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Du Q, Chen B, Zhang X, He H, Qin X, Li L, Du J, He X, Xu S, Xiaojie H. Effects of patient-based self-assessed fatigue intervention on early postoperative ambulation following gynaecological oncology surgery: a randomised controlled non-inferiority trial. BMJ Open 2024; 14:e078461. [PMID: 39019626 PMCID: PMC11256053 DOI: 10.1136/bmjopen-2023-078461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 06/28/2024] [Indexed: 07/19/2024] Open
Abstract
OBJECTIVES To assess the impact of a patient-based self-assessed fatigue intervention aimed at promoting early postoperative ambulation. DESIGN Prospective randomised controlled trial. SETTING Single-centre, conducted at the Obstetrics and Gynaecology Department of the Xiangyang Central Hospital, China. PARTICIPANTS Eligible were adult patients undergoing elective gynaecologic oncologic surgery. INTERVENTIONS The intervention group utilised a modified Borg Rating of Perceived Experience (RPE) scale for self-assessment of fatigue levels. The control group followed fixed-activity distance guidelines postoperatively. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was the self-reported the time to first flatus postoperatively. Secondary outcomes encompassed the time to first defecation, incidence of moderate-to-severe abdominal distention, ileus, postambulation adverse events (nausea, vomiting and dizziness), patient satisfaction with early ambulation instructions, compliance with early ambulation and average hospital costs and length of stay. RESULTS Between June 2021 and October 2022, 552 patients were enrolled. The self-assessed fatigue intervention group demonstrated non-inferior the time to first flatus compared with the fixed-activity distance assessment group (25.59±14.59 hours vs 26.10±14.19 hours, pnon-inferiority<0.001). Compliance with activity was higher in the intervention group (49.40% vs 36.02%, p<0.001), although it did not reach 50%. The intervention group also exhibited significantly higher mean hospital costs, length of stay and incidence of moderate-to-severe abdominal distention (p<0.001). CONCLUSIONS The self-assessed fatigue intervention for early postoperative ambulation in gynaecologic oncology patients shows promise as an effective strategy; however, compliance is suboptimal. An intervention based on mandatory, yet reasonable, fixed-activity distance may represent the most viable current approach. Further research is warranted to confirm these findings. TRIAL REGISTRATION NUMBER CTR2100046035.
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Affiliation(s)
- Qian Du
- Department of Obstetrics and Gynecology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei, China
| | - Bo Chen
- Department of Endocrinology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei, China
- Evidence-Based Medicine Centre, Office of Academic Research, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei, China
| | - Xiaohong Zhang
- Department of Nursing, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei, China
| | - Hong He
- Department of Nursing, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei, China
| | - Xiaomin Qin
- Department of Obstetrics and Gynecology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei, China
| | - Lin Li
- Department of Obstetrics and Gynecology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei, China
| | - Junyi Du
- Department of Obstetrics and Gynecology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei, China
| | - Xindi He
- Department of Obstetrics and Gynecology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei, China
| | - Shaoyong Xu
- Department of Endocrinology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei, China
- Evidence-Based Medicine Centre, Office of Academic Research, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei, China
| | - Huang Xiaojie
- Department of Obstetrics and Gynecology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei, China
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Zvolensky MJ, Bakhshaie J, Redmond BY, Garey L, de Dios M, Cano MÁ, Schmidt NB. Anxiety sensitivity reduction-smoking cessation intervention among individuals who engage in dual cigarette and cannabis use: A secondary analysis. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 156:209211. [PMID: 37931686 PMCID: PMC11200176 DOI: 10.1016/j.josat.2023.209211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 06/27/2023] [Accepted: 10/24/2023] [Indexed: 11/08/2023]
Abstract
INTRODUCTION Cannabis use among individuals who smoke is prevalent in the general population and related to adverse health effects, including higher levels of interoceptive perturbation (i.e., a disturbance in internal experiences). An important aspect of smoking cessation among individuals who co-use cannabis is to address behavioral associations between physiological sensations and habitual behaviors via integrated treatments focused on reducing reactivity to internal perturbations such as anxiety sensitivity (i.e., the belief that such symptoms produce personal harm). METHODS The current study involved a secondary analysis of a randomized clinical trial (RCT) of an integrated anxiety sensitivity-smoking cessation intervention compared to standard smoking cessation. The current study sought to extend findings from the initial trial to examine if the integrated intervention produced better smoking cessation outcomes than standard care among individuals who engage in dual cigarette and cannabis use. Participants were 149 adults who engage in dual cigarette and cannabis use (41.6 % female; Mage = 30.89, SD = 13.1). RESULTS Results indicated that the anxiety sensitivity intervention produced statistically significant differences in distal (long-term) smoking abstinence at 3-, 6-, and 12-month follow-up assessments but not proximal (short-term; quit-week to 2-weeks) smoking abstinence. CONCLUSIONS Overall, the potential of an integrated anxiety sensitivity smoking cessation intervention to yield better long-term smoking abstinence rates than standard cessation treatment among individuals who engage in dual cigarette and cannabis use is clinically significant.
