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Walker ME, De Matteis R, Perretti M, Dalli J. Resolvin T4 enhances macrophage cholesterol efflux to reduce vascular disease. Nat Commun 2024; 15:975. [PMID: 38316794 PMCID: PMC10844649 DOI: 10.1038/s41467-024-44868-1] [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: 06/28/2020] [Accepted: 01/08/2024] [Indexed: 02/07/2024] Open
Abstract
While cardiovascular disease (CVD) is one of the major co-morbidities in patients with rheumatoid arthritis (RA), the mechanism(s) that contribute to CVD in patients with RA remain to be fully elucidated. Herein, we observe that plasma concentrations of 13-series resolvin (RvT)4 negatively correlate with vascular lipid load in mouse inflammatory arthritis. Administration of RvT4 to male arthritic mice fed an atherogenic diet significantly reduces atherosclerosis. Assessment of the mechanisms elicited by this mediator demonstrates that RvT4 activates cholesterol efflux in lipid laden macrophages via a Scavenger Receptor class B type 1 (SR-BI)-Neutral Cholesterol Ester Hydrolase-dependent pathway. This leads to the reprogramming of lipid laden macrophages yielding tissue protection. Pharmacological inhibition or knockdown of macrophage SR-BI reverses the vasculo-protective activities of RvT4 in vitro and in male mice in vivo. Together these findings elucidate a RvT4-SR-BI centered mechanism that orchestrates macrophage responses to limit atherosclerosis during inflammatory arthritis.
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Affiliation(s)
- Mary E Walker
- William Harvey Research Institute, Faculty of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK
| | - Roberta De Matteis
- William Harvey Research Institute, Faculty of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK
| | - Mauro Perretti
- William Harvey Research Institute, Faculty of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK
- Centre for Inflammation and Therapeutic Innovation, Queen Mary University of London, London, UK
| | - Jesmond Dalli
- William Harvey Research Institute, Faculty of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK.
- Centre for Inflammation and Therapeutic Innovation, Queen Mary University of London, London, UK.
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Almutary H. A Cross-sectional Study of Depression among Non-dialysis Stage 3-5 Chronic Kidney Disease Patients. SAUDI JOURNAL OF KIDNEY DISEASES AND TRANSPLANTATION 2022; 33:535-542. [PMID: 37929546 DOI: 10.4103/1319-2442.388188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023] Open
Abstract
Depression is common among patients undergoing dialysis. However, there is a dearth of data on depression and its predictors among patients at different stages of chronic kidney disease (CKD). This study assessed the prevalence of depression and the relationships between depression and sociodemographic and clinical factors among non-dialysis CKD patients. A convenience sample of 88 CKD patients was recruited using a cross-sectional study design. The Beck Depression Inventory-II (BDI-II) was used to assess the levels of depression among CKD patients, with a cutoff score of ≥11. Data on the sociodemographic factors and clinical factors were also collected. Inferential statistics were used to determine the characteristics of the sample and assess the prevalence and severity of depression. Multiple regression analysis was used to assess the associations between the characteristics of the sample and depression. The overall mean BDI-II score was 6.23 ± 6.13. With a cutoff score of ≥11, patients with major depressive episodes constituted 18.2% of the sample. Stages of the disease, comorbidities, and sex were independently associated with a high depression score. The model explained 39% of the variation in the depression score. Depression is common among non-dialysis CKD patients. Screening for depression with brief validated tools should be integrated into routine clinical practice at renal clinics because patients in the advanced stages of CKD and those with multiple comorbidities require close attention. Furthermore, large studies assessing the prevalence and predictors of depression among different stages of CKD are required.
