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Edge D, Watkins E, Newbold A, Ehring T, Frost M, Rosenkranz T. Evaluating the Effects of a Self-Help Mobile Phone App on Worry and Rumination Experienced by Young Adults: Randomized Controlled Trial. JMIR Mhealth Uhealth 2024; 12:e51932. [PMID: 39137411 DOI: 10.2196/51932] [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: 09/15/2023] [Revised: 04/25/2024] [Accepted: 05/06/2024] [Indexed: 08/15/2024] Open
Abstract
BACKGROUND Delivery of preventative interventions via mobile phone apps offers an effective and accessible way to address the global priority of improving the mental health of adolescents and young adults. A proven risk factor for anxiety and depression is elevated worry and rumination, also known as repetitive negative thinking (RNT). OBJECTIVE This was a prevention mechanism trial that aimed to investigate whether an RNT-targeting self-help mobile phone app (MyMoodCoach) reduces worry and rumination in young adults residing in the United Kingdom. A secondary objective was to test whether the app reduces symptoms of anxiety and depression and improves well-being. METHODS A web-based, single-blind, 2-arm parallel-group randomized controlled trial was conducted with 236 people aged between 16 and 24 years, who self-reported high levels of worry or rumination. Eligible participants were randomized to an active intervention group (usual practice, plus up to 6 weeks of using the RNT-targeting mobile app, n=119) or a waitlist control group (usual practice with no access to the app until after 6 weeks, n=117). The primary outcome was changes in worry and rumination 6 weeks after randomization. Secondary outcomes included changes in well-being and symptoms of anxiety and depression after 6 weeks and changes in all measures after 12 weeks. RESULTS Participants randomly allocated to use the RNT-targeting self-help app showed significantly lower levels of rumination (mean difference -2.92, 95% CI -5.57 to -0.28; P=.03; ηp2=0.02) and worry (mean difference -3.97, 95% CI -6.21 to -1.73; P<.001; ηp2=0.06) at 6-week follow-up, relative to the waitlist control. Similar differences were observed for well-being (P<.001), anxiety (P=.03), and depression (P=.04). The waitlist control group also showed improvement when given access to the app after 6 weeks. Improvements observed in the intervention group after 6 weeks of using the app were maintained at the 12-week follow-up point. CONCLUSIONS The MyMoodCoach app had a significant positive effect on worry and rumination, well-being, anxiety, and depression in young adults, relative to waitlist controls, providing proof-of-principle that an unguided self-help app can effectively reduce RNT. This app, therefore, has potential for the prevention of anxiety and depression although longer-term effects on incidence need to be directly evaluated. TRIAL REGISTRATION ClinicalTrials.gov NCT04950257; https://www.clinicaltrials.gov/ct2/show/NCT04950257. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1186/s12888-021-03536-0.
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Affiliation(s)
- Daniel Edge
- Mood Disorders Centre, School of Psychology, University of Exeter, Exeter, United Kingdom
| | - Edward Watkins
- Mood Disorders Centre, School of Psychology, University of Exeter, Exeter, United Kingdom
| | - Alexandra Newbold
- Mood Disorders Centre, School of Psychology, University of Exeter, Exeter, United Kingdom
| | - Thomas Ehring
- Department of Psychology, Ludwig-Maximilians-University of Munich, Munich, Germany
| | | | - Tabea Rosenkranz
- Department of Psychology, Ludwig-Maximilians-University of Munich, Munich, Germany
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Medcalf E, Turner RM, Espinoza D, He V, Bell KJL. Addressing missing outcome data in randomised controlled trials: A methodological scoping review. Contemp Clin Trials 2024; 143:107602. [PMID: 38857674 DOI: 10.1016/j.cct.2024.107602] [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: 04/03/2024] [Revised: 05/20/2024] [Accepted: 06/05/2024] [Indexed: 06/12/2024]
Abstract
BACKGROUND Missing outcome data is common in trials, and robust methods to address this are needed. Most trial reports currently use methods applicable under a missing completely at random assumption (MCAR), although this strong assumption can often be inappropriate. OBJECTIVE To identify and summarise current literature on the analytical methods for handling missing outcome data in randomised controlled trials (RCTs), emphasising methods appropriate for data missing at random (MAR) or missing not at random (MNAR). STUDY DESIGN AND SETTING We conducted a methodological scoping review and identified papers through searching four databases (MEDLINE, Embase, CENTRAL, and CINAHL) from January 2015 to March 2023. We also performed forward and backward citation searching. Eligible papers discussed methods or frameworks for handling missing outcome data in RCTs or simulation studies with an RCT design. RESULTS From 1878 records screened, our search identified 101 eligible papers. 90 (89%) papers described specific methods for addressing missing outcome data and 11 (11%) described frameworks for overall methodological approach. Of the 90 methods papers, 30 (33%) described methods under the MAR assumption, 48 (53%) explored methods under the MNAR assumption and 11 (12%) discussed methods under a hybrid of MAR and MNAR assumptions. Control-based methods under the MNAR assumption were the most common method explored, followed by multiple imputation under the MAR assumption. CONCLUSION This review provides guidance on available analytic approaches for handling missing outcome data, particularly under the MNAR assumption. These findings may support trialists in using appropriate methods to address missing outcome data.
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Affiliation(s)
- Ellie Medcalf
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.
| | - Robin M Turner
- Biostatistics Centre, University of Otago, Dunedin, New Zealand
| | - David Espinoza
- National Health and Medical Research Council Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Vicky He
- The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Katy J L Bell
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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Sooriyaarachchi P, Jayawardena R, Pavey T, King NA. A low-calorie meal replacement improves body composition and metabolic parameters in shift workers with overweight and obesity: a randomized, controlled, parallel group trial. Nutr Metab (Lond) 2024; 21:32. [PMID: 38858723 PMCID: PMC11165784 DOI: 10.1186/s12986-024-00799-8] [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: 10/02/2023] [Accepted: 04/30/2024] [Indexed: 06/12/2024] Open
Abstract
BACKGROUND Shift work has been identified as a risk factor for several chronic health conditions including obesity. This study evaluated the impact of a low-calorie meal replacement (MR) as a dinner substitute on body composition and metabolic parameters in shift workers with overweight and obesity. METHODS An 8-week parallel, randomized controlled trial was conducted on overweight and obese shift workers in a large hospital. An intervention group (IG) (n = 25) was provided with a low-calorie MR shake (∼200 kcal) as a replacement for dinner, every day for 8 weeks, while the control group (CG) (n = 25) continued their habitual diet. Anthropometric measurements, body composition, biochemical, and lifestyle data were assessed at the first and last visits. Analyses were done per protocol (PP) and by intention to treat (ITT). RESULTS Over the study duration, both groups displayed moderate changes in anthropometric measurements and body composition, although these were not statistically significant according to the PP analysis. In the ITT analysis, apart from the hip circumference (HC), all other anthropometric parameters demonstrated significant group and time interactions, suggesting the advantageous effects of the meal replacement over the study period (P < 0.05). HDL and VLDL cholesterol measures showed significant main effects, influenced by both group (P = 0.031) and time (P = 0.050) respectively. The most pronounced dietary shift in the IG was a reduction in carbohydrate consumption and an increase in protein intake. Throughout the study, the meal replacement was well-tolerated, with no adverse events reported. CONCLUSIONS The meal replacement dietary intervention appears to offer beneficial health effects over time. Extended research is crucial to understand the broader implications of meal replacements across diverse populations. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12622000231741. Registered on 09 February 2022. https://www.anzctr.org.au/ACTRN12622000231741.aspx .
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Affiliation(s)
- Piumika Sooriyaarachchi
- Faculty of Health, School of Exercise and Nutrition Sciences, Queensland University of Technology (QUT), Brisbane, QLD, Australia.
- Health and Wellness Unit, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka.
| | - Ranil Jayawardena
- Faculty of Health, School of Exercise and Nutrition Sciences, Queensland University of Technology (QUT), Brisbane, QLD, Australia
- Department of Physiology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
- Nawaloka Hospital Research and Education Foundation, Nawaloka Hospitals PLC, Colombo, Sri Lanka
| | - Toby Pavey
- Faculty of Health, School of Exercise and Nutrition Sciences, Queensland University of Technology (QUT), Brisbane, QLD, Australia
| | - Neil A King
- Faculty of Health, School of Exercise and Nutrition Sciences, Queensland University of Technology (QUT), Brisbane, QLD, Australia
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McIntosh JG, Jenkins M, Wood A, Chondros P, Campbell T, Wenkart E, O'Reilly C, Dixon I, Toner J, Martinez-Gutierrez J, Govan L, Emery JD. Increasing bowel cancer screening using SMS in general practice: the SMARTscreen cluster randomised trial. Br J Gen Pract 2024; 74:BJGP.2023.0230. [PMID: 38164588 PMCID: PMC10962502 DOI: 10.3399/bjgp.2023.0230] [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: 05/16/2023] [Accepted: 12/11/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND Australia has one of the highest incidences of colorectal cancer (CRC) worldwide. The Australian National Bowel Cancer Screening Program (NBCSP) is a best-practice, organised screening programme, but uptake is low (40.9%) and increasing participation could reduce morbidity and mortality associated with CRC. Endorsement by GPs is strongly associated with increasing screening uptake. AIM This study (SMARTscreen) aimed to test whether a multi-intervention short message service (SMS) sent by general practices to 50-60-year-old patients who were due to receive the NBCSP kit would increase NBCSP uptake, by comparing it with usual care. DESIGN AND SETTING A stratified cluster randomised controlled trial was undertaken, involving 21 Australian general practices in Western Victoria, Australia. METHOD For intervention practices, people due to receive the NBCSP kit within a 6-month study period were sent an SMS just before receiving the kit. The SMS included a personalised message from the person's general practice endorsing the kit, a motivational narrative video, an instructional video, and a link to more information. Control practices continued with usual care, comprising at-home testing with a faecal immunochemical test (FIT) through the NBCSP. The primary outcome was the between-arm percentage difference in uptake of FIT screening within 12 months from randomisation, which was estimated using generalised linear model regression. RESULTS In total, 39.2% (1143/2914) of people in 11 intervention practices and 23.0% (583/2537) of people in 10 control practices had a FIT result in their electronic health records - a difference of 16.5% (95% confidence interval = 2.02 to 30.9). CONCLUSION The SMS intervention increased NBCSP kit return in 50-60-year-old patients in general practice. This finding informed a larger trial - SMARTERscreen - to test this intervention in a broader Australian population.
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Affiliation(s)
- Jennifer G McIntosh
- Centre for Epidemiology and Biostatistics, University of Melbourne, Melbourne
| | - Mark Jenkins
- Centre for Epidemiology and Biostatistics, University of Melbourne, Melbourne
| | - Anna Wood
- Department of General Practice and Primary Care, University of Melbourne, Melbourne
| | - Patty Chondros
- Department of General Practice and Primary Care, University of Melbourne, Melbourne
| | | | | | - Clare O'Reilly
- Workforce Development, Screening Early Detection and Immunisation, Cancer Council Victoria, Melbourne, and executive manager, Chronic Health, Population Health Unit, VACCHO, Melbourne
| | | | | | | | - Linda Govan
- Ballarat Goldfields/Wimmera Grampians, Western Victoria Primary Health Network, Ballarat
| | - Jon D Emery
- Department of General Practice and Primary Care, University of Melbourne, Melbourne
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Li G, Liu Y, Zhang J, DeMauro SB, Meng Q, Mbuagbaw L, Schmidt B, Kirpalani H, Thabane L. Missing Outcome Data in Recent Perinatal and Neonatal Clinical Trials. Pediatrics 2024; 153:e2023063101. [PMID: 38389453 DOI: 10.1542/peds.2023-063101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/08/2023] [Indexed: 02/24/2024] Open
Abstract
Missing outcome data in clinical trials may jeopardize the validity of the trial results and inferences for clinical practice. Although sick and preterm newborns are treated as a captive patient population during their stay in the NICUs, their long-term outcomes are often ascertained after discharge. This greatly increases the risk of attrition. We surveyed recently published perinatal and neonatal randomized trials in 7 high-impact general medical and pediatric journals to review the handling of missing primary outcome data and any choice of imputation methods. Of 87 eligible trials in this survey, 77 (89%) had incomplete primary outcome data. The missing outcome data were not discussed at all in 9 reports (12%). Most study teams restricted their main analysis to participants with complete information for the primary outcome (61 trials; 79%). Only 38 of the 77 teams (49%) performed sensitivity analyses using a variety of imputation methods. We conclude that the handling of missing primary outcome data was frequently inadequate in recent randomized perinatal and neonatal trials. To improve future approaches to missing outcome data, we discuss the strengths and limitations of different imputation methods, the appropriate estimation of sample size, and how to deal with data withdrawal. However, the best strategy to reduce bias from missing outcome data in perinatal and neonatal trials remains prevention. Investigators should anticipate and preempt missing data through careful study design, and closely monitor all incoming primary outcome data for completeness during the conduct of the trial.
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Affiliation(s)
- Guowei Li
- Center for Clinical Epidemiology and Methodology
- Father Sean O'Sullivan Research Centre, St Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Yingxin Liu
- Center for Clinical Epidemiology and Methodology
| | - Jingyi Zhang
- Center for Clinical Epidemiology and Methodology
| | - Sara B DeMauro
- Division of Neonatology, Children's Hospital of Philadelphia
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Qiong Meng
- Department of Pediatrics, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Lawrence Mbuagbaw
- Father Sean O'Sullivan Research Centre, St Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
- Evidence, and Impact; Department of Health Research Methods
- Anesthesia
- Pediatrics, McMaster University, Hamilton, Ontario, Canada
- Centre for Development of Best Practices in Health, Yaoundé Central Hospital, Yaoundé, Cameroon, Central Africa
- Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | - Barbara Schmidt
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Evidence, and Impact; Department of Health Research Methods
| | - Haresh Kirpalani
- Emeritus Professor Pediatrics at University Pennsylvania, Philadelphia, PA
- Emeritus Professor Pediatrics McMaster University, Hamilton, Ontario, Canada
| | - Lehana Thabane
- Father Sean O'Sullivan Research Centre, St Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
- Evidence, and Impact; Department of Health Research Methods
- Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Cape Town, South Africa
- University of Johannesburg, Johannesburg, South Africa
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Hegarty K, Tarzia L, Navarro Medel C, Hameed M, Chondros P, Gold L, Tassone S, Feder G, Humphreys C. Protocol for a randomised controlled trial of a healthy relationship tool for men who use intimate partner violence (BETTER MAN). BMC Public Health 2023; 23:2395. [PMID: 38042810 PMCID: PMC10693163 DOI: 10.1186/s12889-023-17032-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 10/20/2023] [Indexed: 12/04/2023] Open
Abstract
BACKGROUND Intimate partner violence (IPV) is common globally, but there is a lack of research on how to intervene early with men who might be using IPV. Building on evidence supporting the benefits of online interventions for women victim/survivors, this study aims to test whether a healthy relationship website (BETTER MAN) is effective at improving men's help seeking, their recognition of behaviours as IPV and their readiness to change their behaviours. METHODS/DESIGN In this two-group, pragmatic randomised controlled trial, men aged 18-50 years residing in Australia who have been in an adult intimate relationship (female, male or non-binary partner) in the past 12 months are eligible. Men who report being worried about their behaviour or have had others express concerns about their behaviour towards a partner in the past 12 months will be randomised with a 1:1 allocation ratio to receive the BETTER MAN website or a comparator website (basic healthy relationships information). The BETTER MAN intervention includes self-directed, interactive reflection activities spread across three modules: Better Relationships, Better Values and Better Communication, with a final "action plan" of strategies and resources. Using an intention to treat approach, the primary analysis will estimate between-group difference in the proportion of men who report undertaking help-seeking behaviours for relationship issues in the last 6 months, at 6 months post-baseline. Analysis of secondary outcomes will estimate between-group differences in: (i) mean score of awareness of behaviours in relationships as abusive immediately post-use of website; (ii) mean score on readiness to change immediately post-use of website and 3 months after baseline; and (iii) cost-effectiveness. DISCUSSION This trial will evaluate the effectiveness of an online healthy relationship tool for men who may use IPV. BETTER MAN could be incorporated into practice in community and health settings, providing an evidence-informed website to assist men to seek help to promote healthy relationships and reduce use of IPV. TRIAL REGISTRATION ACTRN12622000786796 with the Australian New Zealand Clinical Trials Registry: 2 June 2022. Version: 1 (28 September 2023).
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Affiliation(s)
- Kelsey Hegarty
- Department of General Practice & Primary Care, The University of Melbourne, Melbourne, Australia
- Centre for Family Violence Prevention, The Royal Women's Hospital, Melbourne, Australia
| | - Laura Tarzia
- Department of General Practice & Primary Care, The University of Melbourne, Melbourne, Australia.
- Centre for Family Violence Prevention, The Royal Women's Hospital, Melbourne, Australia.
| | - Carolina Navarro Medel
- Department of General Practice & Primary Care, The University of Melbourne, Melbourne, Australia
| | - Mohajer Hameed
- School of Public Health, La Trobe University, Melbourne, Australia
| | - Patty Chondros
- Department of General Practice & Primary Care, The University of Melbourne, Melbourne, Australia
| | - Lisa Gold
- School of Health & Social Development, Deakin University, Burwood, Australia
| | | | - Gene Feder
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Cathy Humphreys
- School of Social Work, The University of Melbourne, Melbourne, Australia
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Matthews AK, Steffen A, Burke L, Harris Vilona B, Donenberg G. MiQuit: A Study Protocol to Link Low-Income Smokers to a State Tobacco Quitline. Ethn Dis 2023; DECIPHeR:44-51. [PMID: 38846727 PMCID: PMC11099521 DOI: 10.18865/ed.decipher.44] [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] [Indexed: 06/09/2024] Open
Abstract
Purpose To conduct a randomized controlled trial to compare 3 implementation strategies and the impact of facilitated referrals on linkage of Federally Qualified Health Center patients to the Illinois Tobacco Quitline (ITQL). Methods This study will be a hybrid type 3 implementation-effectiveness trial guided by 2 implementation science frameworks: reach, effectiveness, adoption, implementation, and maintenance and exploration preparation implementation sustainment. We will evaluate whether sending provider messages through the patient electronic health portal increases patient linkage to the ITQL. We will (1) randomly assign all eligible patients to receive 1 of 3 messages (information about quitting, advice to quit, and advice to quit or cut down), and (2) we will offer a facilitated linkage to the ITQL. For patients who opt into a facilitated referral, we will share their contact information with the ITQL, who will contact them. Four weeks after the initial message, patients who expressed interest in services but were not reached by the ITQL will be rerandomized to 1 of 2 arms, an offer to reconnect to the ITQL or an offer to engage a peer navigator who can help them reconnect to the ITQL. We will assess the implementation strategies' reach, adoption, linkage, and sustainability with the ITQL. Discussion This study will provide a new cost-effective and efficient model to link low-income smokers to state tobacco quitlines. Message delivery via patient health portals has important implications for addressing other tobacco-related morbidities.