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Affiliation(s)
- Michael J Zvolensky
- Department of Psychology, University of Houston, Houston, TX, USA; Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; HEALTH Institute, University of Houston, Houston, TX, USA.
| | - Jafar Bakhshaie
- Integrated Brain Health Clinical and Research Program, Massachusetts General Hospital, 1 Bowdoin Square, Suite 100, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Brooke Y Redmond
- Department of Psychology, University of Houston, Houston, TX, USA
| | - Lorra Garey
- Department of Psychology, University of Houston, Houston, TX, USA
| | - Marcel de Dios
- Department of Psychological, Health, and Learning Sciences, University of Houston, Houston, TX, USA
| | - Miguel Ángel Cano
- Peter O'Donnell Jr. School of Public Health, The University of Texas Southwestern Medical Center
| | - Norman B Schmidt
- Department of Psychology, Florida State University, Tallahassee, FL, USA
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Lindahl AK. Should Health Literacy Be the New Target for Intervention in Claudicants? Eur J Vasc Endovasc Surg 2023; 66:380. [PMID: 37480980 DOI: 10.1016/j.ejvs.2023.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 07/17/2023] [Indexed: 07/24/2023]
Affiliation(s)
- Anne Karin Lindahl
- Head of Division of Surgery, Akerhus University Hospital, Oslo, Norway; Professor, University of Oslo, Oslo, Norway.
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Karbownik MS, Hicks SD. The Association of Salivary Serotonin With Mood and Cardio-Autonomic Function: A Preliminary Report. Front Psychiatry 2022; 13:788153. [PMID: 35711584 PMCID: PMC9193578 DOI: 10.3389/fpsyt.2022.788153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 05/02/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Serotonin plays an important role in mood regulation and depression. However, it is not clear whether the levels of serotonin in saliva are related to current mood. AIM To test the association of salivary serotonin concentrations with mood, as well as cardiovascular and autonomic parameters. MATERIALS AND METHODS Saliva samples were obtained from collegiate runners and output parameters were examined before and after physical activity. RESULTS Salivary serotonin concentration was negatively associated with current mood (β = -0.32, 95%CI -0.62 to -0.02, p = 0.037, analysis adjusted for potential confounders), but insignificantly with measured cardiovascular and autonomic parameters. CONCLUSIONS Salivary serotonin may reflect current mood. The results are preliminary and require further evaluation.