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Affiliation(s)
- Hayfa Almutary
- Medical Surgical Nursing Department, Faculty of Nursing, King Abdulaziz University, Jeddah, Saudi Arabia
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Daw P, Harrison A, Doherty PJ, van Zanten JJCSV, Dalal HM, Taylor RS, van Beurden SB, McDonagh STJ, Greaves CJ. A pragmatic effectiveness-implementation study comparing trial evidence with routinely collected outcome data for patients receiving the REACH-HF home-based cardiac rehabilitation programme. BMC Cardiovasc Disord 2022; 22:270. [PMID: 35710336 PMCID: PMC9202968 DOI: 10.1186/s12872-022-02707-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 06/02/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Cardiac rehabilitation for heart failure continues to be greatly underused worldwide despite being a Class I recommendation in international clinical guidelines and uptake is low in women and patients with mental health comorbidities. METHODS Rehabilitation EnAblement in CHronic Heart Failure (REACH-HF) programme was implemented in four UK National Health Service early adopter sites ('Beacon Sites') between June 2019 and June 2020. Implementation and patient-reported outcome data were collected across sites as part of the National Audit of Cardiac Rehabilitation. The change in key outcomes before and after the supervised period of REACH-HF intervention across the Beacon Sites was assessed and compared to those of the intervention arm of the REACH-HF multicentre trial. RESULTS Compared to the REACH-HF multicentre trial, patients treated at the Beacon Site were more likely to be female (33.8% vs 22.9%), older (75.6 vs 70.1), had a more severe classification of heart failure (26.5% vs 17.7%), had poorer baseline health-related quality of life (MLHFQ score 36.1 vs 31.4), were more depressed (HADS score 6.4 vs 4.1) and anxious (HADS score 7.2 vs 4.7), and had lower exercise capacity (ISWT distance 190 m vs 274.7 m). There appeared to be a substantial heterogeneity in the implementation process across the four Beacon Sites as evidenced by the variation in levels of patient recruitment, operationalisation of the REACH-HF intervention and patient outcomes. Overall lower improvements in patient-reported outcomes at the Beacon Sites compared to the trial may reflect differences in the population studied (having higher morbidity at baseline) as well as the marked challenges in intervention delivery during the COVID-19 pandemic. CONCLUSION The results of this study illustrate the challenges in consistently implementing an intervention (shown to be clinically effective and cost-effective in a multicentre trial) into real-world practice, especially in the midst of a global pandemic. Further research is needed to establish the real-world effectiveness of the REACH-HF intervention in different populations.
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Affiliation(s)
- Paulina Daw
- grid.6572.60000 0004 1936 7486School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Edgbaston, B15 2TT UK
| | - Alexander Harrison
- grid.5685.e0000 0004 1936 9668Health Sciences, University of York, York, UK
| | - Patrick J. Doherty
- grid.5685.e0000 0004 1936 9668Health Sciences, University of York, York, UK
| | | | - Hasnain M. Dalal
- grid.416116.50000 0004 0391 2873University of Exeter Medical School, Royal Cornwall Hospital, Truro, UK
- grid.8391.30000 0004 1936 8024Primary Care Research Group, University of Exeter Medical School, St Luke’s Campus, Exeter, UK
| | - Rod S. Taylor
- grid.8756.c0000 0001 2193 314XMRC/CSO Social and Public Health Sciences Unit & Robertson Centre for Biostatistics, Institute of Health and Well Being, University of Glasgow, Glasgow, UK
| | - Samantha B. van Beurden
- grid.8391.30000 0004 1936 8024College of Medicine and Health, University of Exeter, Exeter, UK
| | - Sinéad T. J. McDonagh
- grid.8391.30000 0004 1936 8024Primary Care Research Group, College of Medicine and Health, University of Exeter, St Luke’s Campus, Exeter, UK
| | - Colin J. Greaves
- grid.6572.60000 0004 1936 7486School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Edgbaston, B15 2TT UK
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Vereecke S, Sorensen K, Zhu J, Liu D, Jiao F, Wang X, Wang S, Zhou X, Duan X, Liu Y, Wang J. The impact of physical conditions on the incidence of major depressive disorder in Chinese university students: Results from a longitudinal study. J Affect Disord 2022; 303:301-305. [PMID: 35176340 DOI: 10.1016/j.jad.2022.02.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 01/09/2022] [Accepted: 02/13/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND Major depressive disorder (MDD) is prevalent, and highly comorbid with physical illnesses. Few longitudinal studies have investigated the relationship between physical health conditions and MDD. The objectives of this study were to investigate the comorbid relationship between physical conditions and MDD, and the association between physical conditions and the 2-year risk of MDD. METHODS A study was conducted in first-year Chinese university students (n = 8,079) over two and half years, using a longitudinal design. An adapted version of the Composite International Diagnostic Interview (CIDI - 3.0) was used to assess for MDD. The presence of physician diagnosed physical conditions was assessed using ten self-report questions. Cross-sectional and longitudinal associations between self-reported physical conditions and MDD were estimated, adjusting for possible confounders. RESULTS The most frequently reported physical conditions were migraines, chronic rhinitis, and gastritis. We found that migraines, gastritis, and stomach ulcers were associated with a significantly higher lifetime prevalence of MDD than those without any physical health conditions. In those without a lifetime MDD, migraines, gastritis and stomach ulcers were also found to be significant predictors for 2-year risk of new onset MDD. LIMITATIONS Recall and selection biases are possible when using self-reporting measures. Additionally, the COVID-19 outbreak impacted the response rate at the second follow-up assessment. Lastly, the severity of the physical conditions was not measured. CONCLUSIONS Physical conditions and MDD are highly prevalent and comorbid in university students. Migraines, gastritis and stomach ulcers are associated with the risk of developing MDD. Future studies should further investigate how this information can be used to prevent MDD.
