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Beck A, Thomson S, Reddick D, Brunner R, Campbell-Wilson D, Achard D, Isaka N, Trotel A, Karembe H. A single subcutaneous dose of eprinomectin (Eprecis ®) is effective against common gastrointestinal nematodes and lungworms in experimentally infected lactating goats. Parasit Vectors 2024; 17:211. [PMID: 38730429 PMCID: PMC11084049 DOI: 10.1186/s13071-024-06301-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 04/24/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND The health and productivity of dairy goats continue to be impacted by gastrointestinal nematodes (GIN) and lungworms (LW). Eprinomectin (EPN) is frequently selected for treatment because it is generally effective and does not require a milk withdrawal period. However, some factors, such as lactation, can have an impact on EPN pharmacokinetics and potentially its efficacy. To evaluate whether this can alter the efficacy of Eprecis® 2%, an eprinomectin injectable solution, a study was performed in lactating goats using the dose currently registered in cattle, sheep and goats (0.2 mg/kg). METHODS This study was a blinded, randomized, controlled trial performed according to the VICH guidelines. Eighteen (18) worm-free lactating goats were included and experimentally challenged on day 28 with a mixed culture of infective gastrointestinal and lung nematode larvae (Haemonchus contortus, Trichostrongylus colubriformis, Teladorsagia circumcincta, Dictyocaulus filaria). At D-1, fecal samples were collected to confirm patent infection in all animals. On D0, the goats were randomly allocated into two groups of nine goats; group 1 was treated with Eprecis® 2% at 0.2 mg/kg BW by subcutaneous injection, while group 2 remained untreated. Fecal samples for egg counts were collected from all animals on days 3, 5, 7, 9, 11 and 14. On D14, all goats were killed, and the abomasum, small intestine and lungs were removed, processed and subsampled to record the number and species of worms. RESULTS The treatment was well tolerated. After treatment, the arithmetic mean FEC decreased in the treated group and remained < 5 EPG until the end of the study, while the arithmetic mean FEC in the control group remained > 849.0 EPG. At D14, goats in the treated group had very limited or zero total worm counts, whereas all animals from the control group had a high worm burden. The measured efficacy was 100.0% against H. contortus and T. colubriformis, 99.9% against T. circumcincta and 98.0% against D. filaria. CONCLUSIONS Eprinomectin (Eprecis®, 20 mg/ml), administered at the label dose (0.2 mg/kg), is highly effective against gastrointestinal nematodes and lungworms in lactating goats.
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Affiliation(s)
- Alexandra Beck
- Ceva Santé Animale, 10 Avenue de La Ballastière, 33500, Libourne, France.
| | - Sarah Thomson
- Moredun Scientific, Pentlands Science Park (PSP), Bush Loan, Penicuik, Midlothian, EH26 0PZ, UK
| | - David Reddick
- Moredun Scientific, Pentlands Science Park (PSP), Bush Loan, Penicuik, Midlothian, EH26 0PZ, UK
| | - Rike Brunner
- Argenta DE Geyersperger Str. 27, 80689, München, Germany
| | | | - Damien Achard
- Ceva Santé Animale, 10 Avenue de La Ballastière, 33500, Libourne, France
| | - Naomi Isaka
- Ceva Santé Animale, 10 Avenue de La Ballastière, 33500, Libourne, France
| | - Anne Trotel
- Ceva Santé Animale, 10 Avenue de La Ballastière, 33500, Libourne, France
| | - Hamadi Karembe
- Ceva Santé Animale, 10 Avenue de La Ballastière, 33500, Libourne, France
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Golling M, Breul V, Zielska Z, Baumann P. The 6:1 short stitch SL-WL-ratio: short term closure results of transverse and midline incisions in elective and emergency operations. Hernia 2024; 28:447-456. [PMID: 38285168 PMCID: PMC10997695 DOI: 10.1007/s10029-023-02927-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 10/27/2023] [Indexed: 01/30/2024]
Abstract
