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Bergdolt J, Hubert S, Schreiter J, Jenderny S, Beblo T, Driessen M, Steinhart I, Dehn LB. Predictors of return to work in people with major depression: Results from a supported employment program in Germany. J Affect Disord 2024; 364:1-8. [PMID: 39029690 DOI: 10.1016/j.jad.2024.07.084] [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: 04/05/2024] [Revised: 06/26/2024] [Accepted: 07/14/2024] [Indexed: 07/21/2024]
Abstract
BACKGROUND Depression is a common mental disorder and is associated with work disability. For the implementation of evidence-based interventions, such as Individual Placement and Support (IPS) for people with depression in Germany, the aim of this study was to investigate client variables that predict return to work. METHODS The sample consisted of 129 participants, initially treated in a psychiatric hospital due to major depression, who participated in IPS as part of a German clinical trial. Baseline demographic (age, sex, education, sickness absence days, employment status), psychiatric (symptom severity, comorbidity, general physical and mental health, disability), and neuropsychological (self-rated deficits, test performance) variables were included. Return to work within one year was predicted using separate and overall binary logistic regression analyses. RESULTS A total of 70 participants (56 %) returned to work within the one-year follow-up period. >100 days of sick leave in the year prior to study entry (vs. <100 days) and higher self-rated cognitive deficits were significantly associated with reduced odds of return to work within one year of IPS. LIMITATIONS The sample consisted of participants with a relatively good work history who were assigned to IPS by the treatment team, thus, the generalizability of the results is limited. CONCLUSIONS People with depression who participate in IPS interventions might benefit from specifically targeting perceived cognitive deficits. Factors associated with prolonged sick leave due to depression and their role in return to work with IPS need further investigation.
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Affiliation(s)
- Juliane Bergdolt
- Universitätsklinik für Psychiatrie und Psychotherapie, Evangelisches Klinikum Bethel gGmbH, Universitätsklinikum OWL, Universität Bielefeld, Remterweg 69-71, 33617 Bielefeld, Germany; Department of Psychology, University of Bielefeld, Universitätsstraße 25, 33615 Bielefeld, Germany.
| | - Stella Hubert
- Universitätsklinik für Psychiatrie und Psychotherapie, Evangelisches Klinikum Bethel gGmbH, Universitätsklinikum OWL, Universität Bielefeld, Remterweg 69-71, 33617 Bielefeld, Germany
| | - Julia Schreiter
- Institut für Sozialpsychiatrie Mecklenburg-Vorpommern e.V., Universität Greifswald, Greifswald, Germany
| | - Sarah Jenderny
- Institut für Sozialpsychiatrie Mecklenburg-Vorpommern e.V., Universität Greifswald, Greifswald, Germany
| | - Thomas Beblo
- Universitätsklinik für Psychiatrie und Psychotherapie, Evangelisches Klinikum Bethel gGmbH, Universitätsklinikum OWL, Universität Bielefeld, Remterweg 69-71, 33617 Bielefeld, Germany; Department of Psychology, University of Bielefeld, Universitätsstraße 25, 33615 Bielefeld, Germany
| | - Martin Driessen
- Universitätsklinik für Psychiatrie und Psychotherapie, Evangelisches Klinikum Bethel gGmbH, Universitätsklinikum OWL, Universität Bielefeld, Remterweg 69-71, 33617 Bielefeld, Germany; Department of Psychology, University of Bielefeld, Universitätsstraße 25, 33615 Bielefeld, Germany
| | - Ingmar Steinhart
- Institut für Sozialpsychiatrie Mecklenburg-Vorpommern e.V., Universität Greifswald, Greifswald, Germany
| | - Lorenz B Dehn
- Universitätsklinik für Psychiatrie und Psychotherapie, Evangelisches Klinikum Bethel gGmbH, Universitätsklinikum OWL, Universität Bielefeld, Remterweg 69-71, 33617 Bielefeld, Germany; Department of Psychology, University of Bielefeld, Universitätsstraße 25, 33615 Bielefeld, Germany
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Tournayre L, Balbinotti MAA, Monthuy-Blanc J. Some hope for a dimensional assessment? A critical review of psychometric validated (semi-)structured interview to assess eating disorders. EUROPEAN EATING DISORDERS REVIEW 2024; 32:1138-1156. [PMID: 38873932 DOI: 10.1002/erv.3115] [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: 02/02/2024] [Revised: 05/10/2024] [Accepted: 06/02/2024] [Indexed: 06/15/2024]
Abstract
OBJECTIVE Given that eating disorders (EDs) are considered one of the deadliest mental illnesses, the development of appropriate assessment instruments is a necessity. Despite the extensive literature on assessing EDs, there has been a lack of focus on semi-structured interviews. The purpose of this article is to provide a comprehensive review of psychometrically validated semi-structured interviews for EDs. METHODS Included studies (N = 24) were required to present a semi-structured interview for EDs that has been validated through a psychometric process. The APA PsycNet, MEDLINE, APA Psycinfo, Pubmed, and Health & Psychosocial Instruments databases were searched. The literature search included publications through May 2024, with no earliest year restriction. RESULTS A total of six instruments were identified and reviewed in terms of conceptual design, purpose and content, psychometric characteristics, and strengths and limitations. Three main findings were highlighted: (a) only half of the instruments are up to date; (b) the instruments are based on either a categorical or a mixed categorical-dimensional approach; and (c) the predominance of the categorical approach. CONCLUSIONS The results are discussed regarding the conceptual approaches of the instrument to provide clinical and research implications. Despite the many strengths of the instrument, additional psychometric research is needed.
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Affiliation(s)
- Lola Tournayre
- Research Unity Loricorps, Research Center of Mental Health University Institute of Montreal, Montreal, QC, Canada
- Département de Psychologie, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | | | - Johana Monthuy-Blanc
- Research Unity Loricorps, Research Center of Mental Health University Institute of Montreal, Montreal, QC, Canada
- Département de Sciences de l'Éducation, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
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Wessa C, Janssens J, Coppens V, El Abdellati K, Vergaelen E, van den Ameele S, Baeken C, Zeeuws D, Milaneschi Y, Lamers F, Penninx B, Claes S, Morrens M, De Picker L. Efficacy of inflammation-based stratification for add-on celecoxib or minocycline in major depressive disorder: Protocol of the INSTA-MD double-blind placebo-controlled randomised clinical trial. Brain Behav Immun Health 2024; 41:100871. [PMID: 39350954 PMCID: PMC11440344 DOI: 10.1016/j.bbih.2024.100871] [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: 07/21/2024] [Revised: 09/12/2024] [Accepted: 09/16/2024] [Indexed: 10/04/2024] Open
Abstract
Introduction Different lines of evidence confirm the involvement of the immune system in the pathophysiology of major depressive disorder. Up to 30% of depressed patients present with an immune-mediated subtype, characterized by peripheral inflammation (high-sensitive C-reactive protein (hsCRP) ≥ 3 mg/l) and an atypical symptom profile with fatigue, anhedonia, increased appetite, and hypersomnia. This immune-mediated subtype of MDD is associated with poorer response to first-line antidepressant treatment. Consequently, strategies for immune-targeted augmentation should be prioritised towards patients with this subtype. Meta-analyses have shown modest but heterogeneous treatment effects with immune-targeted augmentation in unstratified MDD cohorts, with celecoxib and minocycline as most promising first-line treatment options. However, no study has prospectively evaluated the effectiveness of a priori stratification by baseline inflammation levels for add-on celecoxib or minocycline in MDD. Methods The INSTA-MD trial is a multicentre, 12-week, randomised, double-blind, placebo-controlled, parallel-group stratified clinical trial of adjunctive minocycline or celecoxib to treatment-as-usual for patients with MDD. Two hundred forty adult patients with Major Depressive Disorder who failed to remit with one or two trials of antidepressant treatment will be enrolled and allocated to high-hsCRP (hsCRP ≥3 mg/L) or low-hsCRP (hsCRP <3 mg/L) strata, where disproportional stratified sampling will ensure equally sized strata. Participants in each hsCRP stratum will be randomised to augment their ongoing antidepressant treatment with either adjunctive minocycline, celecoxib or placebo for a duration of 12 weeks, resulting in six treatment arms of each 40 participants. The primary objective is to evaluate the efficacy of immune-targeted augmentation with minocycline or celecoxib versus placebo, and the use of baseline hsCRP stratification to predict treatment response. Additionally, we will perform a head-to-head analysis between the two active compounds. The primary outcome measure is change in the Hamilton Depression Rating Scale (HDRS-17) total score. Secondary outcome measures will be response and remission rates, and change in inflammation-specific symptoms, adverse events and therapy acceptability (adherence). Further exploratory analyses will be performed with an array of peripheral inflammatory biomarkers, metabolic outcomes and physiological data. Expected impact The aim of INSTA-MD is to advance the use of immune-targeted precision psychiatry, by supporting the implementation of targeted hsCRP screening and treatment of immune-mediated MDD as a cost-effective intervention in primary care settings. Based on previous studies, we expect immune-targeted augmentation with minocycline or celecoxib to yield a superior remission rate of 15-30% compared to treatment as usual for immune-mediated cases of MDD. By treating immune-related depression early in the treatment algorithm with repurposed first-line anti-inflammatory treatments, we can significantly improve the outcomes of these patients, and reduce the global societal and economic burden of depression. Ethics and dissemination This protocol has been approved by the Medical Ethics Review Board (CTR - 04/08/2023). Registration details Trial registration number NCT05644301 (Clinical trial.gov), EU-CT 2022-501692-35-00.
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Affiliation(s)
- C Wessa
- Collaborative Antwerp Psychiatric Research Institute, University of Antwerp, Belgium
- Scientific Initiative for Neuropsychiatric and Psychopharmacological Studies, University Psychiatric Centre Duffel, Belgium
| | - J Janssens
- Collaborative Antwerp Psychiatric Research Institute, University of Antwerp, Belgium
| | - V Coppens
- Collaborative Antwerp Psychiatric Research Institute, University of Antwerp, Belgium
- Scientific Initiative for Neuropsychiatric and Psychopharmacological Studies, University Psychiatric Centre Duffel, Belgium
| | - K El Abdellati
- Collaborative Antwerp Psychiatric Research Institute, University of Antwerp, Belgium
| | - E Vergaelen
- Catholic University Leuven, Belgium
- University Psychiatric Centre KU Leuven, Belgium
| | - S van den Ameele
- Collaborative Antwerp Psychiatric Research Institute, University of Antwerp, Belgium
- UVC Brugmann, Brussels, Belgium
| | - C Baeken
- Department of Psychiatry, Universitair Ziekenhuis Brussel, Brussels, Belgium
- Faculty of Medicine and Health Sciences, Department of Head and Skin, Ghent Experimental Psychiatry (GHEP) lab, Ghent University, Ghent, Belgium
- Eindhoven University of Technology, Department of Electrical Engineering, Eindhoven, the Netherlands
| | - D Zeeuws
- Department of Psychiatry, Universitair Ziekenhuis Brussel, Brussels, Belgium
- Center for Neurosciences (C4N), Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Y Milaneschi
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Amsterdam Public Health, Mental Health Program, Amsterdam, the Netherlands
| | - F Lamers
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Amsterdam Public Health, Mental Health Program, Amsterdam, the Netherlands
| | - B Penninx
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Amsterdam Public Health, Mental Health Program, Amsterdam, the Netherlands
| | - S Claes
- Catholic University Leuven, Belgium
- University Psychiatric Centre KU Leuven, Belgium
| | - M Morrens
- Collaborative Antwerp Psychiatric Research Institute, University of Antwerp, Belgium
- Scientific Initiative for Neuropsychiatric and Psychopharmacological Studies, University Psychiatric Centre Duffel, Belgium
| | - L De Picker
- Collaborative Antwerp Psychiatric Research Institute, University of Antwerp, Belgium
- Scientific Initiative for Neuropsychiatric and Psychopharmacological Studies, University Psychiatric Centre Duffel, Belgium
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Stålnacke S, Liira H, Vangelova-Korpinen V, Virrantaus H, Kanerva M, Kvarnström K, Sainio M, Malmivaara A, Vuokko A, Varonen M, Venäläinen M, Arokoski J. Functioning of post-COVID-19 patients: a cross-sectional study at the outpatient clinic for long-term effects. Scand J Prim Health Care 2024:1-9. [PMID: 39360345 DOI: 10.1080/02813432.2024.2410986] [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: 05/21/2024] [Accepted: 09/25/2024] [Indexed: 10/04/2024] Open
Abstract
BACKGROUND After COVID-19 infection, long-term impacts on functioning may occur. We studied the functioning of patients with post-COVID-19 condition (PCC) and compared them to controls without PCC. METHODS This cross-sectional study consisted of 442 patients with PCC referred to rehabilitation at the Helsinki University Hospital (HUS) Outpatient Clinic for the Long-Term Effects of COVID-19, and 198 controls without PCC. Functioning was assessed with a questionnaire including WHODAS 2.0. Patients underwent physical testing including a hand grip strength test (HGST) and a 6-minute walking test (6MWT). Lifestyle was assessed by questionnaire and comorbidities were collected as ICD-10 codes from the HUS Data Lake on the HUS Acamedic platform. RESULTS The WHODAS 2.0 average total score was 34 (SD 18) (moderate functional limitation) for patients with PCC and 6 (SD 8) (normal or mild limitation) for the controls. The disability was higher in all aspects of WHODAS 2.0 in patients with PCC. Bivariate binomial and multivariable regression analyses showed that the presence of comorbidities, anxiety, depression, and smoking predicted a WHODAS 2.0 score of 24 (moderate functional limitation) or above in the PCC group. The average 6MWT distance was 435 m (SD 98 m) in patients with PCC and 627 m (SD 70 m) in controls. HGST measurements showed no significant differences from controls. CONCLUSIONS In conclusion, patients with PCC had significantly reduced functioning based on WHODAS 2.0 scores and the 6MWT results. Comorbidities, anxiety, depression, and smoking were associated with moderate or severe limitations in functioning. Findings support that PCC is multifactorial and requires a holistic approach to rehabilitation.
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Affiliation(s)
- Sanna Stålnacke
- Outpatient Clinic for Persistent Symptom Rehabilitation, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - Helena Liira
- Outpatient Clinic for Persistent Symptom Rehabilitation, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - Velina Vangelova-Korpinen
- Outpatient Clinic for Persistent Symptom Rehabilitation, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - Hélène Virrantaus
- Outpatient Clinic for Persistent Symptom Rehabilitation, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - Mari Kanerva
- Outpatient Clinic for Persistent Symptom Rehabilitation, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
- Turku University Hospital and University, Turku, Finland
| | - Kirsi Kvarnström
- Outpatient Clinic for Persistent Symptom Rehabilitation, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - Markku Sainio
- Outpatient Clinic for Persistent Symptom Rehabilitation, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - Antti Malmivaara
- Finnish Institute for Health and Welfare, Orton Orthopaedic Hospital, University of Helsinki, Helsinki, Finland
| | - Aki Vuokko
- Finnish Institute of Occupational Health, Helsinki, Finland
| | - Mikko Varonen
- Outpatient Clinic for Persistent Symptom Rehabilitation, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - Mikko Venäläinen
- Department of Medical Physics, University of Turku, Turku, Finland
| | - Jari Arokoski
- Department of Internal Medicine and Rehabilitation, Division of Rehabilitation, Helsinki University Hospital and Helsinki University, Helsinki, Finland
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Jules-Elysee KM, Sigmund AE, Tsai MH, Simmons JW. Expanding the perioperative lens: Does the end justify the means? J Clin Anesth 2024; 97:111522. [PMID: 38870702 DOI: 10.1016/j.jclinane.2024.111522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 04/26/2024] [Accepted: 06/07/2024] [Indexed: 06/15/2024]
Abstract
In 1994, Fischer et al. established the preoperative clinic for the perioperative services at Stanford University Medical Center. By lowering the risk of cancellation and reducing morbidity and mortality against the push to move surgeries to an outpatient, basis, they demonstrated a return on investment. In the 2000s, Aronson et al. designed the prehabilitation clinics at Duke University with the notion that the preoperative process should not only ensure that patients were appropriately risk-stratified, but also clinically optimized before surgery. With a trend towards ambulatory procedures due to current reimbursement structures, hospital administrators should be searching for potential avenues to bolster sagging profits. In this narrative review, we argue that the perioperative services needs to extend beyond the hospital into the postoperative period.
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Affiliation(s)
- Kethy M Jules-Elysee
- Hospital for Special Surgery, Department of Anesthesiology, Critical Care, and Pain Management, New York, NY, USA.
| | - Alana E Sigmund
- Hospital for Special Surgery, Department of Internal Medicine, Division of Perioperative Medicine, New York, NY, USA.
| | - Mitchell H Tsai
- Department of Anesthesiology and Perioperative Medicine, Heersink School of Medicine, University of Alabama Birmingham, Birmingham, AL, USA; Department of Anesthesiology, Anschutz School of Medicine, University of Colorado, Aurora, CO, USA; Department of Anesthesiology, University of Vermont, Larner College of Medicine, Burlington, VT, USA; Department of Orthopedics and Rehabilitation (by courtesy), Department of Surgery (by courtesy), Larner College of Medicine, University of Vermont, Burlington, VT, USA.
| | - Jeff W Simmons
- Department of Anesthesiology and Perioperative Medicine, Heersink School of Medicine, University of Alabama Birmingham, Birmingham, AL, USA.
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MacIntyre E, Braithwaite FA, Stanton TR. Painful distortions: people with painful knee osteoarthritis have biased visuospatial perception of the environment. Pain 2024; 165:2313-2322. [PMID: 38635468 DOI: 10.1097/j.pain.0000000000003231] [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: 11/22/2023] [Accepted: 02/20/2024] [Indexed: 04/20/2024]
Abstract
ABSTRACT Visuospatial perception is thought to be adaptive-ie, hills are perceived as steeper when capacity is low, or threat is high-guiding appropriate interaction with the environment. Pain (bodily threat) may similarly modulate visuospatial perception, with the extent of modulation influenced by threat magnitude (pain intensity, fear) and associated with behaviour (physical activity). We compared visuospatial perception of the environment between 50 people with painful knee osteoarthritis and 50 age-/sex-matched pain-free control participants using 3 virtual reality tasks (uphill steepness estimation, downhill steepness estimation, and a distance-on-hill measure), exploring associations between visuospatial perception, clinical characteristics (pain intensity, state and trait fear), and behaviour (wrist-worn accelerometry) within a larger knee osteoarthritis group (n = 85). People with knee osteoarthritis overestimated uphill (F 1,485 = 19.4, P < 0.001) and downhill (F 1,480 = 32.3, P < 0.001) steepness more so than pain-free controls, but the groups did not differ for distance-on-hill measures (U = 1273, P = 0.61). There was also a significant group x steepness interaction for the downhill steepness task (F 4,480 = 3.11, P = 0.02). Heightened overestimation in people with knee osteoarthritis relative to pain-free controls increased as downhill slopes became steeper. Results were unchanged in a replication analysis using all knee osteoarthritis participants (n = 85), except the downhill steepness interaction was no longer significant. In people with knee osteoarthritis, higher state fear was associated with greater over-estimation of downhill slope steepness (rho = 0.69, P < 0.001), and greater visuospatial overestimation (distance-on-hill) was associated with lower physical activity levels (rho = -0.22, P = 0.045). These findings suggest that chronic pain may shift perception of the environment in line with protection, with overestimation heightened when threat is greater (steeper hills, more fearful), although impact on real-world behaviour is uncertain.
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Affiliation(s)
- Erin MacIntyre
- IIMPACT in Health, University of South Australia, Adelaide, Australia
- Persistent Pain Research Group, Hopwood Centre for Neurobiology, Lifelong Health Theme, South Australia Health and Medical Research Institute (SAHMRI), Adelaide, Australia
| | - Felicity A Braithwaite
- IIMPACT in Health, University of South Australia, Adelaide, Australia
- Persistent Pain Research Group, Hopwood Centre for Neurobiology, Lifelong Health Theme, South Australia Health and Medical Research Institute (SAHMRI), Adelaide, Australia
| | - Tasha R Stanton
- IIMPACT in Health, University of South Australia, Adelaide, Australia
- Persistent Pain Research Group, Hopwood Centre for Neurobiology, Lifelong Health Theme, South Australia Health and Medical Research Institute (SAHMRI), Adelaide, Australia
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Hicks C, Menant J, Delbaere K, Sturnieks DL, Brodaty H, Sachdev PS, Lord SR. Two simple modifications to the World Falls Guidelines algorithm improves its ability to stratify older people into low, intermediate and high fall risk groups. Age Ageing 2024; 53:afae192. [PMID: 39348910 DOI: 10.1093/ageing/afae192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Indexed: 10/02/2024] Open
Abstract
BACKGROUND We conducted a secondary analysis of a cohort study to examine the World Falls Guidelines algorithm's ability to stratify older people into sizable fall risk groups or whether minor modifications were necessary to achieve this. METHODS Six hundred and ninety-three community-living people aged 70-90 years (52.4% women) were stratified into low, intermediate and high fall risk groups using the original algorithm and a modified algorithm applying broader Timed Up and Go test screening with a >10-s cut point (originally >15 s). Prospective fall rates and physical and neuropsychological performance among the three groups were compared. RESULTS The original algorithm was not able to identify three sizable groups, i.e. only five participants (0.7%) were classified as intermediate risk. The modified algorithm classified 349 participants (50.3%) as low risk, 127 participants (18.3%) as intermediate risk and 217 participants (31.3%) as high risk. The sizable intermediate-risk group had physical and neuropsychological characteristics similar to the high-risk group, but a fall rate similar to the low-risk group. The high-risk group had a significantly higher rate of falls than both the low- [incidence rate ratio (IRR) = 2.52, 95% confidence interval (CI) = 1.99-3.20] and intermediate-risk groups (IRR = 2.19, 95% CI = 1.58-3.03). CONCLUSION A modified algorithm stratified older people into three sizable fall risk groups including an intermediate group who may be at risk of transitioning to high fall rates in the medium to long term. These simple modifications may assist in better triaging older people to appropriate and tailored fall prevention interventions.
