Lifestyle patterns and incident type 2 diabetes in the Dutch lifelines cohort study. Prev Med Rep 2022; 30:102012. [PMID: 36237838 PMCID: PMC9551208 DOI: 10.1016/j.pmedr.2022.102012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 09/16/2022] [Accepted: 10/01/2022] [Indexed: 11/05/2022] Open
Abstract
Lifestyle factors clustered in behavioral patterns within the population. Different lifestyle patterns were differentially associated with risk of developing type 2 diabetes. A lifestyle pattern may be a proxy for an underlying variable that is relevant for the prevention of type 2 diabetes.
We aimed to identify the underlying subgroups of the population characterized by distinct lifestyle patterns, and to investigate the associations between lifestyle patterns and risk of incident type 2 diabetes. Using data from the Dutch Lifelines cohort study, latent class analysis was performed to derive lifestyle patterns on five lifestyle factors, i.e., smoking, diet quality, TV watching time, physical activity level, and risk drinking. Associations between lifestyle patterns and incident type 2 diabetes were estimated. Among 61,869 participants analyzed, we identified 900 cases of type 2 diabetes during follow-up (205,696 person-years; incidence rate 4.38 per 1000 person-years). Five lifestyle pattern groups were identified. Using the “healthy lifestyle group” as reference, the “unhealthy lifestyle group” had the highest risk for type 2 diabetes (HR 1.51 [95%CI 1.24, 1.85]), followed by the “poor diet and low physical activity group” (HR 1.26 [95%CI 1.03, 1.55]). The “risk drinker group” and the “couch potato group” (characterized by excessive TV watching) showed no significantly elevated risk. These models were adjusted for age, sex, total energy intake, education, BMI, family history of diabetes, and blood glucose level at baseline. Our study shows that lifestyle factors tended to cluster in unique behavioral patterns within the heterogeneous population. These lifestyle patterns were differentially associated with incident type 2 diabetes. Our findings support the relevance of considering lifestyle patterns in type 2 diabetes prevention. Tailored prevention strategies that target multiple lifestyle risk factors for different lifestyle pattern groups may optimize the effectiveness of diabetes prevention at the population level.
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Affiliation(s)
- Ming-Jie Duan
- Department of Internal Medicine, University Medical Center Groningen, Groningen, The Netherlands,Corresponding author at: Hanzeplein 1, P.O. Box 30 001, 9700RB Groningen, The Netherlands.
| | - Louise H. Dekker
- Department of Internal Medicine, University Medical Center Groningen, Groningen, The Netherlands,National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Juan-Jesus Carrero
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Gerjan Navis
- Department of Internal Medicine, University Medical Center Groningen, Groningen, The Netherlands
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25
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Ben ÂJ, van Dongen JM, Alili ME, Heymans MW, Twisk JWR, MacNeil-Vroomen JL, de Wit M, van Dijk SEM, Oosterhuis T, Bosmans JE. The handling of missing data in trial-based economic evaluations: should data be multiply imputed prior to longitudinal linear mixed-model analyses? THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2022:10.1007/s10198-022-01525-y. [PMID: 36161553 DOI: 10.1007/s10198-022-01525-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 08/29/2022] [Indexed: 06/16/2023]
Abstract
INTRODUCTION For the analysis of clinical effects, multiple imputation (MI) of missing data were shown to be unnecessary when using longitudinal linear mixed-models (LLM). It remains unclear whether this also applies to trial-based economic evaluations. Therefore, this study aimed to assess whether MI is required prior to LLM when analyzing longitudinal cost and effect data. METHODS Two-thousand complete datasets were simulated containing five time points. Incomplete datasets were generated with 10, 25, and 50% missing data in follow-up costs and effects, assuming a Missing At Random (MAR) mechanism. Six different strategies were compared using empirical bias (EB), root-mean-squared error (RMSE), and coverage rate (CR). These strategies were: LLM alone (LLM) and MI with LLM (MI-LLM), and, as reference strategies, mean imputation with LLM (M-LLM), seemingly unrelated regression alone (SUR-CCA), MI with SUR (MI-SUR), and mean imputation with SUR (M-SUR). RESULTS For costs and effects, LLM, MI-LLM, and MI-SUR performed better than M-LLM, SUR-CCA, and M-SUR, with smaller EBs and RMSEs as well as CRs closers to nominal levels. However, even though LLM, MI-LLM and MI-SUR performed equally well for effects, MI-LLM and MI-SUR were found to perform better than LLM for costs at 10 and 25% missing data. At 50% missing data, all strategies resulted in relatively high EBs and RMSEs for costs. CONCLUSION LLM should be combined with MI when analyzing trial-based economic evaluation data. MI-SUR is more efficient and can also be used, but then an average intervention effect over time cannot be estimated.
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Affiliation(s)
- Ângela Jornada Ben
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.
| | - Johanna M van Dongen
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
| | - Mohamed El Alili
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
| | - Martijn W Heymans
- Department of Epidemiology and Data Science, Amsterdam UMC, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Jos W R Twisk
- Department of Epidemiology and Data Science, Amsterdam UMC, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Janet L MacNeil-Vroomen
- Section of Geriatrics, Department of Internal Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Maartje de Wit
- Department of Medical Psychology, Amsterdam UMC, Vrije Universiteit, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Susan E M van Dijk
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
| | - Teddy Oosterhuis
- Netherlands Society of Occupational Medicine (NVAB), Utrecht, The Netherlands
| | - Judith E Bosmans
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
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26
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Diets differing in carbohydrate cellularity and amount similarly reduced visceral fat in people with obesity - a randomized controlled trial (CARBFUNC). Clin Nutr 2022; 41:2345-2355. [PMID: 36116147 DOI: 10.1016/j.clnu.2022.08.028] [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: 01/04/2022] [Revised: 07/26/2022] [Accepted: 08/25/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND & AIMS Visceral adipose tissue (VAT) volume is associated with common lifestyle diseases. Dietary quality, including food matrix and degree of carbohydrate cellularity, as well as the carbohydrate/fat ratio, may influence VAT volume. We aimed to determine the effects of isocaloric diets differing in either "cellularity", a novel marker of dietary carbohydrate quality, or carbohydrate amount on visceral fat volume and anthropometric measures in adults with obesity. METHODS In a randomized controlled trial of 193 people with obesity/central adiposity, we compared changes in VAT volume after 6 and 12 months, measured by abdominal computed tomography, on three isocaloric eating patterns based on "acellular" carbohydrate sources (e.g., flour-based whole-grain products; comparator arm), "cellular" carbohydrate sources (minimally processed foods with intact cellular structures such as fruits, potatoes/tubers, and rice), or low-carbohydrate high-fat (LCHF) principles. Outcomes were compared by an intention-to-treat (ITT) analysis using constrained linear mixed-effects modelling (cLMM) providing baseline-adjusted change scores and proper missing data handling without imputation. RESULTS 78 and 57 participants completed 6 and 12 months, respectively, with similar intakes of energy (females: 1820-2060 kcal, males: 2480-2550 kcal) and protein (16-17 energy percent, E%) throughout the intervention, and only modest reductions in energy from baseline. Reported dietary intakes were 42-44, 41-42, and 11-15 E% carbohydrate and 36-38, 37-38, and 66-70 E% fat in the acellular, cellular and LCHF groups, respectively. There were no significant between-group differences in VAT volume after 6 months (cellular vs. acellular [95% CI]: -55 cm³ [-545, 436]; LCHF vs. acellular [95% CI]: -225 cm³ [-703, 253]) or after 12 months (cellular vs. acellular [95% CI]: -122 cm³ [-757, 514]; LCHF vs. acellular [95% CI]: -317 cm³ [-943, 309]). VAT volume decreased significantly within all groups by 14-18% and 12-17% after 6 and 12 months, respectively. Waist circumference was reduced to a significantly greater degree in the LCHF vs. acellular group at 6 months (LCHF vs. acellular [95% CI]: -2.78 cm [-5.54, -0.017]). CONCLUSIONS Despite modest energy restriction, the three isocaloric eating patterns, differing in carbohydrate cellularity and amount, decreased visceral fat volume significantly and to a similar clinically relevant degree. CLINICAL TRIALS IDENTIFIER NCT03401970. https://clinicaltrials.gov/ct2/show/NCT03401970.
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Canturk TC, Czikk D, Wai EK, Phan P, Stratton A, Michalowski W, Kingwell S. A scoping review of complication prediction models in spinal surgery: An analysis of model development, validation and impact. NORTH AMERICAN SPINE SOCIETY JOURNAL (NASSJ) 2022; 11:100142. [PMID: 35983028 PMCID: PMC9379667 DOI: 10.1016/j.xnsj.2022.100142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 07/04/2022] [Accepted: 07/06/2022] [Indexed: 12/04/2022]
Abstract
Background Predictive analytics are being used increasingly in the field of spinal surgery with the development of models to predict post-surgical complications. Predictive models should be valid, generalizable, and clinically useful. The purpose of this review was to identify existing post-surgical complication prediction models for spinal surgery and to determine if these models are being adequately investigated with internal/external validation, model updating and model impact studies. Methods This was a scoping review of studies pertaining to models for the prediction of post-surgical complication after spinal surgery published over 10 years (2010-2020). Qualitative data was extracted from the studies to include study classification, adherence to Transparent Reporting of a multivariable prediction model for Individual Prognosis Or Diagnosis (TRIPOD) guidelines and risk of bias (ROB) assessment using the Prediction model study Risk Of Bias Assessment Tool (PROBAST). Model evaluation was determined using area under the curve (AUC) when available. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement was used as a basis for the search methodology in four different databases. Results Thirty studies were included in the scoping review and 80% (24/30) included model development with or without internal validation. Twenty percent (6/30) were exclusively external validation studies and only one study included an impact analysis in addition to model development and internal validation. Two studies referenced the TRIPOD guidelines and there was a high ROB in 100% of the studies using the PROBAST tool. Conclusions The majority of post-surgical complication prediction models in spinal surgery have not undergone standardized model development and internal validation or adequate external validation and impact evaluation. As such there is uncertainty as to their validity, generalizability, and clinical utility. Future efforts should be made to use existing tools to ensure standardization in development and rigorous evaluation of prediction models in spinal surgery.