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Affiliation(s)
| | - Steven Daniel Hicks
- Division of Academic General Pediatrics, Penn State College of Medicine, Hershey, PA, United States
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Important news on nutritional support in cancer patients - but some EFFORT is still ahead: Referring to Bargetzi et al., 'Nutritional support during hospital stay reduces mortality in patients with different types of cancer: a secondary analysis of a prospective randomized trial'. Ann Oncol 2021; 32:954-956. [PMID: 34272040 DOI: 10.1016/j.annonc.2021.06.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 06/18/2021] [Indexed: 11/24/2022] Open
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Lim A, Harijanto C, Vogrin S, Guillemin G, Duque G. Does Exercise Influence Kynurenine/Tryptophan Metabolism and Psychological Outcomes in Persons With Age-Related Diseases? A Systematic Review. Int J Tryptophan Res 2021; 14:1178646921991119. [PMID: 33613029 PMCID: PMC7876580 DOI: 10.1177/1178646921991119] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 01/07/2021] [Indexed: 12/12/2022] Open
Abstract
Background: The kynurenine (KYN) pathway has been implicated in many diseases associated with inflammation and aging (“inflammaging”). Targeting the kynurenine pathway to modify disease outcomes has been trialled pharmacologically, but the evidence of non-pharmacological means (ie, exercise) remains unclear. Objective: We aim to assess the evidence of the effects of exercise on the kynurenine pathway and psychological outcomes. Methods: Under Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines, a systematic literature search was performed in MEDLINE, EMBASE, EMCARE, and the Cochrane Central Registry of Controlled Trials. The main outcomes were changes in kynurenine pathway metabolite levels and psychological outcomes. Results: Six studies were analyzed (total n = 379) with exercise demonstrating significant concomitant effects on kynurenine pathway metabolite levels and associated psychological outcomes in domains of somatization, anxiety, and depression. Conclusion: Exercise has significant concomitant effect on kynurenine pathway metabolite levels and psychological outcomes. However, clear limitations exist in determining if the changes in the kynurenine pathway can fully explain the changes in psychological outcomes, or whether different diseases and exercise interventions act as confounding factors.
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Affiliation(s)
- Anthony Lim
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St Albans, VIC, Australia.,Melbourne Medical School-Western Precinct, The University of Melbourne, St Albans, VIC, Australia
| | - Christel Harijanto
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St Albans, VIC, Australia.,Melbourne Medical School-Western Precinct, The University of Melbourne, St Albans, VIC, Australia
| | - Sara Vogrin
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St Albans, VIC, Australia.,Department of Medicine-Western Health, Melbourne Medical School, The University of Melbourne, St Albans, VIC, Australia
| | - Gilles Guillemin
- Neuroinflammation Group, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia
| | - Gustavo Duque
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St Albans, VIC, Australia.,Melbourne Medical School-Western Precinct, The University of Melbourne, St Albans, VIC, Australia.,Department of Medicine-Western Health, Melbourne Medical School, The University of Melbourne, St Albans, VIC, Australia
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Lavery JA, Callahan MK, Panageas KS. Apples and Oranges? Considerations for EHR-Based Analyses Aggregating Data From Interventional Clinical Trials and Point-of-Care Encounters in Oncology. JCO Clin Cancer Inform 2021; 5:21-23. [PMID: 33411618 DOI: 10.1200/cci.20.00096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Jessica A Lavery
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Margaret K Callahan
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Katherine S Panageas
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
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Karbownik MS, Kręczyńska J, Wiktorowska-Owczarek A, Kwarta P, Cybula M, Stilinović N, Pietras T, Kowalczyk E. Decrease in Salivary Serotonin in Response to Probiotic Supplementation With Saccharomyces boulardii in Healthy Volunteers Under Psychological Stress: Secondary Analysis of a Randomized, Double-Blind, Placebo-Controlled Trial. Front Endocrinol (Lausanne) 2021; 12:800023. [PMID: 35069447 PMCID: PMC8772029 DOI: 10.3389/fendo.2021.800023] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 12/10/2021] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Bacterial probiotics are thought to exert a serotonergic effect relevant to their potential antidepressant and pro-cognitive action, but yeast probiotics have not been tested. The aim of the present study was to determine whether 30-day supplementation with Saccharomyces boulardii affects the level of salivary serotonin under psychological stress and identify the factors associated with it. METHODS Healthy medical students were randomized to ingest Saccharomyces boulardii CNCM I-1079 or placebo before a stressful event. Salivary serotonin concentration was assessed before and at the end of supplementation. Moreover, obtained results were compared to psychological, biochemical, physiological and sociodemographic study participants data. RESULTS Data of thirty-two participants (22.8 ± 1.7 years of age, 16 males) was available for the main analysis. Supplementation with Saccharomyces boulardii decreased salivary serotonin concentration under psychological stress by 3.13 (95% CI 0.20 to 6.07) ng/mL, p = 0.037, as compared to placebo. Salivary serotonin was positively correlated with salivary metanephrine (β = 0.27, 95% CI 0.02 to 0.52, p = 0.031) and pulse rate (β = 0.28, 95% CI 0.05 to 0.50, p = 0.018), but insignificantly with anxiety, depression, eating attitudes and information retrieval. CONCLUSIONS Saccharomyces boulardii CNCM I-1079 may be distinct from bacterial probiotics in its salivary serotonergic effect, which appears positively linked to symapathoadrenal markers. The study requires cautious interpretation, and further investigation.