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Affiliation(s)
- Alicia K. Matthews
- Behavioral Science, School of Nursing, Columbia University, New York, NY
| | - Alana Steffen
- College of Nursing, The University of Illinois Chicago, Chicago, IL
| | - Larisa Burke
- College of Nursing, The University of Illinois Chicago, Chicago, IL
| | - Brittany Harris Vilona
- Department of Medicine, Center for Dissemination and Implementation Science, University of Illinois at Chicago, Chicago, IL
| | - Geri Donenberg
- Department of Medicine, Center for Dissemination and Implementation Science, University of Illinois at Chicago, Chicago, IL
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Chalmers I, Matthews R, Glasziou P, Boutron I, Armitage P. Trial analysis by treatment allocated or by treatment received? Origins of 'the intention-to-treat principle' to reduce allocation bias: Part 2. J R Soc Med 2023; 116:386-394. [PMID: 37975723 PMCID: PMC10686203 DOI: 10.1177/01410768231203936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023] Open
Affiliation(s)
- I Chalmers
- Centre for Evidence-Based Medicine, University of Oxford, OX2 6HX, UK
| | - R Matthews
- Department of Mathematics, Aston University, Birmingham, B4 7ET, UK
| | - P Glasziou
- Institute for Evidence Based Healthcare, Bond University, Queensland, QLD 4226, Australia
| | - I Boutron
- Université Paris Cité and Université Sorbonne Paris Nord, Inserm, INRAE, Centre for Research in Epidemiology and Statistics (CR ESS), F-75004 Paris, France
| | - P Armitage
- 2 Reading Road, Wallingford OX10 9DP, UK
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Yue H, Yao F, Yin X, Li S, Zhang Q, Zhang W, Mi Y, Lao L, Xu S. Electroacupuncture for Pain Relief After Endoscopic Sinus Surgery: A Randomized Controlled Trial. THE JOURNAL OF PAIN 2023; 24:2014-2023. [PMID: 37348776 DOI: 10.1016/j.jpain.2023.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 06/02/2023] [Accepted: 06/09/2023] [Indexed: 06/24/2023]
Abstract
Postoperative pain is a common problem after endoscopic sinus surgery (ESS). Electroacupuncture (EA) is proven to be effective in relieving postoperative pain. However, EA has not been studied in patients undergoing ESS. This study was designed to evaluate the efficacy and safety of EA compared to a sham control in relieving pain after ESS. A total of 62 patients were randomly allocated to receive either EA (n = 31) or sham EA (n = 31) for 5 sessions, 30 minutes per session for 4 days (2 hours before and 2 hours after surgery, and 3 sessions daily for the following 3 days). There were no significant differences between the 2 groups with regard to demographic characteristics. Compared to the sham EA group, the EA group showed a significantly greater reduction in the pain intensity of single daily scoring with a numerical rating scale at the day following surgery (postoperative day 1, POD1) (-1.35; 95% confidence interval [CI], -1.74 to -0.97; P < .001) and POD2 (-1.16; 95% CI, -1.55 to -0.77; P < .001), whereas no significant between-group difference was detected at the day of surgery (POD0), POD3 or POD6. Intraoperative heart rate and mean blood pressure in the EA group showed a more stable trend. A significant improvement was found for an actigraphy-measured average time of night wakings, recovery time from anesthesia, and quality of recovery-15 in the EA group. No severe adverse events occurred during the trial. Our results demonstrate that EA can serve as an effective adjuvant therapeutic tool for pain relief after ESS. PERSPECTIVE: This randomized sham-controlled, patient-and-assessor blinded trial provided evidence for the first time that EA can relieve postoperative pain and other symptom management in patients after ESS. TRIAL REGISTRATION NUMBER: Chinese Clinical Trial Registry, ChiCTR1900024183, http://www.chictr.org.cn/showproj.aspx?proj=40573.
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Affiliation(s)
- Hongyu Yue
- Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Fei Yao
- Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China; School of Acupuncture-Moxibustion and Tuina, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xuan Yin
- Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Shanshan Li
- Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Qing Zhang
- Department of anesthesiology, Shanghai Jingan District Zhabei Central Hospital, Shanghai, China
| | - Wei Zhang
- Department of Biostatistics, School of Public Health, Fudan University, Shanghai, China
| | - Yiqun Mi
- Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Lixing Lao
- Virginia University of Integrative Medicine, Fairfax, Virginia
| | - Shifen Xu
- Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
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Johnson RW, White BK, Gibson N, Gucciardi DF, Williams SA. A Mixed-Methods Feasibility Study of a Gamified Therapy Prescription App for Children with Neurodisability. Phys Occup Ther Pediatr 2023; 44:586-603. [PMID: 37814984 DOI: 10.1080/01942638.2023.2263576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 09/12/2023] [Indexed: 10/11/2023]
Abstract
AIM Determine the feasibility of a gamified therapy (occupational therapy, physiotherapy, speech pathology) prescription app developed for children with neurodisability for delivering school and home therapy programs (the Zingo app). METHOD A mixed-methods feasibility study was conducted with children (and their parents, therapists, and teachers) with neurodisability (n = 8, female= 5) who were prescribed a 4-week individualized therapy program by their usual treating therapist using Zingo. Primary outcome measures were program adherence, engagement, app quality, and user experience, collected with quantitative and qualitative methods. RESULTS Mean adherence to the program was 58.0% (SD 27.2). Our combined Engagement Index (EI) score was 74.4% (SD 11.7). App quality measured using Mobile Application Rating Scale- User version was 4.6/5 (SD 0.7, n = 6) for parents, 4.6/5 (SD 0.5, n = 5) for teachers, and 4.4/5 (SD 0.6, n = 6) for therapists. Thematic analysis of semi-structured interviews yielded a primary theme of "app as motivator" for therapy. CONCLUSIONS Adherence findings were affected by COVID-19 outbreak however remain comparable with other studies in this cohort. EI findings compared favorably with other studies. The findings are supportive of the feasibility of Zingo for delivering home and school therapy programs for children with neurodisability and was found to motivate therapy program completion.
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Affiliation(s)
- Rowan W Johnson
- Curtin School of Allied Health, Curtin University, Perth, Australia
- Therapy Services, Ability WA, Perth, Australia
| | - Becky K White
- Curtin School of Population Health, Curtin University, Perth, Australia
- Reach Health Promotion Innovations, Perth, Australia
| | - Noula Gibson
- Curtin School of Allied Health, Curtin University, Perth, Australia
- Department of Physiotherapy, Perth Children's Hospital, Perth, Australia
| | - Daniel F Gucciardi
- Curtin School of Allied Health, Curtin University, Perth, Australia
- Curtin enAble Institute, Faculty of Health Sciences, Curtin University, Perth, Australia
| | - Sîan A Williams
- Curtin School of Allied Health, Curtin University, Perth, Australia
- Liggins Institute, The University of Auckland, Auckland, New Zealand
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Huhtiniemi M, Sääkslahti A, Tolvanen A, Lubans DR, Jaakkola T. A scalable school-based intervention to increase early adolescents' motor competence and health-related fitness. Scand J Med Sci Sports 2023; 33:2046-2057. [PMID: 37231614 PMCID: PMC10946856 DOI: 10.1111/sms.14410] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 04/28/2023] [Accepted: 05/16/2023] [Indexed: 05/27/2023]
Abstract
Schools are key settings for the promotion of students' physical activity, fitness, and motor competence. The purpose of our study was to investigate the efficacy of a 5-month-long intervention program that aimed to increase students' motor competence and health-related fitness during school days. We conducted a quasi-experimental study with 325 Finnish Grade 5 (Mage = 11.26, SD = 0.33) students from five schools. Two schools were allocated to the intervention group and three schools to the control group. The intervention consisted of three components: (a) weekly 20 min session during regular PE lessons, (b) weekly 20 min session during recess, and (c) daily 5-minute-long classroom activity breaks. All activities were designed to systematically develop different elements of motor competence and fitness. The following assessments were conducted at baseline and 5-months: cardiorespiratory fitness levels were measured by 20-meter shuttle run test, muscular fitness by curl-up and push-up tests, and motor competence by 5-leaps and throwing-catching combination tests. We analyzed the data using a multi-group latent change score modeling. Results showed that students in the intervention group developed significantly better in 20-meter shuttle run test (β = 0.269, p = 0.000, 95% CI [0.141, 0.397]; +5.0 laps), push-up (β = 0.442, p = 0.000, 95% CI [0.267, 0.617]; +6.5 repetitions), curl-up (β = 0.353, p = 0.001, 95% CI [0.154, 0.552]; +7.8 repetitions), and throwing-catching combination tests (β = 0.195, p = 0.019, 95% CI [0.033, 0.356]; +1.1 repetitions) than students in the control group. The intervention program appeared to be feasible and effective in increasing students' cardiorespiratory fitness, muscular fitness, and object control skills. This indicates that guided school-based physical activity programs can be influential in promoting physical fitness and motor competence among early adolescent students.
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Affiliation(s)
- Mikko Huhtiniemi
- Faculty of Sport and Health SciencesUniversity of JyväskyläJyväskyläFinland
| | - Arja Sääkslahti
- Faculty of Sport and Health SciencesUniversity of JyväskyläJyväskyläFinland
| | - Asko Tolvanen
- Faculty of Education and PsychologyUniversity of JyväskyläJyväskyläFinland
| | - David R. Lubans
- Faculty of Sport and Health SciencesUniversity of JyväskyläJyväskyläFinland
- Centre for Active Living and Learning, School of EducationThe University of NewcastleCallaghanNew South WalesAustralia
| | - Timo Jaakkola
- Faculty of Sport and Health SciencesUniversity of JyväskyläJyväskyläFinland
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12
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Wennerberg C, Hellström A, Schildmeijer K, Ekstedt M. Effects of Web-Based and Mobile Self-Care Support in Addition to Standard Care in Patients After Radical Prostatectomy: Randomized Controlled Trial. JMIR Cancer 2023; 9:e44320. [PMID: 37672332 PMCID: PMC10512115 DOI: 10.2196/44320] [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: 11/16/2022] [Revised: 06/09/2023] [Accepted: 07/21/2023] [Indexed: 09/07/2023] Open
Abstract
BACKGROUND Prostate cancer is a common form of cancer that is often treated with radical prostatectomy, which can leave patients with urinary incontinence and sexual dysfunction. Self-care (pelvic floor muscle exercises and physical activity) is recommended to reduce the side effects. As more and more men are living in the aftermath of treatment, effective rehabilitation support is warranted. Digital self-care support has the potential to improve patient outcomes, but it has rarely been evaluated longitudinally in randomized controlled trials. Therefore, we developed and evaluated the effects of digital self-care support (electronic Patient Activation in Treatment at Home [ePATH]) on prostate-specific symptoms. OBJECTIVE This study aimed to investigate the effects of web-based and mobile self-care support on urinary continence, sexual function, and self-care, compared with standard care, at 1, 3, 6, and 12 months after radical prostatectomy. METHODS A multicenter randomized controlled trial with 2 study arms was conducted, with the longitudinal effects of additional digital self-care support (ePATH) compared with those of standard care alone. ePATH was designed based on the self-determination theory to strengthen patients' activation in self-care through nurse-assisted individualized modules. Men planned for radical prostatectomy at 3 county hospitals in southern Sweden were included offline and randomly assigned to the intervention or control group. The effects of ePATH were evaluated for 1 year after surgery using self-assessed questionnaires. Linear mixed models and ordinal regression analyses were performed. RESULTS This study included 170 men (85 in each group) from January 2018 to December 2019. The participants in the intervention and control groups did not differ in their demographic characteristics. In the intervention group, 64% (53/83) of the participants used ePATH, but the use declined over time. The linear mixed model showed no substantial differences between the groups in urinary continence (β=-5.60; P=.09; 95% CI -12.15 to -0.96) or sexual function (β=-.12; P=.97; 95% CI -7.05 to -6.81). Participants in the intervention and control groups did not differ in physical activity (odds ratio 1.16, 95% CI 0.71-1.89; P=.57) or pelvic floor muscle exercises (odds ratio 1.51, 95% CI 0.86-2.66; P=.15). CONCLUSIONS ePATH did not affect postoperative side effects or self-care but reflected how this support may work in typical clinical conditions. To complement standard rehabilitation, digital self-care support must be adapted to the context and individual preferences for use and effect. TRIAL REGISTRATION ISRCTN Registry ISRCTN18055968; https://www.isrctn.com/ISRCTN18055968. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/11625.
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Affiliation(s)
- Camilla Wennerberg
- Department of Health and Caring Sciences, Linnaeus University, Kalmar, Sweden
- Department of Surgery, Region Kalmar County, Kalmar, Sweden
| | - Amanda Hellström
- Department of Health and Caring Sciences, Linnaeus University, Kalmar, Sweden
| | | | - Mirjam Ekstedt
- Department of Health and Caring Sciences, Linnaeus University, Kalmar, Sweden
- Department of Learning, Management, Informatics and Ethics, Karolinska Institutet, Stockholm, Sweden
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Palmer M, Beckley-Hoelscher N, Shearer J, Kostyrka-Allchorne K, Robertson O, Koch M, Pearson O, Slovak P, Day C, Byford S, Goldsmith K, Waite P, Creswell C, Sonuga-Barke EJS. The Effectiveness and Cost-Effectiveness of a Universal Digital Parenting Intervention Designed and Implemented During the COVID-19 Pandemic: Evidence From a Rapid-Implementation Randomized Controlled Trial Within a Cohort. J Med Internet Res 2023; 25:e44079. [PMID: 37498669 PMCID: PMC10415938 DOI: 10.2196/44079] [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: 11/07/2022] [Revised: 04/12/2023] [Accepted: 04/13/2023] [Indexed: 07/28/2023] Open
Abstract
BACKGROUND Children's conduct and emotional problems increased during the COVID-19 pandemic. OBJECTIVE We tested whether a smartphone parenting support app, Parent Positive, developed specifically for this purpose, reversed these effects in a cost-effective way. Parent Positive includes 3 zones. Parenting Boosters (zone 1) provided content adapted from standard face-to-face parent training programs to tackle 8 specific challenges identified by parents and parenting experts as particularly relevant for parents during the pandemic. The Parenting Exchange (zone 2) was a parent-to-parent and parent-to-expert communication forum. Parenting Resources (zone 3) provided access to existing high-quality web-based resources on a range of additional topics of value to parents (eg, neurodevelopmental problems, diet, and sleep). METHODS Supporting Parents And Kids Through Lockdown Experiences (SPARKLE), a randomized controlled trial, was embedded in the UK-wide COVID-19: Supporting Parents, Adolescents and Children during Epidemics (Co-SPACE) longitudinal study on families' mental health during the pandemic. Parents of children aged 4 to 10 years were randomized 1:1 to Parent Positive or follow-up as usual (FAU) between May 19, 2021, and July 26, 2021. Parent Positive provided advice on common parenting challenges and evidence-based web-based resources and facilitated parent-to-parent and expert-to-parent support. Child conduct and emotional problems and family well-being were measured before randomization (T1) and at 1 (T2) and 2 (T3) months after randomization. Service use, costs, and adverse events were measured, along with app use and satisfaction. The primary outcome was T2 parent-reported child conduct problems, which were analyzed using linear mixed regression models. RESULTS A total of 320 participants were randomized to Parent Positive, and 326 were randomized to FAU. The primary outcome analysis included 79.3% (512/646) of the participants (dropout: 84/320, 26% on Parent Positive and 50/326, 15% on FAU). There were no statistically significant intervention effects on conduct problems at either T2 (standardized effect=-0.01) or T3 (secondary outcome; standardized effect=-0.09) and no moderation by baseline conduct problems. Significant intervention-related reductions in emotional problems were observed at T2 and T3 (secondary outcomes; standardized effect=-0.13 in both cases). Parent Positive, relative to FAU, was associated with more parental worries at T3 (standardized effect=0.14). Few intervention-attributable adverse events were reported. Parent Positive was cost-effective once 4 outliers with extremely high health care costs were excluded. CONCLUSIONS Parent Positive reduced child emotional problems and was cost-effective compared with FAU once outliers were removed. Although small when considered against targeted therapeutic interventions, the size of these effects was in line with trials of nontargeted universal mental health interventions. This highlights the public health potential of Parent Positive if implemented at the community level. Nevertheless, caution is required before making such an interpretation, and the findings need to be replicated in large-scale, whole-community studies. TRIAL REGISTRATION ClinicalTrials.gov NCT04786080; https://clinicaltrials.gov/ct2/show/NCT04786080.
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Affiliation(s)
- Melanie Palmer
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | | | - James Shearer
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | | | | | - Marta Koch
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Oliver Pearson
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Petr Slovak
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Crispin Day
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Sarah Byford
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Kimberley Goldsmith
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Polly Waite
- University of Oxford, Oxford, United Kingdom
| | | | - Edmund J S Sonuga-Barke
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
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14
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Weaver RG, Armstrong B, Adams E, Beets MW, White J, Flory K, Wilson D, McLain A, Tennie B. Feasibility and preliminary efficacy of structured programming and a parent intervention to mitigate accelerated summer BMI gain: a pilot study. Pilot Feasibility Stud 2023; 9:83. [PMID: 37189190 PMCID: PMC10184061 DOI: 10.1186/s40814-023-01312-3] [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: 03/18/2022] [Accepted: 05/02/2023] [Indexed: 05/17/2023] Open
Abstract
BACKGROUND This study assessed the initial feasibility and preliminary efficacy of providing children a free summer day camp and a parent intervention to improve self-regulation and mitigate accelerated summer BMI gain. METHODS This pilot 2x2 factorial randomized control trial used a mixed-methods design to evaluate providing children a free summer day camp (SCV), a parent intervention (PI), and the combination of these two strategies (SCV+PI) to mitigate accelerated summer body mass index (BMI) gain. Progression criteria for feasibility and efficacy were assessed to determine if a full-scale trial was warranted. Feasibility criteria included recruitment capability (≥80 participants recruited) retention (≥70% participants retained), compliance (≥80% of participants attending the summer program with children attending ≥60% of program days, and ≥80% of participants completing goal setting calls with ≥60% of weeks syncing their child's Fitbit), and treatment fidelity (≥80% of summer program days delivered for ≥9 h/day, and ≥80% of participant texts delivered). Efficacy criteria were assessed via achieving a clinically meaningful impact on zBMI (i.e., ≥0.15). Changes in BMI were estimated using intent-to-treat and post hoc dose-response analyses via multilevel mixed-effects regressions. RESULTS For recruitment, capability and retention progression criteria were met with a total of 89 families participating and 24 participants randomized to the PI group, 21 randomized to the SCV group, 23 randomized to the SCV+PI group, and 21 randomized to the control. However, fidelity and compliance progression criteria were not achieved due to COVID-19 and lack of transportation. Progression criteria for efficacy was also not achieved as intent-to-treat analyses did not show changes in BMI gain that were clinically meaningful. Post hoc dose-response analyses showed that for each day (0 to 29) of summer programming children attended they gained -0.009 (95CI= -0.018, -0.001) less in BMI z score. CONCLUSIONS Engagement in both the SCV and PI was not ideal due to COVID-19 and lack of transportation. Providing children with structured summer programming to mitigate accelerated summer BMI gain may be an effective strategy. However, because feasibility and efficacy progression criteria were not met, a larger trial is not warranted until further pilot work is completed to ensure children attend the programming. TRIAL REGISTRATION The trial reported herein was prospectively registered at ClinicalTrials.gov. Trial #: NCT04608188.