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Affiliation(s)
- Cameron Hicks
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, NSW 2031, Australia
- School of Population Health, Faculty of Medicine and Health, University of New South Wales, Kensington, NSW 2052, Australia
| | - Jasmine Menant
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, NSW 2031, Australia
- School of Population Health, Faculty of Medicine and Health, University of New South Wales, Kensington, NSW 2052, Australia
| | - Kim Delbaere
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, NSW 2031, Australia
- School of Population Health, Faculty of Medicine and Health, University of New South Wales, Kensington, NSW 2052, Australia
| | - Daina L Sturnieks
- School of Biomedical Sciences, Faculty of Medicine and Health, University of New South Wales, Kensington, NSW 2052, Australia
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, NSW 2031, Australia
| | - Henry Brodaty
- Centre for Healthy Brain Ageing, Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Kensington, NSW 2052, Australia
| | - Perminder S Sachdev
- Centre for Healthy Brain Ageing, Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Kensington, NSW 2052, Australia
| | - Stephen R Lord
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, NSW 2031, Australia
- School of Population Health, Faculty of Medicine and Health, University of New South Wales, Kensington, NSW 2052, Australia
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van den End A, Snoek A, Aarts I, Beekman ATF, Dekker J, Blankers M, Lommerse N, Thomaes K. Predictors of treatment attendance in patients with posttraumatic stress disorder and comorbid personality disorders. Compr Psychiatry 2024; 134:152516. [PMID: 38991291 DOI: 10.1016/j.comppsych.2024.152516] [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: 03/02/2024] [Revised: 06/25/2024] [Accepted: 07/05/2024] [Indexed: 07/13/2024] Open
Abstract
INTRODUCTION High dropout and low treatment attendance rates among patients with posttraumatic stress disorder (PTSD) and personality disorders (PDs) continue to pose a significant challenge. Despite numerous studies focusing on enhancing treatment attendance, the identification of consistent and reliable predictors in patients with PTSD and comorbid PDs remains limited. OBJECTIVES This study aims to investigate a wide range of potential predictors of treatment attendance, encompassing demographic, patient-severity, treatment, and therapist-related variables in patients with PTSD and comorbid borderline and/or cluster C PDs. METHODS Utilizing data from 255 patients participating in two randomized controlled trials comparing trauma-focused treatment with or without concurrent PD treatment, candidate predictors were individually analyzed in univariate regression models. Significant predictors were then combined in a multiple ordinal regression model. RESULTS In total, 40% of patients attended fewer trauma-focused treatment sessions than the minimum recommended in treatment guidelines. Out of the 38 candidate predictors examined, five significant, independent predictors of treatment attendance emerged in a multiple ordinal regression model. Higher baseline PTSD severity (OR = 1.04, p = .036), higher education level (OR = 1.22, p = .009) and a stronger patient-rated working alliance (OR = 1.72, p = .047) with the therapist predicted higher treatment attendance. Conversely, inadequate social support from friends (OR = 0.90, p = .042) and concurrent PD treatment and trauma-focused treatment (OR = 0.52, p = .022) were associated with lower treatment attendance. CONCLUSIONS In conclusion, this constitutes the first study investigating predictors of treatment attendance in patients with PTSD and comorbid PDs. The results highlight the complexity of pinpointing reliable predictors. Nevertheless, the identification of five predictors provides valuable insights, aiding clinicians in customizing treatment strategies for individual patients and enhancing overall treatment attendance.
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Affiliation(s)
- Arne van den End
- Arkin, Sinai Centrum, Laan van de Helende Meesters 2, 1186AM Amstelveen, the Netherlands; Amsterdam UMC, University of Amsterdam, Department of Psychiatry, Oldenaller 1, 1081HJ Amsterdam, the Netherlands.
| | - Aishah Snoek
- Arkin, Sinai Centrum, Laan van de Helende Meesters 2, 1186AM Amstelveen, the Netherlands; Amsterdam UMC, University of Amsterdam, Department of Psychiatry, Oldenaller 1, 1081HJ Amsterdam, the Netherlands.
| | - Inga Aarts
- Arkin, Sinai Centrum, Laan van de Helende Meesters 2, 1186AM Amstelveen, the Netherlands; Amsterdam UMC, University of Amsterdam, Department of Psychiatry, Oldenaller 1, 1081HJ Amsterdam, the Netherlands; Amsterdam UMC, University of Amsterdam, Department of Anatomy and Neurosciences, De Boelelaan 1085, 1081HV Amsterdam, the Netherlands.
| | - Aartjan T F Beekman
- Amsterdam UMC, University of Amsterdam, Department of Psychiatry, Oldenaller 1, 1081HJ Amsterdam, the Netherlands.
| | - Jack Dekker
- Arkin Mental Health Care, Klaprozenweg 111, 1033NN, Amsterdam, the Netherlands; Vrije Universiteit Amsterdam, Faculty of Behavioural and Movement Sciences, van der Boechorststraat 7, 1081BT Amsterdam, the Netherlands.
| | - Matthijs Blankers
- Arkin Mental Health Care, Klaprozenweg 111, 1033NN, Amsterdam, the Netherlands.
| | - Nick Lommerse
- Arkin Mental Health Care, Klaprozenweg 111, 1033NN, Amsterdam, the Netherlands.
| | - Kathleen Thomaes
- Arkin, Sinai Centrum, Laan van de Helende Meesters 2, 1186AM Amstelveen, the Netherlands; Amsterdam UMC, University of Amsterdam, Department of Psychiatry, Oldenaller 1, 1081HJ Amsterdam, the Netherlands; Arkin Mental Health Care, Klaprozenweg 111, 1033NN, Amsterdam, the Netherlands.
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Abdin E, Seet V, Jeyagurunathan A, Tan SC, Mohmad Khalid MIS, Mok YM, Verma S, Subramaniam M. Mapping the World Health Organization Disability Assessment Scale 2.0 to the EQ-5D-5L in patients with mental disorders. Expert Rev Pharmacoecon Outcomes Res 2024; 24:1009-1015. [PMID: 38967393 DOI: 10.1080/14737167.2024.2376100] [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: 04/15/2024] [Accepted: 06/25/2024] [Indexed: 07/06/2024]
Abstract
OBJECTIVE The current study aims to develop an algorithm for mapping the WHODAS 2.0 to the EQ-5D-5 L for patients with mental disorders. METHODS This cross-sectional study was conducted at the Institute of Mental Health and Community Wellness Clinics in Singapore between June 2019 and November 2022. We included four regression methods including the Ordinary Least Square (OLS) regression, the Tobit regression model (Tobit), the robust regression with MM estimator (MM), and the adjusted limited dependent variable mixture model (ALDVMM) to map EQ-5D-5 L utility scores from the WHODAS 2.0. RESULTS A total of 797 participants were included. The mean EQ-5D-5 L utility and WHODAS 2.0 total scores were 0.615 (SD = 0.342) and 11.957 (SD = 8.969), respectively. We found that the EQ-5D-5 L utility score was best predicted by the robust regression model with the MM estimator. Our findings suggest that the WHODAS 2.0 total scores were significantly and inversely associated with the EQ-5D-5 L utility scores. CONCLUSION This study provides a mapping algorithm for converting the WHODAS 2.0 scores into EQ-5D-5 L utility scores which can be implemented using a simple online calculator in the following web application: https://eastats.shinyapps.io/whodas_eq5d/.
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Affiliation(s)
- Edimansyah Abdin
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Vanessa Seet
- Research Division, Institute of Mental Health, Singapore, Singapore
| | | | - Sing Chik Tan
- Research Division, Institute of Mental Health, Singapore, Singapore
| | | | - Yee Ming Mok
- Department of Mood and Anxiety, Institute of Mental Health, Singapore, Singapore
| | - Swapna Verma
- Department of Psychosis, Institute of Mental Health, Singapore, Singapore
| | - Mythily Subramaniam
- Research Division, Institute of Mental Health, Singapore, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
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10
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Modiano YA, Woods SP. Health literacy is associated with cognition and everyday functioning in a consecutive clinical series of people with epilepsy in a surgical setting. Epilepsy Behav 2024; 159:110013. [PMID: 39182261 DOI: 10.1016/j.yebeh.2024.110013] [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: 02/15/2024] [Revised: 08/13/2024] [Accepted: 08/21/2024] [Indexed: 08/27/2024]
Abstract
OBJECTIVE Low health literacy is common among people with epilepsy (PWE) and may play an important role in disease management and outcomes. The current study evaluated whether health literacy is related to cognition, health, and everyday functioning in PWE. METHODS This cross-sectional, correlational study included 25 demographically comparable healthy adults retrospectively matched to a consecutive series of 89 PWE presenting for neuropsychological evaluation in a surgical setting and who completed the Newest Vital Sign and Brief Health Literacy Screener. The PWE also completed a comprehensive neuropsychological battery and measures of quality of life and everyday functioning. RESULTS PWE had significantly lower health literacy as compared to healthy adults (ps < 0.05) at a medium-to-large effect size. In analyses covarying for education and oral word reading literacy in the PWE sample, lower health literacy was independently associated with bilateral seizure onsets, greater antiseizure medication burden, poorer performance on measures of memory and information processing speed, and difficulties with self-care (ps < 0.05). SIGNIFICANCE Findings suggest that PWE are at risk for low health literacy, which may be partly attributable to disrupted brain-behavior relationships and contribute to poorer everyday functioning. Future studies are needed to identify effective methods to support and improve health literacy in PWE.
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Affiliation(s)
- Yosefa A Modiano
- Vivian L. Smith Department of Neurosurgery and Texas Institute for Restorative Neurotechnologies, UTHealth Houston, Houston, TX, USA.
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11
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Yan E, Butris N, Alhamdah Y, Kapoor P, Lovblom LE, Islam S, Saripella A, Wong J, Tang-Wai DF, Mah L, Alibhai SMH, Tartaglia MC, He D, Chung F. The utility of remote cognitive screening tools in identifying cognitive impairment in older surgical patients: An observational cohort study. J Clin Anesth 2024; 97:111557. [PMID: 39047531 DOI: 10.1016/j.jclinane.2024.111557] [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: 01/26/2024] [Revised: 05/13/2024] [Accepted: 07/17/2024] [Indexed: 07/27/2024]
Abstract
STUDY OBJECTIVES To determine the prevalence of suspected cognitive impairment using the Centers for Disease Control and Prevention (CDC) cognitive question, Ascertain Dementia Eight-item Questionnaire (AD8), Modified Telephone Interview for Cognitive Status (TICS-M), and Telephone Montreal Cognitive Assessment (T-MoCA), the agreement between each tool beyond chance, and the risk factors associated with a positive screen. DESIGN Multicenter prospective study. SETTING Remote preoperative assessments. PATIENTS 307 non-cardiac surgical patients aged ≥65 years. MEASUREMENTS Prevalence, Cohen's kappa (κ). MAIN RESULTS The T-MoCA detected the highest prevalence of suspected cognitive impairment (28%), followed by the AD8 (17%), CDC cognitive question (9%), and TICS-M (6%). The four screening tools showed poor agreement beyond chance with one another, with the CDC cognitive question and AD8 approaching the threshold for weak agreement (κ = 0.39). Depression was associated with screening positive on the CDC cognitive question (OR: 2.81; 95% CI: 1.04, 7.68). Obstructive sleep apnea (OSA) (OR: 3.10; 95% CI: 1.26, 7.71) and functional disability (OR: 3.74; 95% CI: 1.34, 11.11) were associated with a positive AD8 screen. Older age (OR: 1.56; 95% CI: 1.01, 2.41), male sex (OR: 3.08; 95% CI: 1.09, 9.40), and higher pain level (OR: 1.21; 95% CI: 1.01, 1.47) were associated with a positive TICS-M screen. Similarly, older age (OR: 1.33; 95% CI: 1.03, 1.73), male sex (OR: 2.02; 95% CI: 1.09, 3.83), and higher pain level (OR: 1.15; 95% CI: 1.02, 1.30) were associated with a positive T-MoCA screen. CONCLUSIONS The CDC cognitive question, AD8, TICS-M, and T-MoCA were easily implemented during preoperative assessment among older surgical patients. OSA, functional disability, and depression were associated with complaints on the CDC cognitive question and AD8. Older age, male sex, and higher pain level were associated with screening positive on the TICS-M and T-MoCA. Early remote cognitive screening may enhance risk stratification of vulnerable patients.
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Affiliation(s)
- Ellene Yan
- Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada; Temerty Faculty of Medicine, University of Toronto, ON, Canada
| | - Nina Butris
- Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada; Temerty Faculty of Medicine, University of Toronto, ON, Canada
| | - Yasmin Alhamdah
- Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada; Temerty Faculty of Medicine, University of Toronto, ON, Canada
| | - Paras Kapoor
- Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada; Temerty Faculty of Medicine, University of Toronto, ON, Canada
| | - Leif Erik Lovblom
- Biostatistics Department, University Health Network, Toronto, ON, Canada
| | - Sazzadul Islam
- Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Aparna Saripella
- Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Jean Wong
- Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada; Temerty Faculty of Medicine, University of Toronto, ON, Canada; Women's College Hospital, Toronto, ON, Canada
| | - David F Tang-Wai
- Temerty Faculty of Medicine, University of Toronto, ON, Canada; Division of Neurology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Linda Mah
- Temerty Faculty of Medicine, University of Toronto, ON, Canada; Division of Geriatric Psychiatry, Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Rotman Research Institute, Baycrest Health Sciences Centre, Toronto, ON, Canada
| | - Shabbir M H Alibhai
- Temerty Faculty of Medicine, University of Toronto, ON, Canada; Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
| | - Maria Carmela Tartaglia
- Temerty Faculty of Medicine, University of Toronto, ON, Canada; Division of Neurology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - David He
- Department of Anesthesiology and Pain Medicine, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - Frances Chung
- Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada; Temerty Faculty of Medicine, University of Toronto, ON, Canada.
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12
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Fettes L, Bayly J, Chukwusa E, Ashford S, Higginson I, Maddocks M. Predictors of increasing disability in activities of daily living among people with advanced respiratory disease: a multi-site prospective cohort study, England UK. Disabil Rehabil 2024; 46:4735-4744. [PMID: 38073190 PMCID: PMC11441397 DOI: 10.1080/09638288.2023.2288673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 11/12/2023] [Accepted: 11/23/2023] [Indexed: 01/14/2024]
Abstract
PURPOSE Disability in activities of daily living (ADL) is a common unmet need among people with advanced respiratory disease. Rehabilitation could help prolong independence, but indicators for timely intervention in this population are lacking. This study aimed to identify trajectories of disability in ADLs over time, and predicting factors, in advanced respiratory disease. METHOD Multi-site prospective cohort study in people with advanced non-small cell lung cancer (NSCLC), chronic obstructive pulmonary disease (COPD) or interstitial lung disease (ILD), recruited from hospital or community services, throughout England. Disability in basic (Barthel Index) and instrumental (Lawton-Brody IADL Scale) ADLs were assessed monthly over six months. Visual graphical analysis determined individual trajectories. Multivariate logistic regression examined predictors of increasing disability in basic and instrumental ADLs. FINDINGS Between March 2020 and January 2021, we recruited participants with a diagnosis of NSCLC (n = 110), COPD (n = 72), and ILD (n = 19). 151 participants completed ≥3 timepoints and were included in the longitudinal analysis. Mobility limitation was an independent predictor of increasing disability in instrumental ADLs (odds ratio, 1⋅41 [CI: 1⋅14-1⋅74], p = 0⋅002). CONCLUSION Mobility limitation could be used as a simple referral criterion across people with advanced respiratory disease to ensure timely rehabilitation that targets independence in ADLs.
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Affiliation(s)
- Lucy Fettes
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | - Joanne Bayly
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | - Emeka Chukwusa
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | - Stephen Ashford
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | - Irene Higginson
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | - Matthew Maddocks
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
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13
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Acarturk C, Kurt G, İlkkurşun Z, de Graaff AM, Bryant R, Cuijpers P, Fuhr D, McDaid D, Park AL, Sijbrandij M, Ventevogel P, Uygun E. Effectiveness of group problem management plus in distressed Syrian refugees in Türkiye: a randomized controlled trial. Epidemiol Psychiatr Sci 2024; 33:e43. [PMID: 39344836 DOI: 10.1017/s2045796024000453] [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] [Indexed: 10/01/2024] Open
Abstract
AIMS Despite high levels of psychological distress, mental health service use among Syrian refugees in urban settings is low. To address the mental healthcare gap, the World Health Organization developed group problem management plus (gPM+), a scalable psychological intervention delivered by non-specialist peer facilitators. The study aimed to evaluate the effectiveness of gPM+ in reducing symptoms of depression and anxiety among Syrian refugees in Istanbul, Türkiye. METHODS A randomized controlled trial was conducted among 368 distressed (Kessler Psychological Distress Scale, K10 > 15) adult Syrian refugees with impaired functioning (World Health Organization Disability Assessment Schedule, WHODAS 2.0 > 16). Participants were recruited between August 2019 and September 2020 through a non-governmental organization providing services to refugees. Participants were randomly allocated to gPM+ and enhanced care as usual (gPM+/E-CAU) (184 participants) or E-CAU only (184 participants). Primary outcomes were symptoms of depression and anxiety (Hopkins Symptom Checklist (HSCL-25)) at 3-month follow-up. Secondary outcomes were post-traumatic stress disorder (PTSD) symptoms (PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders-5; PCL-5), functional impairment (WHODAS 2.0), and self-identified problems (psychological outcome profiles). RESULTS Intent-to-treat analyses showed no significant effect of gPM+ on symptoms of anxiety, depression, PTSD and self-identified problems. Yet, there was a significant reduction in functional impairment in gPM+/E-CAU compared to E-CAU at 3-month follow-up (adjusted mean difference 1.66, 95 % CI 0.04, 3.27, p = 0.045, d = 0.19). Post-hoc subgroup analyses among participants with probable baseline depression or anxiety showed that there was a small but significant reduction in depression (adjusted mean difference -0.17, 95 % CI -0.32, -0.02, p = 0.028, d = 0.27) and anxiety (adjusted mean difference -0.21, 95 % CI -0.37, -0.05, p = 0.009, d = 0.30) symptoms comparing gPM+/E-CAU to E-CAU only at 1-week post assessment, but not at 3-month follow-up. There was a significant difference between conditions on functional impairment at 3-month follow-up, favouring gPM+/E-CAU condition (adjusted mean difference -1.98, 95 % CI -3.93, -0.02, p = 0.048, d = 0.26). CONCLUSION In this study in an urban setting in Türkiye, gPM+ did not alleviate symptoms of depression and anxiety among Syrian refugees experiencing psychological distress and daily living difficulties. However, participants with higher distress at baseline seemed to benefit from gPM+, but treatment gains disappeared in the long term. Current findings highlight the potential benefit of tailored psychosocial interventions for highly distressed refugees in volatile low-resource settings.