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Affiliation(s)
- Michał Seweryn Karbownik
- Department of Pharmacology and Toxicology, Medical University of Lodz, Łódź, Poland
- *Correspondence: Michał Seweryn Karbownik,
| | - Joanna Kręczyńska
- Department of Infectious Diseases and Hepatology, Medical University of Lodz, Łódź, Poland
| | | | - Paulina Kwarta
- Psychiatric Ward for Adolescents, Babinski Specialist Psychiatric Healthcare Center, Łódź, Poland
| | - Magdalena Cybula
- Oklahoma Medical Research Foundation, Aging and Metabolism Program, Oklahoma City, OK, United States
| | - Nebojša Stilinović
- Department of Pharmacology, Toxicology and Clinical Pharmacology, University of Novi Sad, Novi Sad, Serbia
| | - Tadeusz Pietras
- Department of Clinical Pharmacology, Medical University of Lodz, Łódź, Poland
| | - Edward Kowalczyk
- Department of Pharmacology and Toxicology, Medical University of Lodz, Łódź, Poland
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Hubbard AE, Kherad-Pajouh S, van der Laan MJ. Statistical Inference for Data Adaptive Target Parameters. Int J Biostat 2017; 12:3-19. [PMID: 27227715 DOI: 10.1515/ijb-2015-0013] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Consider one observes n i.i.d. copies of a random variable with a probability distribution that is known to be an element of a particular statistical model. In order to define our statistical target we partition the sample in V equal size sub-samples, and use this partitioning to define V splits in an estimation sample (one of the V subsamples) and corresponding complementary parameter-generating sample. For each of the V parameter-generating samples, we apply an algorithm that maps the sample to a statistical target parameter. We define our sample-split data adaptive statistical target parameter as the average of these V-sample specific target parameters. We present an estimator (and corresponding central limit theorem) of this type of data adaptive target parameter. This general methodology for generating data adaptive target parameters is demonstrated with a number of practical examples that highlight new opportunities for statistical learning from data. This new framework provides a rigorous statistical methodology for both exploratory and confirmatory analysis within the same data. Given that more research is becoming "data-driven", the theory developed within this paper provides a new impetus for a greater involvement of statistical inference into problems that are being increasingly addressed by clever, yet ad hoc pattern finding methods. To suggest such potential, and to verify the predictions of the theory, extensive simulation studies, along with a data analysis based on adaptively determined intervention rules are shown and give insight into how to structure such an approach. The results show that the data adaptive target parameter approach provides a general framework and resulting methodology for data-driven science.