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Affiliation(s)
- Shelby Vereecke
- School of Mental Health, Jining Medical University, Jining, China; Institute of Mental Health Research, University of Ottawa, Ottawa, Canada
| | - Krystina Sorensen
- School of Mental Health, Jining Medical University, Jining, China; Institute of Mental Health Research, University of Ottawa, Ottawa, Canada
| | - Jin Zhu
- Shandong Key Laboratory of Behavioral Medicine, School of Mental Health, Jining Medical University, Jining, China; Center of Evidence-Based Medicine, Jining Medical University, Jining, China
| | - Debiao Liu
- School of Mental Health, Jining Medical University, Jining, China
| | - Fengjuan Jiao
- Shandong Key Laboratory of Behavioral Medicine, School of Mental Health, Jining Medical University, Jining, China; Center of Evidence-Based Medicine, Jining Medical University, Jining, China
| | - Xin Wang
- Shandong Key Laboratory of Behavioral Medicine, School of Mental Health, Jining Medical University, Jining, China
| | - Shuai Wang
- Shandong Key Laboratory of Behavioral Medicine, School of Mental Health, Jining Medical University, Jining, China; Center of Evidence-Based Medicine, Jining Medical University, Jining, China
| | - Xuan Zhou
- Shandong Key Laboratory of Behavioral Medicine, School of Mental Health, Jining Medical University, Jining, China; Center of Evidence-Based Medicine, Jining Medical University, Jining, China
| | - Ximing Duan
- School of Mental Health, Jining Medical University, Jining, China; Shandong Key Laboratory of Behavioral Medicine, School of Mental Health, Jining Medical University, Jining, China
| | - Yan Liu
- Shandong Key Laboratory of Behavioral Medicine, School of Mental Health, Jining Medical University, Jining, China; Center of Evidence-Based Medicine, Jining Medical University, Jining, China.
| | - JianLi Wang
- School of Mental Health, Jining Medical University, Jining, China; Institute of Mental Health Research, University of Ottawa, Ottawa, Canada.; Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University..
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Helmark C, Harrison A, Pedersen SS, Doherty P. Systematic screening for anxiety and depression in cardiac rehabilitation - are we there yet? Int J Cardiol 2022; 352:65-71. [PMID: 35143875 DOI: 10.1016/j.ijcard.2022.02.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 01/21/2022] [Accepted: 02/04/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Anxiety and depression are prevalent in 20% of patients with acute coronary syndrome (ACS) and associated with poor outcomes. Guidelines recommend screening for these conditions in cardiac rehabilitation (CR) however, clinical practice is inconsistent. Sparse knowledge exists on determinants for screening. METHODS This observational study used data from the National Audit of Cardiac Rehabilitation from January 2016-December 2019. A multivariate logistic regression model was performed to analyze patient- and provider level determinants for screening for anxiety and depression among patients with ACS. RESULTS The population consisted of 138,018 patients, where 82,507 (59.8%) were screened and 55,511 (40.2%) were not. Younger age, non-white ethnicity, living in areas of social deprivation, current smoking, body mass index>30, and physical activity<150 min per week were negatively correlated with patients being screened. Compared to patients having a percutaneous coronary intervention, patients undergoing coronary artery bypass grafting or medical treatment were less likely to be screened. History of anxiety, depression, osteoporosis, chronic back problems, and asthma were positively correlated with screening, while chronic obstructive pulmonary disease, diabetes, hypertension, and stroke were negatively correlated with screening. Regarding provider level, certification of CR centers was positively associated with screening, while looking over time data showed an incremental negative trend in screening from 2016 to 2019. CONCLUSION We found both patient and provider level determinants of screening for anxiety and depression. Clinical practice is still inconsistent especially for high-risk groups. We recommend systematic screening to enable tailored interventions which in turn may mitigate inequity in health outcomes.