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Affiliation(s)
- C Acarturk
- Department of Psychology, Koc University, Istanbul, Türkiye
| | - G Kurt
- School of Psychiatry and Mental Health, University of New South Wales, Sydney, NSW, Australia
| | - Z İlkkurşun
- Department of Psychology, Koc University, Istanbul, Türkiye
| | - A M de Graaff
- Department of Clinical, Neuro- and Developmental Psychology, WHO Collaborating Center for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - R Bryant
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - P Cuijpers
- Department of Clinical, Neuro- and Developmental Psychology, WHO Collaborating Center for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Babeș-Bolyai University, International Institute for Psychotherapy, Cluj-Napoca, Romania
| | - D Fuhr
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany
- University of Bremen, Health Sciences, Bremen, Germany
| | - D McDaid
- Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science, London, UK
| | - A L Park
- Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science, London, UK
| | - M Sijbrandij
- Department of Clinical, Neuro- and Developmental Psychology, WHO Collaborating Center for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - P Ventevogel
- United Nations High Commissioner for Refugees, Public Health Section, Geneva, Switzerland
| | - E Uygun
- Trauma and Disaster Mental Health, Istanbul Bilgi University, Istanbul, Türkiye
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14
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Amin S, Mikolic A, Silverberg ND. Criterion validity of a single-item measure of fear avoidance behavior following mild traumatic brain injury. BMC Neurol 2024; 24:363. [PMID: 39342161 PMCID: PMC11437642 DOI: 10.1186/s12883-024-03861-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 09/11/2024] [Indexed: 10/01/2024] Open
Abstract
Maladaptive coping such as fear avoidance behavior can prolong recovery from mild traumatic brain injury (mTBI). Routine assessment of fear avoidance may improve management of mTBI. This study aimed to validate a single-item measure of fear avoidance to make its assessment more pragmatic. The present study is a secondary analysis of a clinical trial that involved adults with persistent post-concussion symptoms (N = 90, 63% female). Participants completed the single-item fear avoidance rating, a validated legacy measure of fear avoidance (Fear Avoidance Behavior after Traumatic Brain Injury; FAB-TBI), and measures of anxiety (General Anxiety Disorder-7), depression (Patient Health Questionnaire-9), post-concussion symptoms (Rivermead Postconcussion Symptoms Questionnaire), and disability (World Health Organization Disability Assessment Schedule 12.0). Questionnaires were completed twice, at baseline (mean 18.1 weeks post injury) and again 12-16 weeks later following study-delivered rehabilitation in addition to usual care. We analyzed the associations (Spearman's correlations) and agreement (weighted Kappa) between the single-item and FAB-TBI at baseline, posttreatment, individual FAB-TBI item scores, and the change in scores between baseline and posttreatment. In addition, we examined correlations between the single-item fear avoidance measure and related constructs, including anxiety, depression, post-concussion symptoms, and disability. The single-item fear avoidance measure correlated strongly with the FAB-TBI both at baseline and following treatment (ρ = 0.63 - 0.67, p < .001), and moderately with FAB-TBI item scores (ρ = 0.4 - 0.6). The correlation between the change in these scores from baseline to posttreatment was moderate (ρ = 0.45, p < .001). Agreement between the single-item fear avoidance measure and discretized FAB-TBI scores was moderate (κ = 0.45 - 0.51). Before and after treatment, the single-item fear avoidance measure correlated moderately with anxiety (ρ = 0.34), depression (ρ = 0.43), post-concussion symptoms (ρ = 0.50), and disability (ρ = 0.43). The FAB-TBI was more strongly correlated with these measures (ρ = 0.53 - 0.73). In summary, the present study supports the criterion validity of the single-item fear avoidance measure. This measure may be a useful screening and monitoring tool for patients with mTBI but is not a substitute for the FAB-TBI questionnaire.
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Affiliation(s)
- Shahrazad Amin
- Department of Psychology, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Psychology, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Ana Mikolic
- Department of Psychology, University of British Columbia, Vancouver, British Columbia, Canada
- Rehabilitation Research Program at GF Strong Rehab Centre, Centre for Aging SMART, Vancouver, British Columbia, Canada
| | - Noah D Silverberg
- Department of Psychology, University of British Columbia, Vancouver, British Columbia, Canada.
- Rehabilitation Research Program at GF Strong Rehab Centre, Centre for Aging SMART, Vancouver, British Columbia, Canada.
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15
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Wang X, Wang RX, Bian C, Liu FY, Tang MW, Zhang YH. Sleep quality, psychological resilience, family resilience, social support, and mental disability in patients with chronic schizophrenia: A cross-sectional study. Schizophr Res 2024; 274:199-205. [PMID: 39341099 DOI: 10.1016/j.schres.2024.09.020] [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: 12/16/2023] [Revised: 09/11/2024] [Accepted: 09/17/2024] [Indexed: 09/30/2024]
Abstract
After the remission of psychotic symptoms in patients with chronic schizophrenia, a persistently high rate of disability suggests potential influences from socio-ecological factors. This study aimed to explore the complex relationships between socioecological factors, including sleep quality, psychological resilience, family resilience, and social support, and the severity of psychiatric disability in patients with chronic schizophrenia. Employing a cross-sectional design, the study involved 188 individuals with chronic schizophrenia. Disability was measured using the World Health Organization Disability Assessment Schedule 2.0 (WHO-DAS 2.0), while social support, family resilience, psychological resilience, and sleep quality were assessed using the Social Support Rating Scale (SSRS), Family Hardiness Index (FHI), Connor-Davidson Resilience Scale (CD-RISC), and Pittsburgh Sleep Quality Index (PSQI), respectively. LASSO regression and structural equation modeling (SEM) analyses were conducted to identify predictive factors and their interrelationships. The mean WHO-DAS 2.0 score of 72.91 ± 14.04 indicated substantial difficulties in daily activities, necessitating comprehensive support among participants. LASSO regression identified frequent disease relapses, low education levels, and poor sleep quality as risk factors for disability, whereas strong social support, family resilience, and individual resilience emerged as protective factors against disability. SEM demonstrated that the enhancement of family and individual resilience by social support contributes to the mitigation of disability. The study underscores the critical roles of social support, family resilience, and individual psychological resilience in reducing disability in patients with chronic schizophrenia, suggesting that interventions targeting these factors may improve rehabilitation outcomes.
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Affiliation(s)
- Xin Wang
- Department of Psychiatry, Affiliated Nanjing Brain Hospital, Nanjing Medical University, China
| | - Ru-Xuan Wang
- School of Nursing, Nanjing Medical University, China
| | - Cheng Bian
- Department of Psychiatry, Affiliated Nanjing Brain Hospital, Nanjing Medical University, China
| | - Fu-Ying Liu
- Department of Psychiatry, Affiliated Nanjing Brain Hospital, Nanjing Medical University, China
| | - Ming-Wen Tang
- Department of Psychiatry, Affiliated Nanjing Brain Hospital, Nanjing Medical University, China
| | - Yan-Hong Zhang
- Department of Nursing, Affiliated Nanjing Brain Hospital, Nanjing Medical University, China.
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16
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Ponvel P, Murukesu RR, Shahar S, Rivan NFM, Subramaniam P, Singh DKA. Transition of Physical, Psychological, and Cognitive Frailty and Its' Associated Determinants in Malaysian Older Adults: A 5-Year Follow-up Study. Rejuvenation Res 2024. [PMID: 39225151 DOI: 10.1089/rej.2024.0047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/04/2024] Open
Abstract
Frailty, a multifaceted syndrome, affects approximately 26% of older adults globally, yet there are limited data on the prevalence and longitudinal impact of frailty subtypes. Therefore, in this study, we aim to determine the prevalence of physical, psychological, and cognitive frailty, transitions between subtypes, and associated health determinants among Malaysian community-dwelling older adults. This study is part of the longitudinal aging study in Malaysia (LRGS Ageless and TUA). We assessed 815 older adults in 2014, with successful follow-up of 402 participants (mean age: 67.08 ± 5.38 years) after 5 years. Frailty subtypes were assessed at baseline, and transitions were evaluated at the 5-year mark. At baseline, the prevalence of older adults categorized as robust, physical frailty, cognitive frailty, and psychological frailty was 26.7%, 36.3%, 12.1%, and 16.7%, respectively, with 8.1% exhibiting concurrent psychological and cognitive frailty. Follow-up results showed that 22.9% remained robust, 46.8% experienced no change, 24.9% deteriorated (adversed), and 5.5% improved (reversed). Logistic regression analysis identified living alone (p < 0.001), increased body fat percentage (p < 0.05), increased waist circumference (p < 0.05), reduced fat-free mass (p < 0.05), decreased lower limb flexibility (p < 0.05), and declined cardiorespiratory fitness (p < 0.05) as significant predictors of frailty deterioration. Higher Mini Mental State Examination (MMSE) scores and improved Timed Up and Go and Chair Stand test results (p < 0.05) were significantly associated with the reversal of frailty subtypes (p < 0.05). Younger older adults (p < 0.001), males (p < 0.05), those with lower WHO Disability Scale scores (p < 0.05), and higher MMSE scores (p < 0.05) were significantly less likely to develop frailty subtypes. Intervention strategies that focus on combined physical, cognitive, and psychosocial functions are crucial for both reversing and preventing the progression of frailty subtypes in older adults.
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Affiliation(s)
- Pavapriya Ponvel
- Faculty of Health Sciences, Centre for Healthy Ageing and Wellness (HCARE), Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
- Inti International University, Negeri Sembilan, Malaysia
| | | | - Suzana Shahar
- Faculty of Health Sciences, Centre for Healthy Ageing and Wellness (HCARE), Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Nurul Fatin Malek Rivan
- Faculty of Health Sciences, Centre for Healthy Ageing and Wellness (HCARE), Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Ponnusamy Subramaniam
- Faculty of Health Sciences, Centre for Healthy Ageing and Wellness (HCARE), Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Devinder Kaur Ajit Singh
- Faculty of Health Sciences, Centre for Healthy Ageing and Wellness (HCARE), Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
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17
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Tam S, Alibhai SMH, Hassanieh D, Kumar R, Mattsson J, Atenafu EG, Avery L, Bernstein LJ, Chang E, Langelier D, Lopez P, Jones JM. A phase 2 study of a longitudinal multidimensional rehabilitation program for allogeneic blood and marrow transplantation patients. Blood Adv 2024; 8:4778-4791. [PMID: 38985303 DOI: 10.1182/bloodadvances.2024012968] [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: 02/20/2024] [Revised: 06/05/2024] [Accepted: 06/22/2024] [Indexed: 07/11/2024] Open
Abstract
ABSTRACT Allogeneic blood and marrow transplantation (alloBMT) is a curative treatment for blood cancers associated with various treatment-related adverse events and morbidities for which rehabilitation programs are currently limited. A phase 2 randomized controlled trial (RCT) was conducted to assess the feasibility, acceptability, and impact of CaRE-4-alloBMT, a longitudinal, multidimensional cancer rehabilitation program for patients undergoing alloBMT. The primary outcomes included the feasibility and acceptability of the intervention and the methods. Feasibility was assessed through recruitment, retention, and adherence rates. Acceptability was assessed through qualitative interviews. Secondary clinical outcomes were collected through questionnaires and physiological assessments at 4 time points. A total of 80 participants were recruited and randomized. Recruitment (72%) and retention (70%) rates, along with qualitative findings, support the feasibility of the intervention. Adherence was suboptimal, most notably educational module completion (22.7%). Treatment effect sizes of 0.70 (95% confidence interval [CI], 0.20-1.21; 30-second sit-to-stand test) and 0.46 (95% CI, -0.17 to 1.09; 36-Item Short Form Survey) were observed in favor of the intervention. The results appear promising; however, the findings are limited by missing data owing to attrition. Modifications will be required to refine the program and inform a phase 3 RCT. This trial was registered at www.ClinicalTrials.gov as #NCT04966156.
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Affiliation(s)
- Samantha Tam
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Shabbir M H Alibhai
- Department of Medicine, University Health Network, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Dima Hassanieh
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Rajat Kumar
- Hans Messner Allogeneic Transplant Program, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Jonas Mattsson
- Hans Messner Allogeneic Transplant Program, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Eshetu G Atenafu
- Department of Biostatistics, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Lisa Avery
- Department of Biostatistics, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Lori J Bernstein
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Eugene Chang
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - David Langelier
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Paty Lopez
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Jennifer M Jones
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
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18
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Marín-Maicas P, Ambrosio L, Corchon S, González-Moreno J, Portillo MC. Living with long-term conditions: validation of a new instrument for family caregivers in a Spanish-speaking population. BMJ Open 2024; 14:e088773. [PMID: 39306353 PMCID: PMC11418565 DOI: 10.1136/bmjopen-2024-088773] [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: 05/15/2024] [Accepted: 08/27/2024] [Indexed: 09/25/2024] Open
Abstract
INTRODUCTION Optimising the management of chronicity has been a global challenge for decades. Individuals with long-term conditions (LTCs) and their families live with them for years. Thus, it is necessary to include both of their perspectives in the management and adaptation of the interventions proposed. The psychometric properties of the living with LTCs scale from the perspective of the family caregiver are unknown. The objective of the present study is to describe the psychometric properties of the EC-PC-Fam in a Spanish-speaking population. METHODS An observational, cross-sectional study was performed with a retest of part of the sample. The fit of the model was optimised with a factorial analysis, and the psychometric properties were verified. RESULTS A sample of 311 caregivers was recruited. Most of them were women (68.2%) and had a mean age of 58.29±9.91 years (range: 32-84 years). The initial version did not obtain acceptable fit scores. To improve the fit, different versions were tested, refining the distribution of the items until optimisation was reached in V.10 (19 items). Cronbach's alpha was 0.81 for the scale as a whole. The intraclass correlation coefficient was 0.77. The EC-PC-Fam scale is strongly and inversely correlated with a scale that measures the burden of the caregiver (rs=-0.46), and moderately related to the health-related quality of life (rs=0.373) and social support (rs=0.38). CONCLUSIONS The EC-PC-Fam scale from a family perspective is defined as a promising tool for promoting personalised care and for optimising the management of LTCs, and a new approach that includes family caregivers is proposed for clinical practice. The scale is an instrument with a moderate fit and optimum psychometric properties to measure living with LTCs from the perspective of a family caregiver. New validation studies are recommended to verify the fit of the proposed factorial solution.
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Affiliation(s)
- Patricia Marín-Maicas
- Facultad de Enfermería y Podología, Universitat de Valencia, Valencia, Spain
- Faculty of Health Science, Valencian International University, Valencia, Spain
| | - Leire Ambrosio
- National Institute for Health and Care Research (NIHR) Applied Research Collaboration Wessex, Southampton, UK, School of Health Sciences University of Southampton, Southampton, UK
| | | | | | - Mari Carmen Portillo
- National Institute for Health and Care Research (NIHR) Applied Research Collaboration Wessex, Southampton, UK, School of Health Sciences University of Southampton, Southampton, UK
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19
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Rodolico A, Aprile SF, Cutrufelli P, Privitera G, Castellano S, Concerto C, Furnari R, Guerrera CS, Mineo L, Platania GA, Petralia A, Caraci F, Signorelli MS. Disability and Adverse Effects of Oral Versus Long-Acting Injectable Antipsychotics in Schizophrenia-Spectrum and Bipolar Disorder: A Comparison Based on Data-Driven Taxonomy. Clin Drug Investig 2024:10.1007/s40261-024-01391-x. [PMID: 39302586 DOI: 10.1007/s40261-024-01391-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2024] [Indexed: 09/22/2024]
Abstract
BACKGROUND Patients undergoing antipsychotic treatment for psychiatric disorders may experience challenges in functioning, either stemming from the severity of the illness or from the tolerability issues of prescribed medications. OBJECTIVES The aims of this cross-sectional study are to investigate the impact of adverse effects of antipsychotic drugs on patients' daily life functioning, comparing oral and long-acting injectable (LAI) antipsychotics, and further dividing antipsychotics by receptor-binding profiles based on recently defined data-driven taxonomy. METHODS This study involved patients with schizophrenia and bipolar spectrum disorders taking oral or LAI antipsychotics. Disability and functioning levels were assessed using the World Health Organization Disability Assessment Schedule 2.0 (WHODAS), and the adverse effects of medications were evaluated using the Udvalg for Kliniske Undersogelser (UKU) Side Effect Rating Scale and its subscales. RESULTS The total sample consisted of 126 participants with a diagnosis of schizophrenia-spectrum or bipolar disorder, and included 54 males and 72 females ranging from 18 to 78 years of age (mean 45.1, standard deviation 14); 78 patients were taking oral antipsychotics and 48 were taking LAI antipsychotics, with subcategories of muscarinic (31), adrenergic/low dopamine (25), serotonergic/dopaminergic (23), dopaminergic (1), LAI muscarinic (15), LAI adrenergic (6), and LAI serotonergic/dopaminergic (25). The UKU total score for adverse effects showed significant correlations with WHODAS total score (ρ = 0.475; p < 0.001). Compared with oral antipsychotics, LAIs showed significantly lower scores in psychological (p = 0.014), autonomic (p = 0.008), other (p = 0.004), and sexual adverse effects (p = 0.008), as well as the UKU total score (p = 0.002). The Kruskal-Wallis test showed a significant difference in adverse effects between LAI and oral muscarinic subgroups, with LAIs having lower scores compared with antipsychotics binding to muscarinic receptors (p = 0.043). CONCLUSION These findings indicate clinically relevant differences in adverse effects among formulations, warranting further investigation for future observational studies.
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Affiliation(s)
- Alessandro Rodolico
- Department of Psychiatry and Psychotherapy, TUM School of Medicine and Health, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
| | - Sofia Francesca Aprile
- Section of Psychology, Department of Educational Sciences, University of Catania, Via Teatro Greco 84, 95124, Catania, Italy
| | - Pierfelice Cutrufelli
- Psychiatry Unit, Department of Clinical and Experimental Medicine, University of Catania, Via Santa Sofia 78, 95123, Catania, Italy.
| | - Gabriele Privitera
- Psychiatry Unit, Department of Clinical and Experimental Medicine, University of Catania, Via Santa Sofia 78, 95123, Catania, Italy
| | - Sabrina Castellano
- Section of Psychology, Department of Educational Sciences, University of Catania, Via Teatro Greco 84, 95124, Catania, Italy
| | - Carmen Concerto
- Psychiatry Unit, Department of Clinical and Experimental Medicine, University of Catania, Via Santa Sofia 78, 95123, Catania, Italy
| | - Rosaria Furnari
- Psychiatry Unit, Department of Clinical and Experimental Medicine, University of Catania, Via Santa Sofia 78, 95123, Catania, Italy
| | - Claudia Savia Guerrera
- Section of Psychology, Department of Educational Sciences, University of Catania, Via Teatro Greco 84, 95124, Catania, Italy
| | - Ludovico Mineo
- Psychiatry Unit, Department of Clinical and Experimental Medicine, University of Catania, Via Santa Sofia 78, 95123, Catania, Italy
| | - Giuseppe Alessio Platania
- Section of Psychology, Department of Educational Sciences, University of Catania, Via Teatro Greco 84, 95124, Catania, Italy
| | - Antonino Petralia
- Psychiatry Unit, Department of Clinical and Experimental Medicine, University of Catania, Via Santa Sofia 78, 95123, Catania, Italy
| | - Filippo Caraci
- Oasi Research Institute, IRCCS, Via Conte Ruggero 73, 94018, Troina, Italy
- Department of Drug and Health Sciences, University of Catania, Via Valdisavoia, 5, 95123, Catania, Italy
| | - Maria Salvina Signorelli
- Psychiatry Unit, Department of Clinical and Experimental Medicine, University of Catania, Via Santa Sofia 78, 95123, Catania, Italy
- Oasi Research Institute, IRCCS, Via Conte Ruggero 73, 94018, Troina, Italy
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20
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Ngo VK, Vu TT, Levine D, Punter MA, Beane SJ, Weiss MR, Wyka K, Florez-Arango JF, Zhou X. A multisector community-engaged collaborative for mental health integration in primary care and housing developments: Protocol for a stepped-wedge randomized controlled trial (the Harlem Strong Program). BMC Public Health 2024; 24:2554. [PMID: 39300414 DOI: 10.1186/s12889-024-20026-6] [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: 02/16/2024] [Accepted: 09/09/2024] [Indexed: 09/22/2024] Open
Abstract
BACKGROUND Addressing mental health disparities following COVID-19 requires adaptive, multi-sectoral, equity-focused, and community-based approaches. Mental health task-sharing in gateway settings has been found to address mental health care gaps in low- and middle-income countries, but is not a common practice in the U.S., especially in non-medical settings, such as low-income housing developments (LIH). This research study will evaluate the effectiveness of a multisectoral community-engaged collaborative for task-sharing mental health care on consumer, provider, and implementation outcomes, as well as identify barriers and facilitators for implementation. METHODS In this stepped-wedge randomized controlled trial with technology supplementation, LIH and primary care sites will be randomly assigned to one of five sequences of three implementation strategies: (1) Education and Resources (E&R), which involves online training and resources on basic mental health task-sharing skills, (2) Multisectoral Community Collaborative Care (MCC), which consists of all E&R resources plus additional community responsive implementation supports and participation in a multisectoral coalition and (3) MCC + Technology, which combines the MCC condition resources with a community crowdsourced technology solution to support implementation. The primary outcome is the effectiveness in meeting consumers' needs through direct service (e.g., adequately addressing depression and anxiety symptoms), and through implementation to increase access to mental health care (reach). The secondary outcome examines additional consumer outcomes including health functioning and social risks, as well as implementation outcomes including provider skills, program adoption, and factors related to barriers and facilitators of quality implementation. A total of 700 consumers receiving mental health care at 20 sites will be surveyed at baseline, 6-, and 12-month follow-ups. Additionally, 100 providers will be evaluated at baseline, 6-, 12-, and 24-month follow-ups before training and after randomization. DISCUSSION We hypothesize that MCC and MCC + Technology conditions will demonstrate significantly higher efficacy in changing primary outcomes compared to E&R, and the MCC + Technology supplement will show significantly higher levels of reach of mental health tasks compared to the MCC condition alone. These findings will demonstrate the feasibility of mental health integration into accessible, non-medical community settings such as LIH. Moreover, it will help establish a multilevel system solution based on community engagement and planning with a multisectoral collaboration that can be sustained community-wide. TRIAL REGISTRATION NCT05833555 on Clinicaltrials.gov. Registered April 26, 2023.