AIM To analyze laparotomy closure quality (suture/wound length ratio; SL/WL) and short term complications (surgical site occurrence; SSO) of conventional midline and transverse abdominal incisions in elective and emergency laparotomies with a longterm, absorbent, elastic suture material. METHOD Prospective, monocentric, non-randomized, controlled cohort study on short stitches with a longterm resorbable, elastic suture (poly-4-hydroxybutyrate, [p-4OHB]) aiming at a 6:1 SL/WL-ratio in midline and transverse, primary and secondary laparotomies for elective and emergency surgeries. RESULTS We included 351 patients (♂: 208; ♀: 143) with midline (n = 194), transverse (n = 103), and a combined midline/transverse L-shaped (n = 54) incisions. There was no quality difference in short stitches between elective (n = 296) and emergency (n = 55) operations. Average SL/WL-ratio was significantly higher for midline than transverse incisions (6.62 ± 2.5 vs 4.3 ± 1.51, p < 0.001). Results in the first 150 patients showed a reduced SL/WL-ratio to the following 200 suture closures (SL/WL-ratio: 5.64 ± 2.5 vs 6.1 ± 2.3; p < 0.001). SL/WL-ratio varied insignificantly among the six surgeons participating while results were steadily improving over time. Clinically, superficial surgical site infections (SSI, CDC-A1/2) were encountered in 8%, while 4,3% were related to intraabdominal complications (CDC-A3). An abdominal wall dehiscence (AWD) occurred in 22/351 patients (6,3%)-twice as common in emergency than elective surgery (12,7 vs 5,1%)-necessitating an abdominal revision in 86,3% of cases. CONCLUSION We could show that a short stitch 6:1 SL/WL-ratio with a 2-0 single, ultra-long term, absorbent, elastic suture material can be performed in only 43% of cases (85% > 4:1 SL/WL-ratio), significantly better in midline than transverse incisions. Transverse incisions should preferably be closed in two layers to achieve a sufficient SL/WL-ratio equivalent to the median incision. CLINICAL TRIALS GOV IDENTIFIER NCT01938222.
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Affiliation(s)
- M Golling
- Diakonieklinikum Schwäbisch Hall, Schwäbisch Hall, Germany.
| | | | - Z Zielska
- Diakonieklinikum Schwäbisch Hall, Schwäbisch Hall, Germany
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Feda J, Miller T, Young JL, Neilson B, Rhon DI. Measures of sleep are not routinely captured in trials assessing treatment outcomes in knee osteoarthritis - A scoping systematic review and call to action. Osteoarthr Cartil Open 2023; 5:100400. [PMID: 37636007 PMCID: PMC10458296 DOI: 10.1016/j.ocarto.2023.100400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 08/09/2023] [Indexed: 08/29/2023] Open
Abstract
Objective To identify and map the extent to which trials for pain interventions in individuals with knee osteoarthritis (OA) track measures of sleep, characterize the type of sleep measure assessed, and assess their influence on pain-related effect sizes. Design A scoping review was conducted, searching seven bibliometric databases from 2000 to 2022. We included all randomized controlled trials with a primary purpose of assessing non-surgical pain management interventions for adults with knee OA. All non-surgical interventions and any comparator or control were included. Demographic data were pooled from all trials. Results 926 trials conducted in 61 countries met eligibility. Nineteen trials (2.1%) recorded some form of sleep assessment. Eleven trials (1.2%) assessed a formal index of sleep disturbance collected at multiple time points. No trials formally assessed the influence of sleep on the primary pain outcome (e.g., as a potential mediator), nor met the most recent guidelines for core data element recommendations regarding sleep assessment. Conclusion This review highlights the paucity of sleep data captured and reported in randomized controlled trials for knee OA. The vast majority of trials addressing symptomatic knee OA do not capture sleep measures, significantly limiting the ability to accurately determine an intervention's effect on pain. Future research should include formal sleep-centric assessments measured at multiple time points to analyze sleep dysfunction and its relationship on treatment effects.