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Affiliation(s)
- R G Weaver
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, 921 Assembly Street, room 130, Columbia, SC, 29205, USA.
| | - B Armstrong
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, 921 Assembly Street, room 130, Columbia, SC, 29205, USA
| | - E Adams
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, 921 Assembly Street, room 130, Columbia, SC, 29205, USA
| | - M W Beets
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, 921 Assembly Street, room 130, Columbia, SC, 29205, USA
| | - J White
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, 921 Assembly Street, room 130, Columbia, SC, 29205, USA
| | - K Flory
- Department of Psychology, University of South Carolina, Columbia, USA
| | - D Wilson
- Department of Psychology, University of South Carolina, Columbia, USA
| | - A McLain
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, USA
| | - B Tennie
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, USA
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15
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Funk J, Kopf-Beck J, Watkins E, Ehring T. Does an app designed to reduce repetitive negative thinking decrease depression and anxiety in young people? (RETHINK): a randomized controlled prevention trial. Trials 2023; 24:295. [PMID: 37098547 PMCID: PMC10129320 DOI: 10.1186/s13063-023-07295-z] [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: 03/15/2022] [Accepted: 04/05/2023] [Indexed: 04/27/2023] Open
Abstract
BACKGROUND The first onset of common mental health disorders, such as mood and anxiety disorders, mostly lies in adolescence or young adulthood. Hence, effective and scalable prevention programs for this age group are urgently needed. Interventions focusing on repetitive negative thinking (RNT) appear especially promising as RNT is an important transdiagnostic process involved in the development of depression and anxiety disorders. First clinical trials indeed show positive effects of preventative interventions targeting RNT on adult as well as adolescent mental health. Self-help interventions that can be delivered via a mobile phone app may have the advantage of being highly scalable, thus facilitating prevention on a large scale. This trial aims to investigate whether an app-based RNT-focused intervention can reduce depressive and anxiety symptoms in young people at risk for mental health disorders. METHODS The trial will be conducted in a sample (planned N = 351) of individuals aged 16-22 years with elevated levels of RNT but no current depression or anxiety disorder. In a randomized controlled between-subjects design, two versions of the app-based self-help intervention will be compared to a waiting list control condition. The full RNT-focused intervention encompasses a variety of RNT-reducing strategies, whereas the concreteness training intervention focuses on only one of these strategies, i.e., concrete thinking. The primary outcome (depressive symptoms) and secondary outcomes (anxiety symptoms and RNT) will be measured at pre-intervention, post-intervention (6 weeks after pre-intervention), and follow-up (18 weeks after pre-intervention). DISCUSSION This trial aims to find out whether targeting RNT via an app is an effective and feasible way of preventing depression and anxiety disorders in adolescents. Since app-based interventions are highly scalable, this trial might contribute to tackling challenges related to the increasing rates of mental health disorders among young people. TRIAL REGISTRATION https://www.drks.de , DRKS00027384. Registered on 21 February 2022-prospectively registered.
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Affiliation(s)
- Julia Funk
- Department of Psychology, LMU Munich, Munich, Germany.
| | | | - Edward Watkins
- Mood Disorders Centre, School of Psychology, University of Exeter, Exeter, UK
| | - Thomas Ehring
- Department of Psychology, LMU Munich, Munich, Germany
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16
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Henninger SH, Fibieger AY, Magkos F, Ritz C. Effects of Mindful Eating and YogaDance among Overweight and Obese Women: An Exploratory Randomized Controlled Trial. Nutrients 2023; 15:nu15071646. [PMID: 37049487 PMCID: PMC10096929 DOI: 10.3390/nu15071646] [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: 02/26/2023] [Revised: 03/22/2023] [Accepted: 03/27/2023] [Indexed: 03/31/2023] Open
Abstract
Many current treatment options for managing overweight and obesity consist of rather strict diet and exercise regimes that are difficult to implement as a lifelong routine. Therefore, alternative initiatives such as mindful eating and pleasure-oriented physical activity with more focus on implementation and enjoyment are needed to reverse the obesity epidemic. Mindful eating is an approach focusing on inner hunger and satiety signals. YogaDance is a novel exercise approach combining elements of yoga and dance. This study was a randomized controlled trial investigating the individual and combined effects of mindful eating and YogaDance. Participants were healthy, inactive women with overweight or obesity (body mass index ≥ 25 kg/m2 and/or waist circumference ≥ 80 cm) who were randomized to one of four groups for 8 weeks: mindful eating alone, YogaDance alone, the combination of mindful eating and YogaDance, or control. Fat mass was the primary outcome and secondary outcomes included body weight, waist circumference, and other physiological, behavioral, and quality-of-life outcomes. Sixty-one women were included in the study and randomized to mindful eating and YogaDance combined, YogaDance, mindful eating, or control. Fat mass was reduced by 1.3 kg (95% CI [−10.0, 7.3] kg; p = 0.77), 3.0 kg (95% CI [−11.1, 5.1] kg; p = 0.48), and 1.8 kg (95% CI [−10.1, 6.6] kg; p = 0.69) for the mindful eating, YogaDance, and combined mindful eating and YogaDance interventions, respectively, compared to the control, with corresponding effect sizes of 0.15, 0.34, and 0.21. In complete-case analyses, fat percent and waist circumference were reduced whereas mental quality of life and eating behavior were improved for mindful eating and mindful eating and YogaDance combined compared to the control. In conclusion, the study found modest benefits of an 8-week combination of mindful eating and YogaDance, corroborating findings in previous studies on mindful eating, yoga, and dance. However, the study had several limitations that should be taken into consideration, including low power due to a large drop-out as well as low to moderate training load and compliance. The trial was retrospectively registered (ISRCTN87234794).
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Affiliation(s)
- Sofie Hauerberg Henninger
- Department of Nutrition, Exercise and Sports, University of Copenhagen, DK-1958 Frederiksberg, Denmark
| | - Anna Yde Fibieger
- Department of Nutrition, Exercise and Sports, University of Copenhagen, DK-1958 Frederiksberg, Denmark
| | - Faidon Magkos
- Department of Nutrition, Exercise and Sports, University of Copenhagen, DK-1958 Frederiksberg, Denmark
| | - Christian Ritz
- Department of National Institute of Public Health, University of Southern Denmark, DK-1455 Copenhagen, Denmark
- Correspondence: ; Tel.: +45-6550-9696
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17
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Salmon J, Arundell L, Cerin E, Ridgers ND, Hesketh KD, Daly RM, Dunstan D, Brown H, Della Gatta J, Della Gatta P, Chinapaw MJM, Shepphard L, Moodie M, Hume C, Brown V, Ball K, Crawford D. Transform-Us! cluster RCT: 18-month and 30-month effects on children's physical activity, sedentary time and cardiometabolic risk markers. Br J Sports Med 2023; 57:311-319. [PMID: 36428089 PMCID: PMC9985722 DOI: 10.1136/bjsports-2022-105825] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To test the efficacy of the Transform-Us! school- and home-based intervention on children's physical activity (PA), sedentary behaviour (SB) and cardiometabolic risk factor profiles. METHODS A 30-month 2×2 factorial design cluster randomised controlled trial delivered in 20 primary schools (148 Year 3 classes) in Melbourne, Australia (2010-2012), that used pedagogical and environmental strategies to reduce and break up SB, promote PA or a combined approach, compared with usual practice. Primary outcomes (accelerometry data; n=348) were assessed at baseline, 18 and 30 months. Secondary outcomes included body mass index (BMI) and waist circumference (WC) (n=564), blood pressure (BP) (n=537) and biomarkers (minimum n=206). Generalised linear mixed models estimated the interactive effects of the PA and SB interventions on the outcomes. If there was no interaction, the main effects were assessed. RESULTS At 18 months, there were intervention effects on children's weekday SB (-27 min, 95% CI: -47.3 to -5.3) for the PA intervention, and on children's average day PA (5.5 min, 95% CI: 0.1 to 10.8) for the SB intervention. At 30 months, there was an intervention effect for children's average day SB (-33.3 min, 95% CI: -50.6 and -16.0) for the SB intervention. Children's BMI (PA and SB groups) and systolic BP (combined group) were lower, and diastolic BP (PA group) was higher. There were positive effects on WC at both time points (SB intervention) and mixed effects on blood parameters. CONCLUSIONS The Transform-Us! PA and SB interventions show promise as a pragmatic approach for reducing children's SB and adiposity indicators; but achieving substantial increases in PA remains challenging. TRIAL REGISTRATION ISRCTN83725066; ACTRN12609000715279.
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Affiliation(s)
- Jo Salmon
- School of Exercise and Nutrition Sciences, Deakin University Institute for Physical Activity and Nutrition, Geelong, Victoria, Australia
| | - Lauren Arundell
- School of Exercise and Nutrition Sciences, Deakin University Institute for Physical Activity and Nutrition, Geelong, Victoria, Australia
| | - Ester Cerin
- Institute for Health and Ageing, Australian Catholic University Faculty of Health Sciences, Melbourne, Victoria, Australia
| | - Nicola Dawn Ridgers
- Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia
| | - Kylie D Hesketh
- School of Exercise and Nutrition Sciences, Deakin University Institute for Physical Activity and Nutrition, Geelong, Victoria, Australia
| | - Robin M Daly
- School of Exercise and Nutrition Sciences, Deakin University Institute for Physical Activity and Nutrition, Geelong, Victoria, Australia
| | - David Dunstan
- School of Exercise and Nutrition Sciences, Deakin University Institute for Physical Activity and Nutrition, Geelong, Victoria, Australia
- Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Helen Brown
- School of Exercise and Nutrition Sciences, Deakin University Centre for Sport Research, Geelong, Victoria, Australia
| | - Jacqui Della Gatta
- School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
| | - Paul Della Gatta
- School of Exercise and Nutrition Sciences, Deakin University Institute for Physical Activity and Nutrition, Geelong, Victoria, Australia
| | - Mai J M Chinapaw
- Department of Public and Occupational Health, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Lauren Shepphard
- Institute for Health Transformation, Deakin University Faculty of Health, Burwood, Victoria, Australia
| | - Marj Moodie
- Deakin Health Economics, Deakin University, Geelong, Victoria, Australia
| | - Clare Hume
- School of Public Health, The University of Adelaide, Adelaide, South Australia, Australia
| | - Vicki Brown
- Deakin Health Economics, Deakin University, Geelong, Victoria, Australia
| | - Kylie Ball
- School of Exercise and Nutrition Sciences, Deakin University Institute for Physical Activity and Nutrition, Geelong, Victoria, Australia
| | - David Crawford
- School of Exercise and Nutrition Sciences, Deakin University Institute for Physical Activity and Nutrition, Geelong, Victoria, Australia
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18
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Eysenbach G, Schuurmans J, Aouizerate B, Atipei Craggs M, Batterham P, Bührmann L, Calear A, Cerga Pashoja A, Christensen H, Dozeman E, Duedal Pedersen C, Ebert DD, Etzelmueller A, Fanaj N, Finch TL, Hanssen D, Hegerl U, Hoogendoorn A, Mathiasen K, May C, Meksi A, Mustafa S, O'Dea B, Oehler C, Piera-Jiménez J, Potthoff S, Qirjako G, Rapley T, Rosmalen J, Sacco Y, Samalin L, Skjoth MM, Tarp K, Titzler I, Van der Eycken E, van Genugten CR, Whitton A, Zanalda E, Smit JH, Riper H. Effectiveness of Self-guided Tailored Implementation Strategies in Integrating and Embedding Internet-Based Cognitive Behavioral Therapy in Routine Mental Health Care: Results of a Multicenter Stepped-Wedge Cluster Randomized Trial. J Med Internet Res 2023; 25:e41532. [PMID: 36735287 PMCID: PMC9938445 DOI: 10.2196/41532] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 11/18/2022] [Accepted: 11/30/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Internet-based cognitive behavioral therapy (iCBT) services for common mental health disorders have been found to be effective. There is a need for strategies that improve implementation in routine practice. One-size-fits-all strategies are likely to be ineffective. Tailored implementation is considered as a promising approach. The self-guided integrated theory-based Framework for intervention tailoring strategies toolkit (ItFits-toolkit) supports local implementers in developing tailored implementation strategies. Tailoring involves identifying local barriers; matching selected barriers to implementation strategies; developing an actionable work plan; and applying, monitoring, and adapting where necessary. OBJECTIVE This study aimed to compare the effectiveness of the ItFits-toolkit with implementation-as-usual (IAU) in implementing iCBT services in 12 routine mental health care organizations in 9 countries in Europe and Australia. METHODS A stepped-wedge cluster randomized trial design with repeated measures was applied. The trial period lasted 30 months. The primary outcome was the normalization of iCBT delivery by service providers (therapists, referrers, IT developers, and administrators), which was measured with the Normalization Measure Development as a proxy for implementation success. A 3-level linear mixed-effects modeling was applied to estimate the effects. iCBT service uptake (referral and treatment completion rates) and implementation effort (hours) were used as secondary outcomes. The perceived satisfaction (Client Satisfaction Questionnaire), usability (System Usability Scale), and impact of the ItFits-toolkit by implementers were used to assess the acceptability of the ItFits-toolkit. RESULTS In total, 456 mental health service providers were included in this study. Compared with IAU, the ItFits-toolkit had a small positive statistically significant effect on normalization levels in service providers (mean 0.09, SD 0.04; P=.02; Cohen d=0.12). The uptake of iCBT by patients was similar to that of IAU. Implementers did not spend more time on implementation work when using the ItFits-toolkit and generally regarded the ItFits-toolkit as usable and were satisfied with it. CONCLUSIONS The ItFits-toolkit performed better than the usual implementation activities in implementing iCBT services in routine practice. There is practical utility in the ItFits-toolkit for supporting implementers in developing and applying effective tailored implementation strategies. However, the effect on normalization levels among mental health service providers was small. These findings warrant modesty regarding the effectiveness of self-guided tailored implementation of iCBT services in routine practice. TRIAL REGISTRATION ClinicalTrials.gov NCT03652883; https://clinicaltrials.gov/ct2/show/NCT03652883. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1186/s13063-020-04686-4.
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Affiliation(s)
| | | | - Bruno Aouizerate
- Regional Reference Center for the Management and Treatment of Anxiety and Depressive Disorders, FondaMental Advanced Centre of Expertise in Resistant Depression, Deparment of General and Academic Psychiatry, Charles Perrens Hospital, Bordeaux, France
| | - Mette Atipei Craggs
- Research Unit for Digital Psychiatry, Deptartment of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Philip Batterham
- Centre for Mental Health Research, The Australian National University, Canberra, Australia
| | - Leah Bührmann
- Department of Social Work, Education and Community Wellbeing, Northumbria University, Newcastle Upon Tyne, United Kingdom
| | - Alison Calear
- Centre for Mental Health Research, The Australian National University, Canberra, Australia
| | | | - Helen Christensen
- Department of Medicine, University of New South Wales, Sydney, Australia
| | | | | | - David Daniel Ebert
- Professorship Psychology & Digital Mental Health, Technical University of Munich, Munich, Germany.,HelloBetter, GET.ON Institut für Online Gesundheitstrainings GmbH, Berlin, Germany
| | - Anne Etzelmueller
- Professorship Psychology & Digital Mental Health, Technical University of Munich, Munich, Germany.,HelloBetter, GET.ON Institut für Online Gesundheitstrainings GmbH, Berlin, Germany
| | - Naim Fanaj
- Mental Health Center Prizren, Prizren, Kosovo
| | - Tracy L Finch
- Department of Nursing, Midwifery and Health, Northumbria University, Newcastle Upon Tyne, United Kingdom
| | - Denise Hanssen
- Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Ulrich Hegerl
- German Depression Foundation, Leipzig, Germany.,Department of Psychiatry, Psychosomatics, and Psychotherapy, Goethe Universität, Frankfurt am Main, Germany
| | - Adriaan Hoogendoorn
- Amsterdam Public Health research institute, Amsterdam, Netherlands.,GGZ InGeest, Amsterdam, Netherlands.,Psychiatry, Amsterdam University Medical Center - location VUmc, Amsterdam, Netherlands
| | - Kim Mathiasen
- Research Unit for Digital Psychiatry, Deptartment of Clinical Research, University of Southern Denmark, Odense, Denmark.,Centre for Digital Psychiatry, Mental Health Services of Southern Denmark, Odense, Denmark
| | - Carl May
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | | | - Bridianne O'Dea
- Black Dog Institute, University of New South Wales, Sydney, Australia
| | | | - Jordi Piera-Jiménez
- Catalan Health Service, Barcelona, Spain.,Digitalization for the Sustainability of the Healthcare System DS3-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain.,Faculty of Informatics, Multimedia and Telecommunications, Universitat Oberta de Catalunya, Barcelona, Spain
| | - Sebastian Potthoff
- Department of Social Work, Education and Community Wellbeing, Northumbria University, Newcastle Upon Tyne, United Kingdom
| | - Gentiana Qirjako
- Department of Public Health, Faculty of Medicine, University of Medicine, Tirana, Albania
| | - Tim Rapley
- Department of Social Work, Education and Community Wellbeing, Northumbria University, Newcastle Upon Tyne, United Kingdom
| | - Judith Rosmalen
- Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, Netherlands.,Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Ylenia Sacco
- Department of Mental Health, Local Health Authority Torino 3, ASLTO3, Torino, Italy
| | - Ludovic Samalin
- Department of psychiatry, Centre Hospitalier Universitaire de Clermont-Ferrand, Expert center for bipolar disorder (Foundation FondaMental), University of Clermont Auvergne, Clermont-Ferrand, France.,Centre national de la recherche scientifique, Clermont-Auvergne INP, Institut Pascal (UMR 6602), Clermont-Ferrand, France
| | - Mette Maria Skjoth
- Department of Dermatology and Allergy Centre, Odense University Hospital, Odense, Denmark
| | - Kristine Tarp
- Research Unit for Digital Psychiatry, Deptartment of Clinical Research, University of Southern Denmark, Odense, Denmark.,Centre for Digital Psychiatry, Mental Health Services of Southern Denmark, Odense, Denmark
| | - Ingrid Titzler
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | | | - Claire Rosalie van Genugten
- Clinical, Neuro-, & Developmental Psychology, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Amsterdam Public Health research institute, Amsterdam, Netherlands
| | - Alexis Whitton
- Black Dog Institute, University of New South Wales, Sydney, Australia
| | - Enrico Zanalda
- Department of Mental Health, Local Health Authority Torino 3, ASLTO3, Torino, Italy
| | - Jan H Smit
- Amsterdam Public Health research institute, Amsterdam, Netherlands.,Psychiatry, Amsterdam University Medical Center - location VUmc, Amsterdam, Netherlands
| | - Heleen Riper
- Clinical, Neuro-, & Developmental Psychology, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Amsterdam Public Health research institute, Amsterdam, Netherlands.,Psychiatry, Amsterdam University Medical Center - location VUmc, Amsterdam, Netherlands
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19
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Effectiveness of an intensive care telehealth programme to improve process quality (ERIC): a multicentre stepped wedge cluster randomised controlled trial. Intensive Care Med 2023; 49:191-204. [PMID: 36645446 PMCID: PMC9841931 DOI: 10.1007/s00134-022-06949-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 12/01/2022] [Indexed: 01/17/2023]
Abstract
PURPOSE Supporting the provision of intensive care medicine through telehealth potentially improves process quality. This may improve patient recovery and long-term outcomes. We investigated the effectiveness of a multifaceted telemedical programme on the adherence to German quality indicators (QIs) in a regional network of intensive care units (ICUs) in Germany. METHODS We conducted an investigator-initiated, large-scale, open-label, stepped-wedge cluster randomised controlled trial enrolling adult ICU patients with an expected ICU stay of ≥ 24 h. Twelve ICU clusters in Berlin and Brandenburg were randomly assigned to three sequence groups to transition from control (standard care) to the intervention condition (telemedicine). The quality improvement intervention consisted of daily telemedical rounds guided by eight German acute ICU care QIs and expert consultations. Co-primary effectiveness outcomes were patient-specific daily adherence (fulfilled yes/no) to QIs, assessed by a central end point adjudication committee. Analyses used mixed-effects logistic modelling adjusted for time. This study is completed and registered with ClinicalTrials.gov (NCT03671447). RESULTS Between September 4, 2018, and March 31, 2020, 1463 patients (414 treated on control, 1049 on intervention condition) were enrolled at ten clusters, resulting in 14,783 evaluated days. Two randomised clusters recruited no patients (one withdrew informed consent; one dropped out). The intervention, as implemented, significantly increased QI performance for "sedation, analgesia and delirium" (adjusted odds ratio (99.375% confidence interval [CI]) 5.328, 3.395-8.358), "ventilation" (OR 2.248, 1.198-4.217), "weaning from ventilation" (OR 9.049, 2.707-30.247), "infection management" (OR 4.397, 1.482-13.037), "enteral nutrition" (OR 1.579, 1.032-2.416), "patient and family communication" (OR 6.787, 3.976-11.589), and "early mobilisation" (OR 3.161, 2.160-4.624). No evidence for a difference in adherence to "daily multi-professional and interdisciplinary clinical visits" between both conditions was found (OR 1.606, 0.780-3.309). Temporal trends related and unrelated to the intervention were detected. 149 patients died during their index ICU stay (45 treated on control, 104 on intervention condition). CONCLUSION A telemedical quality improvement program increased adherence to seven evidence-based German performance indicators in acute ICU care. These results need further confirmation in a broader setting of regional, non-academic community hospitals and other healthcare systems.