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28
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Zheng H, Li H, Wang Y, Li Z, Hu B, Li X, Fu L, Hu H, Nie Z, Zhao B, Wei D, Karlson BW, Bots ML, Meng X, Chen Y, Wang Y. Rosuvastatin Slows Progression of Carotid Intima-Media Thickness: The METEOR-China Randomized Controlled Study. Stroke 2022; 53:3004-3013. [PMID: 36017704 PMCID: PMC9508961 DOI: 10.1161/strokeaha.120.031877] [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] [Indexed: 11/16/2022]
Abstract
BACKGROUND Atherosclerosis is the leading cause of cardiovascular disease worldwide, including in China. Primary prevention, through lipid-lowering, could avert development of atherosclerosis. Carotid intima-media thickness (CIMT) is a well-validated measure of atherosclerosis used in intervention studies as the primary outcome and alternative end point for cardiovascular disease events. METHODS This randomized, double-blind, placebo-controlled, multicenter, parallel-group study assessed the effects of rosuvastatin 20 mg/d compared with placebo on progression of CIMT over 104 weeks in Chinese people with subclinical atherosclerosis. The primary end point was the annualized rate of change in mean of the maximum CIMT measurements taken 7× over the study period from each of 12 carotid artery sites (near and far walls of the right and left common carotid artery, carotid bulb, and internal carotid artery). Secondary end points included CIMT changes at different artery sites and lipid-parameter changes. Safety was also assessed. RESULTS Participants were randomized (1:1) to receive rosuvastatin (n=272) or placebo (n=271). Baseline characteristics were well balanced between groups. The change in mean of the maximum CIMT of the 12 carotid sites was 0.0038 mm/y (95% CI, -0.0023-0.0100) for the rosuvastatin group versus 0.0142 mm/y (95% CI, 0.0080-0.0204) for the placebo group, with a difference of -0.0103 mm/y (95% CI, -0.0191 to -0.0016; P=0.020). For the CIMT secondary end points, the results were generally consistent with the primary end point. There were clinically relevant improvements in lipid parameters with rosuvastatin. We observed an adverse-event profile consistent with the known safety profile of rosuvastatin. CONCLUSIONS Rosuvastatin 20 mg/d significantly reduced the progression of CIMT over 2 years in Chinese adults with subclinical atherosclerosis and was well tolerated. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT02546323.
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Affiliation(s)
- Huaguang Zheng
- Beijing Tiantan Hospital, Capital Medical University, China (H.Z., Yilong Wang, Yongjun Wang).,China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, China (H.Z., Yilong Wang, Yongjun Wang)
| | - Hongwei Li
- Department of Cardiology, Beijing Friendship Hospital affiliated to Capital Medical University, China (H.L.)
| | - Yilong Wang
- Beijing Tiantan Hospital, Capital Medical University, China (H.Z., Yilong Wang, Yongjun Wang).,China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, China (H.Z., Yilong Wang, Yongjun Wang)
| | - Zhanquan Li
- The People's Hospital of Liaoning Province, Shenyang, China (Z.L.)
| | - Bo Hu
- Department of Neurology, Union Hospital of Huazhong University of Science and Technology, Wuhan, China (B.H.)
| | - Xiaogang Li
- Department of Neurology, Peking University Third Hospital, Beijing, China (X.L.)
| | - Lu Fu
- The First Affiliated Hospital of Harbin Medical University, China (L.F.)
| | - Hongtao Hu
- Beijing Ji Shui Tan Hospital, China (H.H.)
| | - Zhiyu Nie
- Department of Neurology, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, China (Z.N.)
| | - Bilian Zhao
- AstraZeneca R&D, Shanghai, China (B.Z., D.W. [at the time the work was conducted], X.W.M.)
| | - Di Wei
- AstraZeneca R&D, Shanghai, China (B.Z., D.W. [at the time the work was conducted], X.W.M.).,Bayer Healthcare Co Ltd, Beijing, China (D.W.)
| | - Björn W Karlson
- AstraZeneca R&D Gothenburg, Mölndal, and Department of Molecular and Clinical Medicine, Institution of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden (B.W.K.)
| | - Michiel L Bots
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, the Netherlands (M.L.B.)
| | - XiangWen Meng
- AstraZeneca R&D, Shanghai, China (B.Z., D.W. [at the time the work was conducted], X.W.M.)
| | - Yundai Chen
- Department of Cardiology, China PLA General Hospital, Beijing, China (Y.C.)
| | - Yongjun Wang
- Beijing Tiantan Hospital, Capital Medical University, China (H.Z., Yilong Wang, Yongjun Wang).,China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, China (H.Z., Yilong Wang, Yongjun Wang)
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Barends H, van der Wouden JC, Claassen-van Dessel N, Twisk JWR, van der Horst HE, Dekker J. Potentially traumatic events, social support and burden of persistent somatic symptoms: A longitudinal study. J Psychosom Res 2022; 159:110945. [PMID: 35665613 DOI: 10.1016/j.jpsychores.2022.110945] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 05/06/2022] [Accepted: 05/10/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Psychological trauma is a well-known risk factor for the onset of persistent somatic symptoms (PSS). In contrast, little is known on the relation between potentially traumatic events (PTEs) and the severity of PSS, and on the protective effect of social support. We aimed to: (i) determine whether childhood, adulthood and recent PTEs are associated with burden of PSS over four years of follow-up; (ii) examine associations of multiple and cumulative (in childhood and adulthood) exposure to PTEs with burden of PSS; and (iii) determine whether social support modifies these associations. METHODS Longitudinal data of 322 patients with PSS were analyzed. PTEs (Life Events Questionnaire) and social support (Social Support Scale) were assessed at baseline. Burden of PSS was measured in terms of symptom severity (PHQ-15) and physical functioning (RAND-36 PCS) at six repeated measurements over a four-year interval. Associations were analyzed using longitudinal mixed model analysis. RESULTS Patients with multiple childhood PTEs reported higher burden of PSS over four-year time. Adulthood PTEs were associated with burden of PSS in patients with, but not in patients without childhood PTEs. Recent PTEs were not associated with burden over time. Social support did not modify any of the associations. CONCLUSIONS PTEs are associated with higher burden of PSS over time, in addition to the well-known association with the onset of PSS. PTEs in early life and cumulative exposure to PTEs in childhood and adulthood are associated with higher burden over time in patients with PSS. Social support did not attenuate the associations.
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Affiliation(s)
- Hieke Barends
- Department of General Practice, Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands; Amsterdam Public Health research institute, Amsterdam, the Netherlands.
| | - Johannes C van der Wouden
- Department of General Practice, Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands; Amsterdam Public Health research institute, Amsterdam, the Netherlands
| | - Nikki Claassen-van Dessel
- Department of General Practice, Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands; Amsterdam Public Health research institute, Amsterdam, the Netherlands
| | - Jos W R Twisk
- Amsterdam Public Health research institute, Amsterdam, the Netherlands; Department of Health Sciences, Vrije Universiteit Amsterdam, the Netherlands
| | - Henriëtte E van der Horst
- Department of General Practice, Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands; Amsterdam Public Health research institute, Amsterdam, the Netherlands
| | - Joost Dekker
- Amsterdam Public Health research institute, Amsterdam, the Netherlands; Department of Rehabilitation Medicine and Department of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands
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30
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Casey MB, Smart KM, Segurado R, Hearty C, Gopal H, Lowry D, Flanagan D, McCracken L, Doody C. Exercise combined with Acceptance and Commitment Therapy compared with a standalone supervised exercise programme for adults with chronic pain: a randomised controlled trial. Pain 2022; 163:1158-1171. [PMID: 34913883 DOI: 10.1097/j.pain.0000000000002487] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 09/10/2021] [Indexed: 10/20/2022]
Abstract
ABSTRACT A prospective, 2-armed, parallel group randomised controlled trial (RCT) was conducted to compare the effectiveness of Acceptance and Commitment Therapy (ACT) combined with a supervised exercise programme with a supervised exercise programme alone for adults with chronic pain. One hundred seventy-five participants were individually randomised to receive either the combined Exercise and ACT (ExACT) intervention or supervised exercise alone. Those allocated to the ExACT group attended 8 weekly sessions with a psychologist based on the ACT approach, in addition to supervised exercise classes led by a physiotherapist. The control group attended weekly supervised exercise classes but did not take part in an ACT programme. Both groups were followed up postintervention and again after 12 weeks. The primary outcome was pain interference at 12-week follow-up. Estimates of treatment effects at follow-up were based on intention-to-treat analyses, implemented using a linear mixed-effects model. The findings of this RCT showed no difference in the effectiveness of ExACT, compared with a supervised exercise programme alone for the primary outcome pain interference at 12-week follow-up (mean difference -0.18, 95% confidence interval -0.84 to 0.48, P = 0.59, d = 0.11). ExACT group participants reported superior outcomes for pain self-efficacy, pain catastrophising, and committed action, compared with the control group, but there were no differences between the groups for other secondary outcomes or treatment process measures. Higher levels of treatment satisfaction and global impression of change were reported by ExACT group participants. Exercise combined with Acceptance and Commitment Therapy was not superior to a standalone supervised exercise programme for reducing pain interference in adults with chronic pain.
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Affiliation(s)
- Máire-Bríd Casey
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Belfield, Dublin, Ireland
| | - Keith M Smart
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Belfield, Dublin, Ireland
| | - Ricardo Segurado
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Belfield, Dublin, Ireland
| | - Conor Hearty
- Department of Pain Medicine, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Hari Gopal
- Department of Pain Medicine, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Damien Lowry
- Department of Psychology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Dearbhail Flanagan
- Physiotherapy Department, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Lance McCracken
- Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Catherine Doody
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Belfield, Dublin, Ireland
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31
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Rösel I, Serna-Higuita LM, Al Sayah F, Buchholz M, Buchholz I, Kohlmann T, Martus P, Feng YS. What difference does multiple imputation make in longitudinal modeling of EQ-5D-5L data? Empirical analyses of simulated and observed missing data patterns. Qual Life Res 2022; 31:1521-1532. [PMID: 34797507 PMCID: PMC9023409 DOI: 10.1007/s11136-021-03037-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE Although multiple imputation is the state-of-the-art method for managing missing data, mixed models without multiple imputation may be equally valid for longitudinal data. Additionally, it is not clear whether missing values in multi-item instruments should be imputed at item or score-level. We therefore explored the differences in analyzing the scores of a health-related quality of life questionnaire (EQ-5D-5L) using four approaches in two empirical datasets. METHODS We used simulated (GR dataset) and observed missingness patterns (ABCD dataset) in EQ-5D-5L scores to investigate the following approaches: approach-1) mixed models using respondents with complete cases, approach-2) mixed models using all available data, approach-3) mixed models after multiple imputation of the EQ-5D-5L scores, and approach-4) mixed models after multiple imputation of EQ-5D 5L items. RESULTS Approach-1 yielded the highest estimates of all approaches (ABCD, GR), increasingly overestimating the EQ-5D-5L score with higher percentages of missing data (GR). Approach-4 produced the lowest scores at follow-up evaluations (ABCD, GR). Standard errors (0.006-0.008) and mean squared errors (0.032-0.035) increased with increasing percentages of simulated missing GR data. Approaches 2 and 3 showed similar results (both datasets). CONCLUSION Complete cases analyses overestimated the scores and mixed models after multiple imputation by items yielded the lowest scores. As there was no loss of accuracy, mixed models without multiple imputation, when baseline covariates are complete, might be the most parsimonious choice to deal with missing data. However, multiple imputation may be needed when baseline covariates are missing and/or more than two timepoints are considered.