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Affiliation(s)
- Jessica Feda
- Doctor of Science in Physical Therapy Program, Bellin College, Green Bay, WI, USA
- Doctor of Physical Therapy Program, Baylor University, Waco, TX, USA
| | - Tyler Miller
- Doctor of Science in Physical Therapy Program, Bellin College, Green Bay, WI, USA
- School of Physical Therapy, Belmont University, Nashville, TN, USA
| | - Jodi L. Young
- Doctor of Science in Physical Therapy Program, Bellin College, Green Bay, WI, USA
| | - Brett Neilson
- Doctor of Science in Physical Therapy Program, Bellin College, Green Bay, WI, USA
- Doctor of Physical Therapy Program, Hawai'i Pacific University, Honolulu, HI, USA
| | - Daniel I. Rhon
- Doctor of Science in Physical Therapy Program, Bellin College, Green Bay, WI, USA
- Department of Rehabilitation Medicine, School of Medicine, Uniformed Services University of Health Sciences, Bethesda, MD, USA
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Li PWC, Yu DSF, Yan BP, Wong CW, Chan CMC. Theory-based cognitive-narrative intervention versus didactic education for promoting prompt care-seeking for acute myocardial infarction: A multisite mixed-methods randomized controlled trial. Int J Nurs Stud 2023; 148:104564. [PMID: 37852046 DOI: 10.1016/j.ijnurstu.2023.104564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 07/06/2023] [Accepted: 07/10/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND Prolonged delays by patients in making care-seeking decisions remain a significant obstacle to the effective management of acute myocardial infarction. OBJECTIVES This study aimed to compare the effects of a theory-based cognitive-narrative intervention with those of didactic education over a 24-month period on the participants' attitudes, beliefs, and knowledge regarding acute myocardial infarction, prehospital delay time, and the use of an ambulance. We also explored participants' engagement in the intervention. DESIGN This study adopted a sequential mixed-methods design comprising a multisite randomized controlled trial and a qualitative study. METHODS Community-dwelling adult patients with a prior history of acute myocardial infarction in the past year were recruited from four hospitals in Hong Kong. They were randomly assigned to an 8-week theory-based cognitive-narrative intervention that involved a vivid experience of complex decision-making or didactic education. The Acute Coronary Syndrome Response Index questionnaire was administered at baseline (T0) and at 3- (T1), 12- (T2), and 24-month (T3) follow-up time points. Prehospital delay time and the use of an ambulance were evaluated for those participants who had recurrent acute myocardial infarction attacks during the study period. RESULTS A total of 608 participants were randomly assigned to the theory-based cognitive-narrative intervention group (n = 304) or the didactic education group (n = 304). The intervention group reported greater improvements than the control group in their attitudes (β = -1.053, p = 0.002) and beliefs (β = -0.686, p = 0.041) regarding acute myocardial infarction and care-seeking at T1. These effects were sustained at T2 [attitudes (β = -0.797, p = 0.018); beliefs (β = -0.692, p = 0.047)] and T3 [attitudes (β = -0.717, p = 0.024); beliefs (β = -0.701, p = 0.032)]. Sixty-three participants experienced another acute myocardial infarction event by T2. The median delay times for the intervention and control groups were 3.13 h (interquartile range (IQR: 1.15-6.48)) and 4.82 h (IQR: 2.23-9.02), respectively. The prehospital delay time was significantly reduced in the intervention group compared with the control group (β = -0.07, p = 0.011). The qualitative findings echoed the quantitative findings, as participants indicated that the intervention helped them to understand the variable nature of the disease presentation, which enabled them to recognize the symptoms more readily. CONCLUSION The novel cognitive-narrative intervention used in this study effectively improved the participants' attitudes and beliefs regarding acute myocardial infarction and reduced the prehospital delay time. TRIAL REGISTRATION This study was registered with the International Clinical Trials Registry Platform of the World Health Organization (ChiCTR-IIC-17010576) on February 2, 2017; the first participant was recruited on January 11, 2018.