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20
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Aarsland D, Khalifa K, Bergland AK, Soennesyn H, Oppedal K, Holteng LBA, Oesterhus R, Nakling A, Jarholm JA, de Lucia C, Fladby T, Brooker H, Dalen I, Ballard C. A Randomised Placebo-Controlled Study of Purified Anthocyanins on Cognition in Individuals at Increased Risk for Dementia. Am J Geriatr Psychiatry 2023; 31:141-151. [PMID: 36372613 DOI: 10.1016/j.jagp.2022.10.002] [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: 08/15/2022] [Revised: 10/07/2022] [Accepted: 10/13/2022] [Indexed: 11/06/2022]
Abstract
IMPORTANCE Identifying nutritional compounds which can reduce cognitive decline in older people is a hugely important topic. OBJECTIVE To study the safety and effect of anthocyanins in maintaining cognitive functioning in people at increased risk for dementia. DESIGN, SETTING, AND PARTICIPANTS Participants (206 individuals, aged 60-80 years) diagnosed with either mild cognitive impairment (MCI) or two or more cardiometabolic disorders (i.e., diabetes, hypertension, obesity) were enrolled at three different centres in Norway. INTERVENTION Participants were randomly assigned to four capsules with a total of 320 mg/d of naturally purified anthocyanins or placebo 1:1 for 24 weeks. MAIN OUTCOMES AND MEASURES The primary outcome was the Quality of Episodic Memory composite measure (0-100) from an online cognitive test battery CogTrack, which was administered at baseline and monthly for the next 24 weeks. Secondary outcomes included other cognitive scores from the CogTrack battery. We applied mixed effects models with a baseline test score, group, time and their interaction as fixed effects, as well as other predefined baseline covariates. The primary comparison was the group difference at week 24 based on a modified intention-to-treat principle. RESULTS The primary analysis did not show a significant group difference at 24 weeks (78.2 versus 76.8; adjusted mean difference 1.4 (95% confidence interval -0.9-3.7); effect size 0.15; p = 0.23). However, there was a significant difference in slopes during weeks 8-24 (p = 0.007); the anthocyanin group improved while the placebo group worsened. No differences were found for the secondary cognitive outcomes. Anthocyanin capsules were well-tolerated and safe to use. CONCLUSION Anthocyanin supplementation for 24 weeks was safe and well tolerated in people with MCI or cardiometabolic disorders. We found no significant group difference in episodic memory at the end of the study but statistically significant differences in slopes. Further studies are warranted to explore whether anthocyanins supplementation can reduce cognitive decline in people at increased risk of dementia. TRIAL REGISTRATION ClinicalTrials.gov, (Identifier NCT03419039). http://www. CLINICALTRIALS gov/, NCT03419039.
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Affiliation(s)
- Dag Aarsland
- Centre for Age-Related Medicine (DA, KK, AKB, HS, LBAH, RO, AN, CDL), Stavanger University Hospital, Stavanger, Norway; Department of Old Age Psychiatry (DA), King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Khadija Khalifa
- Centre for Age-Related Medicine (DA, KK, AKB, HS, LBAH, RO, AN, CDL), Stavanger University Hospital, Stavanger, Norway; Department of Old Age Psychiatry (DA), King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK; The Faculty of Health Sciences (KK), University of Stavanger, Stavanger, Norway.
| | - Anne K Bergland
- Centre for Age-Related Medicine (DA, KK, AKB, HS, LBAH, RO, AN, CDL), Stavanger University Hospital, Stavanger, Norway
| | - Hogne Soennesyn
- Centre for Age-Related Medicine (DA, KK, AKB, HS, LBAH, RO, AN, CDL), Stavanger University Hospital, Stavanger, Norway
| | - Ketil Oppedal
- Department of Electrical Engineering and Computer Science (KO), University of Stavanger, Stavanger, Norway
| | - Lise B A Holteng
- Centre for Age-Related Medicine (DA, KK, AKB, HS, LBAH, RO, AN, CDL), Stavanger University Hospital, Stavanger, Norway; Department of Clinical Medicine (LBAH, AN), University of Bergen, Bergen, Norway
| | - Ragnhild Oesterhus
- Centre for Age-Related Medicine (DA, KK, AKB, HS, LBAH, RO, AN, CDL), Stavanger University Hospital, Stavanger, Norway; The Hospital Pharmacy Enterprise of Western Norway (RO), Bergen, Norway
| | - Arne Nakling
- Centre for Age-Related Medicine (DA, KK, AKB, HS, LBAH, RO, AN, CDL), Stavanger University Hospital, Stavanger, Norway; Department of Clinical Medicine (LBAH, AN), University of Bergen, Bergen, Norway
| | - Jonas A Jarholm
- Department of Neurology (AJ, TF), Akershus University Hospital, Lørenskog, Norway
| | - Chiara de Lucia
- Centre for Age-Related Medicine (DA, KK, AKB, HS, LBAH, RO, AN, CDL), Stavanger University Hospital, Stavanger, Norway; Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology & Neuroscience (CDL), King's College London, London, UK
| | - Tormod Fladby
- Department of Neurology (AJ, TF), Akershus University Hospital, Lørenskog, Norway; Institute of Clinical Medicine (HB, TF), University of Oslo, Oslo, Norway
| | - Helen Brooker
- Medical School (HB), University of Exeter, Exeter, UK; Ecog Pro Ltd. (HB, CB), Bristol, UK
| | - Ingvild Dalen
- Section of Biostatistics, Department of Research (ID), Stavanger University Hospital, Stavanger, Norway
| | - Clive Ballard
- Medical School (HB), University of Exeter, Exeter, UK
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21
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Gathier AW, Verhoeven JE, van Oppen PC, Penninx BWJH, Merkx MJM, Dingemanse P, Stehouwer KMKS, van den Bulck CMM, Vinkers CH. Design and rationale of the REStoring mood after early life trauma with psychotherapy (RESET-psychotherapy) study: a multicenter randomized controlled trial on the efficacy of adjunctive trauma-focused therapy (TFT) versus treatment as usual (TAU) for adult patients with major depressive disorder (MDD) and childhood trauma. BMC Psychiatry 2023; 23:41. [PMID: 36650502 PMCID: PMC9843991 DOI: 10.1186/s12888-023-04518-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 01/02/2023] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Major depressive disorder (MDD) is a common, recurrent mental disorder and a leading cause of disability worldwide. A large part of adult MDD patients report a history of childhood trauma (CT). Patients with MDD and CT are assumed to represent a clinically and neurobiologically distinct MDD subtype with an earlier onset, unfavorable disease course, stress systems' dysregulations and brain alterations. Currently, there is no evidence-based treatment strategy for MDD that specifically targets CT. Given the central role of trauma in MDD patients with CT, trauma-focused therapy (TFT), adjunctive to treatment as usual (TAU), may be efficacious to alleviate depressive symptoms in this patient population. METHODS The RESET-psychotherapy study is a 12-week, single-blind, randomized controlled trial testing the efficacy of TFT in 158 adults with moderate to severe MDD, as a 'stand-alone' depression diagnosis or superimposed on a persistent depressive disorder (PDD), and CT. TFT (6-10 sessions of Eye Movement Desensitization and Reprocessing and/or imagery rescripting) + TAU is compared to TAU only. Assessments, including a wide range of psychological/psychiatric and biological characteristics, take place before randomization (T0), during treatment (T1), at post-treatment (T2) and at 6-month follow-up (T3). Pre-post treatment stress-related biomarkers in hair (cortisol) and blood (epigenetics and inflammation) will be assessed to better understand working mechanisms of TFT. A subgroup of 60 participants will undergo structural and functional Magnetic Resonance Imaging (MRI) assessments to determine pre-post treatment brain activity. The primary outcome is self-reported depression symptom severity at post-treatment, measured with the 30-item Inventory of Depressive Symptomatology - Self Report (IDS-SR). DISCUSSION If adjunctive TFT efficaciously alleviates depressive symptoms in MDD patients with CT, this novel treatment strategy could pave the way for a more personalized and targeted MDD treatment. TRIAL REGISTRATION ClinicalTrials.gov, registered at 08-12-2021, number of identification: NCT05149352.
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Affiliation(s)
- Anouk W. Gathier
- grid.509540.d0000 0004 6880 3010Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Psychiatry, Boelelaan 1117, Amsterdam, The Netherlands ,Amsterdam Public Health, Mental Health Program, Amsterdam, The Netherlands
| | - Josine E. Verhoeven
- grid.509540.d0000 0004 6880 3010Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Psychiatry, Boelelaan 1117, Amsterdam, The Netherlands ,Amsterdam Public Health, Mental Health Program, Amsterdam, The Netherlands ,grid.420193.d0000 0004 0546 0540GGZ inGeest Mental Health Care, Amsterdam, The Netherlands
| | - Patricia C. van Oppen
- grid.509540.d0000 0004 6880 3010Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Psychiatry, Boelelaan 1117, Amsterdam, The Netherlands ,Amsterdam Public Health, Mental Health Program, Amsterdam, The Netherlands ,grid.420193.d0000 0004 0546 0540GGZ inGeest Mental Health Care, Amsterdam, The Netherlands
| | - Brenda W. J. H. Penninx
- grid.509540.d0000 0004 6880 3010Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Psychiatry, Boelelaan 1117, Amsterdam, The Netherlands ,Amsterdam Public Health, Mental Health Program, Amsterdam, The Netherlands ,grid.484519.5Amsterdam Neuroscience, Mood, Anxiety, Psychosis, Sleep & Stress Program, Amsterdam, The Netherlands
| | | | - Pieter Dingemanse
- grid.413664.2Altrecht GGZ, Nieuwe Houtenseweg 12, Utrecht, The Netherlands
| | | | | | - Christiaan H. Vinkers
- grid.509540.d0000 0004 6880 3010Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Psychiatry, Boelelaan 1117, Amsterdam, The Netherlands ,Amsterdam Public Health, Mental Health Program, Amsterdam, The Netherlands ,grid.420193.d0000 0004 0546 0540GGZ inGeest Mental Health Care, Amsterdam, The Netherlands ,grid.484519.5Amsterdam Neuroscience, Mood, Anxiety, Psychosis, Sleep & Stress Program, Amsterdam, The Netherlands
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22
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Kostyrka-Allchorne K, Ballard C, Byford S, Cortese S, Daley D, Downs J, French B, Glazebrook C, Goldsmith K, Hall CL, Hedstrom E, Kovshoff H, Kreppner J, Lean N, Sayal K, Shearer J, Simonoff E, Thompson M, Sonuga-Barke EJS. Online Parent Training for The Initial Management of ADHD referrals (OPTIMA): the protocol for a randomised controlled trial of a digital parenting intervention implemented to support parents and children on a treatment waitlist. Trials 2022; 23:1003. [PMID: 36510236 PMCID: PMC9744042 DOI: 10.1186/s13063-022-06952-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 11/22/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Children referred for attention-deficit/hyperactivity disorder (ADHD) often present with a broader pattern of conduct problems including oppositionality and defiance. This combination can be extremely stressful to parents, lower parents' self-esteem and negatively impact family life. The National Institute for Health and Care Excellence (NICE) recommends that families receive support as soon as possible after their referral. However, as clinical services are overstretched, and traditional in-person parenting intervention programmes are expensive, families often must wait times a long time prior to receiving this vital input. To address this, we have created a digital parenting programme called STEPS. It is delivered as a mobile phone app providing a set of tools and resources that can be easily accessed at parents' convenience. This study aims to evaluate the clinical and cost-effectiveness of STEPS in supporting parents of children with high levels of hyperactivity/impulsivity, inattention and conduct problems, who are waiting to be assessed by specialist children's clinical services. METHODS Online Parent Training for The Initial Management of ADHD referrals (OPTIMA) is a two-arm superiority parallel randomised controlled trial with an internal pilot study. We aim to recruit 352 parents and their children, who have been accepted onto a waitlist in Child and Adolescent Mental Health Services or similar child health services. Parents who consent will be randomised 1:1 to either the STEPS or wait-as-usual (WAU) group. The trial will be conducted remotely (online and telephone) with measures taken at baseline and 3, 6, 9 and 12 months post-randomisation. The primary objective is to evaluate whether STEPS reduces the severity of children's oppositional and defiant behaviour, as rated by parents, measured at 3 months post-randomisation compared to WAU. DISCUSSION Digital solutions, such as mobile phone apps, have potential for delivering psychological support for parents of children with clinical-level needs in a timely and inexpensive manner. This trial will provide data on the clinical and cost-effectiveness of the STEPS app, which could support the implementation of this scalable parenting intervention programme into standard clinical care and, ultimately, improve the outcomes for families of children referred to specialist child and adolescent health services. TRIAL REGISTRATION ISRCTN 16523503. Prospectively registered on 18 November 2021. https://www.isrctn.com/ISRCTN16523503.
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Affiliation(s)
- Katarzyna Kostyrka-Allchorne
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK
| | - Claire Ballard
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK
| | - Sarah Byford
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Samuele Cortese
- Centre for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
- Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, Southampton, UK
- Solent NHS Trust, Southampton, UK
- Hassenfeld Children's Hospital at NYU Langone, New York University Child Study Center, New York City, NY, USA
| | - David Daley
- NTU Psychology, School of Social Science, Nottingham Trent University, Nottingham, UK
| | - Johnny Downs
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK
| | - Blandine French
- Academic Unit of Mental Health & Clinical Neurosciences, Faculty of Medicine & Health Sciences, University of Nottingham, Nottingham, UK
- Centre for ADHD and Neurodevelopmental Disorders Across the Lifespan CANDAL Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Cristine Glazebrook
- Academic Unit of Mental Health & Clinical Neurosciences, Faculty of Medicine & Health Sciences, University of Nottingham, Nottingham, UK
- Centre for ADHD and Neurodevelopmental Disorders Across the Lifespan CANDAL Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Kimberley Goldsmith
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Charlotte L Hall
- Academic Unit of Mental Health & Clinical Neurosciences, Faculty of Medicine & Health Sciences, University of Nottingham, Nottingham, UK
- Centre for ADHD and Neurodevelopmental Disorders Across the Lifespan CANDAL Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Ellen Hedstrom
- Centre for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - Hanna Kovshoff
- Centre for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - Jana Kreppner
- Centre for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - Nancy Lean
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK
| | - Kapil Sayal
- Academic Unit of Mental Health & Clinical Neurosciences, Faculty of Medicine & Health Sciences, University of Nottingham, Nottingham, UK
- Centre for ADHD and Neurodevelopmental Disorders Across the Lifespan CANDAL Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - James Shearer
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Emily Simonoff
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK
| | - Margaret Thompson
- Centre for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
- Solent NHS Trust, Southampton, UK
| | - Edmund J S Sonuga-Barke
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK.
- Department of Child & Adolescent Psychiatry, Aarhus University, Aarhus, Denmark.
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23
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van der Asdonk S, Kesarlal AR, Schuengel C, Draaisma N, de Roos C, Zuidgeest K, Rippe RCA, Alink LRA. Testing an attachment- and trauma-informed intervention approach for parents and young children after interparental violence: protocol for a randomized controlled trial. Trials 2022; 23:973. [PMID: 36471412 PMCID: PMC9720940 DOI: 10.1186/s13063-022-06902-9] [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: 10/05/2022] [Accepted: 11/09/2022] [Indexed: 12/07/2022] Open
Abstract
BACKGROUND Interparental violence has persistent adverse effects on victimized parents and children. Young children, including infants and toddlers, are at particular risk to develop long-lasting negative outcomes, and yet specific evidence on effective intervention approaches for this vulnerable group is still lacking. This study will test the effectiveness of an attachment- and trauma-informed intervention approach in a sample of parent-child dyads who have experienced severe interparental violence. We test the individual and combined effects of two interventions: (1) "Nederlandse Interventie Kortdurend op Atypisch oudergedrag" (NIKA; Dutch, short-term intervention focused on atypical parenting behavior) aimed at improving the attachment relationship and (2) eye movement desensitization and reprocessing (EMDR) therapy aimed at reducing parental post-traumatic stress disorder (PTSD) symptoms. METHODS This study uses a multicenter randomized controlled design across multiple domestic violence shelters in the Netherlands. We aim to recruit 150 parent-child dyads with children aged between 0.5 and 6 years old. The study design consists of two phases. During the first phase for testing the effect of NIKA only, eligible dyads are randomly allocated to either NIKA or a waitlist usual care group. A pre-test is conducted prior to the treatment period and a post-test takes place directly afterwards (6 weeks after the pre-test). Phase 2 follows directly for testing the effects of EMDR and the combination of NIKA and EMDR. Parents who report clinical PTSD symptoms are randomly allocated to either EMDR therapy or a waitlist usual care group. Parents who do not report clinical PTSD symptoms only receive care as usual. Six weeks later, a post-test of phase 2 is conducted for all participating dyads. Primary study outcomes are disrupted parenting behavior, sensitive parenting behavior, and parental PTSD symptoms. Secondary study outcomes include PTSD symptoms and behavioral and emotional problems of the child. DISCUSSION This study will inform and enhance the clinical field by providing new insights regarding effective treatment combinations for traumatized parents and their young children after interparental violence. TRIAL REGISTRATION Netherlands Trial Register (NTR) NL9179 . Registered 7 January 2021.