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Affiliation(s)
- Charlotte Helmark
- Department of Cardiology, Zealand University Hospital, Sygehusvej 10, 4000 Roskilde, Denmark; Department of Psychology, University of Southern Denmark, Campusvej 55, 5330 Odense M, Denmark.
| | - Alex Harrison
- Department of Health Sciences, University of York, Heslington, York YO10 5DD, United Kingdom
| | - Susanne S Pedersen
- Department of Psychology, University of Southern Denmark, Campusvej 55, 5330 Odense M, Denmark; Department of Cardiology, Odense University Hospital, J. B. Winsloews Vej 4, 5000 Odense, Denmark
| | - Patrick Doherty
- Department of Health Sciences, University of York, Heslington, York YO10 5DD, United Kingdom
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Sever S, Doherty P, Golder S, Harrison AS. Is improvement in depression in patients attending cardiac rehabilitation with new-onset depressive symptoms determined by patient characteristics? Open Heart 2020; 7:openhrt-2020-001264. [PMID: 32847994 PMCID: PMC7451288 DOI: 10.1136/openhrt-2020-001264] [Citation(s) in RCA: 8] [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: 02/11/2020] [Revised: 06/24/2020] [Accepted: 07/13/2020] [Indexed: 12/20/2022] Open
Abstract
Background Patients with cardiovascular disease (CVD) commonly experience depressive symptoms which is associated with adverse outcome and increased mortality. Examining the baseline characteristics of cardiac rehabilitation (CR) patients that determine Hospital Anxiety and Depression Scale (HADS) depression outcome may facilitate adjustments in CR programme delivery. This study aims to investigate whether comorbidities, demographic and clinical characteristics of patients, with new-onset post-cardiac event depressive symptoms, determine change in their depression following CR. Methods Analysing the routine practice data of British Heart Foundation National Audit of Cardiac Rehabilitation between April 2012 and March 2018, an observational study was conducted. Patients with new-onset post-cardiac event depressive symptoms and no previous documented history of depression constituted the study population. Results The analyses included 64 658 CR patients (66.24±10.69 years, 75% male) with new-onset HADS measures, excluding patients with a history of depression. The comorbidities determining reduced likelihood of improvement in depression outcomes after CR were angina, diabetes, stroke, emphysema and chronic back problems. In addition, higher total number of comorbidities, increased weight, a higher HADS anxiety score, smoking at baseline, physical inactivity, presence of heart failure and being single were other significant determinants. However, receiving coronary artery bypass graft treatment was associated with better improvement. Conclusion The study identified specific baseline comorbid conditions of patients with new-onset depressive symptoms including angina, diabetes, stroke, emphysema and chronic back problems that were determinants of poorer mental health outcomes (HADS) following CR. Higher total number of comorbidities, increased weight, physical inactivity, smoking, presence of heart failure and being single were other determinants of a negative change in depression. These findings could help CR programmes focus on tailoring the CR intervention around comorbidity, physical activity status, weight management and smoking cessation in patients with new-onset depressive symptoms.
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Affiliation(s)
- Serdar Sever
- Department of Health Sciences, University of York, York, North Yorkshire, UK
| | - Patrick Doherty
- Department of Health Sciences, University of York, York, North Yorkshire, UK
| | - Su Golder
- Department of Health Sciences, University of York, York, North Yorkshire, UK
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Marzolini S, Colella TJF. Factors That Predispose Women to Greater Depressive Symptoms: A Sex-, Age-, and Diagnosis-Matched Cardiac Rehabilitation Cohort. Can J Cardiol 2020; 37:382-390. [PMID: 32882330 DOI: 10.1016/j.cjca.2020.08.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 08/21/2020] [Accepted: 08/25/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Depressive symptoms (DS) disproportionately affect women with cardiac disease; however, no analyses have been conducted that would allow for focused sex-specific interventions. METHODS Consecutively enrolled women (n = 663) were matched with men postcardiac revascularization at cardiac rehabilitation (CR) entry by primary diagnosis, age, and year of CR entry from database records (2006 to 2017). Multivariate analyses were conducted to determine predictors of DS (≥16 on the Center for Epidemiologic Studies Depression Scale) in all patients and men and women separately. RESULTS In bivariate analysis, women were more likely than men to have DS (30.2% vs 19.3%; P < 0.001) in the matched cohort. A greater proportion of women than men had DS in all 10-year age categories (P < 0.05) except youngest (<50 years; 37% vs 30.4%; P = 0.7) and oldest (≥80; 12.3% vs 10.3%; P = 0.8). DS peaked in women aged 50 to 59 (42.5%) and men <50 years (30.4%). In all patients, independent predictors of DS were younger age, lower cardiorespiratory fitness (VO2peak), being unemployed, greater comorbidities, smoking, anxiolytics, antidepressants, not being married, but not sex. Shared predictors in women-only and men-only analyses were younger age, lower VO2peak, antidepressants, and being unemployed. Unique predictors for women were obesity, smoking, and delayed CR entry and, for men, hypertension, myocardial infarction, anxiolytics, and not being married. CONCLUSIONS Despite matching for age and diagnosis, women were more likely to have DS than men. However, sex was not a predictor of DS in multivariate analyses. This suggests that the profile of women predisposes them to greater DS. Obesity, smoking, and greater delayed CR entry were unique correlates for women and targets for intervention.