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Affiliation(s)
- Polly W C Li
- School of Nursing, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong.
| | - Doris S F Yu
- School of Nursing, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Bryan P Yan
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - C W Wong
- Department of Medicine and Geriatrics, Pok Oi Hospital, Hong Kong
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Bes I, Shoman Y, Al-Gobari M, Rousson V, Guseva Canu I. Organizational interventions and occupational burnout: a meta-analysis with focus on exhaustion. Int Arch Occup Environ Health 2023; 96:1211-1223. [PMID: 37758838 PMCID: PMC10560169 DOI: 10.1007/s00420-023-02009-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 09/08/2023] [Indexed: 09/29/2023]
Abstract
PURPOSE To assess whether organizational interventions are effective to prevent or reduce exhaustion, the core dimension of occupational burnout. METHODS We searched in PubMed, EMBASE, PsycINFO, and Cochrane Library databases randomized and non-randomized controlled trials conducted among active workers and reporting the outcome as exhaustion score. We calculated the effect sizes using the pre-test-post-test control group design's estimate. We used the random effects model in meta-analysis and Cochrane collaboration's tool for interventions to assess the risk of bias. Overall quality of evidence was appraised using the GRADE. RESULTS From the 2425 identified records, we assessed 228 full texts for eligibility and included 11 original articles describing 13 studies, 11 on organizational interventions, and 2 on combined inventions. The interventions were participatory (n = 9), focused on workload (n = 2), or on work schedule (n = 2). The overall effect size was - 0.30 ((95% CI = - 0.42; - 0.18), I2 = 62.28%), corresponding to a small reduction in exhaustion with a very low quality of evidence. Combined interventions had a larger effect (- 0.54 (95% CI = - 0.76; - 0.32)) than organizational interventions. When split by type of intervention, both participatory interventions and interventions focused on workload had a benefic effect of exhaustion reduction, with an estimated effect size of - 0.34 (95% CI = - 0.47; - 0.20) and - 0.44 (95% CI = - 0.68, - 0.20), respectively. CONCLUSION Interventions at combined level in workplaces could be helpful in preventing exhaustion. However, the evidence is still limited, due to a high heterogeneity between studies, bias potential, and small number of eligible studies. This calls for further research, using workload interventions at organizational level, especially in sectors with high risk of job stress and exhaustion.
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Affiliation(s)
- Isabelle Bes
- Department of Occupational and Environmental Health, Center for Primary Cary and Public Health (Unisanté), University of Lausanne, Epalinges, Switzerland
| | - Yara Shoman
- Department of Occupational and Environmental Health, Center for Primary Cary and Public Health (Unisanté), University of Lausanne, Epalinges, Switzerland
| | - Muaamar Al-Gobari
- Department of Occupational and Environmental Health, Center for Primary Cary and Public Health (Unisanté), University of Lausanne, Epalinges, Switzerland
| | - Valentin Rousson
- Quantitative Research Secteur, Unisanté, University of Lausanne, Lausanne, Switzerland
| | - Irina Guseva Canu
- Department of Occupational and Environmental Health, Center for Primary Cary and Public Health (Unisanté), University of Lausanne, Epalinges, Switzerland.