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Affiliation(s)
- Victoria K Ngo
- Center for Innovation in Mental Health, Graduate School of Public Health and Health Policy, The City University of New York, NY, New York, USA
- Department of Community Health and Social Sciences, Graduate School of Public Health and Health Policy, The City University of New York, NY, New York, USA
| | - Thinh T Vu
- Center for Innovation in Mental Health, Graduate School of Public Health and Health Policy, The City University of New York, NY, New York, USA.
- Department of Community Health and Social Sciences, Graduate School of Public Health and Health Policy, The City University of New York, NY, New York, USA.
| | - Deborah Levine
- Harlem Health Initiative, Graduate School of Public Health and Health Policy, The City University of New York, New York, NY, USA
| | - Malcolm A Punter
- Harlem Congregations for Community Improvement, Inc., New York, USA
| | | | - Marina R Weiss
- Center for Innovation in Mental Health, Graduate School of Public Health and Health Policy, The City University of New York, NY, New York, USA
| | - Katarzyna Wyka
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, The City University of New York, NY, New York, USA
| | | | - Xin Zhou
- Department of Biostatistics, Yale School of Public Health, Connecticut, USA
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21
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de Souza CCC, Zacarias LC, Campos NG, Fortaleza SCB, Madeira CA, Sousa Almondes JGD, Leite CF. Validation of the World Health Organization Disability Assessment Schedule (WHODAS 2.0) for individuals with asthma. Disabil Rehabil 2024:1-8. [PMID: 39264096 DOI: 10.1080/09638288.2024.2402077] [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: 03/14/2024] [Revised: 08/15/2024] [Accepted: 09/04/2024] [Indexed: 09/13/2024]
Abstract
PURPOSE There are no disease-specific tools for assessing the functioning of patients with asthma. This study aims to evaluate the psychometric properties of the Brazilian version of the World Health Organization Disability Assessment Schedule (WHODAS 2.0) in individuals with asthma. METHODS 101 individuals with asthma responded to the 36-item version of the WHODAS 2.0, Asthma Quality of Life Questionnaire (AQLQ), and Asthma Control Test (ACT). The following psychometric properties were tested: internal consistency, factor structure, and convergent and discriminative validity. RESULTS Homogeneity was found between WHODAS 2.0 items and domains, except "Getting along" (Cronbach's α = 0.57). When item "D4.5 Sexual activities" was deleted, the Cronbach's increased to 0.70. Exploratory factor analysis identified four factors (explained variance 56%). There was a strong correlation between the WHODAS 2.0 and AQLQ (r=-0.72) and between the WHODAS 2.0 and ACT (r= -0.59). There was no evidence of the influence of obstruction level (FEV1) on functioning. CONCLUSION WHODAS 2.0 is a valid and reliable tool for assessing functioning in individuals with asthma. Exclusion of item D.4.5 Sexual activity increased the homogeneity between the items of the "Getting along" domain. When applied to asthmatics, the WHODAS total functioning score is preferable to the domain-specific scores.
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Affiliation(s)
| | - Laíla Cândida Zacarias
- Graduate Program in Cardiovascular Sciences, Federal University of Ceara, Fortaleza, Ceara, Brazil
| | - Nataly Gurgel Campos
- Master Program in Physiotherapy and Functioning, Federal University of Ceara, Fortaleza, Brazil
| | | | | | | | - Camila Ferreira Leite
- Graduate Program in Cardiovascular Sciences, Federal University of Ceara, Fortaleza, Ceara, Brazil
- Master Program in Physiotherapy and Functioning, Federal University of Ceara, Fortaleza, Brazil
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22
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Maiuolo ML, Giorgini R, Vaccaro MG, Facchin A, Quattrone A, Quattrone A. Assessments scales for the evaluation of health-related quality of life in Parkinson's disease, progressive supranuclear palsy, and multiple system atrophy: a systematic review. Front Psychol 2024; 15:1438830. [PMID: 39319068 PMCID: PMC11420144 DOI: 10.3389/fpsyg.2024.1438830] [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: 05/26/2024] [Accepted: 08/13/2024] [Indexed: 09/26/2024] Open
Abstract
Background The concept of wellbeing is expansive and intricate, making it challenging to define precisely. Similarly, the instruments employed to assess wellbeing are complex and multifaceted. Therefore, it is more appropriate to refer to the notion of wellbeing as Health-Related Quality of Life (HRQoL), which is the central focus of many measures used to assess the feeling of wellbeing. This review aimed to identify the tools most commonly used to evaluate HRQoL in individuals with Parkinsonism-a group of movement disorders that negatively impact the quality of life due to the intricate interplay of symptoms, socio-demographic characteristics, and psychological factors. The main aim was to assess the psychometric properties of these measures in terms of validity and reliability. Methods A literature review was conducted, focusing on research related to the assessment of HRQoL in connection to symptoms of Parkinsonism. This review included all studies that examined HRQoL using evaluation scales, exams, or self-reported questionnaires. The literature review was conducted using the databases Scopus and Web of Science and the search engine PubMed to identify studies published between 1996 and 2023. Only records that assessed HRQoL in individuals with Parkinson's disease and Parkinsonism were selected for evaluation. Results A total of 393 records were examined, and eight tools were identified as the most frequently used in the evaluation of HRQoL. Discussion The results show a significant gap in knowledge regarding the latent structure and measurement invariance of HRQoL measurements, which may have a significant influence on the interpretation of test outcomes. Moreover, there is a lack of clear divergent validity between HRQoL assessments and other tests used as predictors of HRQoL. This could represent a significant limitation, affecting the construct and criterion validity of HRQoL measures.
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Affiliation(s)
- Maria Lucia Maiuolo
- Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Roberto Giorgini
- Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Maria Grazia Vaccaro
- Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Alessio Facchin
- Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Andrea Quattrone
- Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Aldo Quattrone
- Neuroscience Research Centre, Magna Graecia University of Catanzaro, Catanzaro, Italy
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23
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Shaw R, Pengelly C, Crinnin C, Amina E, Wutz AV, King PR. Scoping review of the role of social support in women veterans' psychosocial and health outcomes. J Women Aging 2024:1-25. [PMID: 39252402 DOI: 10.1080/08952841.2024.2395111] [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: 10/31/2023] [Revised: 06/04/2024] [Accepted: 07/16/2024] [Indexed: 09/11/2024]
Abstract
Women veterans are a steadily growing population and have unique military experiences (e.g., report high rates of sexual harassment and assault) that are impactful across the lifespan. High levels of positive social support have been linked to a range of positive outcomes in both civilian and military populations. However, research has not consistently explored social support and interpersonal functioning in women veterans, or as potential mechanisms of change within interventions for women veterans. This is a scoping review of peer-reviewed articles that evaluated social support. Articles with at least 10% women or formally evaluated sex or gender in reference to social support were included. A total of 69 studies evaluated social support in relation to women veterans' health outcomes. From a biopsychosocial perspective, social support is an important construct to examine relative to health care engagement and response. Limited research considered aging women veterans needs or focused on the intersectional identities of women veterans. Positive social support can have major physical and mental health benefits, yet limited research and disparate methodological approaches minimize the ability to draw conclusions on how social support can best be leveraged to support women veterans. Women veterans' roles and military experiences (e.g., increased likelihood of combat exposure) are changing and this population is aging. Research is needed to inform best practices for this growing segment of the veteran population.
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Affiliation(s)
- Rachael Shaw
- VA Center for Integrated Healthcare, Buffalo, New York, USA
- Department of Psychology, University at Buffalo, Buffalo, New York, USA
- VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Charlotte Crinnin
- VA Center for Integrated Healthcare, Buffalo, New York, USA
- School of Education & Human Services, Canisius College, Buffalo, New York, USA
| | - Evodie Amina
- VA Center for Integrated Healthcare, Buffalo, New York, USA
- School of Public Health and Health Professions, University at Buffalo, Buffalo, New York, USA
| | | | - Paul R King
- VA Center for Integrated Healthcare, Buffalo, New York, USA
- Department of Rehabilitation Science, University at Buffalo, Buffalo, New York, USA
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24
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Schäfer C, Moksnes HØ, Rasmussen MS, Hellstrøm T, Brunborg C, Soberg HL, Røise O, Røe C, Andelic N, Anke A. Return to Work One Year after Moderate to Severe Traumatic Injury in a Working Age Population. J Clin Med 2024; 13:5308. [PMID: 39274521 PMCID: PMC11396350 DOI: 10.3390/jcm13175308] [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: 08/15/2024] [Revised: 09/02/2024] [Accepted: 09/05/2024] [Indexed: 09/16/2024] Open
Abstract
Background/Objectives: Physical trauma may cause long-term disabilities. The importance of place of residence in the return to work after injuries is little researched. The primary aims of this study were to describe return to work or school (RTW) at 6 and 12 months after moderate to severe traumatic injury and to investigate demographic and injury-related predictors for RTW with an initial focus on geographic centrality of residency. The secondary aim was to investigate the association between RTW and functioning. Methods: A prospective cohort study conducted at two Norwegian trauma centres. Inclusion criteria: age 18 to 70 years, at least a two-day hospital stay and a New Injury Severity Score > 9. Information about centrality, demographics, injuries, and return to work were collected. Associations between possible predictors and RTW were assessed using binary logistic regression. Results: Of the 223 participants, 68% had returned to work after 6 months and 77% after 12 months. Twelve-month RTW was 89% after thorax/abdomen injuries, 78% after extremity/spine injuries and 73% after head injuries. More central residency was a significant predictor for RTW in univariable but only within the extremity/spine injury subgroup in multivariable analysis. Negative factors were age, having a blue-collar job, number of injuries and rehabilitation complexity. Function 12 months post-injury was associated with RTW in the multivariable model. Conclusions: RTW after one year was high in all major trauma groups. Demographic and injury-related factors were more important predictors of RTW than centrality of residency. Blue-collar workers and patients with multiple injuries and high rehabilitation complexity should be given special attention to support RTW.
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Affiliation(s)
- Christoph Schäfer
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, 0424 Oslo, Norway
- Faculty of Health Sciences, Department of Clinical Medicine, UiT The Arctic University of Norway, Postboks 6050 Langnes, 9037 Tromsø, Norway
- Department of Physical Medicine and Rehabilitation, University Hospital of North Norway, Postboks 100, 9038 Tromsø, Norway
- Institute of Health and Society, Research Centre for Habilitation and Rehabilitation Models & Services (CHARM), Faculty of Medicine, University of Oslo, 0373 Oslo, Norway
| | - Håkon Øgreid Moksnes
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, 0424 Oslo, Norway
- Institute of Health and Society, Research Centre for Habilitation and Rehabilitation Models & Services (CHARM), Faculty of Medicine, University of Oslo, 0373 Oslo, Norway
| | - Mari Storli Rasmussen
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, 0424 Oslo, Norway
- Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway
| | - Torgeir Hellstrøm
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, 0424 Oslo, Norway
| | - Cathrine Brunborg
- Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, 0424 Oslo, Norway
| | - Helene Lundgaard Soberg
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, 0424 Oslo, Norway
- Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway
| | - Olav Røise
- Norwegian Trauma Registry, Division of Orthopaedic Surgery, Oslo University Hospital, 0424 Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, 0130 Oslo, Norway
| | - Cecilie Røe
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, 0424 Oslo, Norway
- Institute of Health and Society, Research Centre for Habilitation and Rehabilitation Models & Services (CHARM), Faculty of Medicine, University of Oslo, 0373 Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, 0130 Oslo, Norway
| | - Nada Andelic
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, 0424 Oslo, Norway
- Institute of Health and Society, Research Centre for Habilitation and Rehabilitation Models & Services (CHARM), Faculty of Medicine, University of Oslo, 0373 Oslo, Norway
| | - Audny Anke
- Faculty of Health Sciences, Department of Clinical Medicine, UiT The Arctic University of Norway, Postboks 6050 Langnes, 9037 Tromsø, Norway
- Department of Physical Medicine and Rehabilitation, University Hospital of North Norway, Postboks 100, 9038 Tromsø, Norway
- Institute of Health and Society, Research Centre for Habilitation and Rehabilitation Models & Services (CHARM), Faculty of Medicine, University of Oslo, 0373 Oslo, Norway
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25
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Lundin J, Jansson-Fröjmark M, Gustafsson-Björverud L, Grey N, Santoft F, Ehlers A, Carlbring P, Lundgren T, Bragesjö M, Salomonsson S. Integrating digital and in-person therapy for PTSD: feasibility and acceptability of blended trauma-focused cognitive therapy in routine care. Front Psychiatry 2024; 15:1447651. [PMID: 39301223 PMCID: PMC11410639 DOI: 10.3389/fpsyt.2024.1447651] [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: 06/11/2024] [Accepted: 08/16/2024] [Indexed: 09/22/2024] Open
Abstract
Introduction Access to evidence-based psychological therapy for posttraumatic stress disorder (PTSD) is limited. Blended Trauma-focused Cognitive Therapy (bTF-CT), merging internet-modules with a few therapy sessions, may be a pathway to enhance treatment access while maintaining the benefits of face-to-face therapy. Objectives This study aimed to evaluate the feasibility, acceptability, and preliminary effectiveness of bTF-CT for PTSD in routine care, as well as the feasibility of assessments and data collection. Method A single-arm design was adopted. bTF-CT was provided to 17 participants across two psychiatric and one primary care clinic. Assessments were conducted pre, during, post and 6-months following treatment. We assessed feasibility and acceptability via self-report questionnaires, retention, and attrition rates. To estimate preliminary treatment effectiveness the PTSD Symptom Checklist (PCL-5) was used to assess PTSD symptom severity. Results Treatment satisfaction was high with a mean score of 28.7 out of 32 on the Client Satisfaction Questionnaire (SD = 3.5). The dropout rate was low, with 88% treatment retention. Program adherence was satisfactory, with scores ranging from 2.13 to 3.13 out of 4 on the internet intervention patient adherence scale. On the PCL-5, 88% made a reliable change, 64% demonstrated a clinically significant change, and the mean change from pre to post was 24 points (d = 2.13). Some negative effects were reported, such as unpleasant memories, feelings, and disrupted sleep, but these were temporary according to symptom scales. Conclusions bTF-CT appears to be acceptable, feasible, and potentially effective when delivered in routine care. A large-scale non-inferiority trial to assess effectiveness compared to a gold-standard treatment is warranted. Clinical Trial Registration Clinicaltrials.gov, identifier NCT04881643.
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Affiliation(s)
- Johan Lundin
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institute and Stockholm Health Care Services, Stockholm, Sweden
| | - Markus Jansson-Fröjmark
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institute and Stockholm Health Care Services, Stockholm, Sweden
| | - Linda Gustafsson-Björverud
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institute and Stockholm Health Care Services, Stockholm, Sweden
| | - Nick Grey
- Sussex Partnership NHS Foundation Trust and School of Psychology, University of Sussex, Brighton, United Kingdom
| | - Fredrik Santoft
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institute and Stockholm Health Care Services, Stockholm, Sweden
| | - Anke Ehlers
- Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom
| | - Per Carlbring
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Tobias Lundgren
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institute and Stockholm Health Care Services, Stockholm, Sweden
| | - Maria Bragesjö
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institute and Stockholm Health Care Services, Stockholm, Sweden
| | - Sigrid Salomonsson
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institute and Stockholm Health Care Services, Stockholm, Sweden
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Cytera C, Muehlan H, Rapp M, Guyard A, Thyen U, Schmidt S, Markwart H. Development and Validation of the Questionnaire of Young People's Participation-Young Adults (QYPP-YA). Child Care Health Dev 2024; 50:e13326. [PMID: 39237254 DOI: 10.1111/cch.13326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 07/25/2024] [Accepted: 08/13/2024] [Indexed: 09/07/2024]
Abstract
BACKGROUND The Questionnaire of Young People's Participation (QYPP) was developed for use in children and adolescents. To track participation throughout transition from childhood to adulthood, we adapted it for young adults using focus groups. Aim of this study was to validate this measure, the QYPP-Young Adults (QYPP-YA). METHODS We recruited young adults with cerebral palsy (CP) and a representative, same-aged sample of the general population (GP). The GP-sample was split into two equivalent subsamples, one part to identify the factor structure via exploratory factor analysis and another part to test the resulting model via confirmatory factor analysis. Reliability and different forms of validity were investigated. RESULTS The final QYPP-YA includes 17 items assigned to six domains (Autonomy, Independency, Intimate Relationships, Interpersonal Relationships, Social Life, Online Communication). Scales show satisfying internal consistencies in the CP-sample and in the GP-sample, except for 'Online Communication'. Convergent, divergent and known-group validity were confirmed. CONCLUSIONS The QYPP-YA instrument features promising psychometric characteristics to assess key domains of participation in healthy and disabled young adults. It provides a multidimensional, economic and sound assessment for use in population surveys and clinical trials.
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Affiliation(s)
- Chirine Cytera
- Department of Pediatric and Adolescent Medicine, Universität zu Lübeck, Lübeck, Germany
- Institute of Psychology, University of Greifswald, Greifswald, Germany
| | - Holger Muehlan
- Institute of Medical Psychology, Health and Medical University, Erfurt, Germany
| | - Marion Rapp
- Department of Pediatric and Adolescent Medicine, Universität zu Lübeck, Lübeck, Germany
| | - Audrey Guyard
- UMR 5525 CNRS/TIMC-IMAG Team MESP, Grenoble Alpes University, Grenoble, France
| | - Ute Thyen
- Department of Pediatric and Adolescent Medicine, Universität zu Lübeck, Lübeck, Germany
| | - Silke Schmidt
- Institute of Psychology, University of Greifswald, Greifswald, Germany
| | - Henriette Markwart
- Community Medicine, Department Methods of Community Medicine, University Medicine of Greifswald, Greifswald, Germany
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de Oliveira ACS, Zacarias LC, de Souza CCC, Bezerra JPDS, Viana-Junior AB, Sobreira-Neto MA, Leite CF. Validity, reliability, and responsiveness of the Brazilian version of the instrument World Health Organization Disability Assessment Schedule (WHODAS 2.0) for individuals with obstructive sleep apnoea. Heart Lung 2024; 67:183-190. [PMID: 38848628 DOI: 10.1016/j.hrtlng.2024.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 04/26/2024] [Accepted: 05/28/2024] [Indexed: 06/09/2024]
Abstract
BACKGROUND Obstructive sleep apnoea (OSA) is a disabling health condition, and there is no disease-specific patient-reported outcome instrument to assess individuals with OSA. OBJECTIVES To evaluate the psychometric properties of the Brazilian version of the World Health Organization Disability Assessment Schedule (WHODAS 2.0) in individuals with OSA. METHODS One hundred individuals with OSA responded to the WHODAS 2.0 version of 36 items, the Epworth Sleepiness Scale (ESS), the Pittsburgh Sleep Quality Index (PSQI), and the 12-item health survey (SF-12). Internal consistency, convergent and discriminative validity, and responsiveness to continuous positive airway pressure (CPAP) were the psychometric properties tested. RESULTS Cronbach's α values indicate good internal consistency (0.91 - 0.73), except for the self-care domain (α = 0.52). Convergent validity indicated an excellent correlation (r = -0.80) between the domains of functioning and quality of life. Discriminative validity showed no association between OSA severity and functioning (p = 0.90). The responsiveness to CPAP treatment showed a large effect size (r = 0.82; p < 0.05) CONCLUSIONS: The WHODAS 2.0 instrument is valid, reliable, and responsive for assessing individuals with OSA.
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Affiliation(s)
- Ana Cecília Silva de Oliveira
- Master Program in Physiotherapy and Functioning, Federal University of Ceara, Fortaleza, Ceara, Brazil, Rua Coronel Nunes Melo, 1127, Rodolfo Teófilo, Campus Porangabussu, ZIP Code:60.430-275
| | - Laíla Cândida Zacarias
- Graduate Program in Cardiovascular Sciences, Federal University of Ceara, Fortaleza, CE, Brazil, Rua Papi Júnior, 1232, sala 209, Rodolfo Teófilo, ZIP Code: 60430-235
| | - Clarice Cristina Cunha de Souza
- Graduate Program in Cardiovascular Sciences, Federal University of Ceara, Fortaleza, CE, Brazil, Rua Papi Júnior, 1232, sala 209, Rodolfo Teófilo, ZIP Code: 60430-235
| | - João Paulo da Silva Bezerra
- Department of Physical Therapy, Federal University of Ceara, Fortaleza, Ceara, Brazil, Rua Major Weyne, 1440, Campus do Porangabussu, Rodolfo Teófilo, ZIP Code: 60430-160
| | - Antônio Brazil Viana-Junior
- Clinical Research Unit of Hospital Universitario Walter Cantidio, Federal University of Ceara - EBSERH, Fortaleza, Brazil, Rua Coronel Nunes de Melo, Rodolfo Teófilo, ZIP Code: 60430-275
| | - Manoel Alves Sobreira-Neto
- Department of Clinical Medicine, Federal University of Ceara, Fortaleza, Ceara, Brazil. R. Alexandre Baraúna, 949, Rodolfo Teófilo, ZIP Code: 60430-160
| | - Camila Ferreira Leite
- Master Program in Physiotherapy and Functioning, Federal University of Ceara, Fortaleza, Ceara, Brazil, Rua Coronel Nunes Melo, 1127, Rodolfo Teófilo, Campus Porangabussu, ZIP Code:60.430-275; Graduate Program in Cardiovascular Sciences, Federal University of Ceara, Fortaleza, CE, Brazil, Rua Papi Júnior, 1232, sala 209, Rodolfo Teófilo, ZIP Code: 60430-235.