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Affiliation(s)
- Sabine van der Asdonk
- grid.5132.50000 0001 2312 1970Institute of Education and Child Studies, Faculty of Social and Behavioural Sciences, Leiden University, Leiden, the Netherlands
| | - Ashwina R. Kesarlal
- grid.5132.50000 0001 2312 1970Institute of Education and Child Studies, Faculty of Social and Behavioural Sciences, Leiden University, Leiden, the Netherlands
| | - Carlo Schuengel
- grid.12380.380000 0004 1754 9227Clinical Child & Family Studies, Faculty of Behavioral and Movement Sciences, Vrije Universiteit, Amsterdam, the Netherlands
| | - Nina Draaisma
- grid.5132.50000 0001 2312 1970Institute of Education and Child Studies, Faculty of Social and Behavioural Sciences, Leiden University, Leiden, the Netherlands ,NIKA Nederland, Haarlem, the Netherlands
| | - Carlijn de Roos
- grid.509540.d0000 0004 6880 3010Department of Child and Adolescent Psychiatry, Amsterdam University Medical Centre, Amsterdam, the Netherlands
| | | | - Ralph C. A. Rippe
- grid.5132.50000 0001 2312 1970Institute of Education and Child Studies, Faculty of Social and Behavioural Sciences, Leiden University, Leiden, the Netherlands
| | - Lenneke R. A. Alink
- grid.5132.50000 0001 2312 1970Institute of Education and Child Studies, Faculty of Social and Behavioural Sciences, Leiden University, Leiden, the Netherlands
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24
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Lubans DR, Sanders T, Noetel M, Parker P, McKay H, Morgan PJ, Salmon J, Kirwan M, Bennie A, Peralta L, Cinelli R, Moodie M, Hartwig T, Boyer J, Kennedy SG, Plotnikoff RC, Hansen V, Vasconcellos D, Lee J, Antczak D, Lonsdale C. Scale-up of the Internet-based Professional Learning to help teachers promote Activity in Youth (iPLAY) intervention: a hybrid type 3 implementation-effectiveness trial. Int J Behav Nutr Phys Act 2022; 19:141. [PMID: 36451168 PMCID: PMC9713961 DOI: 10.1186/s12966-022-01371-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 10/06/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Whole-of-school programs have demonstrated success in improving student physical activity levels, but few have progressed beyond efficacy testing to implementation at-scale. The purpose of our study was to evaluate the scale-up of the 'Internet-based Professional Learning to help teachers promote Activity in Youth' (iPLAY) intervention in primary schools using the RE-AIM framework. METHODS We conducted a type 3 hybrid implementation-effectiveness study and collected data between April 2016 and June 2021, in New South Wales (NSW), Australia. RE-AIM was operationalised as: (i) Reach: Number and representativeness of students exposed to iPLAY; (ii) Effectiveness: Impact of iPLAY in a sub-sample of students (n = 5,959); (iii) Adoption: Number and representativeness of schools that received iPLAY; (iv) Implementation: Extent to which the three curricular and three non-curricular components of iPLAY were delivered as intended; (v) Maintenance: Extent to which iPLAY was sustained in schools. We conducted 43 semi-structured interviews with teachers (n = 14), leaders (n = 19), and principals (n = 10) from 18 schools (11 from urban and 7 from rural locations) to determine program maintenance. RESULTS Reach: iPLAY reached ~ 31,000 students from a variety of socio-economic strata (35% of students were in the bottom quartile, almost half in the middle two quartiles, and 20% in the top quartile). EFFECTIVENESS We observed small positive intervention effects for enjoyment of PE/sport (0.12 units, 95% CI: 0.05 to 0.20, d = 0.17), perceptions of need support from teachers (0.26 units, 95% CI: 0.16 to 0.53, d = 0.40), physical activity participation (0.28 units, 95% CI: 0.10 to 0.47, d = 0.14), and subjective well-being (0.82 units, 95% CI: 0.32 to 1.32, d = 0.12) at 24-months. Adoption: 115 schools received iPLAY. IMPLEMENTATION Most schools implemented the curricular (59%) and non-curricular (55%) strategies as intended. Maintenance: Based on our qualitative data, changes in teacher practices and school culture resulting from iPLAY were sustained. CONCLUSIONS iPLAY had extensive reach and adoption in NSW primary schools. Most of the schools implemented iPLAY as intended and effectiveness data suggest the positive effects observed in our cluster RCT were sustained when the intervention was delivered at-scale. TRIAL REGISTRATION ACTRN12621001132831.
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Affiliation(s)
- D R Lubans
- grid.266842.c0000 0000 8831 109XCentre for Active Living and Learning, College of Human and Social Futures, University of Newcastle, Callaghan, NSW Australia ,grid.413648.cHunter Medical Research Institute, New Lambton Heights, NSW Australia ,grid.9681.60000 0001 1013 7965Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - T Sanders
- grid.411958.00000 0001 2194 1270Institute for Positive Psychology and Education, Australian Catholic University, North Sydney, NSW Australia
| | - M Noetel
- grid.1003.20000 0000 9320 7537School of Psychology, University of Queensland, Brisbane, QLD Australia
| | - P Parker
- grid.411958.00000 0001 2194 1270Institute for Positive Psychology and Education, Australian Catholic University, North Sydney, NSW Australia
| | - H McKay
- grid.17091.3e0000 0001 2288 9830Centre for Hip Health and Mobility, University of British Columbia, Vancouver, BC Canada
| | - PJ Morgan
- grid.266842.c0000 0000 8831 109XCentre for Active Living and Learning, College of Human and Social Futures, University of Newcastle, Callaghan, NSW Australia ,grid.413648.cHunter Medical Research Institute, New Lambton Heights, NSW Australia
| | - J Salmon
- grid.1021.20000 0001 0526 7079Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC Australia
| | - M Kirwan
- grid.1004.50000 0001 2158 5405Faculty of Medicine, Health and Human Sciences, Macquarie University, Macquarie Park, NSW Australia
| | - A Bennie
- grid.1029.a0000 0000 9939 5719School of Health Sciences, Western Sydney University, Penrith, NSW Australia
| | - L Peralta
- grid.1013.30000 0004 1936 834XSchool of Education and Social Work, University of Sydney, Camperdown, NSW Australia
| | - R Cinelli
- grid.411958.00000 0001 2194 1270School of Education, Australian Catholic University, Strathfield, NSW Australia
| | - M Moodie
- grid.1021.20000 0001 0526 7079Deakin Health Economics Deakin University, Burwood, VIC Australia
| | - T Hartwig
- grid.411958.00000 0001 2194 1270School of Behavioural and Health Sciences, Australian Catholic University, Strathfield, NSW Australia
| | - J Boyer
- grid.461941.f0000 0001 0703 8464NSW Department of Education, Turrella, NSW Australia
| | - S G Kennedy
- grid.1029.a0000 0000 9939 5719School of Health Sciences, Western Sydney University, Penrith, NSW Australia
| | - R C Plotnikoff
- grid.266842.c0000 0000 8831 109XCentre for Active Living and Learning, College of Human and Social Futures, University of Newcastle, Callaghan, NSW Australia ,grid.413648.cHunter Medical Research Institute, New Lambton Heights, NSW Australia
| | - V Hansen
- grid.1031.30000000121532610Southern Cross University, East Lismore, NSW Australia
| | | | - J Lee
- Global Centre for Modern Ageing, Tonsley, South Australia Australia
| | - D Antczak
- grid.411958.00000 0001 2194 1270Institute for Positive Psychology and Education, Australian Catholic University, North Sydney, NSW Australia
| | - C Lonsdale
- grid.411958.00000 0001 2194 1270Institute for Positive Psychology and Education, Australian Catholic University, North Sydney, NSW Australia
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Broadney MM, Belcher BR, Ghane N, Sheni R, Jayson MJ, Trenschel RW, Collins SM, Brychta RJ, Davis EK, Brady SM, Yang SB, Courville AB, Smith KP, Rosing DR, Chen KY, Yanovski JA. Effects of interrupting daily sedentary behavior on children's glucose metabolism: A 6-day randomized controlled trial. Pediatr Diabetes 2022; 23:1567-1578. [PMID: 36205036 PMCID: PMC9772039 DOI: 10.1111/pedi.13430] [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: 07/08/2022] [Revised: 09/14/2022] [Accepted: 10/02/2022] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Metabolic disease risk in youth is influenced by sedentary behaviors. Acute in-lab studies show that, during a single day, interrupting a sedentary period with short bouts of physical activity improves glucometabolic outcomes. OBJECTIVE To determine if acutely improved glucose metabolism persists after multi-day interruptions of sitting with walking brief bouts. We hypothesized that children who underwent interrupting sitting on multiple days would demonstrate lower insulin area under the curve during an oral glucose tolerance test compared to uninterrupted sitting. METHODS Healthy, normoglycemic children (N = 109) ages 7-11 years were randomized to one of two conditions: Control (3 h of daily Uninterrupted Sitting) or Interrupted Sitting (3-min of moderate-intensity walking every 30 min for 3 h daily); with dietary intake controlled through provision of foodstuffs for the entire experiment. Participants attended six consecutive daily visits at a research ambulatory unit. The primary outcome was insulin area under the curve during the oral glucose tolerance test on day 6 during interrupted or uninterrupted sitting; secondary outcomes included glucose and c-peptide area under the curve, energy intake at a buffet meal on day 6, and free-living activity. RESULTS Among 93 children (42 uninterrupted sitting, 51 interrupted sitting), daily interrupted sitting resulted in 21% lower insulin (β = 0.102 CI:0.032-0.172, p = 0.005) and a 10% lower C-peptide (β = 0.043, CI:0.001-0.084, p = 0.045) area under the curve. Matsuda and Glucose Effectiveness Indices were also improved (p's < 0.05). There were no group differences in energy intake or expenditure. CONCLUSIONS Sustained behavioral change by interrupting sedentary behaviors is a promising intervention strategy for improving metabolic risk in children.
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Affiliation(s)
- Miranda M. Broadney
- Section on Growth and Obesity, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA,Current address: Division of Diabetes, Endocrinology, and Metabolic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, USA
| | - Britni R. Belcher
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Bethesda, MD, USA,Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
| | - Nejla Ghane
- Section on Growth and Obesity, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA
| | - Risha Sheni
- Section on Growth and Obesity, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA
| | - Michael J. Jayson
- Section on Growth and Obesity, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA
| | - Robert W. Trenschel
- Section on Growth and Obesity, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA
| | - Shavonne M. Collins
- Section on Growth and Obesity, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA
| | - Robert J. Brychta
- Diabetes, Endocrinology, and Obesity Branch, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, USA
| | - Elisabeth K. Davis
- Section on Growth and Obesity, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA
| | - Sheila M. Brady
- Section on Growth and Obesity, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA
| | - Shanna B. Yang
- Nutrition Department, Hatfield Clinical Center, Bethesda, MD, USA
| | - Amber B. Courville
- Diabetes, Endocrinology, and Obesity Branch, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, USA,Nutrition Department, Hatfield Clinical Center, Bethesda, MD, USA
| | - Kevin P. Smith
- Nursing Department, Hatfield Clinical Center, Bethesda, MD, USA,Cardiovascular Branch, National Heart Lung and Blood Institute, National Institutes of Health, USA
| | - Douglas R. Rosing
- Cardiovascular Branch, National Heart Lung and Blood Institute, National Institutes of Health, USA
| | - Kong Y. Chen
- Diabetes, Endocrinology, and Obesity Branch, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, USA
| | - Jack A. Yanovski
- Section on Growth and Obesity, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA
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White IR, Pandis N, Pham TM. Missing data, part 6. Choices in doing multiple imputation. Am J Orthod Dentofacial Orthop 2022; 162:795-797. [PMID: 37830536 DOI: 10.1016/j.ajodo.2022.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 08/10/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Ian R White
- Medical Research Council Clinical Trials Unit at University College London, London, United Kingdom
| | - Nikolaos Pandis
- Department of Orthodontics and Dentofacial Orthopedics, School of Dental Medicine, University of Bern, Bern, Switzerland.
| | - Tra My Pham
- Medical Research Council Clinical Trials Unit at University College London, London, United Kingdom
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27
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Muilwijk M, Loh M, Mahmood S, Palaniswamy S, Siddiqui S, Silva W, Frost GS, Gage HM, Jarvelin MR, Rannan-Eliya RP, Ahmad S, Jha S, Kasturiratne A, Katulanda P, Khawaja KI, Kooner JS, Wickremasinghe AR, van Valkengoed IGM, Chambers JC. The iHealth-T2D study: a cluster randomised trial for the prevention of type 2 diabetes amongst South Asians with central obesity and prediabetes-a statistical analysis plan. Trials 2022; 23:755. [PMID: 36068618 PMCID: PMC9450360 DOI: 10.1186/s13063-022-06667-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 08/18/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND South Asians are at high risk of type 2 diabetes (T2D). Lifestyle modification is effective at preventing T2D amongst South Asians, but the approaches to screening and intervention are limited by high costs, poor scalability and thus low impact on T2D burden. An intensive family-based lifestyle modification programme for the prevention of T2D was developed. The aim of the iHealth-T2D trial is to compare the effectiveness of this programme with usual care. METHODS The iHealth-T2D trial is designed as a cluster randomised controlled trial (RCT) conducted at 120 sites across India, Pakistan, Sri Lanka and the UK. A total of 3682 South Asian men and women with age between 40 and 70 years without T2D but at elevated risk for T2D [defined by central obesity (waist circumference ≥ 95 cm in Sri Lanka or ≥ 100 cm in India, Pakistan and the UK) and/or prediabetes (HbA1c ≥ 6.0%)] were included in the trial. Here, we describe in detail the statistical analysis plan (SAP), which was finalised before outcomes were available to the investigators. The primary outcome will be evaluated after 3 years of follow-up after enrolment to the study and is defined as T2D incidence in the intervention arm compared to usual care. Secondary outcomes are evaluated both after 1 and 3 years of follow-up and include biochemical measurements, anthropometric measurements, behavioural components and treatment compliance. DISCUSSION The iHealth-T2D trial will provide evidence of whether an intensive family-based lifestyle modification programme for South Asians who are at high risk for T2D is effective in the prevention of T2D. The data from the trial will be analysed according to this pre-specified SAP. ETHICS AND DISSEMINATION The trial was approved by the international review board of each participating study site. Study findings will be disseminated through peer-reviewed publications and in conference presentations. TRIAL REGISTRATION EudraCT 2016-001,350-18 . Registered on 14 April 2016. CLINICALTRIALS gov NCT02949739 . Registered on 31 October 2016.
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Affiliation(s)
- Mirthe Muilwijk
- Department of Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Meibergdreef 9, Amsterdam, The Netherlands.
- Amsterdam Public Health, Health Behaviours & Cardiovascular Diseases, Amsterdam Cardiovascular Sciences, Diabetes & Metabolism, Amsterdam, The Netherlands.
| | - Marie Loh
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, 308232, Singapore
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St Mary's Campus, Norfolk Place, London, W2 1PG, UK
| | - Sara Mahmood
- Department of Endocrinology & Metabolism, Services Institute of Medical Sciences, Services Institute of Medical Sciences, Services Hospital, Ghaus Ul Azam, Jail Road 54700, Lahore, Pakistan
| | - Saranya Palaniswamy
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St Mary's Campus, Norfolk Place, London, W2 1PG, UK
- Center for Life Course Health Research, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Samreen Siddiqui
- Max Healthcare, Institute of Endocrinology, Diabetes and Metabolism, Max Super Speciality Hospital, 2, Press Enclave Road, Skaet, New Delhi, 110017, India
| | - Wnurinham Silva
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St Mary's Campus, Norfolk Place, London, W2 1PG, UK
| | - Gary S Frost
- Faculty of Medicine, Imperial College London, Hammersmith Campus, DuCane Road, London, W12 ONN, UK
| | - Heather M Gage
- Department of Clinical and Experimental Medicine, Surrey Health Economics Centre, University of Surrey, Leggett Building, Daphne Jackson Road, Guildford, Surrey, GU2 7WG, UK
| | - Marjo-Riitta Jarvelin
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St Mary's Campus, Norfolk Place, London, W2 1PG, UK
- Center for Life Course Health Research, Faculty of Medicine, University of Oulu, Oulu, Finland
- Unit of Primary Care, Oulu University Hospital, University of Oulu, Oulu, Finland
- Department of Life Sciences, College of Health and Life Sciences, Brunel University London, Kingston Lane, Uxbridge, UB8 3PH, Middlesex, UK
| | | | - Sajjad Ahmad
- Punjab Institute of Cardiology, Punjab Institute of Cardiology, Jail Road, Shadman, Lahore, Punjab, Pakistan
| | - Sujeet Jha
- Max Healthcare, Institute of Endocrinology, Diabetes and Metabolism, Max Super Speciality Hospital, 2, Press Enclave Road, Skaet, New Delhi, 110017, India
| | - Anuradhani Kasturiratne
- Faculty of Medicine, University of Kelaniya, Thalagolla Road, PO Box 06, Ragama, 11010, Sri Lanka
| | - Prasad Katulanda
- Department of Clinical Medicine, Faculty of Medicine, University of Colombo, 25 Kynsey Rd, Colombo, 00800, Sri Lanka
| | - Khadija I Khawaja
- Department of Endocrinology & Metabolism, Services Institute of Medical Sciences, Services Institute of Medical Sciences, Services Hospital, Ghaus Ul Azam, Jail Road 54700, Lahore, Pakistan
| | - Jaspal S Kooner
- London Northwest University Healthcare NHS Trust, Uxbridge Road, Southall, UB1 3HW, Middlesex, UK
- National Heart and Lung Institute, Imperial College London, Hammersmith Campus, DuCane Road, London, W12 ONN, UK
| | - Ananda R Wickremasinghe
- Faculty of Medicine, University of Kelaniya, Thalagolla Road, PO Box 06, Ragama, 11010, Sri Lanka
| | - Irene G M van Valkengoed
- Department of Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam Public Health, Health Behaviours & Cardiovascular Diseases, Amsterdam Cardiovascular Sciences, Diabetes & Metabolism, Amsterdam, The Netherlands
| | - John C Chambers
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, 308232, Singapore
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St Mary's Campus, Norfolk Place, London, W2 1PG, UK
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López-Durán A, Becoña E, Senra C, Suárez-Castro D, Barroso-Hurtado M, Martínez-Vispo C. A Randomized Clinical Trial to Assess the Efficacy of a Psychological Treatment to Quit Smoking Assisted with an App: Study Protocol. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:9770. [PMID: 35955123 PMCID: PMC9368001 DOI: 10.3390/ijerph19159770] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 08/04/2022] [Accepted: 08/06/2022] [Indexed: 06/15/2023]
Abstract
Numerous studies have shown the efficacy of smoking cessation interventions. However, some challenges, such as relapse rates, remain. The availability of information technologies (ICTs) offers promising opportunities to address such challenges. The aim of this paper is to describe the protocol followed to assess the efficacy of a face-to-face cognitive-behavioral intervention for smoking cessation using a smartphone application as a complement, compared with a control group. A single blind, two-arm, randomized controlled trial is proposed (NCT04765813). The participants will be smokers over 18 years old, who smoke at least eight cigarettes per day. Participants will be randomized to one of two conditions, using a 1:1 allocation ratio: (1) cognitive-behavioral smoking cessation treatment along with an App with active therapeutic components (SinHumo App); or (2) cognitive-behavioral treatment along with the use of a control App (without active components). The experimental App will be used during the eight treatment sessions and for 12 months after the end of treatment. The primary outcome measures will be 7-days point-prevalence abstinence at 12-months follow-up. We expect the experimental App to obtain higher abstinence rates at the end of treatment and at one-year post-treatment follow-ups and lower relapse rates, compared to the control App.