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Affiliation(s)
- Inka Rösel
- Institute for Clinical Epidemiology and Applied Biostatistics, Medical University of Tübingen, Silcherstraße 5, 72076, Tübingen, Germany
- Medical Clinic, Department of Sports Medicine, University Hospital Tuebingen, Tübingen, Germany
| | - Lina María Serna-Higuita
- Institute for Clinical Epidemiology and Applied Biostatistics, Medical University of Tübingen, Silcherstraße 5, 72076, Tübingen, Germany.
| | - Fatima Al Sayah
- Alberta PROMs and EQ-5D Research and Support Unit (APERSU), School of Public Health, University of Alberta, Alberta, Canada
| | - Maresa Buchholz
- Institute for Nursing Science and Interprofessional Education, Medical University Greifswald, Greifswald, Germany
| | - Ines Buchholz
- Institute for Community Medicine, Medical University Greifswald, Greifswald, Germany
| | - Thomas Kohlmann
- Institute for Community Medicine, Medical University Greifswald, Greifswald, Germany
| | - Peter Martus
- Institute for Clinical Epidemiology and Applied Biostatistics, Medical University of Tübingen, Silcherstraße 5, 72076, Tübingen, Germany
| | - You-Shan Feng
- Institute for Clinical Epidemiology and Applied Biostatistics, Medical University of Tübingen, Silcherstraße 5, 72076, Tübingen, Germany
- Institute for Community Medicine, Medical University Greifswald, Greifswald, Germany
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Wu MY, Du MH, Wen H, Wang WQ, Tang J, Shen LR. Effects of n-6 PUFA-rich soybean oil, MUFA-rich olive oil and camellia seed oil on weight and cardiometabolic profiles among Chinese women: a 3-month double-blind randomized controlled-feeding trial. Food Funct 2022; 13:4375-4383. [PMID: 35389391 DOI: 10.1039/d1fo03759e] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Previous studies have suggested that replacing saturated fat with unsaturated fat is beneficial for cardiometabolic health. However, research that directly compares the effects of polyunsaturated fatty acids (PUFAs) and monounsaturated fatty acids (MUFAs) is rare. The present 3-month, three-arm, randomized, controlled-feeding trial aimed to investigate the effects of n-6 PUFA- and MUFA-rich cooking oils on body weight and cardiometabolic profiles among middle-aged and elderly Chinese women at high cardiovascular risk. Ninety participants were recruited and randomly assigned to groups fed diets using n-6 PUFA-rich soybean oil (SO, n = 30), MUFA-rich olive oil (OO, n = 30), and MUFA-rich camellia seed oil (CSO, n = 30) as cooking oils considering traditional Chinese eating habits for 3 months. Participants were required to eat only the foods provided for lunch and dinner, and avoid intake of edible oils in breakfast. Body weight and cardiovascular profiles were measured at the baseline, middle, and end of the intervention, and group differences in changes of outcomes during intervention were examined by a linear mixed model. We found no significant difference in the changes of body weight among the SO group (mean change, 0.31 kg; 95% CI, -0.88 to 0.27), the OO group (mean change, -0.13 kg; 95% CI, -0.62 to 0.36), and the CSO group (mean change, -0.72 kg; 95% CI, -1.38 to -0.07). For secondary outcomes, the OO group showed a slight increase in HDL cholesterol (P = 0.03), while the CSO group showed greater reduction in aspartate aminotransferase (AST) (P = 0.02) when compared with the SO group. These results suggested that MUFA-rich OO and CSO exerted more favorable effects on cardiometabolic profiles among middle-aged and elderly Chinese women at high cardiovascular risk than the n-6 PUFA-rich SO.
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Affiliation(s)
- Min-Yu Wu
- Department of Food Science and Nutrition, Zhejiang Key Laboratory for Agro-Food Processing, Zhejiang University, Hangzhou, China.
| | - Meng-Hao Du
- Research Institute of Subtropical Forestry, Chinese Academy of Forestry, Hangzhou, China
| | - Hao Wen
- Department of Food Science and Nutrition, Zhejiang Key Laboratory for Agro-Food Processing, Zhejiang University, Hangzhou, China.
| | - Wen-Qiang Wang
- Department of Food Science and Nutrition, Zhejiang Key Laboratory for Agro-Food Processing, Zhejiang University, Hangzhou, China.
| | - Jun Tang
- Zhejiang Provincial Laboratory of Life Sciences and Biomedicine, Key Laboratory of Growth Regulation and Translation Research of Zhejiang Province, School of Life Sciences, Westlake University, Hangzhou, China.
| | - Li-Rong Shen
- Department of Food Science and Nutrition, Zhejiang Key Laboratory for Agro-Food Processing, Zhejiang University, Hangzhou, China.
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Duan MJ, Dekker LH, Carrero JJ, Navis G. Using Structural Equation Modeling to Untangle Pathways of Risk Factors Associated with Incident Type 2 Diabetes: the Lifelines Cohort Study. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2022; 23:1090-1100. [PMID: 35230614 PMCID: PMC9489566 DOI: 10.1007/s11121-022-01357-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2022] [Indexed: 12/30/2022]
Abstract
Risk factors for type 2 diabetes are multifaceted and interrelated. Unraveling the complex pathways of modifiable risk factors related to incident type 2 diabetes will help prioritize prevention targets. The current analysis extended a previously proposed conceptual model by Bardenheier et al. (Diabetes Care, 36(9), 2655–2662, 2013) on prediabetes with a cross-sectional design. The model described the pathways of four aspects of modifiable risk factors in relation to incident type 2 diabetes, including socioeconomic status (income and education); lifestyle behaviors (diet quality, physical activity, TV watching, smoking, risk drinking, and unhealthy sleep duration); clinical markers (HDL-cholesterol, triglycerides, BMI, and waist circumference); and blood pressure. We performed structural equation modeling to test this conceptual model using a prospective population-based sample of 68,649 participants (35–80 years) from the Lifelines cohort study. During a median follow-up of 41 months, 1124 new cases of type 2 diabetes were identified (incidence 1.6%). The best-fitting model indicated that among all modifiable risk factors included, waist circumference had the biggest direct effect on type 2 diabetes (standardized β-coefficient 0.214), followed by HDL-cholesterol (standardized β-coefficient − 0.134). Less TV watching and more physical activity were found to play an important role in improving clinical markers that were directly associated with type 2 diabetes. Education had the biggest positive effects on all lifestyle behaviors except for unhealthy sleep duration. Our analysis provides evidence to support that structural equation modeling enables a holistic assessment of the interplay of type 2 diabetes risk factors, which not only allows the estimation of their total effects but also prioritization of prevention targets. Regarding the current guideline for diabetes prevention, waist management in addition to BMI control (clinical level), as well as less TV watching in addition to more physical activity (behavioral level), may provide additional public health benefits. Better education would be the main societal goal for the prevention of type 2 diabetes.
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Affiliation(s)
- Ming-Jie Duan
- Department of Internal Medicine, University Medical Center Groningen, Hanzeplein 1, P.O. Box 30 001, 9700RB, Groningen, The Netherlands.
| | - Louise H Dekker
- Department of Internal Medicine, University Medical Center Groningen, Hanzeplein 1, P.O. Box 30 001, 9700RB, Groningen, The Netherlands.,National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Juan-Jesus Carrero
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Gerjan Navis
- Department of Internal Medicine, University Medical Center Groningen, Hanzeplein 1, P.O. Box 30 001, 9700RB, Groningen, The Netherlands
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Moorthy A, Lowry D, Edgley C, Casey MB, Buggy D. Effect of perioperative cognitive behavioural therapy on chronic post-surgical pain among breast cancer patients with high pain catastrophising characteristics: protocol for a double-blinded randomised controlled trial. Trials 2022; 23:66. [PMID: 35062997 PMCID: PMC8781049 DOI: 10.1186/s13063-022-06019-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 01/11/2022] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Surgery is regarded as the primary treatment for breast cancer. Chronic post-surgical pain (CPSP) is a recognised complication after breast cancer surgery, and it is estimated to affect 20-30% of women. Pain catastrophizing has emerged as one of the most influential psychological variables associated with CPSP. METHODS This trial will be a single-centre, prospective, double-blinded, superiority, randomised controlled trial (RCT). Patients scheduled for elective breast cancer surgery (wide local excision or mastectomy with or without axillary lymph node dissection) will be screened preoperatively for high pain catastrophising. Patients with high pain catastrophising, defined as a score of ≥ 24 on the Pain Catastrophising Scale will be deemed eligible for inclusion in the study. Participants will be randomly assigned to receive either a cognitive behavioural therapy or an educational mindfulness based programme during their perioperative period. The primary outcome is the Brief Pain Inventory short form average pain severity score at 3 months postoperatively. Secondary outcomes include patient-reported quality of recovery at days 1-2 after surgery, levels of pain catastrophising, reported depressed mood and anxiety. DISCUSSION To the best of our knowledge, this protocol describes the first RCT which directly examines the effect of perioperative cognitive behavioural therapy on CPSP among breast cancer patients with high pain catastrophising characteristics. The outcomes of this trial may have significant implications for these patients because perioperative cognitive behavioural therapy has the potential to become an important perioperative intervention to complement patient management. TRIAL REGISTRATION ClinicalTrials.gov NCT04924010 . Registered on 11 June 2021. All item from the World Health Organisation Trial Registration Data set have been included.