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Burchert S, Alkneme MS, Alsaod A, Cuijpers P, Heim E, Hessling J, Hosny N, Sijbrandij M, van’t Hof E, Ventevogel P, Knaevelsrud C. Effects of a self-guided digital mental health self-help intervention for Syrian refugees in Egypt: A pragmatic randomized controlled trial. PLoS Med 2024; 21:e1004460. [PMID: 39250521 PMCID: PMC11419380 DOI: 10.1371/journal.pmed.1004460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 09/23/2024] [Accepted: 08/14/2024] [Indexed: 09/11/2024] Open
Abstract
BACKGROUND Digital mental health interventions for smartphones, such as the World Health Organization (WHO) Step-by-Step (SbS) program, are potentially scalable solutions to improve access to mental health and psychosocial support in refugee populations. Our study objective was to evaluate the effectiveness of SbS as self-guided intervention with optional message-based contact-on-demand (COD) support on reducing psychological distress, functional impairment, symptoms of posttraumatic stress disorder (PTSD), and self-identified problems in a sample of Syrian refugees residing in Egypt. METHODS AND FINDINGS We conducted a 2-arm pragmatic randomized controlled trial. A total of 538 Syrians residing in Egypt with elevated levels of psychological distress (Kessler Psychological Distress Scale; K10 > 15) and reduced psychosocial functioning (WHODAS 2.0 > 16) were randomized into SbS + CAU (N = 266) or CAU only (N = 272). Primary outcomes were psychological distress (Hopkins Symptom Checklist 25) and impaired functioning (WHO Disability Assessment Schedule 2.0) at 3-month follow-up. Secondary outcomes were symptoms of PTSD (PTSD Checklist for DSM-5 short form, PCL-5 short) and self-identified problems (Psychological Outcomes Profiles Scale, PSYCHLOPS). Intention-to-treat (ITT) analyses showed significant but small effects of condition on psychological distress (mean difference: -0.15; 95% CI: -0.28, -0.02; p = .02) and functioning (mean difference: -2.04; 95% CI: -3.87, -0.22; p = .02) at 3-month follow-up. There were no significant differences between groups on symptoms of PTSD and self-identified problems. Remission rates did not differ between conditions on any of the outcomes. COD was used by 9.4% of participants for a median of 1 contact per person. The main limitations are high intervention dropout and low utilization of COD support. CONCLUSIONS The trial provides a real-world implementation case, showing small positive effects of a digital, potentially scalable and self-guided mental health intervention for Syrian refugees in Egypt in reducing psychological distress and improving overall functioning. Further user-centered adaptations are required to improve adherence and effectiveness while maintaining scalability. TRIAL REGISTRATION German Register for Clinical Studies DRKS00023505.
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Affiliation(s)
- Sebastian Burchert
- Department of Education and Psychology, Division of Clinical Psychological Intervention, Freie Universität Berlin, Berlin, Germany
| | - Mhd Salem Alkneme
- Department of Education and Psychology, Division of Clinical Psychological Intervention, Freie Universität Berlin, Berlin, Germany
| | - Ammar Alsaod
- Department of Education and Psychology, Division of Clinical Psychological Intervention, Freie Universität Berlin, Berlin, Germany
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, WHO Collaborating Center for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Babeș-Bolyai University, International Institute for Psychotherapy, Cluj-Napoca, Romania
| | - Eva Heim
- Department of Psychology, University of Lausanne, Lausanne, Switzerland
| | - Jonas Hessling
- Department of Education and Psychology, Division of Clinical Psychological Intervention, Freie Universität Berlin, Berlin, Germany
| | - Nadine Hosny
- Department of Psychology, University of Lausanne, Lausanne, Switzerland
- Department of Psychology, The American University in Cairo, New Cairo, Egypt
| | - Marit Sijbrandij
- Department of Clinical, Neuro and Developmental Psychology, WHO Collaborating Center for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | | | - Pieter Ventevogel
- Public Health Section, Division of Resilience and Solutions, United Nations High Commissioner for Refugees, Geneva, Switzerland
| | - Christine Knaevelsrud
- Department of Education and Psychology, Division of Clinical Psychological Intervention, Freie Universität Berlin, Berlin, Germany
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Lovero KL, Stockton MA, Greene MC, Basaraba C, Khan S, Mabunda D, Mandlate F, Gouveia L, Fumo W, Wall MM, Duarte CS, Oquendo MA, Wainberg ML. Psychometric Evaluation of Screens for Common Mental Disorders, Severe Mental Disorders, Substance Use Disorders, and Suicide Risk in Mozambican Healthcare. MEDICAL RESEARCH ARCHIVES 2024; 12. [PMID: 39268201 PMCID: PMC11391859 DOI: 10.18103/mra.v12i8.5294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/15/2024]
Abstract
Globally, mental and substance use disorders are a leading cause of disease burden. In low- and middle-income countries, where there is an extreme shortage of trained mental health specialists, validated, brief screening tools for mental and substance use disorders are required for non-specialists to efficiently identify patients in need of mental health care. Mozambique, one of the poorest countries in the world, has fewer than two mental health specialists for every 100,000 people. In the present study, we evaluated a comprehensive set of seven measures for depression, anxiety, somatization, alcohol use disorder, substance use disorder, psychosis and mania, and suicide risk among N=911 Mozambican adults in general healthcare settings. All instruments demonstrated acceptable internal consistency (α > 0.75). Compared to diagnoses made by the Mini International Neuropsychiatric Interview, all measures showed good criterion validity (AUC > 0.75), except the Psychosis Screening Questionnaire, which showed low sensitivity (0.58) for psychotic disorder. No substantial differences were observed in internal consistency when stratifying by gender, age, education level, primary language, facility-type, and patient status; criterion validity showed some variability when stratified by sub-population, particularly for education, primary language, and whether the participant was seeking care that day. Exploratory factor analyses indicated that the measures best differentiate categories of diagnoses (common mental disorder, severe mental disorders, substance use disorders, and suicide risk) rather than individual diagnoses, suggesting the utility of a transdiagnostic approach. Our findings support the use of these measures in Mozambique to identify common mental disorders, substance use disorders, and suicide risk, but indicate further research is needed to develop an adequate screen for severe mental disorders. Given the limited mental health specialists in this and other LMIC settings, these brief measures can support non-specialist provision of mental health services and promote closure of the treatment gap.
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Affiliation(s)
- Kathryn L Lovero
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, USA
| | - Melissa A Stockton
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA
| | - M Claire Greene
- Program on Forced Migration and Health, Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, USA
| | - Cale Basaraba
- Department of Population Health, Grossman School of Medicine, New York University
| | - Saida Khan
- Department of Mental Health, Ministry of Health, Maputo, Mozambique
| | - Dirceu Mabunda
- Department of Mental Health, Ministry of Health, Maputo, Mozambique
| | - Flavio Mandlate
- Department of Mental Health, Ministry of Health, Maputo, Mozambique
| | - Lidia Gouveia
- Department of Mental Health, Ministry of Health, Maputo, Mozambique
| | - Wilza Fumo
- Department of Mental Health, Ministry of Health, Maputo, Mozambique
| | - Melanie M Wall
- Department of Psychiatry, New York State Psychiatric Institute and Columbia University Vagelos College of Physicians and Surgeons, New York, USA
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, USA
| | - Cristiane S Duarte
- Department of Psychiatry, New York State Psychiatric Institute and Columbia University Vagelos College of Physicians and Surgeons, New York, USA
| | - Maria A Oquendo
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA
| | - Milton L Wainberg
- Department of Psychiatry, New York State Psychiatric Institute and Columbia University Vagelos College of Physicians and Surgeons, New York, USA
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Britton PN, Burrell R, Chapman E, Boyle J, Alexander S, Belessis Y, Dalby-Payne J, Knight K, Lau C, McMullan B, Milne B, Paull M, Nguyen J, Selvadurai H, Dale R, Baillie A. Post COVID-19 conditions in an Australian pediatric cohort, 3 months following a Delta outbreak. Pediatr Res 2024:10.1038/s41390-024-03492-x. [PMID: 39215197 DOI: 10.1038/s41390-024-03492-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 06/27/2024] [Accepted: 07/30/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND Pediatric long COVID remains incompletely understood with scant Australian data available. We aimed to assess the impacts of the 2021 Delta variant of SARS-CoV-2 outbreak on symptoms and functioning 12 weeks post-acute infection in a cohort of children and adolescents. METHODS The parents/carers of 11,864 patients with PCR-confirmed SARS-CoV-2 were invited, via email or text message, to complete an online survey assessing symptoms and functional impairment. FINDINGS 1731 (17.6%) responded to the survey. 203 (11.7%) reported continued symptoms and/or functional impairment which were flagged for clinical review, all others reported recovery. Of the 169 subsequently clinically reviewed, 63 had already recovered (37.3%) and 17 had exacerbation of pre-existing condition(s) (10.1%); 63 (37.3%) were diagnosed with a Post COVID Condition (PCC). Of these, 21 (12.4%) were considered to have features compatible with the United Kingdom consensus cases definition for Long COVID. INTERPRETATION During an outbreak of SARS-CoV-2 an online questionnaire with subsequent clinical review revealed self-reported non-recovery at 12 weeks in a minority of cases, with a spectrum of features. Long COVID comprised only a subset of cases with self-reported non-recovery, and is infrequent in children and adolescents, but still comprises a likely significant burden that warrants attention. IMPACT Our study provides the only comprehensive estimate of the frequency and spectrum of post-COVID conditions in children from Australia. The high frequency of self-reported recovery, and low frequency of Long COVID compatible illness adds to the literature from other settings. Risk factors for post-COVID conditions in children are identified and include: age >11 year, and previous medical co-morbidity.
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Affiliation(s)
- Philip N Britton
- The Children's Hospital at Westmead Clinical School, Sydney Medical School, the University of Sydney, Westmead, NSW, Australia.
- Department of Infectious Diseases and Microbiology, the Children's Hospital at Westmead, Sydney Children's Hospitals Network, Westmead, NSW, Australia.
- Centre for Pediatric and Perinatal Infection Research, the Children's Hospital at Westmead, Sydney Children's Hospitals Network, Westmead, NSW, Australia.
| | - Rebecca Burrell
- The Children's Hospital at Westmead Clinical School, Sydney Medical School, the University of Sydney, Westmead, NSW, Australia
- Centre for Pediatric and Perinatal Infection Research, the Children's Hospital at Westmead, Sydney Children's Hospitals Network, Westmead, NSW, Australia
| | - Emily Chapman
- Integrated Care team, virtual KIDS- COVID-19 Outpatient Response Team, Sydney Children's Hospitals Network, Westmead, NSW, Australia
| | - Julia Boyle
- Matilda Centre for Research in Mental Health and Substance Use, the University of Sydney, Camperdown, NSW, Australia
| | - Shirley Alexander
- Weight Management Services, the Children's Hospital at Westmead, Sydney Children's Hospitals Network, Westmead, NSW, Australia
| | - Yvonne Belessis
- Department of Respiratory Medicine, Sydney Children's Hospital, Randwick, Sydney Children's Hospitals Network, Randwick, NSW, Australia
- School of Clinical Medicine, Faculty of Medicine and Health, the University of New South Wales, Sydney, NSW, Australia
| | - Jacqueline Dalby-Payne
- Department of General Medicine, the Children's Hospital at Westmead, Sydney Children's Hospital Network, Westmead, NSW, Australia
| | - Katherine Knight
- Department of Psychological Medicine, the Children's Hospital at Westmead, Sydney Children's Hospital Network, Westmead, NSW, Australia
| | - Christine Lau
- Integrated Care team, virtual KIDS- COVID-19 Outpatient Response Team, Sydney Children's Hospitals Network, Westmead, NSW, Australia
| | - Brendan McMullan
- School of Clinical Medicine, Faculty of Medicine and Health, the University of New South Wales, Sydney, NSW, Australia
- Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Randwick, Sydney Children's Hospitals Network, Randwick, NSW, Australia
| | - Bronwyn Milne
- Department of Adolescent Medicine, the Children's Hospital at Westmead, Sydney Children's Hospital Network, Westmead, NSW, Australia
| | - Marilyn Paull
- Department of Adolescent Medicine, the Children's Hospital at Westmead, Sydney Children's Hospital Network, Westmead, NSW, Australia
| | - Jonathan Nguyen
- Integrated Care team, virtual KIDS- COVID-19 Outpatient Response Team, Sydney Children's Hospitals Network, Westmead, NSW, Australia
| | - Hiran Selvadurai
- The Children's Hospital at Westmead Clinical School, Sydney Medical School, the University of Sydney, Westmead, NSW, Australia
- Department of Respiratory Medicine, the Children's Hospital at Westmead, Sydney Children's Hospitals Network, Westmead, NSW, Australia
| | - Russell Dale
- The Children's Hospital at Westmead Clinical School, Sydney Medical School, the University of Sydney, Westmead, NSW, Australia
| | - Andrew Baillie
- The University of Sydney School of Health Sciences the University of Sydney, Camperdown, NSW, Australia
- Sydney Local Health District, the University of Sydney, Camperdown, NSW, Australia
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Qiu D, Li Y, Xiao S, Zhou L, Liu L, Liu H, Gao F, Wu Q, An Y, Tang Z. Public mental health services in Southern China and related health outcomes among individuals living with severe mental illness. Glob Health Res Policy 2024; 9:31. [PMID: 39210438 PMCID: PMC11363596 DOI: 10.1186/s41256-024-00363-0] [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: 02/20/2024] [Accepted: 06/11/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND Although national policies in China are comprehensive and instructive, a wide disparity exists between different cities. The current status of public mental health services by region in China remains unclear. This study aimed to investigate policies related to public mental health services, the contact coverage of public mental health services and outcomes of service users. METHODS A cross-sectional study was carried out in Southern China, between April 2021 and March 2022. Considering the geographical location, socioeconomic development levels, and prevalence of severe mental illness, four cities including Wuhan, Changsha, Guangzhou, and Shenzhen were selected. Relevant service providers were asked to report data on mental health policies and facility-related information, including mental health resources, registration rates of patients, management rates of patients, and medication rates of patients. Eligible patients were invited to report service user-related data, including contact coverage of public mental health services and their outcomes. SPSS 26.0 was used for data analysis. RESULTS The four cities in Southern China have made different efforts to develop public mental health services, primarily focusing on socio-economically disadvantaged individuals. Community health centers in Guangzhou and Shenzhen reported having more professional human resources on mental health and higher mental health budgets for patients. The contact coverage rates of most public mental services were higher than 80%. Patients in Changsha (B = 0.3; 95%CI: 0.1-0.5), Guangzhou (B = 0.2; 95%CI: 0.1-0.3), and Shenzhen (B = 0.3; 95%CI: 0.1-0.4) who received social medical assistance services reported higher levels of medication adherence. Patients in Wuhan (B = -6.5; 95%CI: -12.9--0.1), Guangzhou (B = -2.8; 95%CI: -5.5--0.1), and Shenzhen who received community-based rehabilitation services reported lower levels of disability (B = -2.6; 95%CI: -4.6--0.5). CONCLUSIONS There have been advances in public mental health services in the four Southern cities. The contact coverage rates of most public mental health services were higher than 80%. Patients' utilization of public mental services was associated with better health outcomes. To improve the quality of public mental health services, the government should try to engage service users, their family members, and supporters in the design, delivery, operationalization, and evaluation of these public mental health services in the future.
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Affiliation(s)
- Dan Qiu
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, 110 Xiangya Road, Changsha, 410078, Hunan, China
| | - Yilu Li
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, 110 Xiangya Road, Changsha, 410078, Hunan, China
| | - Shuiyuan Xiao
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, 110 Xiangya Road, Changsha, 410078, Hunan, China.
- Mental Health Institute, Second Xiangya Hospital, Central South University, Changsha, Hunan, China.
| | - Liang Zhou
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | | | - Huiming Liu
- Shenzhen Kangning Hospital, Shenzhen, Guangdong, China
- Shenzhen Mental Health Center, Shenzhen, Guangdong, China
| | - Feihong Gao
- The Ninth Hospital of Changsha, Changsha, Hunan, China
| | - Qiuyan Wu
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, 110 Xiangya Road, Changsha, 410078, Hunan, China
| | - Yanni An
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, 110 Xiangya Road, Changsha, 410078, Hunan, China
| | - Zixuan Tang
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, 110 Xiangya Road, Changsha, 410078, Hunan, China
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Nadkarni A, Gandhi Y, Fernandes L, Mirchandani K, Kamat S, Weiss HA, Singla DR, Velleman R, Lu C, Bhatia U, Biswal B, Sequeira M, D'souza E, Raikar K, Patel V. Effectiveness and cost-effectiveness of a community intervention in enhancing access to care and improving clinical outcomes for depression: a protocol for a cluster randomised controlled trial in India. Trials 2024; 25:569. [PMID: 39198915 PMCID: PMC11351196 DOI: 10.1186/s13063-024-08236-0] [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: 01/18/2024] [Accepted: 06/10/2024] [Indexed: 09/01/2024] Open
Abstract
BACKGROUND Although depression is the leading cause of disability worldwide, treatment coverage for the condition is inadequate. Supply-side barriers (e.g. shortage of specialist mental health professionals) and demand-side barriers (e.g. lack of awareness about depression) lead to limited availability of evidence-based interventions, poor demand for care, and low levels of adherence to care. The aim of our study is to examine if the addition of a community intervention delivered by community volunteers enhances the population-level impact of an evidence based psychosocial intervention (Healthy Activity Program [HAP]) in routine primary care by increasing demand for HAP and improving HAP adherence and effectiveness. METHODS A hybrid type 2 effectiveness implementation cluster randomised controlled trial will be implemented in the state of Goa, India. Twenty-eight clusters of villages and their associated public sector health centres will be randomly allocated through restricted randomisation. Clusters will be randomly allocated to the 'Community Model' or 'Facility Model' arms. All clusters will offer the HAP and clusters in the 'Community Model' arm will additionally receive activities delivered by community volunteers ("Sangathis") to increase awareness about depression and support demand for and adherence to HAP. The primary outcomes are Contact Coverage (Patient Health Questionnaire [PHQ-9] score > 4 as a proportion of those screened) and Effectiveness Coverage (mean PHQ-9 score amongst those who score ≥ 15 at baseline, i.e. those who have moderately severe to severe depression) at 3 months post-recruitment. Additional outcomes at 3 and 6 months will assess sustained effectiveness, remission, response to treatment, depression awareness, social support, treatment completion, and activation levels. Economic and disability outcomes will be assessed to estimate incremental cost-effectiveness ratios. Implementation will be evaluated through process data and qualitative data informed by the RE-AIM framework. A minimum of 79488 primary care attenders will be screened for the Contact Coverage outcome, and 588 individuals with PHQ-9 ≥ 15 will be recruited for the Effectiveness Coverage outcome. DISCUSSION If effective, our community intervention will have relevance to India's Ayushman Bharat universal healthcare programme which is scaling up care for depression in primary care, and also to other low- and middle- income countries. TRIAL REGISTRATION Registered on ClincalTrials.gov ( NCT05890222 .) on 12/05/2023.
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Affiliation(s)
- Abhijit Nadkarni
- Centre for Global Mental Health, Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK.