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Affiliation(s)
- Ana López-Durán
- Smoking and Addictive Disorders Unit, University of Santiago de Compostela, 15782 Santiago de Compostela, Spain
- Department of Clinical Psychology and Psychobiology, University of Santiago de Compostela, 15782 Santiago de Compostela, Spain
| | - Elisardo Becoña
- Smoking and Addictive Disorders Unit, University of Santiago de Compostela, 15782 Santiago de Compostela, Spain
- Department of Clinical Psychology and Psychobiology, University of Santiago de Compostela, 15782 Santiago de Compostela, Spain
| | - Carmen Senra
- Department of Clinical Psychology and Psychobiology, University of Santiago de Compostela, 15782 Santiago de Compostela, Spain
| | - Daniel Suárez-Castro
- Smoking and Addictive Disorders Unit, University of Santiago de Compostela, 15782 Santiago de Compostela, Spain
- Department of Clinical Psychology and Psychobiology, University of Santiago de Compostela, 15782 Santiago de Compostela, Spain
| | - María Barroso-Hurtado
- Smoking and Addictive Disorders Unit, University of Santiago de Compostela, 15782 Santiago de Compostela, Spain
- Department of Clinical Psychology and Psychobiology, University of Santiago de Compostela, 15782 Santiago de Compostela, Spain
| | - Carmela Martínez-Vispo
- Smoking and Addictive Disorders Unit, University of Santiago de Compostela, 15782 Santiago de Compostela, Spain
- Department of Clinical Psychology and Psychobiology, University of Santiago de Compostela, 15782 Santiago de Compostela, Spain
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Oldiges K, Steinmann M, Duevel JA, Gruhn S, Diener R, Leclaire MD, Al-Nawaiseh S, Eter N. SALUS-a non-inferiority trial to compare self-tonometry in glaucoma patients with regular inpatient intraocular pressure controls: study design and set-up. Graefes Arch Clin Exp Ophthalmol 2022; 260:3945-3955. [PMID: 35867146 PMCID: PMC9666328 DOI: 10.1007/s00417-022-05759-7] [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: 01/17/2022] [Revised: 06/28/2022] [Accepted: 06/30/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose The SALUS study aims to improve the healthcare situation for glaucoma patients in Germany. In order to detect diurnal intraocular pressure (IOP) fluctuations, inpatient monitoring of IOP in an eye hospital for a minimum of 24 h is the current standard. SALUS assesses the benefits of a new form of outpatient care, where IOP can be measured by the patients themselves at home using a self-tonometer. This approach should promote the patient’s health competence and empowerment within the healthcare system while reducing treatment costs. Methods The SALUS study is a randomized controlled, open non-inferiority trial, alongside an economic analysis, determining whether outpatient monitoring of IOP with self-tonometry is at least as effective as current standard care and would reduce treatment costs. Participants (n = 1980) will be recruited by local ophthalmologists in the area of Westphalia-Lippe, Germany, and randomized to receive 7-day outpatient or 24-h inpatient monitoring. Participants in both study arms will also receive 24-h blood pressure monitoring. Furthermore, patient data from both study groups will be collected in an electronic case file (ECF), accessible to practitioners, hospitals, and the study participants. The primary endpoint is the percentage of patients with IOP peaks, defined as levels 30% above the patient-specific target pressure. Data will also be collected during initial and final examinations, and at 3, 6, and 9 months after the initial examination. Results The study implementation and trial management are represented below. Conclusion SALUS is a pioneering prospective clinical trial focused on the care of glaucoma patients in Germany. If SALUS is successful, it could improve the healthcare situation and health literacy of the patients through the introduction of various telemedical components. Furthermore, the approach would almost certainly reduce the treatment costs of glaucoma care. Trial registration ClinicalTrials.gov ID: NCT04698876, registration date: 11/25/2020. DRKS-ID: DRKS00023676, registration date: 11/26/2020.
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Affiliation(s)
- Kristina Oldiges
- Department of Ophthalmology, University of Muenster Medical Center, Albert-Schweitzer-Campus 1, Building D15, 48149, Muenster, Germany
| | - Maren Steinmann
- Department for Health Economics and Health Care Management, School of Public Health, Bielefeld University, Universitaetsstrasse 25, 33615, Bielefeld, Germany
| | - Juliane Andrea Duevel
- Department for Health Economics and Health Care Management, School of Public Health, Bielefeld University, Universitaetsstrasse 25, 33615, Bielefeld, Germany
| | - Sebastian Gruhn
- Department for Health Economics and Health Care Management, School of Public Health, Bielefeld University, Universitaetsstrasse 25, 33615, Bielefeld, Germany
| | - Raphael Diener
- Department of Ophthalmology, University of Muenster Medical Center, Albert-Schweitzer-Campus 1, Building D15, 48149, Muenster, Germany
| | - Martin Dominik Leclaire
- Department of Ophthalmology, University of Muenster Medical Center, Albert-Schweitzer-Campus 1, Building D15, 48149, Muenster, Germany
| | - Sami Al-Nawaiseh
- Department of Ophthalmology, University of Muenster Medical Center, Albert-Schweitzer-Campus 1, Building D15, 48149, Muenster, Germany
| | - Nicole Eter
- Department of Ophthalmology, University of Muenster Medical Center, Albert-Schweitzer-Campus 1, Building D15, 48149, Muenster, Germany.
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von Klinggraeff L, Dugger R, Brazendale K, Hunt ET, Moore JB, Turner-McGrievy G, Vogler K, Beets MW, Armstrong B, Weaver RG. Healthy Summer Learners: An explanatory mixed methods study and process evaluation. EVALUATION AND PROGRAM PLANNING 2022; 92:102070. [PMID: 35339766 PMCID: PMC9851796 DOI: 10.1016/j.evalprogplan.2022.102070] [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: 07/19/2020] [Revised: 09/03/2021] [Accepted: 03/13/2022] [Indexed: 06/03/2023]
Abstract
Healthy Summer Learners (HSL), a novel, 6-week summer program for 2-4th grade children from low-income families in the Southeastern United States, aimed to prevent accelerated summer BMI gain and academic learning loss by providing healthy meals and snacks, 15 min of nutrition education, 3 h of physical activity opportunities and 3.5 h of reading instruction daily. This three-armed pilot quasi-experimental study used a repeated measure within- and between-participant design to compare HSL, to an active comparator-21st Century Summer Learning Program (21 C), and no-treatment control. A mixed-methods process evaluation was employed to evaluate program implementation and provide insight for future program development. Though the program was well received, student attendance was lower than anticipated and full program fidelity was not achieved. During interviews, both parents and teachers noted that the bussing schedule was inconsistent, making attendance difficult for some families. These process evaluation findings may help explain why no statistically significant group-by-time interactions at 3- or 12-month follow up were found for the primary outcomes of zBMI or MAP reading score. Future iterations of HSL should seek to extend program hours, lengthen program duration, and explore ways to lower projected cost of attendance.
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Affiliation(s)
- Lauren von Klinggraeff
- Department of Exercise Science, University of South Carolina Arnold School of Public Health, Columbia 29208, USA.
| | - Roddrick Dugger
- Department of Exercise Science, University of South Carolina Arnold School of Public Health, Columbia 29208, USA
| | - Keith Brazendale
- Department of Health Sciences, University of Central Florida, Orlando 32816, USA
| | - Ethan T Hunt
- Department of Exercise Science, University of South Carolina Arnold School of Public Health, Columbia 29208, USA
| | - Justin B Moore
- Department of Implementation Science, Wake Forest School of Medicine, Winston-Salem 27101, USA
| | - Gabrielle Turner-McGrievy
- Department of Health Promotion, Education, and Behavior, University of South Carolina Arnold School of Public Health, Columbia 29208, USA
| | - Kenneth Vogler
- Department of Instruction and Teacher Education, University of South Carolina, Columbia 29208, USA
| | - Michael W Beets
- Department of Exercise Science, University of South Carolina Arnold School of Public Health, Columbia 29208, USA
| | - Bridget Armstrong
- Department of Exercise Science, University of South Carolina Arnold School of Public Health, Columbia 29208, USA
| | - R Glenn Weaver
- Department of Exercise Science, University of South Carolina Arnold School of Public Health, Columbia 29208, USA
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van Leeuwen EH, Knies E, van Rensen ELJ, Taris TW. Stimulating Employability and Job Crafting Behaviour of Physicians: A Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095666. [PMID: 35565061 PMCID: PMC9105376 DOI: 10.3390/ijerph19095666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 05/02/2022] [Accepted: 05/04/2022] [Indexed: 12/04/2022]
Abstract
The demanding work context of physicians challenges their employability (i.e., their ability and willingness to continue to work). This requires them to proactively manage their working life and employability, for instance, through job crafting behaviour. This randomized controlled intervention study aimed to examine the effects of a personalized feedback report on physicians’ employability and job crafting behaviour. A total of 165 physicians from two hospitals in a large Dutch city were randomly assigned to a waitlist control or intervention group in May 2019. Physicians in the intervention group received access to a personalized feedback report with their employability scores, suggestions to improve these and to engage in job crafting. Participants completed a pre-test and eight weeks later a post-test. RM MANOVAs and RM ANOVAs showed that the intervention enhanced participants’ perceptions of their mental (F (1,130) = 4.57, p < 0.05) and physical (F (1,135) = 16.05, p < 0.001) ability to continue working. There was no effect on their willingness to continue to work. Furthermore, while job crafting behaviour significantly increased over time, the personalized feedback report did not account for this change. This low-investment intervention is relevant for organizations to stimulate employees’ proactivity and create positive perceptions of their ability to continue to work. Moreover, this study contributes to the literature by examining a novel approach of a job crafting intervention that does not require many resources to implement.
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Affiliation(s)
- Evelien H. van Leeuwen
- Department of Quality and Patient Safety, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands;
- School of Governance, Utrecht University, Bijlhouwerstraat 6, 3511 ZC Utrecht, The Netherlands;
- Correspondence:
| | - Eva Knies
- School of Governance, Utrecht University, Bijlhouwerstraat 6, 3511 ZC Utrecht, The Netherlands;
| | - Elizabeth L. J. van Rensen
- Department of Quality and Patient Safety, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands;
| | - Toon W. Taris
- Department of Social, Health and Organizational Psychology, Utrecht University, Heidelberglaan 1, 3584 CS Utrecht, The Netherlands;
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Koehler M, Hoppe S, Kropf S, Lux A, Bartsch R, Holzner B, Krauter J, Florschütz A, Jentsch-Ullrich K, Frommer J, Flechtner HH, Fischer T. Randomized Trial of a Supportive Psychotherapy for Parents of Adolescents and Young Adults With Hematologic Malignancies. J Natl Compr Canc Netw 2022; 20:jnccn20614. [PMID: 35405661 DOI: 10.6004/jnccn.2021.7075] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 06/17/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Cancer regularly disrupts health and developmental trajectories in adolescents and young adults (AYAs). Parents have been shown to have a substantial impact on the health and cancer survivorship activities of AYA patients in the form of symptom management. However, no randomized controlled trial has evaluated a coping support intervention (CSI) program for parents of AYAs with cancer aged 18 to 40 years. PATIENTS AND METHODS From November 30, 2012, to August 29, 2016, parents of AYAs with hematologic malignancies were randomized in a phase III controlled trial (1:1 ratio, stratified sampling) to either the research-based CSI AYA-Parents group (CSI group; n=82) or the standard care (SC) group (n=70). CSI consisted of 5 sessions to achieve the enhancement of parental adaptive coping as the primary outcome (per the adaptive coping scale of the 28-item Brief COPE, a validated multidimensional self-assessment-questionnaire recommended for clinical cancer research). Measures of adaptive coping, depression, and mental health were collected at pre-CSI (measurement date T1), at the end of the intervention sessions (measurement date T2), and at follow-up (3 months). We calculated mean change scores in outcomes and estimated intervention effect sizes (Cohen's d) for changes from T1 to T2/T3, with 0.2 indicating a small effect, 0.5 a medium effect, and 0.8 a large effect. All statistical tests were 2-sided. RESULTS In the intention-to-treat analysis, the CSI group significantly improved their adaptive coping compared with the SC group (95% CI, 0.30-2.54; P=.013; d=0.405), whereas adaptive coping in the SC group deteriorated. The CSI group also experienced a significant decrease in depressive symptoms and improved mental health with clinical significance (95% CI, -1.98 to -0.30; P=.008; d=0.433, and 95% CI, -0.19 to 3.97; P=.074; d=0.292, respectively). Sensitivity analyses confirmed the robustness of the main intention-to-treat analysis. CONCLUSIONS CSI improved effectively adaptive coping and depression in parents of AYAs with hematologic malignancies. It may represent a novel family-based approach in AYA oncology care.
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Affiliation(s)
- Michael Koehler
- 1Department of Hematology and Oncology, University Hospital Magdeburg.,2Gesundheitscampus Immunologie, Infektiologie und Inflammation (GCI3), Medical Center, and
| | - Susanne Hoppe
- 1Department of Hematology and Oncology, University Hospital Magdeburg.,2Gesundheitscampus Immunologie, Infektiologie und Inflammation (GCI3), Medical Center, and
| | - Siegfried Kropf
- 3Institute for Biometry and Medical Informatics, Medical Faculty, Otto-von-Guericke University, Magdeburg, Germany
| | - Anke Lux
- 3Institute for Biometry and Medical Informatics, Medical Faculty, Otto-von-Guericke University, Magdeburg, Germany
| | - Rainer Bartsch
- 1Department of Hematology and Oncology, University Hospital Magdeburg.,2Gesundheitscampus Immunologie, Infektiologie und Inflammation (GCI3), Medical Center, and
| | - Bernhard Holzner
- 4Department of Psychiatry, Psychotherapy and Psychosomatic, Innsbruck Medical University, Innsbruck, Austria
| | - Juergen Krauter
- 5Department of Hematology and Oncology, Braunschweig Municipal Hospital, Braunschweig, Germany
| | - Axel Florschütz
- 6Department of Internal Medicine, Dessau Municipal Hospital, Dessau-Roßlau, Germany
| | | | - Joerg Frommer
- 8Department of Psychosomatic Medicine and Psychotherapy, University Hospital Magdeburg, and
| | - Hans-Henning Flechtner
- 9Department of Child and Adolescent Psychiatry, Medical Faculty, Otto-von-Guericke University, Magdeburg, Germany
| | - Thomas Fischer
- 1Department of Hematology and Oncology, University Hospital Magdeburg.,2Gesundheitscampus Immunologie, Infektiologie und Inflammation (GCI3), Medical Center, and
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Robinson KJ, Lubans DR, Mavilidi MF, Hillman CH, Benzing V, Valkenborghs SR, Barker D, Riley N. Effects of Classroom-Based Resistance Training With and Without Cognitive Training on Adolescents' Cognitive Function, On-task Behavior, and Muscular Fitness. Front Psychol 2022; 13:811534. [PMID: 35386901 PMCID: PMC8977488 DOI: 10.3389/fpsyg.2022.811534] [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] [Received: 11/08/2021] [Accepted: 02/28/2022] [Indexed: 11/13/2022] Open
Abstract
Aim: Participation in classroom physical activity breaks may improve children's cognition, but few studies have involved adolescents. The primary aim of this study was to examine the effects of classroom-based resistance training with and without cognitive training on adolescents' cognitive function. Methods: Participants were 97 secondary school students (45.4% females, mean age 15.78 ± 0.44). Four-year 10 classes from one school were included in this four-arm cluster randomized controlled trial. Classes were randomly assigned to the following groups: sedentary control with no cognitive training, sedentary with cognitive training, resistance training without cognitive training, and resistance training with cognitive training. Sessions varied in levels of both cognitive demand and resistance training (i.e., high vs. low) and were administered three times per week for 4 weeks (12 sessions). Inhibition, cognitive flexibility, episodic memory, on-task behavior, and muscular fitness were assessed at baseline and post-test. Linear mixed models were used to examine changes within and between groups. Results: In comparison with the control group, episodic memory improved significantly in the resistance training without cognitive training group (-9.87 units, 95% CI: -17.71 to -2.03, p = 0.014, d = 0.72). There were no group-by-time effects for inhibition or cognitive flexibility. Classroom activity breaks both with and without cognitive demand improved participants' on-task behavior in comparison with the control and sedentary group. The resistance training programs did not lead to improvements in muscular fitness. Conclusion: Participation in body weight resistance training without cognitive training led to selective improvements in episodic memory. No training effects were found for inhibition or cognitive flexibility. A longer study period may be necessary to induce improvements in muscular fitness and associated changes in inhibition and cognitive flexibility. Clinical Trial Registration: https://www.anzctr.org.au/ACTRN12621001341819.aspx, Australian New Zealand Clinical Trials Registry-ACTRN12621001341819.
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Affiliation(s)
- Katie J Robinson
- Priority Research Centre for Physical Activity and Nutrition, College of Human and Social Futures, University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute (HMRI), Newcastle, NSW, Australia
| | - David R Lubans
- Priority Research Centre for Physical Activity and Nutrition, College of Human and Social Futures, University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute (HMRI), Newcastle, NSW, Australia
| | - Myrto F Mavilidi
- School of Education/Early Start, University of Wollongong, Wollongong, NSW, Australia
| | - Charles H Hillman
- Department of Psychology, Northeastern University, Boston, MA, United States.,Department of Physical Therapy, Movement, and Rehabilitation Sciences, Northeastern University, Boston, MA, United States
| | - Valentin Benzing
- Institute of Sport Science, University of Bern, Bern, Switzerland
| | - Sarah R Valkenborghs
- Priority Research Centre for Physical Activity and Nutrition, College of Human and Social Futures, University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute (HMRI), Newcastle, NSW, Australia
| | - Daniel Barker
- Hunter Medical Research Institute (HMRI), Newcastle, NSW, Australia
| | - Nicholas Riley
- Priority Research Centre for Physical Activity and Nutrition, College of Human and Social Futures, University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute (HMRI), Newcastle, NSW, Australia
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Weaver RG, Armstrong B, Adams E, Beets M, White J, Flory K, Wilson D, Mclain A, Tennie B. Feasibility & Preliminary Efficacy of Structured Programming and a Parent Intervention to Mitigate Accelerated Summer BMI Gain: A pilot study. RESEARCH SQUARE 2022:rs.3.rs-1466063. [PMID: 35378750 PMCID: PMC8978946 DOI: 10.21203/rs.3.rs-1466063/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
BackgroundThis study assessed initial feasibility and preliminary efficacy of providing children a free summer day camp and a parent intervention to improve self-regulation and mitigate accelerated summer BMI gain.MethodsThis pilot 2x2 factorial randomized control trial used a mixed methods design to evaluate providing children a free summer day camp (SCV), a parent intervention (PI), and the combination of these two strategies (SCV + PI) to mitigate accelerated summer body mass index (BMI) gain. Feasibility (i.e., recruitment capability, retention, compliance, treatment fidelity, acceptability) was examined using means, standard deviations, and percentages for relevant variables. Changes in BMI were estimated using intent-to-treat and post-hoc dose response analyses via multilevel mixed effects regressions.ResultsA total of 89 families participated, with 24 participants randomized to the PI group, 21 randomized to the SCV group, 23 randomized to the SCV + PI group, and 21 randomized to the control. Parents and children found the summer program acceptable but attendance at the summer program and engagement in the PI were low due to COVID-19 and lack of transportation. Intent-to-treat analyses showed no statistically significant difference between groups in summer BMI gain. Post-hoc dose response analyses showed that for each day (0 to 29) of summer programming children attended they gained - 0.009 (95CI= -0.018, -0.001) less in BMI z-score.ConclusionsEngagement in both the SCV and PI was not ideal and was likely due to COVID-19 and lack of transportation. Providing children with structured summer programming to mitigate accelerated summer BMI gain may be an effective strategy. Thus, a larger trial may be warranted, but more work is needed to ensure children attend the programming.Trial registration: The trial reported herein was prospectively registered at clinicaltrials.gov. Trial #:NCT04608188.
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Affiliation(s)
| | | | | | - Michael Beets
- University of South Carolina Arnold School of Public Health
| | - James White
- University of South Carolina Arnold School of Public Health
| | - Kate Flory
- University of South Carolina Department of Psychology
| | - Dawn Wilson
- University of South Carolina Department of Psychology
| | - Alex Mclain
- University of South Carolina Arnold School of Public Health
| | - Brianna Tennie
- University of South Carolina Arnold School of Public Health
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35
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Wilkinson J, Stocking K. Study design flaws and statistical challenges in evaluating fertility treatments. REPRODUCTION AND FERTILITY 2022; 2:C9-C21. [PMID: 35128452 PMCID: PMC8812412 DOI: 10.1530/raf-21-0015] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 05/21/2021] [Indexed: 12/16/2022] Open
Abstract
Health interventions should be tested before being introduced into clinical practice, to find out whether they work and whether they are harmful. However, research studies will only provide reliable answers to these questions if they are appropriately designed and analysed. But these are not trivial tasks. We review some methodological challenges that arise when evaluating fertility interventions and explain the implications for a non-statistical audience. These include flexibility in outcomes and analyses; use of surrogate outcomes instead of live birth; use of inappropriate denominators; evaluating cumulative outcomes and time to live birth; allowing each patient or couple to contribute to a research study more than once. We highlight recurring errors and present solutions. We conclude by highlighting the importance of collaboration between clinical and methodological experts, as well as people with experience of subfertility, for realising high-quality research. Lay summary We do research to find out whether fertility treatments are beneficial and to make sure they don't cause harm. However, research will only provide reliable answers if it is done properly. It is not unusual for researchers to make mistakes when they are designing research studies and analysing the data that we get from them. In this review, we describe some of the mistakes people make when they do research about fertility treatments and explain how to avoid them. These include challenges which arise due to the large number of things that can be measured and reported when looking to see if fertility treatments work; failure to check whether the treatment increases the number of live births; failing to include all study participants in calculations;challenges in studies where participants may have more than one treatment attempt. We conclude by highlighting the importance of collaboration between clinical and methodological experts, as well as people with experience of fertility problems.