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Sakai D, Schol J, Kawachi A, Sako K, Hiyama A, Katoh H, Sato M, Watanabe M. Adolescent Idiopathic Scoliotic Deformity Correction Surgery Assisted by Smart Glasses Can Enhance Correction Outcomes and Accuracy and Also Improve Surgeon Fatigue. World Neurosurg 2023; 178:e96-e103. [PMID: 37423337 DOI: 10.1016/j.wneu.2023.06.144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 06/29/2023] [Accepted: 06/30/2023] [Indexed: 07/11/2023]
Abstract
OBJECTIVE Augmented reality (AR) is becoming more common and slowly being integrated into the surgical field. With the continuous progression of navigation and visualization techniques, AR has great potential to improve surgical quality and safety. Nevertheless, the effects of AR on surgical outcomes and surgeons' well-being remains poorly studied. The present prospective controlled study aims to assess the effect of surgery assisted with AR smart glasses on adolescent idiopathic scoliosis (AIS) deformity correction outcomes and surgeon fatigue. METHODS AIS patients scheduled for surgical deformity correction were prospectively recruited and assigned to standard or AR-supported surgery, using lightweight AR smart glasses. The demographic and clinical features were recorded. The pre- and postoperative spinal features, operative time, and blood loss were recorded and compared. Finally, the participating surgeons were asked to complete a questionnaire (e.g., visual analog scale for fatigue) to compare the effects of AR on their well-being. RESULTS Our results have shown enhanced spinal deformity corrections with Cobb angle (-35.7° vs. -46.9°), thoracic kyphosis (8.1° vs. 11.6°), and vertebral rotation (-9.3° vs. -13.8°) changes favoring AR-supported surgery. Moreover, AR resulted in significantly lower violation rates per patient (7.5% vs. 6.6%; P = 0.023). Finally, the visual analog scale for fatigue scores consistently showed a significant reduction in fatigue (5.7 ± 1.7 vs. 3.3 ± 1.2; P < 0.001) and other fatigue classifiers for the surgeons after AR-supported surgery. CONCLUSIONS Our controlled study has highlighted the enhanced spinal correction rates in AR-supported surgery and also improved surgeons' well-being and fatigue. These results endorse the adaptation of AR techniques to support AIS surgical correction.
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Affiliation(s)
- Daisuke Sakai
- Department of Orthopedic Surgery, Surgical Science, Tokai University School of Medicine, Isehara, Japan.
| | - Jordy Schol
- Department of Orthopedic Surgery, Surgical Science, Tokai University School of Medicine, Isehara, Japan
| | - Asami Kawachi
- Department of Orthopedic Surgery, Surgical Science, Tokai University School of Medicine, Isehara, Japan; TUNZ Pharma Co. Ltd, Osaka, Japan
| | - Kosuke Sako
- Department of Orthopedic Surgery, Surgical Science, Tokai University School of Medicine, Isehara, Japan
| | - Akihiko Hiyama
- Department of Orthopedic Surgery, Surgical Science, Tokai University School of Medicine, Isehara, Japan
| | - Hiroyuki Katoh
- Department of Orthopedic Surgery, Surgical Science, Tokai University School of Medicine, Isehara, Japan
| | - Masato Sato
- Department of Orthopedic Surgery, Surgical Science, Tokai University School of Medicine, Isehara, Japan
| | - Masahiko Watanabe
- Department of Orthopedic Surgery, Surgical Science, Tokai University School of Medicine, Isehara, Japan
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Alejandro RS, Alejandro DS, Barón ZK, Javier GG, Rocío G GP, Huffman C, Luis M RO, Armando AA, Carla L GR. Single dose of tranexamic acid effectively reduces blood loss in patients undergoing spine surgery: a prospective randomized controlled trial. World Neurosurg 2023:S1878-8750(23)00534-X. [PMID: 37080453 DOI: 10.1016/j.wneu.2023.04.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 04/10/2023] [Accepted: 04/11/2023] [Indexed: 04/22/2023]
Abstract
STUDY DESIGN Randomized control trial. OBJECTIVE Evaluate the efficacy of oral administration of tranexamic acid (TXA) in spine surgeries to achieve blood loss reduction. METHODS A total of 60 patients undergoing major surgery of the spine, were randomly assigned into 2 groups. Group 1 was assigned as the control group and the other one included oral administration of tranexamic acid 2 hours prior to surgery. Outcomes measures included intraoperative blood loss, postoperative blood loss, hematological parameters, blood transfusion needed, and surgical complications. RESULTS Sixty patients linked up with the inclusion criteria. Intraoperative blood loss was significantly lower in the TXA oral group than in the control group, total blood loss in the TXA group with 930.66±614ml lower than the control group with 1075.66±956.11ml. The mean reduction of hemoglobin was almost the same in both groups. Similarly, the total transfusion package received was lower, and the number of complications and length of stay were akin in both groups. A logistic regression model was performed with patients who had blood loss of more than 1000ml and, surgery time longer than 230min. This was related to the risk of bleeding with an OR of 1.31, 95%CI 1.004-1.023, p=0.004 independent of the group. CONCLUSION Oral TXA results as an effective measure for reducing total blood loss among patients undergoing elective spine surgery.