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Affiliation(s)
- Aneurin Moorthy
- Division of Anaesthesiology & Perioperative Medicine, Mater University Hospital, Dublin, Ireland.
| | - Damien Lowry
- Depts of Psychology and Pain Medicine, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Carla Edgley
- School of Medicine, University College Dublin, Dublin, Ireland
| | | | - Donal Buggy
- Division of Anaesthesiology & Perioperative Medicine, Mater University Hospital, School of Medicine, University College Dublin, Dublin, Ireland.,Outcomes Research, Cleveland Clinic, Cleveland, OH, USA
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Pielkenrood BJ, Gal R, Kasperts N, Verhoeff JJC, Bartels MMTJ, Seravalli E, van der Linden YM, Monninkhof EM, Verlaan JJ, van der Velden JM, Verkooijen HM. Quality of Life After Stereotactic Body Radiation Therapy Versus Conventional Radiation Therapy in Patients With Bone Metastases. Int J Radiat Oncol Biol Phys 2022; 112:1203-1215. [PMID: 35017007 DOI: 10.1016/j.ijrobp.2021.12.163] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 12/02/2021] [Accepted: 12/24/2021] [Indexed: 12/29/2022]
Abstract
PURPOSE Painful bone metastases hamper quality of life (QoL). The aim of this prespecified secondary analysis of the PRESENT trial was to compare change in global QoL, physical functioning, emotional functioning, functional interference, and psychosocial aspects after conventional radiation therapy (cRT) versus stereotactic body RT (SBRT). METHODS AND MATERIALS A total of 110 patients were enrolled in the phase 2 randomized controlled VERTICAL trial (NCT02364115) following the "trials within cohorts" design and randomized 1:1 to cRT or SBRT. Patient-reported global QoL, physical functioning, emotional functioning, functional interference, and psychosocial aspects were assessed by the European Organization for Research and Treatment of Cancer QoL Questionnaire (QLQ) Core 15 Palliative Care and QLQ Bone Metastases 22 modules. Changes in QoL domains over time were compared between patients treated with cRT and SBRT using intention-to-treat (ITT) and per-protocol (PP) linear mixed model analysis adjusting for baseline scores. Proportions of patients in the cRT versus SBRT arm reporting a clinically relevant change in QoL within 3 months were compared using a χ2 test. RESULTS QoL scores had improved over time and were comparable between groups for all domains in both the ITT and PP analyses, except for functional interference and psychological aspects in the ITT. Functional interference scores had improved more after 12 weeks in the cRT arm than in the SBRT arm (25.5 vs 14.1 points, respectively; effect size [ES] = 0.49, P = .04). Psychosocial aspects scores had improved more after 8 weeks in the cRT arm than in the SBRT arm (12.2 vs 7.3; ES = 0.56, P = .04). No clinically relevant differences between groups at 12 weeks in terms of global QoL, physical functioning, emotional functioning, functional interference, and psychosocial aspects were observed. CONCLUSIONS Palliative RT improves QoL. Both SBRT and cRT have a comparable effect on patient-reported QoL outcomes in patients with painful bone metastases. Functional interference and psychological aspects scores improved more in patients treated with cRT versus patients offered SBRT.
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Affiliation(s)
- Bart J Pielkenrood
- Division of Imaging and Cancer, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Roxanne Gal
- Division of Imaging and Cancer, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Nicolien Kasperts
- Departments of Radiotherapy, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Joost J C Verhoeff
- Departments of Radiotherapy, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Marcia M T J Bartels
- Division of Imaging and Cancer, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Enrica Seravalli
- Departments of Radiotherapy, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands
| | | | - Evelyn M Monninkhof
- Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Jorrit-Jan Verlaan
- Departments Orthopedic Surgery, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Joanne M van der Velden
- Departments of Radiotherapy, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Helena M Verkooijen
- Division of Imaging and Cancer, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands.
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Associations of quantity and quality of carbohydrate sources with subjective appetite sensations during 3-year weight-loss maintenance: Results from the PREVIEW intervention study. Clin Nutr 2021; 41:219-230. [PMID: 34915273 DOI: 10.1016/j.clnu.2021.11.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 10/04/2021] [Accepted: 11/30/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND & AIMS The association of quantity and quality of carbohydrate sources with appetite during long-term weight-loss maintenance (WLM) after intentional weight loss (WL) is unclear. We aimed to investigate longitudinal associations of quantity and quality of carbohydrate sources with changes in subjective appetite sensations during WLM. METHODS This secondary analysis evaluated longitudinal data from the 3-year WLM phase of the PREVIEW study, a 2 × 2 factorial (diet-physical activity arms), multi-center, randomized trial. 1279 individuals with overweight or obesity and prediabetes (25-70 years; BMI≥25 kg m-2) were included. Individuals were merged into 1 group to assess longitudinal associations of yearly changes in appetite sensations. Quantity and quality of carbohydrate sources including total carbohydrate, glycemic index (GI), glycemic load (GL), and total dietary fiber were assessed via 4-day food diaries at 4 timepoints (26, 52, 104, and 156 weeks) during WLM. Visual analog scales were used to assess appetite sensations in the previous week. RESULTS During WLM, participants consumed on average 160.6 (25th, 75th percentiles 131.1, 195.8) g·day-1 of total carbohydrate, with GI 53.8 (48.7, 58.8) and GL 85.3 (67.2, 108.9) g day-1, and 22.3 (17.6, 27.3) g·day-1 of dietary fiber. In the available-case analysis, multivariable-adjusted linear mixed models with repeated measures showed that each 30-g increment in total carbohydrate was associated with increases in hunger (1.36 mm year-1, 95% CI 0.77, 1.95, P < 0.001), desire to eat (1.10 mm year-1, 0.59, 1.60, P < 0.001), desire to eat something sweet (0.99 mm year-1, 0.30, 1.68, P = 0.005), and weight regain (0.20%·year-1, 0.03, 0.36, P = 0.022). Increasing GI was associated with weight regain, but not associated with increases in appetite sensations. Each 20-unit increment in GL was associated with increases in hunger (0.92 mm year-1, 0.33, 1.51, P = 0.002), desire to eat (1.12 mm year-1, 0.62, 1.62, P < 0.001), desire to eat something sweet (1.13 mm year-1, 0.44, 1.81, P < 0.001), and weight regain (0.35%·year-1, 0.18, 0.52, P < 0.001). Surprisingly, dietary fiber was also associated with increases in desire to eat, after adjustment for carbohydrate or GL. CONCLUSIONS In participants with moderate carbohydrate and dietary fiber intake, and low to moderate GI, we found that higher total carbohydrate, GL, and total fiber, but not GI, were associated with increases in subjective desire to eat or hunger over 3 years. This study was registered as ClinicalTrials.gov, NCT01777893.
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Adherence to a Plant-Based Diet and Consumption of Specific Plant Foods-Associations with 3-Year Weight-Loss Maintenance and Cardiometabolic Risk Factors: A Secondary Analysis of the PREVIEW Intervention Study. Nutrients 2021; 13:nu13113916. [PMID: 34836170 PMCID: PMC8618731 DOI: 10.3390/nu13113916] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 10/27/2021] [Accepted: 10/31/2021] [Indexed: 12/27/2022] Open
Abstract
Plant-based diets are recommended by dietary guidelines. This secondary analysis aimed to assess longitudinal associations of an overall plant-based diet and specific plant foods with weight-loss maintenance and cardiometabolic risk factors. Longitudinal data on 710 participants (aged 26–70 years) with overweight or obesity and pre-diabetes from the 3-year weight-loss maintenance phase of the PREVIEW intervention were analyzed. Adherence to an overall plant-based diet was evaluated using a novel plant-based diet index, where all plant-based foods received positive scores and all animal-based foods received negative scores. After adjustment for potential confounders, linear mixed models with repeated measures showed that the plant-based diet index was inversely associated with weight regain, but not with cardiometabolic risk factors. Nut intake was inversely associated with regain of weight and fat mass and increments in total cholesterol and LDL cholesterol. Fruit intake was inversely associated with increments in diastolic blood pressure, total cholesterol, and LDL cholesterol. Vegetable intake was inversely associated with an increment in diastolic blood pressure and triglycerides and was positively associated with an increase in HDL cholesterol. All reported associations with cardiometabolic risk factors were independent of weight change. Long-term consumption of nuts, fruits, and vegetables may be beneficial for weight management and cardiometabolic health, whereas an overall plant-based diet may improve weight management only.
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Jarbin H, Höglund K, Skarphedinsson G, Bremander A. Aerobic exercise for adolescent outpatients with persistent major depression: Feasibility and acceptability of moderate to vigorous group exercise in a clinically referred sample. Clin Child Psychol Psychiatry 2021; 26:954-967. [PMID: 33858215 DOI: 10.1177/13591045211000782] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
AIMS To assess feasibility and acceptability of exercise in clinically referred adolescents with major depression. METHODS Outpatients12 to 17 years with mild to moderate persistent depression participated in a supervised, pulse monitored, 14-week aerobic exercise but without control group. Primary outcome was adherence and secondary was clinician-rated Quick Inventory of Depressive Symptomatology - Adolescent (QIDS-A17-C), aerobic capacity, functioning, and well-being. RESULTS Twenty-one (66%) of 32 eligible adolescents with major depression with disease duration 2.4 (1.1-5.3) years and comorbid ADHD (71%) and anxiety disorders (62%) consented. Estimated maximum heart rate above 70% was achieved for mean 31.6 minutes, indicating that the intensity and duration of the exercise intervention was well received. Fourteen patients (67%) participated throughout the program and attended a median of 29 (81%, range 20-35) supporting satisfaction with the intervention by most patients. QIDS-A17-C score decreased compared to baseline at 15 weeks (p < .001) and further at 1 year (p < .001). Aerobic capacity improved during the intervention but was not maintained, while functioning improved and after 1 year also well-being. CONCLUSION This 14 week moderate to vigorous aerobic exercise intervention was feasible and well accepted by most adolescents with persistent depression and extensive comorbidities.