- Addictions and Related Research Group, Sangath, Goa, India.
| | - Yashi Gandhi
- Centre for Global Mental Health, Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
- Addictions and Related Research Group, Sangath, Goa, India
| | | | | | - Shreyas Kamat
- Addictions and Related Research Group, Sangath, Goa, India
| | - Helen A Weiss
- Department of Infectious Disease Epidemiology and International Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Daisy R Singla
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Richard Velleman
- Addictions and Related Research Group, Sangath, Goa, India
- Department of Psychology, University of Bath, Bath, UK
| | - Chunling Lu
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, USA
| | - Urvita Bhatia
- Centre for Global Mental Health, Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
- Addictions and Related Research Group, Sangath, Goa, India
| | | | | | - Ethel D'souza
- Addictions and Related Research Group, Sangath, Goa, India
| | - Kedar Raikar
- Non-Communicable Disease Cell, Directorate of Health Services, Panaji, Goa, India
| | - Vikram Patel
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, USA
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Nordin L, Bothe SK, Perrin S, Rorsman I. Severe Cognitive Impairment in Trauma-Affected Refugees-Exploring the Impact of Traumatic Brain Injury. J Clin Med 2024; 13:5096. [PMID: 39274309 PMCID: PMC11396430 DOI: 10.3390/jcm13175096] [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: 07/31/2024] [Revised: 08/21/2024] [Accepted: 08/23/2024] [Indexed: 09/16/2024] Open
Abstract
Background/Objectives: This study explores the relationship between cognitive performance measured by the Symbol Digit Modality Test (SDMT) and the severity of self-reported head injury, traumatic brain injury (TBI), post-traumatic stress disorder (PTSD), depression, pain, and psychosocial dysfunction in a population of trauma-affected refugees. Refugees, especially those who have been subjected to torture, often face various difficulties, such as PTSD, depression and somatic disturbances (e.g., pain), which can significantly impact their day-to-day functioning. Methods: Participants included 141 adult refugees (38% women) with a mean age of 45.4 years (SD = 9.4) and 9.7 years (SD = 4.9) of education who were referred for treatment of post-traumatic distress to DIGNITY, Danish Institute Against Torture. Participants completed standardized self-report measures of PTSD, anxiety, depression, pain, and health-related disability and measures of trauma history, physical injuries including head injury and loss of consciousness, and the SDMT, a quick standardized performance-based measure of cognitive impairment. Results: Eighty-eight percent of participants evidenced signs of substantial cognitive impairment as indexed by lower SDMT scores. Those with a self-reported history of TBI, marked by loss of consciousness, exhibited lower SDMT scores and higher health-related disabilities. Severity of PTSD, depression, anxiety, and pain were highly correlated with lower SDMT scores. TBI history was not significantly associated with the severity of PTSD, depression, anxiety, or pain, suggesting a complex interplay among these factors. Conclusions: Cognitive impairments are prevalent in trauma-affected refugees, interacting with symptoms of post-traumatic stress and pain, likely explaining the high disability levels in this population. Further research should employ a broader range of cognitive measures and detailed investigations of head injury/TBI experiences to investigate their impact on overall functioning, treatment response, and longer-term outcomes. This study adds to a small but growing body of studies documenting cognitive impairments in trauma-affected refugees, highlighting the importance of addressing cognitive impairments in treatment for trauma-affected refugees, particularly those with histories of torture and TBI. Clinicians working with trauma-affected refugees should consider the assessment of cognitive difficulties as part of comprehensive care planning.
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Affiliation(s)
- Linda Nordin
- DIGNITY-Danish Institute Against Torture, 2100 Copenhagen, Denmark
- Department of Psychology, Lund University, 221-00 Lund, Sweden
| | - Søren Kit Bothe
- DIGNITY-Danish Institute Against Torture, 2100 Copenhagen, Denmark
- Department of Psychology, University of Copenhagen, 2100 Copenhagen, Denmark
| | - Sean Perrin
- Department of Psychology, Lund University, 221-00 Lund, Sweden
| | - Ia Rorsman
- Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, 221-85 Lund, Sweden
- Department of Clinical Sciences Neurology, Lund University, 221-85 Lund, Sweden
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Viner Smith E, Summers MJ, Asser I, Louis R, Lange K, Ridley EJ, Chapple LAS. Nutrition intake, muscle thickness, and recovery outcomes for critically ill patients requiring non-invasive forms of respiratory support: A prospective observational study. Aust Crit Care 2024:S1036-7314(24)00207-8. [PMID: 39174383 DOI: 10.1016/j.aucc.2024.07.078] [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: 04/23/2024] [Revised: 07/08/2024] [Accepted: 07/21/2024] [Indexed: 08/24/2024] Open
Abstract
BACKGROUND Use of high-flow nasal cannula (HFNC) and non-invasive ventilation (NIV) in the intensive care unit (ICU) is increasing, yet reporting of nutrition intake, muscle thickness, or recovery outcomes in this population is limited. OBJECTIVE The objective of this study was to quantify muscle thickness, nutrition intake, and functional recovery outcomes for patients receiving HFNC/NIV within the ICU. METHODS A single-centre, prospective, observational study in adult ICU patients recruited within 48 hrs of commencing HFNC/NIV. Change in quadriceps muscle layer thickness using ultrasound (primary outcome) and 24 hr nutrition intake from study inclusion to day 7 (D7), functional capacity (Barthel Index), and quality of life (EuroQol five-dimension five-level utility index) at D90 were assessed. Data are n (%), mean ± standard deviation or median [interquartile range], are compared using paired sample t-test, and a P value of <0.05 was considered significant. RESULTS Primary outcome data were available for n = 28/42: 64 ± 13 y, 61% male, body mass index: 29.1 ± 9.0 kg/m2, and Acute Physiology and Chronic Health Evaluation II score: 17 ± 5. Quadriceps muscle layer thickness reduced from 2.41 ± 0.87 to 2.12 ± 0.73 cm; mean difference: -0.29 cm (95% confidence interval: -0.44, -0.13). Nutrition intake increased from study inclusion to D7: 1735 ± 1283 to 5448 ± 2858 kJ and 17.4 ± 16.6 to 60.9 ± 36.8g protein. Barthel Index was 87 ± 20 at baseline and 91 ± 15 at D90 (out of 100). Quality of life was impaired at D90: 0.64 ± 0.23 (health = 1.0). CONCLUSION Critically ill patients receiving HFNC/NIV experienced muscle loss and impaired quality of life.
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Affiliation(s)
- Elizabeth Viner Smith
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia; Intensive Care Research Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia.
| | - Matthew J Summers
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia; Intensive Care Research Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Imogen Asser
- Intensive Care Research Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Rhea Louis
- Intensive Care Research Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Kylie Lange
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia; Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, South Australia, Australia
| | - Emma J Ridley
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia; Dietetics and Nutrition Department, Alfred Health, Melbourne, Victoria, Australia
| | - Lee-Anne S Chapple
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia; Intensive Care Research Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, South Australia, Australia
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Paparella G, Stragà C, Pesenti N, Dal Molin V, Martorel GA, Merotto V, Genova C, Piazza A, Piccoli G, Panzeri E, Rufini A, Testi R, Martinuzzi A. A Pilot Phase 2 Randomized Trial to Evaluate the Safety and Potential Efficacy of Etravirine in Friedreich Ataxia Patients. CHILDREN (BASEL, SWITZERLAND) 2024; 11:958. [PMID: 39201893 PMCID: PMC11352957 DOI: 10.3390/children11080958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/04/2024] [Revised: 08/01/2024] [Accepted: 08/07/2024] [Indexed: 09/03/2024]
Abstract
BACKGROUND A drug repositioning effort supported the possible use of the anti-HIV drug etravirine as a disease-modifying drug for Friedreich ataxia (FRDA). Etravirine increases frataxin protein and corrects the biochemical defects in cells derived from FRDA patients. Because of these findings, and since etravirine displays a favorable safety profile, we conducted a pilot open-label phase 2 clinical trial assessing the safety and potential efficacy of etravirine in FRDA patients. METHODS Thirty-five patients were stratified into three severity groups and randomized to etravirine 200 mg/day or 400 mg/day. They were treated for 4 months. Safety endpoints were the number and type of adverse events and number of dropouts. Efficacy endpoints were represented by changes in peak oxygen uptake and workload as measured by incremental exercise test, SARA score, cardiac measures, measures of QoL and disability. Data were collected 4 months before the start of the treatment (T - 4), at the start (T0), at the end (T4) and 4 months after the termination of the treatment (T + 4). RESULTS Etravirine was reasonably tolerated, and adverse events were generally mild. Four months of etravirine treatment did not significantly increase the peak oxygen uptake but was associated with a change in the progression of the SARA score (p value < 0.001), compared to the 4 months pre- and post-treatment. It also significantly increased peak workload (p value = 0.021). No changes in the cardiac measures were observed. Health and QoL measures showed a worsening at the suspension of the drug. CONCLUSIONS In this open trial etravirine treatment was safe, reasonably well tolerated and appreciably improved neurological function and exercise performance. Even though a placebo effect cannot be ruled out, these results suggest that etravirine may represent a potential therapeutic agent in FRDA deserving testing in a randomized placebo-controlled clinical trial.
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Affiliation(s)
- Gabriella Paparella
- Department of Conegliano, Scientific Institute IRCCS E. Medea, 31015 Conegliano, Treviso, Italy; (G.P.)
| | - Cristina Stragà
- Department of Conegliano, Scientific Institute IRCCS E. Medea, 31015 Conegliano, Treviso, Italy; (G.P.)
| | - Nicola Pesenti
- Department of Statistics and Quantitative Methods, Division of Biostatistics, Epidemiology and Public Health, University of Milano-Bicocca, 20126 Milan, Milan, Italy
| | - Valentina Dal Molin
- Department of Conegliano, Scientific Institute IRCCS E. Medea, 31015 Conegliano, Treviso, Italy; (G.P.)
| | - Gian Antonio Martorel
- Department of Conegliano, Scientific Institute IRCCS E. Medea, 31015 Conegliano, Treviso, Italy; (G.P.)
| | - Vasco Merotto
- Department of Conegliano, Scientific Institute IRCCS E. Medea, 31015 Conegliano, Treviso, Italy; (G.P.)
| | - Cristina Genova
- Department of Conegliano, Scientific Institute IRCCS E. Medea, 31015 Conegliano, Treviso, Italy; (G.P.)
| | - Arianna Piazza
- Department of Conegliano, Scientific Institute IRCCS E. Medea, 31015 Conegliano, Treviso, Italy; (G.P.)
| | - Giuseppe Piccoli
- Department of Conegliano, Scientific Institute IRCCS E. Medea, 31015 Conegliano, Treviso, Italy; (G.P.)
| | - Elena Panzeri
- Department of Bosisio Parini, Scientific Institute IRCCS E. Medea, 23842 Bosisio Parini, Lecco, Italy
| | - Alessandra Rufini
- Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, 00133 Rome, Italy
| | - Roberto Testi
- Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, 00133 Rome, Italy
| | - Andrea Martinuzzi
- Department of Conegliano, Scientific Institute IRCCS E. Medea, 31015 Conegliano, Treviso, Italy; (G.P.)
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Potcovaru CG, Salmen T, Potcovaru AM, Săndulescu IM, Chiriac O, Balasa AC, Diaconu LS, Poenaru D, Pantea Stoian A, Cinteza D, Berteanu M. The Long-Term Impact of COVID-19 on Disability after Post-Acute Rehabilitation: A Pilot Study. J Clin Med 2024; 13:4694. [PMID: 39200836 PMCID: PMC11355617 DOI: 10.3390/jcm13164694] [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: 07/22/2024] [Revised: 08/05/2024] [Accepted: 08/08/2024] [Indexed: 09/02/2024] Open
Abstract
Background: The long-term effect of the 2019 coronavirus (COVID-19) pandemic is not fully known. Severe cases of COVID-19 have resulted in disability that can be assessed in a biopsychosocial manner with the International Classification of Functioning, Disability and Health with the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) questionnaire. This study aimed to evaluate the long-term effects on disability of COVID-19 three years after post-acute rehabilitation using WHODAS 2.0. Methods: This single-center cohort study included patients with severe COVID-19 who underwent immediate post-discharge post-acute rehabilitation intervention. Three years later, patients were assessed via telephone using the WHODAS 2.0 questionnaire. Results: Of the 69 patients identified in the hospital database, 27 responded. A total of 16 patients refused to respond due to emotional distress. The mean age was 63.4 ± 8.6 years, 81.5% were independent in the community, 55.3% had been previously admitted to the ICU, and the median rehabilitation hospitalization duration was 18 (11.5,24) days. Comorbidities included type 2 diabetes mellitus (DM) (55.5%), grade 2 high blood pressure (62.9%), pressure ulcers (37%), peripheral neurologic deficits (62.9%), and central neurological deficits (14.8%). ICU admission was significantly correlated with advanced rehabilitation needs (measured by the level of the rehabilitation (p < 0.01) and longer hospitalizations (measured by total days in the hospital (p < 0.001). The overall disability score was 35.09%, significantly influenced by DM and central neurological deficits. Conclusions: Central neurological deficits and DM are associated with higher disability scores. Tailored rehabilitation programs, ongoing medical assessment, integrated care models, and patient education are essential for improving long-term outcomes after COVID-19 disease.
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Affiliation(s)
- Claudia-Gabriela Potcovaru
- Doctoral School of Carol Davila, University of Medicine and Pharmacy, 050474 Bucharest, Romania; (C.-G.P.)
- National Institute of Rehabilitation, Physical Medicine and Balneoclimatology, 030079 Bucharest, Romania (D.P.)
| | - Teodor Salmen
- Doctoral School of Carol Davila, University of Medicine and Pharmacy, 050474 Bucharest, Romania; (C.-G.P.)
| | - Ana Mădălina Potcovaru
- Faculty of Administration and Public Management, Bucharest University of Economic Studies, 010374 Bucharest, Romania
| | - Ioana-Miruna Săndulescu
- Doctoral School of Carol Davila, University of Medicine and Pharmacy, 050474 Bucharest, Romania; (C.-G.P.)
- National Institute of Rehabilitation, Physical Medicine and Balneoclimatology, 030079 Bucharest, Romania (D.P.)
| | - Ovidiu Chiriac
- National Institute of Rehabilitation, Physical Medicine and Balneoclimatology, 030079 Bucharest, Romania (D.P.)
| | - Ana-Cristinel Balasa
- National Institute of Rehabilitation, Physical Medicine and Balneoclimatology, 030079 Bucharest, Romania (D.P.)
| | - Laura Sorina Diaconu
- Department of Gastroenterology and Internal Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Daniela Poenaru
- National Institute of Rehabilitation, Physical Medicine and Balneoclimatology, 030079 Bucharest, Romania (D.P.)
| | - Anca Pantea Stoian
- Department of Diabetes, Nutrition and Metabolic Diseases, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Delia Cinteza
- National Institute of Rehabilitation, Physical Medicine and Balneoclimatology, 030079 Bucharest, Romania (D.P.)
- Physical Medicine and Rehabilitation Department 9, University of Medicine and Pharmacy Carol Davila, 050474 Bucharest, Romania
| | - Mihai Berteanu
- Physical Medicine and Rehabilitation Department 9, University of Medicine and Pharmacy Carol Davila, 050474 Bucharest, Romania
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Smoor RM, van Dongen EPA, Daeter EJ, Emmelot-Vonk MH, Cremer OL, Vernooij LM, Noordzij PG. The association between preoperative multidisciplinary team care and patient outcome in frail patients undergoing cardiac surgery. J Thorac Cardiovasc Surg 2024; 168:608-616.e5. [PMID: 37302466 DOI: 10.1016/j.jtcvs.2023.05.037] [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: 12/30/2022] [Revised: 05/12/2023] [Accepted: 05/30/2023] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To evaluate the influence of preoperative multidisciplinary team (MDT) care on perioperative management and outcomes of frail patients undergoing cardiac surgery. BACKGROUND Frail patients are at increased risk for complications and poor functional outcome after cardiac surgery. In these patients, preoperative MDT care may improve outcomes. METHODS Between 2018 and 2021, 1168 patients aged 70 years or older were scheduled for cardiac surgery, of whom 98 (8.4%) frail patients were referred for MDT care. The MDT discussed surgical risk, prehabilitation, and alternative treatment. Outcomes of MDT patients were compared with 183 frail patients (non-MDT group) from a historical study cohort (2015-2017). Inverse probability of treatment weighting was used to minimize bias from nonrandom allocation of MDT versus non-MDT care. Outcomes were severe postoperative complications, total days in hospital after 120 days, disability, and health-related quality of life after 120 days. RESULTS This study included 281 patients (98 MDT and 183 non-MDT patients). Of the MDT patients, 67 (68%) had open surgery, 21 (21%) underwent minimally invasive procedures, and 10 (10%) received conservative treatment. In the non-MDT group, all patients had open surgery. Fourteen (14%) MDT patients experienced a severe complication versus 42 (23%) non-MDT patients (adjusted relative risk, 0.76; 95% CI, 0.51-0.99). Adjusted total days in hospital after 120 days was 8 days (interquartile range, 3-12 days) versus 11 days (interquartile range, 7-16 days) for MDT and non-MDT patients, respectively (P = .01). There was no difference in disability or health-related quality of life. CONCLUSIONS Preoperative MDT care for frail patients undergoing cardiac surgery is associated with alterations in surgical management and with a lower risk for severe complications.
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Affiliation(s)
- Rosa M Smoor
- Department of Anesthesiology, Intensive Care, and Pain Medicine, St Antonius Hospital, Nieuwegein, The Netherlands; Department of Intensive Care Medicine, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Eric P A van Dongen
- Department of Anesthesiology, Intensive Care, and Pain Medicine, St Antonius Hospital, Nieuwegein, The Netherlands
| | - Edgar J Daeter
- Department of Cardiothoracic Surgery, St Antonius Hospital, Nieuwegein, The Netherlands
| | - Marielle H Emmelot-Vonk
- Department of Geriatric Medicine, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Olaf L Cremer
- Department of Intensive Care Medicine, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Lisette M Vernooij
- Department of Anesthesiology, Intensive Care, and Pain Medicine, St Antonius Hospital, Nieuwegein, The Netherlands; Department of Intensive Care Medicine, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Peter G Noordzij
- Department of Anesthesiology, Intensive Care, and Pain Medicine, St Antonius Hospital, Nieuwegein, The Netherlands; Department of Intensive Care Medicine, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands.
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Gyasi RM, Phillips DR, Aikins E, Peltzer K, Accam BT, Frempong F, Dwumah P, Koomson-Yalley ENM, Asiedu HB, Abass K, Hajek A. Later Life Food Insecurity and Social Isolation in Ghana: The Importance of Psychological Factors. Int J Geriatr Psychiatry 2024; 39:e6134. [PMID: 39168834 DOI: 10.1002/gps.6134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Revised: 07/09/2024] [Accepted: 08/05/2024] [Indexed: 08/23/2024]
Abstract
BACKGROUND Social isolation (SI) and food insecurity (FI) are important social determinants of health that can negatively impact well-being in old age. While research on the association between FI and SI is limited in LMICs, the mediators of this association are largely unknown. This cross-sectional study examined whether FI is associated with SI among older adults in Ghana and whether psychological factors (i.e., depression, anxiety, and sleep problems) mediated the association. METHODS Our study consisted of adults aged ≥50 years in the Aging, Health, Well-being, and Health-seeking Behavior Study. SI was assessed with the Berkman-Syme Social Network Index, while FI was assessed with dietary inadequacy-related items. We used an ordinary least squares regression (OLS), logistic regressions, and bootstrapping modeling approach to examine our hypotheses with p < 0.05. RESULTS The analysis included 1201 individuals (Mage = 66 [SD = 12], women = 63%). In the full sample (β = 0.21; p < 0.001) and in women (β = 0.30, p < 0.001) but not in men, FI was independently associated with SI. FI was comparably associated with increases in SI for the 50-64 age group (β = 0.21, p < 0.001) and ≥65 age cohort (β = 0.19, p < 0.01). Moreover, FI showed differential associations with specific domains of SI (OR = 1.81 to 1.45, p < 0.001). Finally, the FI-SI association was mediated by depressive symptoms (65.16%), anxiety symptoms (30.16%), and sleep problems (9.50%). CONCLUSIONS Our data highlight the fundamental role of FI in SI among older adults, and the effect is explained by psychosocial factors. Interventions targeted toward strengthening interpersonal ties in old age should include addressing FI and older adults' psychosocial outcomes.