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Affiliation(s)
- Jack Wilkinson
- Centre for Biostatistics, Division of Population Health, Health Services Research and Primary Care, Faculty of Biology, Medicine, and Health, University of Manchester, Manchester, UK
| | - Katie Stocking
- Centre for Biostatistics, Division of Population Health, Health Services Research and Primary Care, Faculty of Biology, Medicine, and Health, University of Manchester, Manchester, UK
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36
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Yamaguchi Y, Yoshida S, Misumi T, Maruo K. Multiple imputation for longitudinal data using Bayesian lasso imputation model. Stat Med 2022; 41:1042-1058. [PMID: 35064581 DOI: 10.1002/sim.9315] [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: 04/13/2021] [Revised: 11/03/2021] [Accepted: 12/21/2021] [Indexed: 11/11/2022]
Abstract
Multiple imputation is a promising approach to handle missing data and is widely used in analysis of longitudinal clinical studies. A key consideration in the implementation of multiple imputation is to obtain accurate imputed values by specifying an imputation model that incorporates auxiliary variables potentially associated with missing variables. The use of informative auxiliary variables is known to be beneficial to make the missing at random assumption more plausible and help to reduce uncertainty of the imputations; however, it is not straightforward to pre-specify them in many cases. We propose a data-driven specification of the imputation model using Bayesian lasso in the context of longitudinal clinical study, and develop a built-in function of the Bayesian lasso imputation model which is performed within the framework of multiple imputation using chained equations. A simulation study suggested that the Bayesian lasso imputation model worked well in a variety of longitudinal study settings, providing unbiased treatment effect estimates with well-controlled type I error rates and coverage probabilities of the confidence interval; in contrast, ignorance of the informative auxiliary variables led to serious bias and inflation of type I error rate. Moreover, the Bayesian lasso imputation model offered higher statistical powers compared with conventional imputation methods. In our simulation study, the gains in statistical power were remarkable when the sample size was small relative to the number of auxiliary variables. An illustration through a real example also suggested that the Bayesian lasso imputation model could give smaller standard errors of the treatment effect estimate.
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Affiliation(s)
| | - Satoshi Yoshida
- Data Science, Development, Astellas Pharma Inc., Tokyo, Japan
| | - Toshihiro Misumi
- Department of Biostatistics, School of Medicine, Yokohama City University, Yokohama, Japan
| | - Kazushi Maruo
- Department of Biostatistics, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
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37
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Wood A, Emery JD, Jenkins M, Chondros P, Campbell T, Wenkart E, O’Reilly C, Cowie T, Dixon I, Toner J, Khalajzadeh H, Gutierrez JM, Govan L, Buckle G, McIntosh JG. The SMARTscreen Trial: a randomised controlled trial investigating the efficacy of a GP-endorsed narrative SMS to increase participation in the Australian National Bowel Cancer Screening Program. Trials 2022; 23:31. [PMID: 35022080 PMCID: PMC8753594 DOI: 10.1186/s13063-021-05877-3] [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: 08/04/2021] [Accepted: 11/24/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Increasing participation in the Australian National Bowel Cancer Screening Program (NBCSP) is the most efficient and cost-effective way of reducing mortality associated with colorectal cancer by detecting and treating early-stage disease. Currently, only 44% of Australians aged 50-74 years complete the NBCSP. This efficacy trial aims to test whether this SMS intervention is an effective method for increasing participation in the NBCSP. Furthermore, a process evaluation will explore the barriers and facilitators to sending the SMS from general practice. METHODS We will recruit 20 general practices in the western region of Victoria, Australia to participate in a cluster randomised controlled trial. General practices will be randomly allocated with a 1:1 ratio to either a control or intervention group. Established general practice software will be used to identify patients aged 50 to 60 years old who are due to receive a NBCSP kit in the next month. The SMS intervention includes GP endorsement and links to narrative messages about the benefits of and instructions on how to complete the NBCSP kit. It will be sent from intervention general practices to eligible patients prior to receiving the NBCSP kit. We require 1400 eligible patients to provide 80% power with a two-sided 5% significance level to detect a 10% increase in CRC screening participation in the intervention group compared to the control group. Our primary outcome is the difference in the proportion of eligible patients who completed a faecal occult blood test (FOBT) between the intervention and control group for up to 12 months after the SMS was sent, as recorded in their electronic medical record (EMR). A process evaluation using interview data collected from general practice staff (GP, practice managers, nurses) and patients will explore the feasibility and acceptability of sending and receiving a SMS to prompt completing a NBCSP kit. DISCUSSION This efficacy trial will provide initial trial evidence of the utility of an SMS narrative intervention to increase participation in the NBCSP. The results will inform decisions about the need for and design of a larger, multi-state trial of this SMS intervention to determine its cost-effectiveness and future implementation. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ACTRN12620001020976 . Registered on 17 October 2020.
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Affiliation(s)
- Anna Wood
- Centre for Cancer Research, University of Melbourne, Melbourne, Australia
- Department of General Practice, University of Melbourne, Melbourne, Australia
| | - Jon D. Emery
- Centre for Cancer Research, University of Melbourne, Melbourne, Australia
- Department of General Practice, University of Melbourne, Melbourne, Australia
| | - Mark Jenkins
- Melbourne School of Population and Global Health, Centre for Epidemiology and Biostatistics, University of Melbourne, Melbourne, Australia
| | - Patty Chondros
- Department of General Practice, University of Melbourne, Melbourne, Australia
| | | | | | | | - Tony Cowie
- Cancer Council Victoria, Melbourne, Australia
| | - Ian Dixon
- Consumer representative. Healthily Pty Ltd, Melbourne, Australia
| | - Julie Toner
- Consumer representative. Healthily Pty Ltd, Melbourne, Australia
| | - Hourieh Khalajzadeh
- Department of Software Systems & Cybersecurity, Monash University, Melbourne, Australia
| | - Javiera Martinez Gutierrez
- Centre for Cancer Research, University of Melbourne, Melbourne, Australia
- Department of General Practice, University of Melbourne, Melbourne, Australia
- Department of Family Medicine, School of Medicine, Pontificia Universidad Católica de Chile, Región Metropolitana, Chile
| | - Linda Govan
- Western Victoria Primary Health Network Ltd, Ballarat, Australia
| | | | - Jennifer G. McIntosh
- Centre for Cancer Research, University of Melbourne, Melbourne, Australia
- Department of Software Systems & Cybersecurity, Monash University, Melbourne, Australia
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Khunti K, Griffin S, Brennan A, Dallosso H, Davies M, Eborall H, Edwardson C, Gray L, Hardeman W, Heathcote L, Henson J, Morton K, Pollard D, Sharp S, Sutton S, Troughton J, Yates T. Behavioural interventions to promote physical activity in a multiethnic population at high risk of diabetes: PROPELS three-arm RCT. Health Technol Assess 2022; 25:1-190. [PMID: 34995176 DOI: 10.3310/hta25770] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Type 2 diabetes is a leading cause of mortality globally and accounts for significant health resource expenditure. Increased physical activity can reduce the risk of diabetes. However, the longer-term clinical effectiveness and cost-effectiveness of physical activity interventions in those at high risk of type 2 diabetes is unknown. OBJECTIVES To investigate whether or not Walking Away from Diabetes (Walking Away) - a low-resource, 3-hour group-based behavioural intervention designed to promote physical activity through pedometer use in those with prediabetes - leads to sustained increases in physical activity when delivered with and without an integrated mobile health intervention compared with control. DESIGN Three-arm, parallel-group, pragmatic, superiority randomised controlled trial with follow-up conducted at 12 and 48 months. SETTING Primary care and the community. PARTICIPANTS Adults whose primary care record included a prediabetic blood glucose measurement recorded within the past 5 years [HbA1c ≥ 42 mmol/mol (6.0%), < 48 mmol/mol (6.5%) mmol/mol; fasting glucose ≥ 5.5 mmol/l, < 7.0 mmol/l; or 2-hour post-challenge glucose ≥ 7.8 mmol/l, < 11.1 mmol/l] were recruited between December 2013 and February 2015. Data collection was completed in July 2019. INTERVENTIONS Participants were randomised (1 : 1 : 1) using a web-based tool to (1) control (information leaflet), (2) Walking Away with annual group-based support or (3) Walking Away Plus (comprising Walking Away, annual group-based support and a mobile health intervention that provided automated, individually tailored text messages to prompt pedometer use and goal-setting and provide feedback, in addition to biannual telephone calls). Participants and data collectors were not blinded; however, the staff who processed the accelerometer data were blinded to allocation. MAIN OUTCOME MEASURES The primary outcome was accelerometer-measured ambulatory activity (steps per day) at 48 months. Other objective and self-reported measures of physical activity were also assessed. RESULTS A total of 1366 individuals were randomised (median age 61 years, median body mass index 28.4 kg/m2, median ambulatory activity 6638 steps per day, women 49%, black and minority ethnicity 28%). Accelerometer data were available for 1017 (74%) and 993 (73%) individuals at 12 and 48 months, respectively. The primary outcome assessment at 48 months found no differences in ambulatory activity compared with control in either group (Walking Away Plus: 121 steps per day, 97.5% confidence interval -290 to 532 steps per day; Walking Away: 91 steps per day, 97.5% confidence interval -282 to 463). This was consistent across ethnic groups. At the intermediate 12-month assessment, the Walking Away Plus group had increased their ambulatory activity by 547 (97.5% confidence interval 211 to 882) steps per day compared with control and were 1.61 (97.5% confidence interval 1.05 to 2.45) times more likely to achieve 150 minutes per week of objectively assessed unbouted moderate to vigorous physical activity. In the Walking Away group, there were no differences compared with control at 12 months. Secondary anthropometric, biomechanical and mental health outcomes were unaltered in either intervention study arm compared with control at 12 or 48 months, with the exception of small, but sustained, reductions in body weight in the Walking Away study arm (≈ 1 kg) at the 12- and 48-month follow-ups. Lifetime cost-effectiveness modelling suggested that usual care had the highest probability of being cost-effective at a threshold of £20,000 per quality-adjusted life-year. Of 50 serious adverse events, only one (myocardial infarction) was deemed possibly related to the intervention and led to the withdrawal of the participant from the study. LIMITATIONS Loss to follow-up, although the results were unaltered when missing data were replaced using multiple imputation. CONCLUSIONS Combining a physical activity intervention with text messaging and telephone support resulted in modest, but clinically meaningful, changes in physical activity at 12 months, but the changes were not sustained at 48 months. FUTURE WORK Future research is needed to investigate which intervention types, components and features can help to maintain physical activity behaviour change over the longer term. TRIAL REGISTRATION Current Controlled Trials ISRCTN83465245. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 77. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Kamlesh Khunti
- Diabetes Research Centre, College of Medicine, Biological Sciences and Psychology, University of Leicester, Leicester, UK.,NIHR Applied Research Collaboration, East Midlands, UK
| | - Simon Griffin
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Cambridge, UK.,Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Alan Brennan
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Helen Dallosso
- NIHR Applied Research Collaboration, East Midlands, UK.,Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Melanie Davies
- Diabetes Research Centre, College of Medicine, Biological Sciences and Psychology, University of Leicester, Leicester, UK.,NIHR Leicester Biomedical Research Centre, Leicester, UK
| | - Helen Eborall
- Social Science Applied to Healthcare Improvement Research Group, Department of Health Sciences, University of Leicester, Leicester, UK
| | - Charlotte Edwardson
- Diabetes Research Centre, College of Medicine, Biological Sciences and Psychology, University of Leicester, Leicester, UK.,NIHR Leicester Biomedical Research Centre, Leicester, UK
| | - Laura Gray
- Biostatistics Research Group, Department of Health Sciences, University of Leicester, Leicester, UK
| | - Wendy Hardeman
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Laura Heathcote
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Joseph Henson
- Diabetes Research Centre, College of Medicine, Biological Sciences and Psychology, University of Leicester, Leicester, UK.,NIHR Leicester Biomedical Research Centre, Leicester, UK
| | - Katie Morton
- Behavioural Science Group, Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.,UKCRC Centre for Diet and Activity Research (CEDAR), MRC Epidemiology Unit, University of Cambridge, Cambridge, UK.,Innovia Technology Limited, Cambridge, UK
| | - Daniel Pollard
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Stephen Sharp
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - Stephen Sutton
- Behavioural Science Group, Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Jacqui Troughton
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Thomas Yates
- Diabetes Research Centre, College of Medicine, Biological Sciences and Psychology, University of Leicester, Leicester, UK.,NIHR Leicester Biomedical Research Centre, Leicester, UK
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Drew RJ, Morgan PJ, Collins CE, Callister R, Kay-Lambkin F, Kelly BJ, Young MD. Behavioral and Cognitive Outcomes of an Online Weight Loss Program for Men With Low Mood: A Randomized Controlled Trial. Ann Behav Med 2021; 56:1026-1041. [PMID: 34964449 DOI: 10.1093/abm/kaab109] [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] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Depression and obesity are major health concerns and commonly co-exist, but men rarely seek help for these conditions. SHED-IT: Recharge was a gender-tailored eHealth program for men that generated clinically meaningful improvements in weight and depressive symptoms. PURPOSE To evaluate behavioral and psychological outcomes from the SHED-IT: Recharge intervention designed for overweight/obese men with low mood. METHODS Overall, 125 men (18-70 years) with a BMI between 25 and 42 kg/m2 and depressive symptoms (PHQ-9 ≥ 5) were randomly allocated to SHED-IT: Recharge (n = 62) or wait-list control (n = 63) groups. The self-directed program targeted key health behaviors combined with online mental fitness modules based on cognitive behavioral therapy. Behavioral (e.g., physical activity) and psychological outcomes (e.g., cognitive flexibility) were assessed with validated measures at baseline, 3 months (post-test) and 6 months (follow-up). Intention-to-treat linear mixed models examined treatment effects, which were adjusted for covariates, and effect size estimated (Cohen's d). RESULTS At post-test, intervention men achieved small-to-medium improvements in several health behavior outcomes including moderate-to-vigorous physical activity, light physical activity, sedentary behavior, sleep, energy intake, portion size, and risky alcohol consumption (range, d = 0.3-0.5), when compared with the control group. Intervention effects were also observed for perceived physical self-worth, perceived physical strength, cognitive flexibility, and behavioral activation (range, d = 0.3-0.8). No effects were found for fruit and vegetable intake, or mindful attention. Most effects were maintained at follow-up. CONCLUSIONS This gender-tailored, eHealth program with integrated mental fitness support elicited meaningful improvements in health behaviors and psychological outcomes for men with low mood. Trial Registration: Australian New Zealand Clinical Trials Registry (ACTRN12619001209189).
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Affiliation(s)
- Ryan J Drew
- Priority Research Centre for Physical Activity and Nutrition, School of Education, College of Human and Social Futures, University of Newcastle, Callaghan, New South Wales, Australia
| | - Philip J Morgan
- Priority Research Centre for Physical Activity and Nutrition, School of Education, College of Human and Social Futures, University of Newcastle, Callaghan, New South Wales, Australia
| | - Clare E Collins
- Priority Research Centre for Physical Activity and Nutrition, School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia
| | - Robin Callister
- Priority Research Centre for Physical Activity and Nutrition, School of Biomedical Sciences and Pharmacy, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia
| | - Frances Kay-Lambkin
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia
| | - Brian J Kelly
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia
| | - Myles D Young
- Priority Research Centre for Physical Activity and Nutrition, School of Psychology, College of Engineering, Science and Environment, University of Newcastle, Callaghan, New South Wales, Australia
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Ferguson GM, Meeks Gardner JM, Nelson MR, Giray C, Sundaram H, Fiese BH, Koester B, Tran SP, Lewis RP. Food-Focused Media Literacy for Remotely Acculturating Adolescents and Mothers: A Randomized Controlled Trial of the "JUS Media? Programme". J Adolesc Health 2021; 69:1013-1023. [PMID: 34281754 PMCID: PMC8628116 DOI: 10.1016/j.jadohealth.2021.06.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 06/04/2021] [Accepted: 06/07/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Unhealthy eating is a major modifiable risk factor for noncommunicable diseases and obesity, and remote acculturation to U.S. culture is a recently identified cultural determinant of unhealthy eating among adolescents and families in low/middle-income countries. This small-scale randomized controlled trial evaluated the efficacy of the "JUS Media? Programme," a food-focused media literacy intervention promoting healthier eating among remotely acculturating adolescents and mothers in Jamaica. METHODS Gender-stratified randomization of 184 eligible early adolescents and mothers in Kingston, Jamaica (i.e., 92 dyads: Madolescent.age = 12.79 years, 51% girls) determined 31 "Workshops-Only" dyads, 30 "Workshops + SMS/texting" dyads, and 31 "No-Intervention-Control" dyads. Nutrition knowledge (food group knowledge), nutrition attitudes (stage of nutritional change), and nutrition behavior (24-hour recall) were primary outcomes assessed at four time points (T1/baseline, T2, T3, T4) across 5 months using repeated measures analysis of covariances. RESULTS Compared to control, families in one or both intervention groups demonstrated significantly higher nutrition knowledge (T3 adolescents, T4 mothers: mean differences .79-1.08 on a 0-6 scale, 95% confidence interval [CI] .12-1.95, Cohen's ds = .438-.630); were more prepared to eat fruit daily (T3 adolescents and mothers: .36-.41 on a 1-5 scale, 95% CI .02-.77, ds = .431-.493); and were eating more cooked vegetables (T4 adolescents and T2 and T4 mothers: .20-.26 on a 0-1 scale, 95% CI -.03-.50, ds = .406-.607). Postintervention focus groups (6-month-delay) revealed major positive impacts on participants' health and lives more broadly. CONCLUSIONS A food-focused media literacy intervention for remotely acculturating adolescents and mothers can improve nutrition. Replication in Jamaica and extension to the Jamaican diaspora would be useful.
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Affiliation(s)
- Gail M. Ferguson
- University of Minnesota,Corresponding Author: Gail M. Ferguson, Ph.D., Institute of Child Development, University of Minnesota, 51 E. River Road, ChDev Rm 160, Minneapolis, MN 55455, , Phone: +1 (612) 626-3033
- Fax: +1 (612) 624-6373
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Edge D, Newbold A, Ehring T, Rosenkranz T, Frost M, Watkins ER. Reducing worry and rumination in young adults via a mobile phone app: study protocol of the ECoWeB (Emotional Competence for Well-Being in Young Adults) randomised controlled trial focused on repetitive negative thinking. BMC Psychiatry 2021; 21:519. [PMID: 34674669 PMCID: PMC8532278 DOI: 10.1186/s12888-021-03536-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 10/12/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Promoting well-being and preventing poor mental health in young people is a major global priority. Building emotional competence skills via a mobile app may be an effective, scalable and acceptable way to do this. A particular risk factor for anxiety and depression is elevated worry and rumination (repetitive negative thinking, RNT). An app designed to reduce RNT may prevent future incidence of depression and anxiety. METHOD/DESIGN The Emotional Competence for Well-Being in Young Adults study developed an emotional competence app to be tested via randomised controlled trials in a longitudinal prospective cohort. This off-shoot study adapts the app to focus on targeting RNT (worry, rumination), known risk factors for poor mental health. In this study, 16-24 year olds in the UK, who report elevated worry and rumination on standardised questionnaires are randomised to (i) receive the RNT-targeting app immediately for 6 weeks (ii) a waiting list control who receive the app after 6 weeks. In total, the study will aim to recruit 204 participants, with no current diagnosis of major depression, bipolar disorder or psychosis, across the UK. Assessments take place at baseline (pre-randomisation), 6 and 12 weeks post-randomisation. Primary endpoint and outcome for the study is level of rumination assessed on the Rumination Response Styles Questionnaire at 6 weeks. Worry, depressive symptoms, anxiety symptoms and well-being are secondary outcomes. Compliance, adverse events and potentially mediating variables will be carefully monitored. DISCUSSION This trial aims to better understand the benefits of tackling RNT via an mobile phone app intervention in young people. This prevention mechanism trial will establish whether targeting worry and rumination directly via an app provides a feasible approach to prevent depression and anxiety, with scope to become a widescale public health strategy for preventing poor mental health and promoting well-being in young people. TRIAL REGISTRATION ClinicalTrials.gov , NCT04950257 . Registered 6 July 2021 - Retrospectively registered.