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Affiliation(s)
- Håkan Jarbin
- Child and Adolescent Psychiatry, Region Halland, Sweden.,Department of Clinical Sciences Lund, Lund University, Faculty of Medicine, Child and Adolescent Psychiatry, Lund, Sweden
| | | | | | - Ann Bremander
- Section of Rheumatology, Department of Clinical Sciences, Lund University, Sweden.,Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.,Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Sonderborg, Denmark.,The Rydberg Laboratory for Applied Sciences, Halmstad University, Sweden
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O’Brien KK, Davis AM, Chan Carusone S, Avery L, Tang A, Solomon P, Aubry R, Zobeiry M, Ilic I, Pandovski Z, Bayoumi AM. Examining the impact of a community-based exercise intervention on cardiorespiratory fitness, cardiovascular health, strength, flexibility and physical activity among adults living with HIV: A three-phased intervention study. PLoS One 2021; 16:e0257639. [PMID: 34559851 PMCID: PMC8462727 DOI: 10.1371/journal.pone.0257639] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 09/02/2021] [Indexed: 11/25/2022] Open
Abstract
PURPOSE Our aim was to examine the impact of a community-based exercise (CBE) intervention on cardiorespiratory fitness, cardiovascular health, strength, flexibility, and physical activity outcomes among adults living with HIV. METHODS We conducted a longitudinal intervention study with community-dwelling adults living with HIV in Toronto, Canada. We measured cardiopulmonary fitness (V̇O2peak (primary outcome), heart rate, blood pressure), strength (grip strength, vertical jump, back extension, push-ups, curl ups), flexibility (sit and reach test), and self-reported physical activity bimonthly across three phases. Phase 1 included baseline monitoring (8 months); Phase 2 included the CBE Intervention (6 months): participants were asked to exercise (aerobic, strength, balance and flexibility training) for 90 minutes, 3 times/week, with weekly supervised coaching at a community-based fitness centre; and Phase 3 included follow-up (8 months) where participants were expected to continue with thrice weekly exercise independently. We used segmented regression (adjusted for baseline age and sex) to assess the change in trend (slope) among phases. Our main estimates of effect were the estimated change in slope, relative to baseline values, over the 6 month CBE intervention. RESULTS Of the 108 participants who initiated Phase 1, 80 (74%) started and 67/80 (84%) completed the intervention and 52/67 (77%) completed the study. Most participants were males (87%), with median age of 51 years (interquartile range (IQR): 45, 59). Participants reported a median of 4 concurrent health conditions in addition to HIV (IQR: 2,7). Participants attended a median of 18/25 (72%) weekly supervised sessions. Change in V̇O2peak attributed to the six-month Phase 2 CBE intervention was 0.56 ml/kg/min (95% Confidence Interval (CI): -1.27, 2.39). Significant effects of the intervention were observed for systolic blood pressure (-5.18 mmHg; 95% CI: -9.66, -0.71), push-ups (2.30 additional push-ups; 95% CI: 0.69, 3.91), curl ups (2.89 additional curl ups; 95% CI: 0.61, 5.17), and sit and reach test (1.74 cm; 95% CI: 0.21, 3.28). More participants engaged in self-reported strength (p<0.001) and flexibility (p = 0.02) physical activity at the end of intervention. During Phase 3 follow-up, there was a significant reduction in trend of benefits observed during the intervention phase for systolic blood pressure (1.52 mmHg/month; 95% CI: 0.67, 2.37) and sit and reach test (-0.42 cm/month; 95% CI: -0.68, -0.16). CONCLUSION Adults living with HIV who engaged in this six-month CBE intervention demonstrated inconclusive results in relation to V̇O2peak, and potential improvements in other outcomes of cardiovascular health, strength, flexibility and self-reported physical activity. Future research should consider features tailored to promote uptake and sustained engagement in independent exercise among adults living with HIV. CLINICALTRIALS.GOV IDENTIFIER NCT02794415. https://clinicaltrials.gov/ct2/show/record/NCT02794415.
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Affiliation(s)
- Kelly K. O’Brien
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute (RSI), University of Toronto, Toronto, Ontario, Canada
| | - Aileen M. Davis
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada
- University Health Network, Toronto, Ontario, Canada
| | | | - Lisa Avery
- University Health Network, Toronto, Ontario, Canada
- Avery Information, Oshawa, Ontario, Canada
| | - Ada Tang
- School of Rehabilitation Science, Institute of Applied Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Patricia Solomon
- School of Rehabilitation Science, Institute of Applied Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Rachel Aubry
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | | | - Ivan Ilic
- Central Toronto YMCA, Toronto, Ontario, Canada
| | | | - Ahmed M. Bayoumi
- Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
- Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Rieveschl NB, Song W, Li A, Conti TF, Hom GL, Tsai GJ, Conti FF, Babiuch AS, Singh RP. Macular Atrophy Affecting Visual Outcomes in Patients Undergoing Anti-VEGF Treatment in Routine Clinical Practice. Ophthalmic Surg Lasers Imaging Retina 2021; 51:68-75. [PMID: 32084278 DOI: 10.3928/23258160-20200129-01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 08/27/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE To explore how baseline macular atrophy (MA) affects visual acuity (VA) in patients receiving intravitreal anti-vascular endothelial growth factor (VEGF) injections for neovascular age-related macular degeneration (nAMD). PATIENTS AND METHODS A retrospective, case control series. Patients were grouped into three cohorts based on baseline spectral-domain optical coherence tomography image findings: foveal MA, nonfoveal MA, and no MA. Outcomes were assessed at 1, 2, and 3 years following anti-VEGF therapy. RESULTS No differences existed in MA growth between eyes with foveal and nonfoveal MA (0.89 mm2 [95% confidence interval (CI), 0.64-1.14] vs. 0.88 mm2 [95% CI, 0.72-1.05]) after adjusting for baseline lesion sizes at 3 years. Foveal MA patients lost an average of 19.4 ETDRS letters (95% CI, -30.8 to -8.0) after 3 years. Nonfoveal MA patients gained an average of 1.1 ETDRS letters (95% CI, -6.8 to 9.0), and patients without MA averaged a gain of 9.7 ETDRS letters (95% CI, 5.5-14.0). CONCLUSION In patients with nAMD receiving anti-VEGF in routine clinical practice, presence of baseline foveal MA was associated with significant vision loss. [Ophthalmic Surg Lasers Imaging Retina. 2020;51:68-75.].
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Odia T, Malherbe ST, Meier S, Maasdorp E, Kleynhans L, du Plessis N, Loxton AG, Zak DE, Thompson E, Duffy FJ, Kuivaniemi H, Ronacher K, Winter J, Walzl G, Tromp G. The Peripheral Blood Transcriptome Is Correlated With PET Measures of Lung Inflammation During Successful Tuberculosis Treatment. Front Immunol 2021; 11:596173. [PMID: 33643286 PMCID: PMC7902901 DOI: 10.3389/fimmu.2020.596173] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 12/22/2020] [Indexed: 12/13/2022] Open
Abstract
Pulmonary tuberculosis (PTB) is characterized by lung granulomas, inflammation and tissue destruction. Here we used within-subject peripheral blood gene expression over time to correlate with the within-subject lung metabolic activity, as measured by positron emission tomography (PET) to identify biological processes and pathways underlying overall resolution of lung inflammation. We used next-generation RNA sequencing and [18F]FDG PET-CT data, collected at diagnosis, week 4, and week 24, from 75 successfully cured PTB patients, with the [18F]FDG activity as a surrogate for lung inflammation. Our linear mixed-effects models required that for each individual the slope of the line of [18F]FDG data in the outcome and the slope of the peripheral blood transcript expression data correlate, i.e., the slopes of the outcome and explanatory variables had to be similar. Of 10,295 genes that changed as a function of time, we identified 639 genes whose expression profiles correlated with decreasing [18F]FDG uptake levels in the lungs. Gene enrichment over-representation analysis revealed that numerous biological processes were significantly enriched in the 639 genes, including several well known in TB transcriptomics such as platelet degranulation and response to interferon gamma, thus validating our novel approach. Others not previously associated with TB pathobiology included smooth muscle contraction, a set of pathways related to mitochondrial function and cell death, as well as a set of pathways connecting transcription, translation and vesicle formation. We observed up-regulation in genes associated with B cells, and down-regulation in genes associated with platelet activation. We found 254 transcription factor binding sites to be enriched among the 639 gene promoters. In conclusion, we demonstrated that of the 10,295 gene expression changes in peripheral blood, only a subset of 639 genes correlated with inflammation in the lungs, and the enriched pathways provide a description of the biology of resolution of lung inflammation as detectable in peripheral blood. Surprisingly, resolution of PTB inflammation is positively correlated with smooth muscle contraction and, extending our previous observation on mitochondrial genes, shows the presence of mitochondrial stress. We focused on pathway analysis which can enable therapeutic target discovery and potential modulation of the host response to TB.