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Affiliation(s)
| | | | | | - Guerra-Garza Javier
- Spine Surgery Division, National Institute of Rehabilitation, Mexico City, Mexico
| | | | - Curtis Huffman
- Assistant Professor. Development Studies Program, National Autonomous University of Mexico, Mexico City
| | | | | | - García-Ramos Carla L
- Spine Surgery Division, National Institute of Rehabilitation, Mexico City, Mexico.
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Echodu DC, Yeka A, Eganyu T, Odude W, Bukenya F, Amoah B, Wanzira H, Colborn K, Elliott RC, Powell SE, Kilama M, Mulebeke R, Nankabirwa J, Giorgi E, Roskosky M, Omoding O, Gonahasa S, Opigo J. Impact of population based indoor residual spraying with and without mass drug administration with dihydroartemisinin-piperaquine on malaria prevalence in a high transmission setting: a quasi-experimental controlled before-and-after trial in northeastern Uganda. BMC Infect Dis 2023; 23:72. [PMID: 36747133 PMCID: PMC9901833 DOI: 10.1186/s12879-023-07991-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 01/06/2023] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Declines in malaria burden in Uganda have slowed. Modelling predicts that indoor residual spraying (IRS) and mass drug administration (MDA), when co-timed, have synergistic impact. This study investigated additional protective impact of population-based MDA on malaria prevalence, if any, when added to IRS, as compared with IRS alone and with standard of care (SOC). METHODS The 32-month quasi-experimental controlled before-and-after trial enrolled an open cohort of residents (46,765 individuals, 1st enumeration and 52,133, 4th enumeration) of Katakwi District in northeastern Uganda. Consented participants were assigned to three arms based on residential subcounty at study start: MDA+IRS, IRS, SOC. IRS with pirimiphos methyl and MDA with dihydroartemisinin- piperaquine were delivered in 4 co-timed campaign-style rounds 8 months apart. The primary endpoint was population prevalence of malaria, estimated by 6 cross-sectional surveys, starting at baseline and preceding each subsequent round. RESULTS Comparing malaria prevalence in MDA+IRS and IRS only arms over all 6 surveys (intention-to-treat analysis), roughly every 6 months post-interventions, a geostatistical model found a significant additional 15.5% (95% confidence interval (CI): [13.7%, 17.5%], Z = 9.6, p = 5e-20) decrease in the adjusted odds ratio (aOR) due to MDA for all ages, a 13.3% reduction in under 5's (95% CI: [10.5%, 16.8%], Z = 4.02, p = 5e-5), and a 10.1% reduction in children 5-15 (95% CI: [8.5%, 11.8%], Z = 4.7, p = 2e-5). All ages residents of the MDA + IRS arm enjoyed an overall 80.1% reduction (95% CI: [80.0%, 83.0%], p = 0.0001) in odds of qPCR confirmed malaria compared with SOC residents. Secondary difference-in-difference analyses comparing surveys at different timepoints to baseline showed aOR (MDA + IRS vs IRS) of qPCR positivity between 0.28 and 0.66 (p < 0.001). Of three serious adverse events, one (nonfatal) was considered related to study medications. Limitations include the initial non-random assignment of study arms, the single large cluster per arm, and the lack of an MDA-only arm, considered to violate equipoise. CONCLUSIONS Despite being assessed at long time points 5-7 months post-round, MDA plus IRS provided significant additional protection from malaria infection over IRS alone. Randomized trials of MDA in large areas undergoing IRS recommended as well as cohort studies of impact on incidence. TRIAL REGISTRATION This trial was retrospectively registered 11/07/2018 with the Pan African Clinical Trials Registry (PACTR201807166695568).