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Hopewell S, Collins GS, Hirst A, Kirtley S, Tajar A, Gerry S, Altman DG. Reporting characteristics of non-primary publications of results of randomized trials: a cross-sectional review. Trials 2013; 14:240. [PMID: 23902608 PMCID: PMC3733891 DOI: 10.1186/1745-6215-14-240] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Accepted: 07/24/2013] [Indexed: 11/30/2022] Open
Abstract
Background For a randomized trial, the primary publication is usually the one which reports the results of the primary outcome and provides consolidated data from all study centers. Other aspects of a randomized trial’s findings (that is, non-primary results) are often reported in subsequent publications. Methods We carried out a cross-sectional review of the characteristics and type of information reported in non-primary reports (n = 69) of randomized trials (indexed in PubMed core clinical journals in 2009) and whether they report pre-specified or exploratory analyses. We also compared consistency of information in non-primary publications with that reported in the primary publication. Results The majority (n = 56; 81%) of non-primary publications were large, multicenter trials, published in specialty journals. Most reported subgroup analyses (n = 27; 39%), analyzing a specific subgroup of patients from the randomized trial, or reported on secondary outcomes (n = 29; 42%); 19% (n = 13) reported extended follow-up. Less than half reported details of trial registration (n = 30; 43%) or the trial protocol (n = 27; 39%) and in 41% (n = 28) it was unclear from reading the abstract that the report was not the primary publication for the trial. Non-primary publications often analyzed and reported multiple different outcomes (16% reported >20 outcomes) and in 10% (n = 7) it was unclear how many outcomes had actually been assessed; in 42% (n = 29) it was unclear whether the analyses reported were pre-specified or exploratory. Only 39% (n = 27) of non-primary publications described the primary outcome of the randomized trial, 6% (n = 4) reported its numerical results and 9% (n = 6) details of how participants were randomized. Conclusion Non-primary publications often lack important information about the randomized trial and the type of analyses conducted and whether these were pre-specified or exploratory to enable readers to accurately identify and assess the validity and reliably of the study findings. We provide recommendations for what information authors should include in non-primary reports of randomized trials.
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Affiliation(s)
- Sally Hopewell
- Centre for Statistics in Medicine, University of Oxford, Botnar Recpsearch Building, Windmill Road, Oxford, UK.
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Kronish IM, Rieckmann N, Burg MM, Edmondson D, Schwartz JE, Davidson KW. The effect of enhanced depression care on adherence to risk-reducing behaviors after acute coronary syndromes: findings from the COPES trial. Am Heart J 2012; 164:524-9. [PMID: 23067910 PMCID: PMC3607422 DOI: 10.1016/j.ahj.2012.07.024] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2012] [Accepted: 07/25/2012] [Indexed: 12/15/2022]
Abstract
BACKGROUND The presence of depression after an acute coronary syndrome (ACS) is associated with worse prognosis and lower adherence to risk-reducing behaviors. We reported earlier that an enhanced depression care intervention reduces depression symptoms and major adverse cardiac events. This study evaluates the impact of the depression intervention on health behavior and blood pressure control. METHODS Between 2005 and 2008, 157 patients who remained persistently depressed 3 months after ACS were randomized to a 6-month depression intervention (initial patient preference for problem-solving therapy and/or pharmacotherapy, followed by stepped care; 80 patients) or to usual care (77 patients). At randomization, and then 2, 4, and 6 months later, patients were asked if they (1) missed taking their aspirin; (2) followed a heart healthy diet; (3) exercised regularly; and (4) used tobacco products. Blood pressure was measured before randomization and 6 months later. RESULTS At the end of the intervention, there was no significant improvement in the percentage of intervention compared to control group patients who adhered to aspirin (+3% versus -1%, P = .23), followed a healthy diet (+10% versus +8%, P = .39), exercised regularly (+5% versus +4%, P = .65), abstained from tobacco (-3% versus -1%, P = .77), or had controlled blood pressure (+6% versus +16%, P = .26). CONCLUSION Despite improving depression, enhanced depression care after an ACS did not improve health behavior or blood pressure control compared to usual care. Research is needed to test whether adding an adherence intervention to enhanced depression care can improve adherence and cardiovascular prognosis in depressed patients post-ACS.
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Affiliation(s)
- Ian M Kronish
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, PH9-311, 622W168th Street, New York, NY 10032, USA.
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