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Affiliation(s)
- Trust Odia
- Division of Molecular Biology and Human Genetics, Department of Biomedical Sciences, Stellenbosch University, Cape Town, South Africa.,DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research, Stellenbosch University, Cape Town, South Africa.,South African Medical Research Council Centre for Tuberculosis Research, Stellenbosch University, Cape Town, South Africa.,Bioinformatics Unit, South African Tuberculosis Bioinformatics Initiative, Stellenbosch University, Cape Town, South Africa.,Centre for Bioinformatics and Computational Biology, Stellenbosch University, Stellenbosch, South Africa
| | - Stephanus T Malherbe
- Division of Molecular Biology and Human Genetics, Department of Biomedical Sciences, Stellenbosch University, Cape Town, South Africa.,DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research, Stellenbosch University, Cape Town, South Africa.,South African Medical Research Council Centre for Tuberculosis Research, Stellenbosch University, Cape Town, South Africa
| | - Stuart Meier
- Division of Molecular Biology and Human Genetics, Department of Biomedical Sciences, Stellenbosch University, Cape Town, South Africa.,DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research, Stellenbosch University, Cape Town, South Africa.,South African Medical Research Council Centre for Tuberculosis Research, Stellenbosch University, Cape Town, South Africa.,Bioinformatics Unit, South African Tuberculosis Bioinformatics Initiative, Stellenbosch University, Cape Town, South Africa.,Centre for Bioinformatics and Computational Biology, Stellenbosch University, Stellenbosch, South Africa
| | - Elizna Maasdorp
- Division of Molecular Biology and Human Genetics, Department of Biomedical Sciences, Stellenbosch University, Cape Town, South Africa.,DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research, Stellenbosch University, Cape Town, South Africa.,South African Medical Research Council Centre for Tuberculosis Research, Stellenbosch University, Cape Town, South Africa.,Bioinformatics Unit, South African Tuberculosis Bioinformatics Initiative, Stellenbosch University, Cape Town, South Africa.,Centre for Bioinformatics and Computational Biology, Stellenbosch University, Stellenbosch, South Africa
| | - Léanie Kleynhans
- Division of Molecular Biology and Human Genetics, Department of Biomedical Sciences, Stellenbosch University, Cape Town, South Africa.,DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research, Stellenbosch University, Cape Town, South Africa.,South African Medical Research Council Centre for Tuberculosis Research, Stellenbosch University, Cape Town, South Africa
| | - Nelita du Plessis
- Division of Molecular Biology and Human Genetics, Department of Biomedical Sciences, Stellenbosch University, Cape Town, South Africa.,DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research, Stellenbosch University, Cape Town, South Africa.,South African Medical Research Council Centre for Tuberculosis Research, Stellenbosch University, Cape Town, South Africa
| | - Andre G Loxton
- Division of Molecular Biology and Human Genetics, Department of Biomedical Sciences, Stellenbosch University, Cape Town, South Africa.,DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research, Stellenbosch University, Cape Town, South Africa.,South African Medical Research Council Centre for Tuberculosis Research, Stellenbosch University, Cape Town, South Africa
| | - Daniel E Zak
- Center for Infectious Disease Research, Seattle, WA, United States
| | - Ethan Thompson
- Center for Infectious Disease Research, Seattle, WA, United States
| | - Fergal J Duffy
- Center for Infectious Disease Research, Seattle, WA, United States.,Seattle Children's Research Institute, Center for Global Infectious Disease Research, Seattle, WA, United States
| | - Helena Kuivaniemi
- Division of Molecular Biology and Human Genetics, Department of Biomedical Sciences, Stellenbosch University, Cape Town, South Africa.,DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research, Stellenbosch University, Cape Town, South Africa.,South African Medical Research Council Centre for Tuberculosis Research, Stellenbosch University, Cape Town, South Africa
| | - Katharina Ronacher
- Division of Molecular Biology and Human Genetics, Department of Biomedical Sciences, Stellenbosch University, Cape Town, South Africa.,DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research, Stellenbosch University, Cape Town, South Africa.,South African Medical Research Council Centre for Tuberculosis Research, Stellenbosch University, Cape Town, South Africa.,Translational Research Institute, Mater Research Institute - The University of Queensland, Brisbane, QLD, Australia
| | - Jill Winter
- Catalysis Foundation for Health, San Ramon, CA, United States
| | - Gerhard Walzl
- Division of Molecular Biology and Human Genetics, Department of Biomedical Sciences, Stellenbosch University, Cape Town, South Africa.,DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research, Stellenbosch University, Cape Town, South Africa.,South African Medical Research Council Centre for Tuberculosis Research, Stellenbosch University, Cape Town, South Africa.,Bioinformatics Unit, South African Tuberculosis Bioinformatics Initiative, Stellenbosch University, Cape Town, South Africa
| | - Gerard Tromp
- Division of Molecular Biology and Human Genetics, Department of Biomedical Sciences, Stellenbosch University, Cape Town, South Africa.,DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research, Stellenbosch University, Cape Town, South Africa.,South African Medical Research Council Centre for Tuberculosis Research, Stellenbosch University, Cape Town, South Africa.,Bioinformatics Unit, South African Tuberculosis Bioinformatics Initiative, Stellenbosch University, Cape Town, South Africa.,Centre for Bioinformatics and Computational Biology, Stellenbosch University, Stellenbosch, South Africa
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Díaz-García A, González-Robles A, García-Palacios A, Fernández-Álvarez J, Castilla D, Bretón JM, Baños RM, Quero S, Botella C. Negative and Positive Affect Regulation in a Transdiagnostic Internet-Based Protocol for Emotional Disorders: Randomized Controlled Trial. J Med Internet Res 2021; 23:e21335. [PMID: 33522977 PMCID: PMC7884218 DOI: 10.2196/21335] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 09/10/2020] [Accepted: 12/01/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Emotional disorders (EDs) are among the most prevalent mental disorders. Existing evidence-based psychological treatments are not sufficient to reduce the disease burden of mental disorders. It is therefore essential to implement innovative solutions to achieve a successful dissemination of psychological treatment protocols, and in this regard, the use of information and communication technologies such as the internet can be very useful. Furthermore, the literature suggests that not everyone with an ED receives the appropriate treatment. This situation has led to the development of new intervention proposals based on the transdiagnostic perspective, which attempts to address the underlying processes common to EDs. Most of these transdiagnostic interventions focus primarily on downregulating negative affectivity (NA), and less attention has been paid to strengths and the upregulation of positive affectivity, despite its importance for well-being and mental health. OBJECTIVE This study aims to evaluate the efficacy of a transdiagnostic internet-based treatment for EDs in a community sample. METHODS A 3-armed randomized controlled trial was conducted. A total of 216 participants were randomly assigned to a transdiagnostic internet-based protocol (TIBP), a TIBP+ positive affect (PA) component, or a waiting list (WL) control group. The treatment protocol contained core components mainly addressed to downregulate NA (ie, present-focused emotional awareness and acceptance, cognitive flexibility, behavioral and emotional avoidance patterns, and interoceptive and situational exposure) as well as a PA regulation component to promote psychological strengths and enhance well-being. Data on depression, anxiety, quality of life, neuroticism and extraversion, and PA/NA before and after treatment were analyzed. Expectations and opinions of treatment were also analyzed. RESULTS Within-group comparisons indicated significant pre-post reductions in the two experimental conditions. In the TIBP+PA condition, the effect sizes were large for all primary outcomes (d=1.42, Beck Depression Inventory [BDI-II]; d=0.91, Beck Anxiety Inventory [BAI]; d=1.27, Positive and Negative Affect Schedule-Positive [PANAS-P]; d=1.26, Positive and Negative Affect Schedule-Negative [PANAS-N]), whereas the TIBP condition yielded large effect sizes for BDI-II (d=1.19) and PANAS-N (d=1.28) and medium effect sizes for BAI (d=0.63) and PANAS-P (d=0.69). Between-group comparisons revealed that participants who received one of the two active treatments scored better at posttreatment than WL participants. Although there were no statistically significant differences between the two intervention groups on the PA measure, effect sizes were consistently larger in the TIBP+PA condition than in the standard transdiagnostic protocol. CONCLUSIONS Overall, the findings indicate that EDs can be effectively treated with a transdiagnostic intervention via the internet, as significant improvements in depression, anxiety, and quality of life measures were observed. Regarding PA measures, promising effects were found, but more research is needed to study the role of PA as a therapeutic component. TRIAL REGISTRATION ClinicalTrials.gov NCT02578758; https://clinicaltrials.gov/ct2/show/NCT02578758. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1186/s12888-017-1297-z.
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Affiliation(s)
- Amanda Díaz-García
- Department of Psychology and Sociology, Universidad de Zaragoza, Teruel, Spain
| | | | - Azucena García-Palacios
- Universitat Jaume I, Castellón de la Plana, Spain
- CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Carlos III, Madrid, Spain
| | | | - Diana Castilla
- CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Carlos III, Madrid, Spain
- Department of Personality, Evaluation and Psychological Treatments, Universidad de Valencia, Valencia, Spain
| | | | - Rosa María Baños
- CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Carlos III, Madrid, Spain
- Department of Personality, Evaluation and Psychological Treatments, Universidad de Valencia, Valencia, Spain
| | | | - Cristina Botella
- Universitat Jaume I, Castellón de la Plana, Spain
- CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Carlos III, Madrid, Spain
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Morin M, Dumoulin C, Bergeron S, Mayrand MH, Khalifé S, Waddell G, Dubois MF, Girard I, Bureau YA, Ouellet S, Reichetzer B, Simard-Émond L, Brochu I. Multimodal physical therapy versus topical lidocaine for provoked vestibulodynia: a multicenter, randomized trial. Am J Obstet Gynecol 2021; 224:189.e1-189.e12. [PMID: 32818475 DOI: 10.1016/j.ajog.2020.08.038] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 07/19/2020] [Accepted: 08/13/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND Provoked vestibulodynia is the most common subtype of chronic vulvar pain. This highly prevalent and debilitating condition is characterized by acute recurrent pain located at the entry of the vagina in response to pressure application or attempted vaginal penetration. Although physical therapy is advocated as a first-line treatment for provoked vestibulodynia, evidence supporting its efficacy is scarce. OBJECTIVE The purpose of this study was to establish the efficacy of multimodal physical therapy compared with topical lidocaine, a frequently used first-line treatment. STUDY DESIGN We conducted a multicenter, parallel-group, randomized clinical trial in women diagnosed as having provoked vestibulodynia recruited from the community and 4 Canadian university hospitals. Women were randomly assigned (1:1) to receive either weekly sessions of physical therapy or overnight topical lidocaine (5% ointment) for 10 weeks. Randomization was stratified by center using random permuted blocks from a computer-generated list managed by an independent individual. Physical therapy entailed education, pelvic floor muscle exercises with biofeedback, manual therapy, and dilation. Assessments were conducted at baseline, posttreatment, and 6-month follow-up. Outcome assessors, investigators, and data analysts were masked to allocation. The primary outcome was pain intensity during intercourse evaluated with the numeric rating scale (0-10). Secondary outcomes included pain quality (McGill-Melzack Pain Questionnaire), sexual function (Female Sexual Function Index), sexual distress (Female Sexual Distress Scale), satisfaction (numeric rating scale of 0-10), and participants' impression of change (Patient Global Impression of Change). Intention-to-treat analyses were conducted using piecewise linear-growth models. RESULTS Among 212 women who were recruited and randomized, 201 (95%) completed the posttreatment assessment and 195 (92%) completed the 6-month follow-up. Multimodal physical therapy was more effective than lidocaine for reducing pain intensity during intercourse (between-group pre-post slope difference, P<.001; mean group postdifference, 1.8; 95% confidence interval, 1.2-2.3), and results were maintained at 6-month follow-up (mean group difference, 1.8; 95% confidence interval, 1.2-2.5). The physical therapy group also performed better than the lidocaine group in all secondary outcomes (pain quality, sexual function, sexual distress, satisfaction, and participants' impression of change) at posttreatment and 6-month follow-up. Moreover, the changes observed after physical therapy were shown to be clinically meaningful. Regarding participants' impression of change, 79% of women in the physical therapy group reported being very much or much improved compared with 39% in the lidocaine group (P<.001). CONCLUSION The findings provide strong evidence that physical therapy is effective for pain, sexual function, and sexual distress and support its recommendation as the first-line treatment of choice for provoked vestibulodynia.