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Affiliation(s)
- Daniel Edge
- grid.8391.30000 0004 1936 8024Mood Disorders Centre, School of Psychology, University of Exeter, Exeter, EX4 4LN UK
| | - Alexandra Newbold
- grid.8391.30000 0004 1936 8024Mood Disorders Centre, School of Psychology, University of Exeter, Exeter, EX4 4LN UK
| | | | | | | | - Edward R. Watkins
- grid.8391.30000 0004 1936 8024Mood Disorders Centre, School of Psychology, University of Exeter, Exeter, EX4 4LN UK
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Doets JJR, Topper M, Nugter AM. A systematic review and meta-analysis of the effect of whole body cryotherapy on mental health problems. Complement Ther Med 2021; 63:102783. [PMID: 34655758 DOI: 10.1016/j.ctim.2021.102783] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 09/26/2021] [Accepted: 10/12/2021] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To give an overview of the nature and methodological quality of studies on whole body cryotherapy (WBC) as add-on intervention for mental health problems. METHODS A meta-analysis according to PRISMA guidelines was conducted (Prospero registration: CRD42020167443). Databases MEDLINE, PsycINFO and the Cochrane Library were searched. Risk of bias was scored according to the Cochrane ROBINS-I-tool to which an extra bias-dimension of allegiance bias was added. Within and between Hedges' g pooled effect sizes were calculated for the main aspect of mental health measured. Treatment efficacy was examined using a random effects model. Heterogeneity was examined through identification of visual outliers and by I2 statistics. RESULTS Out of 196 articles coming up from the search, ten studies met all inclusion criteria, six of which were (randomized) controlled trials. Together these studies report on a total of 294 participants receiving WBC. The within-group pooled effect size for mental health problems is large (Hedges' g = 1.63, CI: 1.05-2.21), with high heterogeneity (I2 = 93%). Subgroup analyses on depressive symptoms and quality of life (QOL) showed a diminution of heterogeneity to moderate. Effect sizes for depressive symptoms are very large (Hedges' g = 2.95, CI: 2.44-3.45) and for QOL medium (Hedges' g = 0.70, CI: 0.15-1.24). The between-group pooled effect size is medium (Hedges' g = 0.76, CI: 0.17-1.36). CONCLUSIONS Results indicate preliminary evidence for WBC as efficacious add-on intervention for mental health problems, especially depressive symptoms. Further research in the form of RCTs with larger numbers of participants is needed.
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Affiliation(s)
- Julia J R Doets
- Department of Anxiety Disorders, Mental Health Service Organization 'GGZ Noord-Holland-Noord', Alkmaar, The Netherlands.
| | - Maurice Topper
- Department of Research, Mental Health Service Organization 'GGZ Noord-Holland-Noord', Heerhugowaard, The Netherlands
| | - Annet M Nugter
- Department of Research, Mental Health Service Organization 'GGZ Noord-Holland-Noord', Heerhugowaard, The Netherlands
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Namaky N, Glenn JJ, Eberle JW, Teachman BA. Adapting cognitive bias modification to train healthy prospection. Behav Res Ther 2021; 144:103923. [PMID: 34280584 DOI: 10.1016/j.brat.2021.103923] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 04/16/2021] [Accepted: 06/29/2021] [Indexed: 11/25/2022]
Abstract
Prospection, the mental simulation of future events, has been theoretically linked to physical and mental health. Prior studies have found that prospection is malleable; however, no research to our knowledge has tested whether a scalable intervention explicitly targeting the simulation of positive future outcomes can lead to more generalized positive prospection, and enhance positive outlook and reduce distress. The current study tested a novel, web-based cognitive bias modification for interpretation (CBM-I) program designed to shift prospective bias towards more positive (as opposed to negative) representations of future outcomes among 172 participants selected for having a relatively negative baseline expectancy bias. Results showed that following CBM-I, participants in active training conditions exhibited more positive expectations about the future, and increased self-efficacy and growth mindset. Also, optimism increased and depression and anxiety symptoms decreased following active training, but this also occurred for the control condition. Analyses did not suggest that changes in positive expectations mediated changes in positive outlook outcomes. Results suggest that an online prospection intervention can lead to more positive expectations about future events and improve positive outlook, though open questions remain about what accounts for the training effects.
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Affiliation(s)
| | - Jeffrey J Glenn
- University of Virginia, United States; Durham Veterans Affairs Health Care System, United States; VA Mid-Atlantic Mental Illness Research, Education and Clinical Center (VISN 6 MIRECC), United States
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Enhancing Planning Behavior during Retirement: Effects of a Time Perspective Based Training Intervention. SOCIAL SCIENCES 2021. [DOI: 10.3390/socsci10080306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Time perspective is a psychological construct that reflects the way people view time. Two schools of thought exist that theorize how this temporal mindset affects behavior—dominant and balanced. We applied dominant and balanced time perspective frameworks separately to two versions of an online intervention that aimed to promote goal-setting and accumulation of essential retirement resources (health, physical, social, cognitive and emotional) and compared effects with a control group. The effectiveness of the intervention was tested with 109 US retirees using a 4-wave design over a 6-month period. Linear mixed models showed an increase in health goal striving for the balanced group at posttraining and gains were maintained at the 3-month time point. Both training groups demonstrated an increase in the number and specificity of goals at posttraining and 3-months. Applying a time perspective framework to an online planning intervention for retirees shows promise in promoting planning for retirement resources. Practical implications, limitations, and suggestions for developing future interventions are discussed.
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Effect of a parenting intervention on decreasing adolescents' behavioral problems via reduction in attachment insecurity: A longitudinal, multicenter, randomized controlled trial. J Adolesc 2021; 91:82-96. [PMID: 34352497 DOI: 10.1016/j.adolescence.2021.07.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 07/25/2021] [Accepted: 07/29/2021] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Secure attachment in adolescence, related to caregiving quality, is a robust predictor of positive behavioral adjustment in early adulthood and beyond. Nevertheless, few attempts have been made to develop treatments to promote parent-adolescent attachment security. METHODS Using a longitudinal, multicenter, randomized controlled trial design, two questionnaire-based studies were run in Italy (Study 1: n = 100 mothers of adolescents, 60% boys, Mage = 14.89, SD = 1.58; Study 2: n = 40 mothers and 40 adolescents, 60% boys, Mage = 14.90, SD = 1.91) to test the effectiveness of an attachment-based parenting intervention (i.e., Connect) in reducing adolescents' behavioral problems and attachment insecurity 2 weeks post-intervention (t2) and at a 4-month follow-up (t3). It was further investigated whether a decrease in avoidant and anxious attachment at t2 would account for changes in externalizing and internalizing problems, respectively, at t3. All adolescents belonged to two-parent intact families. RESULTS Mothers who completed Connect reported significantly fewer adolescent behavioral problems and lower adolescent attachment insecurity, compared to mothers in the waitlist group, at both t2 and t3 (Study 1). These findings were confirmed in a second subsample (Study 2), considering both mothers' and adolescents' reports. Controlling for pre-intervention behavioral problems, reductions in internalizing and externalizing problems were observed in both studies at t3 via a decrease in anxious and avoidant attachment, respectively, at t2. CONCLUSIONS The findings point to the malleability of attachment security in adolescence and highlight the importance of targeting parenting quality to promote adolescent behavioral adjustment.
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Östbring MJ, Eriksson T, Petersson G, Hellström L. Effects of a pharmaceutical care intervention on clinical outcomes and patient adherence in coronary heart disease: the MIMeRiC randomized controlled trial. BMC Cardiovasc Disord 2021; 21:367. [PMID: 34334142 PMCID: PMC8327441 DOI: 10.1186/s12872-021-02178-0] [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] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 07/23/2021] [Indexed: 01/22/2023] Open
Abstract
Background In the treatment of coronary heart disease, secondary prevention goals are still often unmet and poor adherence to prescribed drugs has been suggested as one of the reasons. We aimed to investigate whether pharmaceutical care by a pharmacist at the cardiology clinic trained in motivational interviewing improves clinical outcomes and patient adherence. Methods This was a prospective, randomized, controlled, outcomes-blinded trial designed to compare pharmaceutical care follow-up with standard care. After standard follow-up at the cardiology clinic, patients in the intervention group were seen by a clinical pharmacist two to five times as required over seven months. Pharmacists were trained to use motivational interviewing in the consultations and they tailored their support to each patient’s clinical needs and beliefs about medicines. The primary study end-point was the proportion of patients who reached the treatment goal for low-density lipoprotein cholesterol by 12 months after discharge. The key secondary outcome was patient adherence to lipid-lowering therapy at 15 months after discharge, and other secondary outcomes were the effects on patient adherence to other preventive drugs, systolic blood pressure, disease-specific quality of life, and healthcare use. Results 316 patients were included. The proportion of patients who reached the target for low-density lipoprotein cholesterol were 37.0% in the intervention group and 44.2% in the control group (P = .263). More intervention than control patients were adherent to cholesterol-lowering drugs (88 vs 77%; P = .033) and aspirin (97 vs 91%; P = .036) but not to beta-blocking agents or renin–angiotensin–aldosterone system inhibitors. Conclusions Our intervention had no positive effects on risk factors for CHD, but it increased patient adherence. Further investigation of the intervention process is needed to explore the difference in results between patient adherence and medication effects. Longer follow-up of healthcare use and mortality will determine if the increased adherence per se eventually will have a meaningful effect on patient health. Trial registration: ClinicalTrials.gov NCT02102503, 03/04/2014 retrospectively registered. Supplementary Information The online version contains supplementary material available at 10.1186/s12872-021-02178-0.
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Affiliation(s)
- Malin Johansson Östbring
- eHealth Institute, Department of Medicine and Optometry, Linnaeus University, Kalmar, Sweden. .,Pharmaceutical Department, Region Kalmar County, Building 2, floor 2, County Council Hospital, 391 85, Kalmar, Sweden.
| | - Tommy Eriksson
- Department of Biomedical Science, and Biofilm - Research Center for Biointerfaces, Malmö University, Malmö, Sweden
| | - Göran Petersson
- eHealth Institute, Department of Medicine and Optometry, Linnaeus University, Kalmar, Sweden
| | - Lina Hellström
- eHealth Institute, Department of Medicine and Optometry, Linnaeus University, Kalmar, Sweden.,Pharmaceutical Department, Region Kalmar County, Building 2, floor 2, County Council Hospital, 391 85, Kalmar, Sweden
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An RCT of a decision aid to support informed choices about taking aspirin to prevent colorectal cancer and other chronic diseases: a study protocol for the SITA (Should I Take Aspirin?) trial. Trials 2021; 22:452. [PMID: 34266464 PMCID: PMC8280579 DOI: 10.1186/s13063-021-05365-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 06/09/2021] [Indexed: 12/21/2022] Open
Abstract
Background Australian guidelines recommend that all people aged 50–70 years old actively consider taking daily low-dose aspirin (100–300 mg per day) for 2.5 to 5 years to reduce their risk of colorectal cancer (CRC). Despite the change of national CRC prevention guidelines, there has been no active implementation of the guidelines into clinical practice. We aim to test the efficacy of a health consultation and decision aid, using a novel expected frequency tree (EFT) to present the benefits and harms of low dose aspirin prior to a general practice consultation with patients aged 50–70 years, on informed decision-making and uptake of aspirin. Methods Approximately five to seven general practices in Victoria, Australia, will be recruited to participate. Patients 50–70 years old, attending an appointment with their general practitioner (GP) for any reason, will be invited to participate in the trial. Two hundred fifty-eight eligible participants will be randomly allocated 1:1 to intervention or active control arms using a computer-generated allocation sequence stratified by general practice, sex, and mode of trial delivery (face-to-face or teletrial). There are two co-primary outcomes: informed decision-making at 1-month post randomisation, measured by the Multi-dimensional Measure of Informed Choice (MMIC), and self-reported daily use of aspirin at 6 months. Secondary outcomes include decisional conflict at 1-month and other behavioural changes to reduce CRC risk at both time points. Discussion This trial will test the efficacy of novel methods for implementing national guidelines to support informed decision-making about taking aspirin in 50–70-year-olds to reduce the risk of CRC and other chronic diseases. Trial registration The Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12620001003965. Registered on 10 October 2020. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-021-05365-8.
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Mavilidi MF, Vazou S. Classroom-based physical activity and math performance: Integrated physical activity or not? Acta Paediatr 2021; 110:2149-2156. [PMID: 33780563 DOI: 10.1111/apa.15860] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 02/19/2021] [Accepted: 03/26/2021] [Indexed: 01/11/2023]
Abstract
AIM This 8-week intervention examined the effect of two different types of classroom-based physical activity on math performance in elementary school children. METHODS Students in 4th and 5th grade (N = 560; 32 classes, 9-11 years old) from six schools were assigned to integrated physical activity (Move for Thought [M4T], n = 221), activity break (AB; n = 134) and a control group (n = 205; usual instruction) for eight weeks. Students completed a standardised math test before and after the intervention. Programme fidelity was measured with a teacher daily log, recording the duration and frequency of the physical activity sessions. Linear mixed models were used for the analyses. Grade and gender were explored as moderators. RESULTS Move for Thought group outperformed AB (p < 0.001, d = 0.44) and control groups (p = 0.013, d = 0.38). However, subgroup analyses showed that these effects were evident only in Grade 4. No gender differences were found. Intervention fidelity showed that the classroom-based physical activities (M4T and AB) were used about every other day, with higher implementation among 4th graders. CONCLUSION This study indicated that integrating physical activity with mathematics has stronger effects on mathematics than activity breaks and traditional instruction.
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Affiliation(s)
- Myrto F. Mavilidi
- Early Start, School of Education University of Wollongong Keiraville NSW Australia
- Illawarra Health and Medical Research Institute Keiraville NSW Australia
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Delage C, Lelong H, Brion F, Blacher J. Effect of a pharmacist-led educational intervention on clinical outcomes: a randomised controlled study in patients with hypertension, type 2 diabetes and hypercholesterolaemia. Eur J Hosp Pharm 2021; 28:e197-e202. [PMID: 34183458 DOI: 10.1136/ejhpharm-2021-002787] [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: 03/08/2021] [Accepted: 06/15/2021] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES In recent years, hospital pharmacists have gained more importance in the clinical support of patients. However, most of the studies evaluating the impact of clinical pharmacy have only studied patients' adherence or satisfaction. The aim of this study was to evaluate the direct clinical outcomes of a pharmacist-led educational intervention in patients with chronic disease. METHODS We conducted a randomised, controlled, parallel, physician-blinded study in a day hospital and a consultation unit of a French teaching hospital over a 1-year period. Patients with hypertension, type 2 diabetes or hypercholesterolaemia who did not reach their therapeutic goals despite drug therapy were eligible. Patients in the intervention group received an intervention from a hospital pharmacist who provided patient education on pathology and drug management. The primary outcome was the proportion of patients reaching their therapeutic goals for blood pressure, glycated haemoglobin level or low-density lipoprotein cholesterol level at the 3-month follow-up consultation. RESULTS From January to December 2015, 89 patients were included and 73 completed the study. In the intervention group, 61.7% (21/34) of the patients reached their therapeutic goals compared with 33.3% (13/39) in the control group (p=0.015). The intervention was significantly more effective in polypharmacy patients (60.0% (12/20) vs 16.7% (4/24); p=0.005), in those aged >60 years (57.9% (11/19) vs 26.1% (6/23); p=0.037) and in patients with a high education level (68.8% (11/16) vs 29.4% (5/17); p=0.024). CONCLUSION A single pharmacist-led educational intervention has a clinical impact, doubling the proportion of patients reaching their therapeutic goals at 3 months, especially in polypharmacy patients and those aged >60 years. This study confirms the value of clinical involvement of hospital pharmacists in patient care in a consultation unit and day hospital.
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Affiliation(s)
- Clement Delage
- Diagnosis and Therapeutic Center, Hypertension and Cardiovascular Prevention Unit, Hôtel-Dieu Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, Île-de-France, France .,Université de Paris, Faculté de Pharmacie, Paris, Île-de-France, France
| | - Hélène Lelong
- Diagnosis and Therapeutic Center, Hypertension and Cardiovascular Prevention Unit, Hôtel-Dieu Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, Île-de-France, France.,Université de Paris, Faculté de Médecine, Paris, Île-de-France, France
| | - Francoise Brion
- Université de Paris, Faculté de Pharmacie, Paris, Île-de-France, France
| | - Jacques Blacher
- Diagnosis and Therapeutic Center, Hypertension and Cardiovascular Prevention Unit, Hôtel-Dieu Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, Île-de-France, France.,Université de Paris, Faculté de Médecine, Paris, Île-de-France, France
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Tackney MS, Cook DG, Stahl D, Ismail K, Williamson E, Carpenter J. A framework for handling missing accelerometer outcome data in trials. Trials 2021; 22:379. [PMID: 34090494 PMCID: PMC8178870 DOI: 10.1186/s13063-021-05284-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 04/20/2021] [Indexed: 11/10/2022] Open
Abstract
Accelerometers and other wearable devices are increasingly being used in clinical trials to provide an objective measure of the impact of an intervention on physical activity. Missing data are ubiquitous in this setting, typically for one of two reasons: patients may not wear the device as per protocol, and/or the device may fail to collect data (e.g. flat battery, water damage). However, it is not always possible to distinguish whether the participant stopped wearing the device, or if the participant is wearing the device but staying still. Further, a lack of consensus in the literature on how to aggregate the data before analysis (hourly, daily, weekly) leads to a lack of consensus in how to define a "missing" outcome. Different trials have adopted different definitions (ranging from having insufficient step counts in a day, through to missing a certain number of days in a week). We propose an analysis framework that uses wear time to define missingness on the epoch and day level, and propose a multiple imputation approach, at the day level, which treats partially observed daily step counts as right censored. This flexible approach allows the inclusion of auxiliary variables, and is consistent with almost all the primary analysis models described in the literature, and readily allows sensitivity analysis (to the missing at random assumption) to be performed. Having presented our framework, we illustrate its application to the analysis of the 2019 MOVE-IT trial of motivational interviewing to increase exercise.
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Affiliation(s)
- Mia S. Tackney
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - Derek G. Cook
- Population Health Research Institute, St George’s, University of London, London, UK
| | - Daniel Stahl
- Department of Biostatistics & Health Informatics, King’s College London, London, UK
| | - Khalida Ismail
- Department of Psychological Medicine, King’s College London, London, UK
| | - Elizabeth Williamson
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - James Carpenter
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
- MRC Clinical Trials Unit, University College London, London, UK
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