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Affiliation(s)
- Razak M Gyasi
- Aging and Development Unit, African Population and Health Research Center, Nairobi, Nairobi County, Kenya
- National Centre for Naturopathic Medicine, Faculty of Health, Southern Cross University, Lismore, Australia
| | - David R Phillips
- Department of Sociology and Social Policy, Lingnan University, Hong Kong, Hong Kong
| | - Emelia Aikins
- Faculty of Social Sciences, Department of Geography and Rural Development, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Karl Peltzer
- Faculty of Public Health, Department of Health Education and Behavioral Sciences, Mahidol University, Bangkok, Thailand
- Department of Psychology, University of the Free State, Bloemfontein, South Africa
- Department of Psychology, College of Medical and Health Science, Asia University, Taichung, Taiwan
| | - Burnett Tetteh Accam
- Department of Statistics and Actuarial Science, College of Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Foster Frempong
- Department of Hospitality and Tourism Studies, School of Business, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Peter Dwumah
- Department of Sociology and Social Work, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | - Hubert Bimpeh Asiedu
- Department of Sociology and Social Work, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Kabila Abass
- Faculty of Social Sciences, Department of Geography and Rural Development, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - André Hajek
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg Center for Health Economics, Hamburg, Germany
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van den End A, Beekman ATF, Dekker J, Aarts I, Snoek A, Blankers M, Vriend C, van den Heuvel OA, Thomaes K. Trauma-focused and personality disorder treatment for posttraumatic stress disorder and comorbid cluster C personality disorder: a randomized clinical trial. Eur J Psychotraumatol 2024; 15:2382652. [PMID: 39087734 PMCID: PMC11295684 DOI: 10.1080/20008066.2024.2382652] [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: 12/08/2023] [Revised: 03/15/2024] [Accepted: 07/12/2024] [Indexed: 08/02/2024] Open
Abstract
Background: Posttraumatic stress disorder (PTSD) is associated with high rates of cluster C personality disorders (PD), which may negatively affect PTSD treatment. It is unknown whether concurrent treatment for PTSD and comorbid PD leads to superior treatment effects, compared to standard trauma-focused treatment.Objective: The objective was to test the efficacy of adding personality disorder treatment (group schema therapy; GST) to individual trauma-focused treatment (imagery rescripting; ImRs).Method: A two-arm randomized clinical trial (1:1 allocation ratio) was conducted between 2018 and 2023 at two sites of a mental health institution in the Netherlands. Raters were blind to treatment allocation. Adult outpatients with PTSD and comorbid cluster C personality disorders were randomized to receive either ImRs (12-18 sessions) or ImRs + GST (12-18 ImRs + 52-58 GST). The main outcome was PTSD severity one year after start of treatment measured with the Clinician-Administered PTSD Scale for DSM-5.Results: Of 130 patients (mean [SD] age = 40.6 [11.2], 110 [85%] females), 66 were assigned to ImRs and 64 to ImRs + GST. At 12 months, there were large decreases in PTSD severity (dImRs = 2.42, 95%CI = 1.97-2.87; dImRs + GST = 2.44, 95%CI = 1.99-2.90), but there was no significant difference between conditions (d = 0.02, 95%CI = -0.33-0.36, p = .944). Reductions in personality disorder symptoms and all other secondary outcomes were observed in both conditions. There were no significant differences between conditions on any of the secondary outcomes at 12 months.Conclusion: The more intensive concurrent trauma-focused and personality disorder treatment (ImRs + GST) was not superior to trauma-focused treatment alone (ImRs) for patients with PTSD and comorbid CPD. This suggests that trauma-focused treatment is the preferred primary treatment in patients presenting with both internalizing personality disorder and PTSD, reserving the stepping up to more intensive psychotherapy aimed at the personality disorder as a second line of treatment.Trial registration: ClinicalTrials.gov identifier: NCT03833531.
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Affiliation(s)
- Arne van den End
- Psychiatry, Amsterdam UMC, Amsterdam, The Netherlands
- Sinai Centrum, Amstelveen, The Netherlands
| | | | - Jack Dekker
- Arkin Mental Health Care, Amsterdam, The Netherlands
- Clinical Psychology, VU University, Amsterdam, The Netherlands
| | - Inga Aarts
- Sinai Centrum, Amstelveen, The Netherlands
- Anatomy and Neurosciences, Amsterdam UMC, Amsterdam, The Netherlands
| | - Aishah Snoek
- Psychiatry, Amsterdam UMC, Amsterdam, The Netherlands
- Sinai Centrum, Amstelveen, The Netherlands
| | | | - Chris Vriend
- Psychiatry, Amsterdam UMC, Amsterdam, The Netherlands
- Anatomy and Neurosciences, Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Compulsivity Impulsivity & Attention Program, Amsterdam, The Netherlands
| | - Odile A. van den Heuvel
- Psychiatry, Amsterdam UMC, Amsterdam, The Netherlands
- Anatomy and Neurosciences, Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Compulsivity Impulsivity & Attention Program, Amsterdam, The Netherlands
| | - Kathleen Thomaes
- Psychiatry, Amsterdam UMC, Amsterdam, The Netherlands
- Sinai Centrum, Amstelveen, The Netherlands
- Anatomy and Neurosciences, Amsterdam UMC, Amsterdam, The Netherlands
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Levy D, Saura O, Passarelli MT, Lucenteforte M, Lebreton G, Bougle A, Monsel A, Ortuno S, Benitha Y, Hammoudi N, Assouline B, Petit M, Gautier M, Le Fevre L, Pineton de Chambrun M, Juvin C, Chommeloux J, Luyt CE, Hékimian G, Leprince P, Combes A, Schmidt M. Thrombolysis before venoarterial ECMO for high-risk pulmonary embolism: a retrospective cohort study. Intensive Care Med 2024; 50:1287-1297. [PMID: 38913095 DOI: 10.1007/s00134-024-07501-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Accepted: 05/21/2024] [Indexed: 06/25/2024]
Abstract
PURPOSE Despite systemic thrombolysis, a few patients with high-risk pulmonary embolism (PE) remain hemodynamically unstable. Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is a considerable lifesaving therapy but systemic thrombolysis before cannulation could carry a high risk of hemorrhage and alter the prognosis. METHODS Between June 2012 and June 2023, we retrospectively analyzed from three intensive care units in Sorbonne University, ECMO-related complications and 90-day mortality for high-risk PE patients who received ECMO without previous systemic thrombolysis compared to those cannulated after systemic thrombolysis failure. Hospital discharge survivors were assessed for long-term health-related quality of life and echocardiographic evaluations. RESULTS 72 high-risk PE patients [median age 48 (37-61) years, Simplified Acute Physiology Score II (SAPS II) 74 (60-85)] were placed on VA-ECMO for 5 (5-7) days. 31 (43%) patients underwent pre-ECMO thrombolysis (thrombolysis ECMO group, T +) compared to 41 patients (57%, no thrombolysis ECMO group, T-). There was more pre-ECMO cardiac arrest in the thrombolysis ECMO group (94% vs. 67%, p = 0.02). Ninety-day survival was not different between groups (39% vs 46%, log-rank test, p = 0.31). There was no difference in severe hemorrhages (61% vs 59%, p = 1). Twenty-five over 28 patients attended follow-up at a median time of 69 (52-95) months. Long-term quality of life was acceptable and none of them experienced chronic thromboembolic pulmonary hypertension. CONCLUSIONS Ninety-day survival and bleeding events rates did not differ in patients treated with VA-ECMO after systemic thrombolysis compared to those who were not. Recent systemic thrombolysis, as a single parameter, should not be considered as a contraindication for VA-ECMO in high-risk PE.
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Affiliation(s)
- David Levy
- Institute of Cardiometabolism and Nutrition, Sorbonne Université, INSERM, UMRS_1166-ICAN, Paris, France
- Service de Médecine Intensive-Réanimation, Institut de Cardiologie, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne Université, Hôpital Pitié-Salpêtrière, 47-83 Boulevard de L'Hôpital, 75013, Paris, France
| | - Ouriel Saura
- Institute of Cardiometabolism and Nutrition, Sorbonne Université, INSERM, UMRS_1166-ICAN, Paris, France
- Service de Médecine Intensive-Réanimation, Institut de Cardiologie, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne Université, Hôpital Pitié-Salpêtrière, 47-83 Boulevard de L'Hôpital, 75013, Paris, France
| | - Maria Teresa Passarelli
- Service de Médecine Intensive-Réanimation, Institut de Cardiologie, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne Université, Hôpital Pitié-Salpêtrière, 47-83 Boulevard de L'Hôpital, 75013, Paris, France
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Manuela Lucenteforte
- Service de Médecine Intensive-Réanimation, Institut de Cardiologie, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne Université, Hôpital Pitié-Salpêtrière, 47-83 Boulevard de L'Hôpital, 75013, Paris, France
- Department of Health Sciences, University of Milan, Milan, Italy
| | - Guillaume Lebreton
- Institute of Cardiometabolism and Nutrition, Sorbonne Université, INSERM, UMRS_1166-ICAN, Paris, France
- Service de Chirurgie Cardiaque et Thoracique, Institut de Cardiologie, AP-HP, Sorbonne Université, Hôpital Pitié-Salpêtrière, Paris, France
| | - Adrien Bougle
- Department of Anesthesiology and Critical Care Medicine, Cardiology Institute, GRC 29, AP-HP, Pitié-Salpêtrière Hospital, Sorbonne University, 47-83 Boulevard de L'Hôpital, 75013, Paris, France
| | - Antoine Monsel
- Multidisciplinary Intensive Care Unit, Department of Anesthesiology and Critical Care, La Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris (APHP), Sorbonne University, Paris, France
- INSERM UMRS-959 Immunology-Immunopathology-Immunotherapy (I3), Sorbonne University, Paris, France
| | - Sofia Ortuno
- Service de Médecine Intensive-Réanimation, Institut de Cardiologie, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne Université, Hôpital Pitié-Salpêtrière, 47-83 Boulevard de L'Hôpital, 75013, Paris, France
| | - Yoël Benitha
- Service de Médecine Intensive-Réanimation, Institut de Cardiologie, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne Université, Hôpital Pitié-Salpêtrière, 47-83 Boulevard de L'Hôpital, 75013, Paris, France
| | - Nadjib Hammoudi
- Institute of Cardiometabolism and Nutrition, Sorbonne Université, INSERM, UMRS_1166-ICAN, Paris, France
- ACTION Study Group, Sorbonne Université, INSERM UMR_S 1166, Hôpital Pitié-Salpêtrière (AP-HP), Boulevard de L'Hôpital, 75013, Paris, France
| | - Benjamin Assouline
- Service de Médecine Intensive-Réanimation, Institut de Cardiologie, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne Université, Hôpital Pitié-Salpêtrière, 47-83 Boulevard de L'Hôpital, 75013, Paris, France
- Intensive Care Medicine Unit, Division of Intensive Care, Department of Acute Medicine, University Hospital of Geneva, Geneva, Switzerland
| | - Matthieu Petit
- Service de Médecine Intensive-Réanimation, Institut de Cardiologie, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne Université, Hôpital Pitié-Salpêtrière, 47-83 Boulevard de L'Hôpital, 75013, Paris, France
| | - Melchior Gautier
- Service de Médecine Intensive-Réanimation, Institut de Cardiologie, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne Université, Hôpital Pitié-Salpêtrière, 47-83 Boulevard de L'Hôpital, 75013, Paris, France
| | - Lucie Le Fevre
- Service de Médecine Intensive-Réanimation, Institut de Cardiologie, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne Université, Hôpital Pitié-Salpêtrière, 47-83 Boulevard de L'Hôpital, 75013, Paris, France
| | - Marc Pineton de Chambrun
- Institute of Cardiometabolism and Nutrition, Sorbonne Université, INSERM, UMRS_1166-ICAN, Paris, France
- Service de Médecine Intensive-Réanimation, Institut de Cardiologie, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne Université, Hôpital Pitié-Salpêtrière, 47-83 Boulevard de L'Hôpital, 75013, Paris, France
- Service de Médecine Interne 2, Centre de Référence Lupus Systémique, SAPL et Autres Maladies Auto-Immunes et Systémiques Rares, AP-HP, Sorbonne Université, Hôpital de La Pitié-Salpêtrière, 75013, Paris, France
| | - Charles Juvin
- Institute of Cardiometabolism and Nutrition, Sorbonne Université, INSERM, UMRS_1166-ICAN, Paris, France
- Service de Chirurgie Cardiaque et Thoracique, Institut de Cardiologie, AP-HP, Sorbonne Université, Hôpital Pitié-Salpêtrière, Paris, France
| | - Juliette Chommeloux
- Institute of Cardiometabolism and Nutrition, Sorbonne Université, INSERM, UMRS_1166-ICAN, Paris, France
- Service de Médecine Intensive-Réanimation, Institut de Cardiologie, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne Université, Hôpital Pitié-Salpêtrière, 47-83 Boulevard de L'Hôpital, 75013, Paris, France
| | - Charles-Edouard Luyt
- Institute of Cardiometabolism and Nutrition, Sorbonne Université, INSERM, UMRS_1166-ICAN, Paris, France
- Service de Médecine Intensive-Réanimation, Institut de Cardiologie, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne Université, Hôpital Pitié-Salpêtrière, 47-83 Boulevard de L'Hôpital, 75013, Paris, France
| | - Guillaume Hékimian
- Institute of Cardiometabolism and Nutrition, Sorbonne Université, INSERM, UMRS_1166-ICAN, Paris, France
- Service de Médecine Intensive-Réanimation, Institut de Cardiologie, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne Université, Hôpital Pitié-Salpêtrière, 47-83 Boulevard de L'Hôpital, 75013, Paris, France
| | - Pascal Leprince
- Institute of Cardiometabolism and Nutrition, Sorbonne Université, INSERM, UMRS_1166-ICAN, Paris, France
- Service de Chirurgie Cardiaque et Thoracique, Institut de Cardiologie, AP-HP, Sorbonne Université, Hôpital Pitié-Salpêtrière, Paris, France
| | - Alain Combes
- Institute of Cardiometabolism and Nutrition, Sorbonne Université, INSERM, UMRS_1166-ICAN, Paris, France
- Service de Médecine Intensive-Réanimation, Institut de Cardiologie, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne Université, Hôpital Pitié-Salpêtrière, 47-83 Boulevard de L'Hôpital, 75013, Paris, France
| | - Matthieu Schmidt
- Institute of Cardiometabolism and Nutrition, Sorbonne Université, INSERM, UMRS_1166-ICAN, Paris, France.
- Service de Médecine Intensive-Réanimation, Institut de Cardiologie, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne Université, Hôpital Pitié-Salpêtrière, 47-83 Boulevard de L'Hôpital, 75013, Paris, France.
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Goel A, Blaskovich S, Shah A, Prasad A, Vutha R, Shukla A. Post-Traumatic Central or Axial Atlantoaxial Dislocation Presenting with "Atypical" Symptoms-Analyzing the Role of Dynamic Imaging on the Basis of Experience with 14 Patients Treated by Atlantoaxial Fixation surgery. World Neurosurg 2024; 188:e134-e144. [PMID: 38759781 DOI: 10.1016/j.wneu.2024.05.058] [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: 05/05/2024] [Accepted: 05/10/2024] [Indexed: 05/19/2024]
Abstract
BACKGROUND This is a report of a series of 14 patients who presented with a range of "atypical" cranial, spinal, and systemic symptoms that started after they suffered a relatively severe injury to the head and/or neck several months or years before surgical treatment. The implications of diagnosing and treating central or axial atlantoaxial dislocation (CAAD) is discussed. Also, the role of dynamic rotatory and lateral head tilt imaging in the diagnosis and treatment is analyzed. METHODS Of the 14 patients, 7 were men and 7 were women, with an age range of 21-64 years (average, 42 years). Due to the severity of the presenting neurological and non-neurological symptoms, all the patients had lost their occupation and were heavily dependent on painkillers and/or antidepressant drugs. In addition to other characteristic clinical and radiological evidence, CAAD was diagnosed made based on the facet alignments on lateral profile imaging in the neutral head position. Dynamic head flexion-extension, lateral head tilt, and neck rotation imaging findings confirmed and subclassified CAAD. All 14 patients underwent atlantoaxial fixation surgery. RESULT A personalized self-assessment clinical scoring parameter and the World Health Organization Disability Assessment Schedule 2.0 was used to evaluate the outcome. One patient did not follow-up after surgery. At a minimum follow-up of 6 months after atlantoaxial fixation surgery, the remaining 13 patients experienced relief from all major symptoms. CONCLUSIONS Diagnosing and treating CAAD can have major therapeutic implications for patients presenting with progressively worsening disabling clinical symptoms following relatively severe head and/or neck trauma.
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Affiliation(s)
- Atul Goel
- Department of Neurosurgery, Lilavati Hospital and Research Center, Mumbai, India; Department of Neurosurgery, R.N. Cooper Hospital and Medical College, Mumbai, India; Department of Neurosurgery, Bombay Hospital Institute of Medical Sciences, Mumbai, India; Department of Neurosurgery, K.J. Somaiya Medical College, Hospital and Research Center, Mumbai, India; Department of Neurosurgery, K.E.M Hospital and Seth G.S. Medical College, Mumbai, India.
| | | | - Abhidha Shah
- Department of Neurosurgery, K.J. Somaiya Medical College, Hospital and Research Center, Mumbai, India; Department of Neurosurgery, K.E.M Hospital and Seth G.S. Medical College, Mumbai, India; Department of Neurosurgery, Apollo Hospitals, Navi Mumbai, India
| | - Apurva Prasad
- Department of Neurosurgery, Lilavati Hospital and Research Center, Mumbai, India; Department of Neurosurgery, Bhatia Hospital, Mumbai, India
| | - Ravikiran Vutha
- Department of Neurosurgery, K.J. Somaiya Medical College, Hospital and Research Center, Mumbai, India; Department of Neurosurgery, Apollo Hospitals, Navi Mumbai, India
| | - Ashutosh Shukla
- Department of Neurosurgery, Lilavati Hospital and Research Center, Mumbai, India
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Oladejo TS, Myezwa H, Ajidahun AT, Ibeneme S. Prevalence and predictors of HIV-related disability among people living with HIV in Nigeria. SOUTH AFRICAN JOURNAL OF PHYSIOTHERAPY 2024; 80:2001. [PMID: 39114422 PMCID: PMC11304381 DOI: 10.4102/sajp.v80i1.2001] [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: 10/15/2023] [Accepted: 02/15/2024] [Indexed: 08/10/2024] Open
Abstract
Background People living with human immunodeficiency virus (PLWH) live longer, but experience human immunodeficiency virus (HIV)-related comorbidities and disabilities that lower their quality of life. Understanding the prevalence, risk factors, and disability patterns is crucial for tailored interventions. Objectives To explore the prevalence and predictors of HIV-related disability among PLWH in Nigeria. Method This cross-sectional survey involved 385 PLWH, exploring demographic data, HIV history, recent symptoms, disability (measured by the WHO Disability Assessment Schedule-WHODAS 2.0). Descriptive statistics summarised the data, all variables were entered into univariate and multivariate regression models. IBM SPSS 25® was used for all analyses at a 95% confidence level. Results The prevalence of disability among PLWH was 39.5%, the mean age was 42.2 ± 10.43 years, and 73% of the participants were females. Factors significantly associated with disability were marital status (p = 0.009) and level of education (p = 0.001). Conclusion The study reveals a prevalence of disability (39.5%) among PLWH on antiretroviral therapy (ART), emphasising the need for tailored interventions considering socio-demographic factors. Continuous screening, risk identification, and effective management strategies are imperative, recognising disability as an indicator of health and quality of life. Clinical implications With PLWH experiencing increased life expectancy, the study underscores the need for an informed patient-centred approach to care, recognising the specific challenges faced by PLWH in Nigeria and guiding the development of targeted interventions to enhance both functional outcomes and overall well-being.
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Affiliation(s)
- Temitope S Oladejo
- Department of Physiotherapy, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Hellen Myezwa
- School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Adedayo T Ajidahun
- Department of Physiotherapy, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sam Ibeneme
- Department of Medical Rehabilitation, Faculty of Health Sciences, University of Nigeria, Enugu, Nigeria
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Seet V, Abdin E, Jeyagurunathan A, Chik TS, Kit LJ, Sing LE, Verma S, Ker-Chiah W, Ng P, Subramaniam M. Health and disability - a multi-group latent class analysis of the World Health Organization Disability Assessment Schedule 2.0 among those with mental and physical health conditions. Health Qual Life Outcomes 2024; 22:57. [PMID: 39061074 PMCID: PMC11282711 DOI: 10.1186/s12955-024-02273-8] [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: 02/09/2024] [Accepted: 07/05/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND This study aims to identify disability classes among people with schizophrenia spectrum disorder, depression, anxiety or diabetes via the WHODAS 2.0; investigate the invariance of disability patterns among the four diagnostic groups; and examine associations between disability classes and sociodemographic variables. METHODS Patients seeking treatment for schizophrenia spectrum disorder, depression, anxiety or diabetes (n=1076) were recruited. Latent class analysis was used to identify disability classes based on WHODAS 2.0 responses. Measurement invariance was tested using multi-group latent class analysis. Associations between classes and sociodemographic variables were tested via multinomial logistic regression. RESULTS A five-class solution was identified; examination of model invariance showed that the partially constrained five-class model was most appropriate, suggesting that class structure was consistent while class membership differed across diagnostic groups. Finally, significant associations were found between class membership and ethnicity, education level, and employment status. CONCLUSIONS The results show the feasibility of using the WHODAS 2.0 to identify and compare different disability classes among people with mental or physical conditions and their sociodemographic correlates. Establishing a typology of different disability profiles will help guide research and treatment plans that tackle not just clinical but also functional aspects of living with either a chronic psychiatric or physical condition.