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Hawgood J, Ownsworth T, Kõlves K, Spence SH, Arensman E, De Leo D. Impact of Systematic Tailored Assessment for Responding to Suicidality (STARS) Protocol Training on Mental Health Professionals' Attitudes, Perceived Capabilities, Knowledge, and Reluctance to Intervene. Front Psychiatry 2021; 12:827060. [PMID: 35211039 PMCID: PMC8861433 DOI: 10.3389/fpsyt.2021.827060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 12/31/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND AND AIMS Systematic Tailored Assessment for Responding to Suicidality (STARS) protocol and associated training were developed with the key objectives of supporting clinicians to conduct a suicide enquiry, obtaining a comprehensive account of psycho-social factors contributing to suicidality, and collaboratively developing a safety plan with clients. STARS training aims to address knowledge, attitudes and capabilities that influence intervention behavior/skills. This study aimed to examine associations between clinician characteristics and pre-training competencies in suicide risk assessment (SRA), as well as the impact of STARS training workshop on clinician competencies; and to determine the predictors of SRA training outcomes. METHOD Australian mental health professionals working with suicidal persons who undertook the STARS 2-day face-to-face workshop between 2018 and 2020 completed an online survey at pre- and post-training. Of the 222 participants who completed the pre-training questionnaire, 144 (64.9%) also completed the post-training questionnaire. Participants were mostly female (75.7%), had completed a university degree (86.4%), had <10 years of experience in suicide prevention (71.7%), and were allied and mental health professionals (78.1%). We used linear mixed-effects regression for statistical analyses. RESULTS STARS participants who reported higher perceived capability at baseline had significantly greater formal and informal training, more years of experience in suicide prevention, and were more likely to have experienced client suicide and/or suicide attempt and to report fewer SRA related fears. We found overall significant positive impacts of STARS training on clinician competencies (attitudes, perceived capability, declarative knowledge) from pre- to post-training. The most distinct changes following STARS training were for perceived capability and declarative knowledge. Participants who had more positive attitudes after training were significantly more likely to have had less prior supervision/mentoring. Reluctance to intervene was not found to significantly change after training. CONCLUSIONS We found evidence that attitudes, perceived capability and declarative knowledge changed positively from pre- to post-STARS training among mental health professionals. Underpinned by the minimum standardized SRA competencies, STARS training may be critical for informing evidence-based knowledge and skills in SRA and safety planning.
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Affiliation(s)
- Jacinta Hawgood
- Australian Institute for Suicide Research and Prevention, World Health Organization Collaborating Centre for Research and Training in Suicide Prevention, School of Applied Psychology, Griffith University, Mt Gravatt, QLD, Australia
| | - Tamara Ownsworth
- School of Applied Psychology, Menzies Health Institute of Queensland, The Hopkins Centre, Griffith University, Queensland, QLD, Australia
| | - Kairi Kõlves
- Australian Institute for Suicide Research and Prevention, World Health Organization Collaborating Centre for Research and Training in Suicide Prevention, School of Applied Psychology, Griffith University, Mt Gravatt, QLD, Australia
| | - Susan H Spence
- Australian Institute for Suicide Research and Prevention, World Health Organization Collaborating Centre for Research and Training in Suicide Prevention, School of Applied Psychology, Griffith University, Mt Gravatt, QLD, Australia
| | - Ella Arensman
- School of Public Health, College of Medicine and Health, University College Cork, Cork, Ireland.,National Suicide Research Foundation, Cork, Ireland.,Australian Institute for Suicide Research and Prevention, World Health Organization Collaborating Centre for Research and Training in Suicide Prevention, School of Applied Psychology, Griffith University, Mt Gravatt, QLD, Australia
| | - Diego De Leo
- Australian Institute for Suicide Research and Prevention, World Health Organization Collaborating Centre for Research and Training in Suicide Prevention, School of Applied Psychology, Griffith University, Mt Gravatt, QLD, Australia
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Macfarlane S, Atee M, Morris T, Whiting D, Healy M, Alford M, Cunningham C. Evaluating the Clinical Impact of National Dementia Behaviour Support Programs on Neuropsychiatric Outcomes in Australia. Front Psychiatry 2021; 12:652254. [PMID: 33927656 PMCID: PMC8076549 DOI: 10.3389/fpsyt.2021.652254] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 03/02/2021] [Indexed: 01/07/2023] Open
Abstract
Background/Objective: People living with dementia (PLWD) in residential aged care homes (RACHs) are frequently prescribed psychotropic medications due to the high prevalence of neuropsychiatric symptoms, also known as behaviours and psychological symptoms of dementia (BPSD). However, the gold standard to support BPSD is using psychosocial/non-pharmacological therapies. This study aims to describe and evaluate services and neuropsychiatric outcomes associated with the provision of psychosocial person-centred care interventions delivered by national multidisciplinary dementia-specific behaviour support programs. Methods: A 2-year retrospective pre-post study with a single-arm analysis was conducted on BPSD referrals received from Australian RACHs to the two Dementia Support Australia (DSA) programs, the Dementia Behaviour Management Advisory Service (DBMAS) and the Severe Behaviour Response Teams (SBRT). Neuropsychiatric outcomes were measured using the Neuropsychiatric Inventory (NPI) total scores and total distress scores. The questionnaire version "NPI-Q" was administered for DBMAS referrals whereas the nursing home version "NPI-NH" was administered for SBRT referrals. Linear mixed effects models were used for analysis, with time, baseline score, age, sex, and case length as predictors. Clinical significance was measured using Cohen's effect size (d; ≥0.3), the mean change score (MCS; 3 points for the NPI-Q and 4 points for the NPI-NH) and the mean percent change (MPC; ≥30%) in NPI parameters. Results: A total of 5,914 referrals (55.9% female, age 82.3 ± 8.6 y) from 1,996 RACHs were eligible for analysis. The most common types of dementia were Alzheimer's disease (37.4%) and vascular dementia (11.7%). The average case length in DSA programs was 57.2 ± 26.3 days. The NPI scores were significantly reduced as a result of DSA programs, independent of covariates. There were significant reductions in total NPI scores as a result of the DBMAS (61.4%) and SBRT (74.3%) programs. For NPI distress scores, there were 66.5% and 69.1% reductions from baseline for the DBMAS and SBRT programs, respectively. All metrics (d, MCS, MPC) were above the threshold set for determining a clinically significant effect. Conclusions: Multimodal psychosocial interventions delivered by DSA programs are clinically effective as demonstrated by positive referral outcomes, such as improved BPSD and related caregiver distress.
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Affiliation(s)
- Stephen Macfarlane
- The Dementia Centre, HammondCare, St Leonards, NSW, Australia.,Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, Australia
| | - Mustafa Atee
- The Dementia Centre, HammondCare, Wembley, WA, Australia.,Curtin Medical School, Faculty of Health Sciences, Curtin University, Bentley, WA, Australia
| | - Thomas Morris
- The Dementia Centre, HammondCare, St Leonards, NSW, Australia
| | - Daniel Whiting
- The Dementia Centre, HammondCare, St Leonards, NSW, Australia
| | - Madeleine Healy
- The Dementia Centre, HammondCare, St Leonards, NSW, Australia.,Monash Health, Clayton, VIC, Australia
| | - Marie Alford
- The Dementia Centre, HammondCare, St Leonards, NSW, Australia
| | - Colm Cunningham
- The Dementia Centre, HammondCare, St Leonards, NSW, Australia.,School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia
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Boudreau F, Dagenais GR, de Vries H, Walthouwer MJL, Côté J, Turbide G, Bourlaud AS, Poirier P. Effectiveness of a web-based computer-tailored intervention promoting physical activity for adults from Quebec City: a randomized controlled trial. Health Psychol Behav Med 2020; 8:601-622. [PMID: 34040888 PMCID: PMC8114390 DOI: 10.1080/21642850.2020.1850287] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Background The primary objective of this study was to determine the effectiveness of a 3-month web-based computer-tailored intervention on moderate-to-vigorous physical activity (MVPA) in adults. Methods A total of 242 Canadian adults aged between 35 and 70 years were randomized to an experimental group receiving the intervention or a waiting list control group. The fully automated web-based computer-tailored physical activity intervention consists of seven 10- to 15-min sessions over an 8-week period. The theoretical underpinning of the intervention is based on the I-Change Model. Results A repeated-measures ANOVA using a linear mixed model showed a significant 'group-by-time' interaction favoring the intervention group in self-reported MVPA (p = .02). The MVPA was similar in both groups at baseline (mean ± SD; 176 ± 13 vs. 172 ± 15 min/week, p = .72) and higher in the intervention than in the control group at a 3-month follow-up (259 ± 21 vs. 201 ± 22 min/week, p = .04). This finding was comparable across women and men (group-by-sex, p = .57) and across participants meeting or not physical activity guidelines at baseline (group-by-baseline physical activity, p = .43). Although engagement to the web-based sessions declined over time, participants completing more web sessions achieved higher self-reported MVPA (p < .05). Conclusion These findings suggest that this intervention is effective in enhancing self-reported MVPA in this adult population in the short term; however, this needs to be confirmed in a larger trial with better engagement to the web-based sessions.
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Affiliation(s)
- François Boudreau
- Département des sciences infirmières, Université du Québec à Trois-Rivières, Trois-Rivières, Canada
| | - Gilles R Dagenais
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Canada.,Département de médecine, Faculté de médecine, Université Laval, Québec, Canada
| | - Hein de Vries
- School for Public Health and Primary Care (CAPHRI), Department of Health Promotion, Maastricht University, Maastricht, Netherlands
| | - Michel Jean Louis Walthouwer
- School for Public Health and Primary Care (CAPHRI), Department of Health Promotion, Maastricht University, Maastricht, Netherlands
| | - José Côté
- Faculté des sciences infirmières, Centre de recherche du Centre hospitalier de l'Université de Montréal, Quebec, Canada
| | - Ginette Turbide
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Canada
| | - Anne-Sophie Bourlaud
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Canada
| | - Paul Poirier
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Canada.,Faculté de Pharmacie, Université Laval, Québec, Canada
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Andersson HW, Nordfjærn T. Factors associated with quality of life trajectories among inpatients treated for alcohol use disorders: A prospective cohort study. Addict Behav Rep 2020; 12:100285. [PMID: 32637561 PMCID: PMC7330870 DOI: 10.1016/j.abrep.2020.100285] [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: 05/08/2020] [Revised: 05/12/2020] [Accepted: 05/15/2020] [Indexed: 12/05/2022] Open
Abstract
AIMS The main study purpose was to investigate patient- and treatment-related factors associated with overall quality of life (OQOL) trajectories during and after inpatient alcohol use disorder (AUD) treatment. DESIGN A large-scale prospective multicenter cohort study of patients with different substance use disorder (SUD) types who were consecutively admitted for inpatient SUD treatment. Data were obtained at treatment entry (T1), discharge (T2), three months after discharge (T3), and one year after discharge (T4). The inclusion criterion was that the patient be dependent solely on alcohol. OQOL data were collected at all four time points. Independent variables included demographics, mental distress, psychiatric disorders, substance use, treatment history, and patient satisfaction. RESULTS Among the 611 patients available, 236 met the AUD inclusion criterion and completed T1 assessments. A linear mixed model showed substantial co-occurrence between higher mental distress and lower OQOL. Higher patient satisfaction with inpatient treatment (T2) was associated with higher trajectories of OQOL, whereas abstinence (T3) was not. There was a substantial increase in OQOL from T1 to T2, which then remained stable during the last two assessment time points. CONCLUSIONS Routine OQOL screening at treatment entry, and targeting mental distress both during and after inpatient treatment, may be associated with improved OQOL among individuals with AUD. Further research should investigate inpatient treatment factors that contribute to OQOL improvement and those that moderate the relationship between patient satisfaction and OQOL.