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Affiliation(s)
- Susan Marzolini
- KITE Research Institute, Toronto Rehabilitation Institute/University Health Network, Toronto, Ontario, Canada; Department of Exercise Sciences, Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada; Healthy Living for Pandemic Event Protection (HL-PIVOT) Network, Toronto, Ontario, Canada; Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada.
| | - Tracey J F Colella
- KITE Research Institute, Toronto Rehabilitation Institute/University Health Network, Toronto, Ontario, Canada; Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada; Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
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Wells A, Reeves D, Heal C, Fisher P, Davies L, Heagerty A, Doherty P, Capobianco L. Establishing the Feasibility of Group Metacognitive Therapy for Anxiety and Depression in Cardiac Rehabilitation: A Single-Blind Randomized Pilot Study. Front Psychiatry 2020; 11:582. [PMID: 32714216 PMCID: PMC7344162 DOI: 10.3389/fpsyt.2020.00582] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 06/05/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Anxiety and depression are common in cardiac rehabilitation (CR) patients. However, CR programs which incorporate psychological techniques achieve modest reductions in emotional distress. More efficacious interventions that can be easily integrated within services are required. A promising alternative to current psychological interventions is metacognitive therapy (MCT). The aim was to evaluate the acceptability and feasibility of delivering Group-MCT to CR patients experiencing symptoms of anxiety and depression. METHOD AND RESULTS Fifty-two CR patients with elevated anxiety and/or depression were recruited to a single-blind randomized feasibility trial across three UK National Health Service Trusts and randomized to usual CR or usual CR plus six weekly sessions of group-MCT. Acceptability and feasibility of adding group-MCT to CR was based on recruitment rates, withdrawal, and drop-out by the primary end-point of 4 months; number of MCT and CR sessions attended; completion of follow-up questionnaires; and ability of the outcome measures to discriminate between patients. The study was also used to re-estimate the required sample size for a full-scale trial. We also examined the extent by which non-specialists adhered to the Group-MCT protocol. Group-MCT was found to be feasible and acceptable for CR patients with anxiety and depression. Recruitment and retention of participants was high, and attendance rates at CR were similar for both groups. CONCLUSION The results suggest the addition of MCT to CR did not have a negative impact on retention and support a full-scale trial of Group-MCT for cardiac patients.
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Affiliation(s)
- Adrian Wells
- Faculty of Biology, Medicine and Health, School of Psychological Sciences, The University of Manchester, Manchester, United Kingdom.,Research and Innovation, Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | - David Reeves
- NIHR School for Primary Care Research, Manchester Academic Health Science Centre, The University of Manchester, Manchester, United Kingdom
| | - Calvin Heal
- NIHR School for Primary Care Research, Manchester Academic Health Science Centre, The University of Manchester, Manchester, United Kingdom
| | - Peter Fisher
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool, United Kingdom.,Liverpool Clinical Health, The Royal Liverpool and Broadgreen University Hospital NHS Trust, Liverpool, United Kingdom
| | - Linda Davies
- Centre for Health Economics, Division of Population Health, Health Services Research and Primary Care, Faculty of Biology Medicine and Health, School of Health Sciences, The University of Manchester, Manchester, United Kingdom
| | - Anthony Heagerty
- Core Technology Facility, The University of Manchester School of Medical Sciences, Manchester, United Kingdom.,Manchester University NHS Foundation Trust, Manchester Royal Infirmary, Manchester, United Kingdom
| | - Patrick Doherty
- Department of Health Sciences, University of York, York, United Kingdom
| | - Lora Capobianco
- Research and Innovation, Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
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