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Affiliation(s)
- Vanessa Seet
- Research Division, Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, Singapore, 539747, Singapore.
| | - Edimansyah Abdin
- Research Division, Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, Singapore, 539747, Singapore
| | - Anitha Jeyagurunathan
- Research Division, Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, Singapore, 539747, Singapore
| | - Tan Sing Chik
- Research Division, Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, Singapore, 539747, Singapore
| | - Lum Joon Kit
- Clinical Research Unit, National Healthcare Group Polyclinics, Singapore, Singapore
| | - Lee Eng Sing
- Clinical Research Unit, National Healthcare Group Polyclinics, Singapore, Singapore
| | - Swapna Verma
- Department of Psychosis, Institute of Mental Health, Singapore, Singapore
| | - Wei Ker-Chiah
- West Region, Institute of Mental Health, Singapore, Singapore
| | - Pamela Ng
- East Region, Institute of Mental Health, Singapore, Singapore
| | - Mythily Subramaniam
- Research Division, Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, Singapore, 539747, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
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Zhao D, Li G, Qin R, Zhao X, Qi M, Ma Q, Li P. Development and Psychometric Evaluation of the Social Participation Questionnaire: A Methodological and Cross-Sectional Study. Am J Health Promot 2024:8901171241258808. [PMID: 39034733 DOI: 10.1177/08901171241258808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/23/2024]
Abstract
PURPOSE Social participation is vital for the health maintenance of general populations as well as the functional recovery and social ties of clinical patients. To develop a Social Participation Questionnaire (SPQ) to evaluate participation in social activities in an individual's life and to test the reliability and validity of the SPQ. DESIGN Cross-sectional study. SETTING Community and clinic in China. SUBJECTS A total of 1419 healthy adults and 486 breast cancer patients. MEASURES The initial items were developed from a theoretical framework, a literature review, and Delphi expert consultation. Item analysis, exploratory (EFA) and confirmatory factor analysis (CFA), criterion validity, construct reliability, and internal consistency reliability were performed to examine the psychometric properties of the SPQ. RESULTS The final SPQ was comprised of 11 different types of social activities, falling under the 3 dimensions of activities of daily life, sports and entertainment activities, and social service activities. EFA explained 50.674% of the total item variance contributing to the tool. CFA showed that the SPQ fit well. The total SPQ score was significantly associated with social network, quality of life, and cognitive function (r = |.180∼.466|, P < .001). The internal consistency coefficient was acceptable (range of Cronbach's alpha, .695 to .720). CONCLUSIONS The SPQ has robust properties, wide application, and provides a culturally relevant tool to evaluate the social participation of individuals, thus facilitating rigorous clinical and population-based research.
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Affiliation(s)
- Di Zhao
- School of Nursing and Rehabilitation, Shandong University, Jinan, China
| | - Guopeng Li
- School of Nursing and Rehabilitation, Shandong University, Jinan, China
| | - Rui Qin
- School of Nursing and Rehabilitation, Shandong University, Jinan, China
| | - Xiangyu Zhao
- School of Nursing and Rehabilitation, Shandong University, Jinan, China
| | - Meiling Qi
- School of Nursing and Rehabilitation, Shandong University, Jinan, China
| | - Qinghua Ma
- Department of Breast Surgery, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Ping Li
- School of Nursing and Rehabilitation, Shandong University, Jinan, China
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D’Souza AN, Merrett M, Griffin H, Tran-Duy A, Struck C, Fazio TN, Juj G, Granger CL, Peiris CL. Recovering from COVID-19 (ReCOV): Feasibility of an Allied-Health-Led Multidisciplinary Outpatient Rehabilitation Service for People with Long COVID. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:958. [PMID: 39063534 PMCID: PMC11277266 DOI: 10.3390/ijerph21070958] [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: 06/19/2024] [Revised: 07/18/2024] [Accepted: 07/19/2024] [Indexed: 07/28/2024]
Abstract
BACKGROUND A multidisciplinary approach is required for the management of long COVID. The aim of this study was to determine the feasibility (demand, implementation, practicality, acceptability, and limited efficacy) of an allied-health-led multidisciplinary symptom management service (ReCOV) for long COVID. METHODS A single-group observational cohort feasibility study was conducted to determine demand (referrals), acceptability (survey), implementation (waitlist times, health professions seen), practicality (adverse events), and limited efficacy (admission and discharge scores from the World Health Organization Disability Assessment Scale, Brief Illness Perception Questionnaire (BIPQ), Patient Health Questionnaire, and EuroQol 5D-5L). Data are presented as median [interquartile range] or count (percentage). RESULTS During the study, 143 participants (aged 42.00 [32.00-51.00] years, 68% women) participated in ReCOV. Participants were waitlisted for 3.86 [2.14-9.86] weeks and engaged with 5.00 [3.00-6.00] different health professionals. No adverse events occurred. The thematic analysis revealed that ReCOV was helpful but did not fully meet the needs of all participants. Limited efficacy testing indicated that participants had improved understanding and control (p < 0.001) of symptoms (BIPQ) and a small improvement in EQ VAS score (median difference 5.50 points [0.00-25.00], p = 0.004]). CONCLUSIONS A multidisciplinary service was safe and mostly acceptable to participants for the management of long COVID. Further research should investigate the clinical and cost effectiveness of such a service, including optimal service duration and patient outcomes.
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Affiliation(s)
- Aruska N. D’Souza
- Allied Health, The Royal Melbourne Hospital, Parkvillle, VIC 3050, Australia
| | - Myvanwy Merrett
- Allied Health, The Royal Melbourne Hospital, Parkvillle, VIC 3050, Australia
| | - Hilda Griffin
- Allied Health, The Royal Melbourne Hospital, Parkvillle, VIC 3050, Australia
| | - An Tran-Duy
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC 3010, Australia
- Methods and Implementation Support for Clinical and Health Research (MISCH) Hub, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, VIC 3010, Australia
| | - Carly Struck
- Allied Health, The Royal Melbourne Hospital, Parkvillle, VIC 3050, Australia
| | - Timothy N. Fazio
- Health Intelligence Unit, The Royal Melbourne Hospital, Parkvillle, VIC 3050, Australia
- Electronic Medical Records, The Royal Melbourne Hospital, Parkvillle, VIC 3050, Australia
- Melbourne Medical School, The University of Melbourne, Parkvillle, VIC 3010, Australia
| | - Genevieve Juj
- Allied Health, The Royal Melbourne Hospital, Parkvillle, VIC 3050, Australia
| | | | - Casey L. Peiris
- Allied Health, The Royal Melbourne Hospital, Parkvillle, VIC 3050, Australia
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC 3086, Australia
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Kochovska S, Ferreira D, Chang S, Brunelli V, Morgan D, Similowski T, Johnson M, Ekström M, Currow D. Disability and long-term breathlessness: a cross-sectional, population study. BMJ Open Respir Res 2024; 11:e002029. [PMID: 39038915 PMCID: PMC11268077 DOI: 10.1136/bmjresp-2023-002029] [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: 08/20/2023] [Accepted: 06/28/2024] [Indexed: 07/24/2024] Open
Abstract
INTRODUCTION Disability, resulting from altered interactions between individuals and their environment, is a worldwide issue causing inequities and suffering. Many diseases associated with breathlessness cause disability but the relationship between disability and the severity of breathlessness itself is unknown.This study evaluated associations between disability using the WHO's Disability Assessment Schedule (WHODAS) 2.0 and levels of long-term breathlessness limiting exertion. METHODS This population-based, cross-sectional online survey (n=10 033) reflected the most recent national census (2016) by age, sex, state/territory of residence and rurality. Assessments included self-reported disability (WHODAS 2.0 12-item (range 12 (no disability) to 60 (most severe disability)) assessed in 6 domains) and long-term breathlessness limiting exertion (modified Medical Research Council (mMRC) breathlessness scale; 0-4 (4-most severe)). Days in the last month affected by breathlessness were reported. RESULTS Of respondents (52% women; mean age 45), mean total disability score was 20.9 (SD 9.5). 42% (n=4245) had mMRC >0 (mMRC1 31% (n=3139); mMRC2 8% (n=806); mMRC3,4 3% (n=300)). Every level of long-term breathlessness limiting exertion was associated with greater levels of disability (total p <0.001; each domain p <0.001). The most compromised domains were Mobility and Participation.In the last 30 days, people with severe breathlessness (mMRC 3-4): experienced disability (20 days); reduced activities/work (10 days); and completely forwent activities (another 5 days). CONCLUSIONS Disability should be in the definition of persistent breathlessness as it is systematically associated with long-term breathlessness limiting exertion in a grade-dependent, multidimensional manner. Disability should be assessed in people with long-term breathlessness to optimise their social well-being and health.
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Affiliation(s)
- Slavica Kochovska
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Diana Ferreira
- University of Wollongong, Wollongong, New South Wales, Australia
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, Australia
| | - Sungwon Chang
- University of Technology Sydney, Sydney, New South Wales, Australia
| | - Vanessa Brunelli
- University of Wollongong, Wollongong, New South Wales, Australia
| | - Deidre Morgan
- Flinders University, Adelaide, South Australia, Australia
| | - Thomas Similowski
- service de pneumologie département R3S, Hopital Pitie-Salpetriere, Paris, Île-de-France, France
| | - Miriam Johnson
- Hull York Medical School, The University of Hull, Hull, UK
| | - Magnus Ekström
- Faculty of Medicine, Department of Clinical Sciences Lund, Respiratory Medicine and Allergology, Lund, Sweden
| | - David Currow
- University of Wollongong, Wollongong, New South Wales, Australia
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Lecomte T, Heyden I, Raffard S, Khazaal Y, Livet A, Power P, Roy MA, Abdel-Baki A, Corbière M. Validation francophone de la CASIG-rev – un outil clinique visant à soutenir le rétablissement des personnes avec un trouble psychiatrique: French validation of the CASIG-rev – a clinical personal recovery assessment for people with psychiatric disorders. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2024:7067437241261481. [PMID: 39033429 DOI: 10.1177/07067437241261481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/23/2024]
Abstract
OBJECTIVE There are few tools capable of measuring the personal recovery of individuals presenting with mental disorders that take into account the various dimensions of recovery. Personal recovery encompasses several objectives at the level of autonomy, positive interpersonal relationships, mental and physical health, self-acceptance, the school/professional domain, as well as developing a life project. A team of practitioners and researchers from four countries (Canada, Belgium, France, and Switzerland) adapted the Client Assessment of Strengths, Interests, and Goals (CASIG) tool to more accurately measure these different aspects of personal recovery. This study aims to validate the revised version of CASIG (CASIG-rev) in French, in terms of construct validity, test-retest reliability, convergent validity, and clinical sensitivity to change. METHOD A total of 272 individuals were recruited across different French-speaking countries to respond to the CASIG-rev online, as well as Ryff's well-being measure, the Recovery Assessment Scale, and the WHODAS. A subgroup of 29 individuals responded again to the CASIG-rev after 1 month (for temporal stability), and 24 again at six months (for sensitivity to change). RESULTS The confirmatory factor analysis suggests a 5-factor model, very similar to the initially proposed model of 6 factors. Convergent validity was demonstrated between the subscales of tools measuring similar concepts, and test-retest reliability was proven for the majority of scales. The CASIG-rev also appears to be sensitive to clinical or rehabilitation changes, notably at the level of the life project. CONCLUSION This study supports the use of the CASIG-rev in French to measure the recovery of individuals presenting with mental disorders, as well as to support practitioners in the evaluation of their programs and interventions. Limitations, as well as the tool's relevance, are presented. An English validation is underway to make the CASIG-rev available in Anglo-Saxon countries.
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Affiliation(s)
- Tania Lecomte
- Département de Psychologie, Université de Montréal, Centre de recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montréal, Canada
| | - Isabelle Heyden
- Centre de Rééducation Socioprofessionnelle de L'Est (CRSE), Verviers, Belgique
| | - Stéphane Raffard
- Département de Psychologie Clinique et Neuropsychologie, Université Paul Valéry Montpellier 2, Montpellier, France
| | - Yasser Khazaal
- Centre Hospitalier Universitaire Vaudois (CHUV), Université de Lausanne, Suisse
| | - Audrey Livet
- Center hospitalier de l'Universite de Montréal (CHUM), Montréal, Canada
| | - Paméla Power
- Département de Psychologie, Université de Montréal, Montréal, Canada
| | - Marc-André Roy
- Clinique Notre-Dame-des-Victoires, Département de psychiatrie et neurosciences, Université Laval, Québec, Canada
| | - Amal Abdel-Baki
- Center hospitalier de l'Universite de Montréal (CHUM), Montréal, Canada
| | - Marc Corbière
- Département d'éducation et pédagogie, counseling de carrière, Université du Québec à Montréal (UQAM), Centre de recherche de l'Institut Universitaire en Santé Mentale de Montréal (CR-IUSMM), Montréal, Canada
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Kirschneck M, Kus S, Coenen M. Giving insights into an ICF training: evaluation of an in-person interactive ICF training in Germany. FRONTIERS IN REHABILITATION SCIENCES 2024; 5:1419969. [PMID: 39082053 PMCID: PMC11286556 DOI: 10.3389/fresc.2024.1419969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Accepted: 06/25/2024] [Indexed: 08/02/2024]
Abstract
Introduction The World Health Organization (WHO) adopted the International Classification of Functioning, Disability and Health (ICF) in 2001. The classification provides a framework for the standardised description of functioning and disability using health and health-related domains. The implementation of the ICF is diverse and has a wide range of applications. A thorough understanding of the ICF classification is essential for successful implementation. We developed and delivered an in-person interactive ICF training to facilitate the implementation of the ICF in Germany. The aim of this paper is to present the evaluation of this in-person interactive ICF training. Methods The evaluation was conducted with questionnaires assessing the organisation of the workshops and the knowledge gained during the training using Likert scaled questions. Open-ended questions were used to gather feedback on the further development of the ICF training. Data were analysed descriptively using absolute and relative frequencies. Open-ended questions were analysed qualitatively. Results Between 2017 and mid-2020, a team of trainers at the Chair of Public Health and Health Services Research (IBE) at LMU Munich organised 12 in-person interactive ICF trainings with a total of 191 participants. In total 151 participants filled in the questionnaires (response rate: 79.1%). The participants` professional backgrounds were primarily in the social sector (n = 76; 50.3%), clinical sector (n = 36; 23.8%), and administrative sector (n = 31; 20.5%). 42.4% of the participants strongly agreed that the content was relevant to their work, while an additional 51.0% almost agreed. According to this evaluation, 82.1% of the participants would recommend the training to others. Discussion A number of constructive suggestions and proposals were made for the further development of the training programme. These mainly related to the content of the training, such as the themes of children and youth and integration assistance.
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Affiliation(s)
- Michaela Kirschneck
- Chair of Public Health and Health Services Research, Institute for Medical Information Processing, Biometry, and Epidemiology (IBE), Faculty of Medicine, LMU, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Sandra Kus
- Chair of Public Health and Health Services Research, Institute for Medical Information Processing, Biometry, and Epidemiology (IBE), Faculty of Medicine, LMU, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Michaela Coenen
- Chair of Public Health and Health Services Research, Institute for Medical Information Processing, Biometry, and Epidemiology (IBE), Faculty of Medicine, LMU, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
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Sinha K, Gutacker N, Gu Y, Haagsma J, Kumar K, Aghdaee M. Protocol for a longitudinal study examining the trajectory of COVID-19, post-COVID, multidimensional disadvantage and health-related quality of life in India: the IndiQol Project. BMJ Open 2024; 14:e080985. [PMID: 39009459 PMCID: PMC11253756 DOI: 10.1136/bmjopen-2023-080985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 06/27/2024] [Indexed: 07/17/2024] Open
Abstract
INTRODUCTION The COVID-19 pandemic has raised concerns about the persistence of symptoms after infection, commonly referred to as 'post-COVID' or 'long-COVID'. While countries in high-resource countries have highlighted the increased risk of disadvantaged communities, there is limited understanding of how COVID-19 and post-COVID conditions affect marginalised populations in low-income and middle-income countries. We study the longitudinal patterns of COVID-19, post-COVID symptoms and their impact on the health-related quality of life through the IndiQol Project. METHODS AND ANALYSIS The IndiQol Project conducts household surveys across India to collect data on the incidence of COVID-19 and multidimensional well-being using a longitudinal design. We select a representative sample across six states surveyed over four waves. A two-stage sampling design was used to randomly select primary sampling units in rural and urban areas of each State. Using power analysis, we select an initial sample of 3000 household and survey all adult household members in each wave. The survey data will be analysed using limited dependent variable models and matching techniques to provide insights into the impact of COVID-19 pandemic and post-COVID on health and well-being of individuals in India. ETHICS AND DISSEMINATION Ethics approval for the IndiQol Project was obtained from the Macquarie University Human Research Ethics Committee in Sydney, Australia and Institutional Review Board of Morsel in India. The project results will be published in peer-reviewed journals. Data collected from the IndiQol project will be deposited with the EuroQol group and will be available to use by eligible researchers on approval of request.
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Affiliation(s)
- Kompal Sinha
- Department of Economics, Macquarie Business School, Macquarie University, North Ryde, New South Wales, Australia
| | - Nils Gutacker
- Centre for Health Economics, University of York, York, UK
| | - Yuanyuan Gu
- Macquarie University Centre for the Health Economy, Macquarie Business School, Macquarie University, Macquarie Park, New South Wales, Australia
- Australian Institute of Health Innovation, Sydney, South Wales, Australia
| | - Juanita Haagsma
- Department of Public Health, Erasmus MC, Rotterdam, the Netherlands
| | - Kaushalendra Kumar
- International Institute for Population Sciences, Mumbai, Maharashtra, India
| | - Mona Aghdaee
- Macquarie University Centre for the Health Economy, Macquarie Business School, Macquarie University, Macquarie Park, New South Wales, Australia
- Australian Institute of Health Innovation, Sydney, South Wales, Australia
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Steuwe C, Carvalho Fernando S, Runte I, Bender S, Heiler W, Klein F, Kronmüller K, Volmert K, Norra C, Engelbrecht S, Driessen M. Cognitive Behavioral Psychotherapy as an Add-on in Comprehensive Outpatient Care of Non-affective Psychoses: A Multicenter Randomized-Controlled Effectiveness Trial in a Naturalistic Setting. Schizophr Bull 2024:sbae080. [PMID: 39004927 DOI: 10.1093/schbul/sbae080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/16/2024]
Abstract
BACKGROUND AND HYPOTHESIS Non-affective psychoses (NAP) are associated with severe consequences with regard to social functioning, physical health, employment, and suicidality. Treatment guidelines recommend cognitive behavioral therapy for psychosis (CBTp) as an effective additional treatment strategy to psychopharmacology. We hypothesized that outpatient CBTp has an add-on effect in individuals with NAP who already receive comprehensive outpatient care (COC) in Germany. STUDY DESIGN In a randomized-controlled effectiveness trial, 6 months of COC + CBTp were compared to COC. The primary outcomes were change of symptom severity as assessed by the Positive and Negative Symptom Scale (pre-/post-treatment and 6-month follow-up). Mixed linear models and effect sizes were used to compare changes across treatment groups. Additionally, the number of readmissions was compared. STUDY RESULTS N = 130 individuals with chronic NAP were recruited (COC + CBTp: n = 64, COC: n = 66). COC + CBTp participants significantly improved more regarding positive symptom severity (estimated mean difference at follow-up: -2.33, 95% CI: -4.04 to -0.61, P = .0083, d = 0.32) and general psychopathology (estimated mean difference at follow-up: -4.55, 95% CI: -7.30 to -1.81, P = .0013, d = 0.44) than the COC group. In both groups, negative symptom severity did not change significantly over time nor did groups differ regarding readmissions. CONCLUSION The results underline an add-on benefit of CBTp in chronically ill individuals with NAP. Superiority of CBTp was demonstrated in comparison with high-quality comprehensive care and may also be true in different comprehensive care settings. CLINICAL TRIALS REGISTRATION DRKS00015627.
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Affiliation(s)
- Carolin Steuwe
- Department of Psychiatry and Psychotherapy, Ev. Klinikum Bethel, Universität Bielefeld, Bielefeld, Germany
| | - Silvia Carvalho Fernando
- Department of Psychiatry and Psychotherapy, Ev. Klinikum Bethel, Universität Bielefeld, Bielefeld, Germany
| | - Ingo Runte
- Department of Psychiatry and Psychotherapy, Ev. Klinikum Bethel, Universität Bielefeld, Bielefeld, Germany
| | - Stefan Bender
- Department of Psychiatry and Psychotherapy, LWL-Klinikum Marsberg, Marsberg, Germany
| | - Wolfgang Heiler
- Department of Psychiatry and Psychotherapy, LWL-Klinikum Marsberg, Marsberg, Germany
| | - Fabian Klein
- Department of Psychiatry and Psychotherapy, LWL-Klinikum Gütersloh, Gütersloh, Germany
| | - Klaus Kronmüller
- Department of Psychiatry and Psychotherapy, LWL-Klinikum Gütersloh, Gütersloh, Germany
| | - Kathrin Volmert
- Department of Psychiatry, Psychotherapy and Psychosomatics, LWL-Klinik Paderborn, Germany
| | - Christine Norra
- Department of Psychiatry, Psychotherapy and Psychosomatics, LWL-Klinik Paderborn, Germany
- Medical Faculty, Ruhr Universität Bochum, Bochum, Germany
| | | | - Martin Driessen
- Department of Psychiatry and Psychotherapy, Ev. Klinikum Bethel, Universität Bielefeld, Bielefeld, Germany
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