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Affiliation(s)
- Helle Wessel Andersson
- Department of Research and Development, Clinic of Substance Use and Addiction Medicine, St. Olavs University Hospital, Trondheim, Norway
| | - Trond Nordfjærn
- Department of Research and Development, Clinic of Substance Use and Addiction Medicine, St. Olavs University Hospital, Trondheim, Norway
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
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Wang Y, Wang A, Li H, Li Z, Hu B, Li X, Zheng H, Fu L, Hu H, Nie Z, Qin Y, Zhao B, Wei D, Karlson BW, Bots ML, Chen Y, Wang Y. Measuring effects on intima-media thickness: an evaluation of rosuvastatin in Chinese subjects with subclinical atherosclerosis-design, rationale, and methodology of the METEOR-China study. Trials 2020; 21:921. [PMID: 33176842 PMCID: PMC7656706 DOI: 10.1186/s13063-020-04741-0] [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: 03/12/2020] [Accepted: 09/16/2020] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND The beneficial effect of statins on atherosclerosis and cardiovascular outcomes has been well established. The Measuring Effects on intima media Thickness: an Evaluation Of Rosuvastatin (METEOR) global study demonstrated that a 2-year orally administered treatment with rosuvastatin 40 mg daily significantly slowed the progression of carotid intima-media thickness (CIMT) compared to placebo. The current METEOR-China study is designed to evaluate the effect of rosuvastatin 20 mg daily versus placebo on the progression of atherosclerosis measured by CIMT in asymptomatic Chinese subjects. METHODS This is a phase 3, randomised, double-blind, placebo-controlled, multicentre parallel-group study. Asymptomatic Chinese subjects with a 10-year ischaemic cardiovascular disease (ICVD) risk < 10% will be recruited at 25 study sites. They will be treated with rosuvastatin 20 mg or placebo for 104 weeks. The primary endpoint is the annualised rate of change in CIMT measured by B-mode ultrasonography. Secondary endpoints include the annualised rate of change in CIMT at three different sections of the carotid artery and changes in the serum lipid profile. Safety parameters will also be assessed. CONCLUSION The study will evaluate whether rosuvastatin 20 mg slows the progression of CIMT in asymptomatic Chinese subjects at low risk of ICVD. TRIAL REGISTRATION ClinicalTrials.gov NCT02546323 . Registered on September 10, 2015.
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Affiliation(s)
- Yilong Wang
- Beijing Tian Tan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, No. 6 Tiantanxili, Dongcheng District, Beijing, 100050, China
| | - Anxin Wang
- Beijing Tian Tan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, No. 6 Tiantanxili, Dongcheng District, Beijing, 100050, China
| | - Hongwei Li
- Department of Cardiology, Beijing Friendship Hospital Affiliated to Capital Medical University, Beijing, China
| | - Zhanquan Li
- The People's Hospital of Liaoning Province, Shenyang, China
| | - Bo Hu
- Department of Neurology, Union Hospital of Huazhong University of Science and Technology, Wuhan, China
| | - Xiaogang Li
- Department of Neurology, Peking University Third Hospital, Beijing, China
| | - Huaguang Zheng
- Beijing Tian Tan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, No. 6 Tiantanxili, Dongcheng District, Beijing, 100050, China
| | - Lu Fu
- The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Hongtao Hu
- Beijing Ji Shui Tan Hospital, Beijing, China
| | - Zhiyu Nie
- Department of Neurology, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | | | | | - Di Wei
- AstraZeneca R&D, Shanghai, China
| | - Björn W Karlson
- AstraZeneca R&D Gothenburg, Mölndal, Sweden
- Department of Molecular and Clinical Medicine, Institution of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Michiel L Bots
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Yundai Chen
- Department of Cardiology, China PLA General Hospital, 28 Fuxing Rd., Haidian District, Beijing, 100853, China.
| | - Yongjun Wang
- Beijing Tian Tan Hospital, Capital Medical University, Beijing, China.
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, No. 6 Tiantanxili, Dongcheng District, Beijing, 100050, China.
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Cherak SJ, Soo A, Brown KN, Ely EW, Stelfox HT, Fiest KM. Development and validation of delirium prediction model for critically ill adults parameterized to ICU admission acuity. PLoS One 2020; 15:e0237639. [PMID: 32813717 PMCID: PMC7437909 DOI: 10.1371/journal.pone.0237639] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 07/29/2020] [Indexed: 12/23/2022] Open
Abstract
Background Risk prediction models allow clinicians to forecast which individuals are at a higher risk for developing a particular outcome. We developed and internally validated a delirium prediction model for incident delirium parameterized to patient ICU admission acuity. Methods This retrospective, observational, fourteen medical-surgical ICU cohort study evaluated consecutive delirium-free adults surviving hospital stay with ICU length of stay (LOS) greater than or equal to 24 hours with both an admission APACHE II score and an admission type (e.g., elective post-surgery, emergency post-surgery, non-surgical) in whom delirium was assessed using the Intensive Care Delirium Screening Checklist (ICDSC). Risk factors included in the model were readily available in electric medical records. Least absolute shrinkage and selection operator logistic (LASSO) regression was used for model development. Discrimination was determined using area under the receiver operating characteristic curve (AUC). Internal validation was performed by cross-validation. Predictive performance was determined using measures of accuracy and clinical utility was assessed by decision-curve analysis. Results A total of 8,878 patients were included. Delirium incidence was 49.9% (n = 4,431). The delirium prediction model was parameterized to seven patient cohorts, admission type (3 cohorts) or mean quartile APACHE II score (4 cohorts). All parameterized cohort models were well calibrated. The AUC ranged from 0.67 to 0.78 (95% confidence intervals [CI] ranged from 0.63 to 0.79). Model accuracy varied across admission types; sensitivity ranged from 53.2% to 63.9% while specificity ranged from 69.0% to 74.6%. Across mean quartile APACHE II scores, sensitivity ranged from 58.2% to 59.7% while specificity ranged from 70.1% to 73.6%. The clinical utility of the parameterized cohort prediction model to predict and prevent incident delirium was greater than preventing incident delirium by treating all or none of the patients. Conclusions Our results support external validation of a prediction model parameterized to patient ICU admission acuity to predict a patients’ risk for ICU delirium. Classification of patients’ risk for ICU delirium by admission acuity may allow for efficient initiation of prevention measures based on individual risk profiles.
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Affiliation(s)
- Stephana J. Cherak
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- O’Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Andrea Soo
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Alberta Health Services, Calgary, AB, Canada
| | - Kyla N. Brown
- PolicyWise for Children & Families, Calgary, AB, Canada
| | - E. Wesley Ely
- Tennessee Valley Veteran’s Affairs Geriatric Research Education Clinical Center, Nashville, TN, United States of America
- Critical Illness, Brain Dysfunction, and Survivorship Center, Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - Henry T. Stelfox
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- O’Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
- Alberta Health Services, Calgary, AB, Canada
| | - Kirsten M. Fiest
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- O’Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Alberta Health Services, Calgary, AB, Canada
- Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary AB, Canada
- * E-mail:
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50
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Barends H, Claassen-van Dessel N, van der Wouden JC, Twisk JWR, Terluin B, van der Horst HE, Dekker J. Impact of symptom focusing and somatosensory amplification on persistent physical symptoms: A three-year follow-up study. J Psychosom Res 2020; 135:110131. [PMID: 32473411 PMCID: PMC7614434 DOI: 10.1016/j.jpsychores.2020.110131] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 04/29/2020] [Accepted: 05/04/2020] [Indexed: 01/23/2023]
Abstract
OBJECTIVE The somatosensory amplification theory considers symptom focusing and somatosensory amplification as important perpetuating factors of persistent physical symptoms. We investigated whether symptom focusing and somatosensory amplification were associated with symptom severity and mental and physical functioning over a three-year period in patients with persistent physical symptoms (PPS). METHODS Baseline, 6-, 12-, 24- and 36-months follow-up data from the PROSPECTS study, a prospective cohort consisting of 325 patients with PPS, were used. We applied longitudinal mixed model analyses to investigate if symptom focusing (CBRQ Symptom Focusing Subscale) and somatosensory amplification (Somatosensory Amplification Scale) at baseline were associated with symptom severity (PHQ-15), mental and physical functioning (RAND-36 MCS and PCS) over three years, using all measurements. RESULTS Symptom focusing was associated with increased symptom severity and lower mental and physical functioning over time. Somatosensory amplification at baseline was associated with increased symptom severity and lower mental and physical functioning over time. Effect sizes were small. Associations with baseline symptom focusing decreased over time, associations with baseline somatosensory amplification were more stable. There was no interaction effect of both constructs, but they partly overlapped. CONCLUSION This is the first study to show that over an extended period, symptom focusing and somatosensory amplification are associated with symptom severity and lower mental and physical functioning in patients with PPS. These results support the impact of both symptom focusing and somatosensory amplification on the perpetuation of symptoms and lowered mental and physical functioning in individuals with PPS.
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Affiliation(s)
- Hieke Barends
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of General Practice and Elderly Care Medicine, the Netherlands; Amsterdam Public Health research institute, the Netherlands.
| | - Nikki Claassen-van Dessel
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of General Practice and Elderly Care Medicine, the Netherlands; Amsterdam Public Health research institute, the Netherlands.
| | - Johannes C van der Wouden
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of General Practice and Elderly Care Medicine, the Netherlands; Amsterdam Public Health research institute, the Netherlands.
| | - Jos W R Twisk
- Amsterdam Public Health research institute, the Netherlands; Department of Health Sciences, Vrije Universiteit Amsterdam, the Netherlands.
| | - Berend Terluin
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of General Practice and Elderly Care Medicine, the Netherlands; Amsterdam Public Health research institute, the Netherlands.
| | - Henriëtte E van der Horst
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of General Practice and Elderly Care Medicine, the Netherlands; Amsterdam Public Health research institute, the Netherlands.
| | - Joost Dekker
- Amsterdam Public Health research institute, the Netherlands; Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Rehabilitation Medicine and Department of Psychiatry, the Netherlands.
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