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Affiliation(s)
| | - Adoke Yeka
- grid.11194.3c0000 0004 0620 0548Makerere University College of Health Sciences, School of Public Health, P.O. Box 7072, Kampala, Uganda
| | - Thomas Eganyu
- Pilgrim Africa, Plot 8 Engwau Road, PO Box 577, Soroti, Uganda
| | - Wycliff Odude
- Pilgrim Africa, Plot 8 Engwau Road, PO Box 577, Soroti, Uganda
| | - Fred Bukenya
- Pilgrim Africa, Plot 8 Engwau Road, PO Box 577, Soroti, Uganda
| | - Benjamin Amoah
- grid.7445.20000 0001 2113 8111School of Public Health, Imperial College London, Sir Alexander Fleming Building, South Kensington Campus, London, SW7 2AZ UK
| | | | - Kathryn Colborn
- grid.430503.10000 0001 0703 675XUniversity of Colorado Anschutz Medical Campus, 12631 East 17th Avenue, Aurora, CO 80045 USA
| | - Richard C. Elliott
- Pilgrim Africa, 8001 14th Avenue NE, Suite A, Seattle, WA 98115 USA ,grid.184764.80000 0001 0670 228XMicron School of Materials Science and Engineering, Boise State University, Engineering Building, Suite 338, Boise, ID 83725 USA
| | | | - Maxwell Kilama
- Pilgrim Africa, Plot 8 Engwau Road, PO Box 577, Soroti, Uganda
| | - Ronald Mulebeke
- grid.11194.3c0000 0004 0620 0548Makerere University College of Health Sciences, School of Public Health, P.O. Box 7072, Kampala, Uganda
| | - Joaniter Nankabirwa
- grid.463352.50000 0004 8340 3103Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Emanuele Giorgi
- grid.9835.70000 0000 8190 6402Lancaster University Medical School, Centre for Health Informatics, Computing and Statistics, Lancaster, UK
| | - Mellisa Roskosky
- Pilgrim Africa, 8001 14th Avenue NE, Suite A, Seattle, WA 98115 USA ,grid.21107.350000 0001 2171 9311Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | - Osborn Omoding
- Pilgrim Africa, Plot 8 Engwau Road, PO Box 577, Soroti, Uganda
| | - Samuel Gonahasa
- grid.463352.50000 0004 8340 3103Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Jimmy Opigo
- grid.415705.2National Malaria Control Division, Ministry of Health Uganda, Kampala, Uganda
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Orku SE, Suyen G, Bas M. The effect of regular consumption of four low- or no-calorie sweeteners on glycemic response in healthy women: A randomized controlled trial. Nutrition 2023; 106:111885. [PMID: 36470113 DOI: 10.1016/j.nut.2022.111885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 09/03/2022] [Accepted: 10/11/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVES The aim of this study was to determine the effects of regular exposure to certain low- or no-calorie sweeteners (LNCS) on glucose tolerance and glucagon-like peptide 1 (GLP-1) release in healthy individuals. METHODS It was designed as a randomized, single-blinded, controlled study. Healthy and normoglycemic adults who did not have regular consumption of LNCS were recruited. Participants underwent a 75-g oral glucose tolerance test (OGTT) at baseline and were randomly assigned to consume 330 mL water sweetened with saccharine, sucralose, or aspartame + acesulfame-K (Asp+Ace-K), or plain water for the control group, daily for 4 wk. Fasting plasma glucose, insulin, GLP-1, and glycated hemoglobin A1c (HbA1c) levels and 1-h, 2-h, and 3-h plasma glucose and insulin levels during OGTT were obtained at baseline. The change in insulin sensitivity was assessed by both the Homeostatic Model Assessment Insulin Resistance (HOMA-IR) Index and the Matsuda Index. Anthropometric measurements and dietary intakes were determined at baseline. Baseline measurements were repeated at week 4. RESULTS Of the participants enrolled in the study, 42 (age, 21.24 ± 2.26 y; body mass index, 20.65 ± 2.88 kg/m2) completed the 4-wk intervention period. There were no differences for glucose, insulin, GLP-1, or HbA1c levels or HOMA-IR scores at baseline or at week 4 when compared with the control group. The area under the curve of mean glucose and insulin values during OGTT were also found to be similar between groups at baseline and week 4. There were also no effects of LNCS intake on body weight, body composition, and waist circumference. CONCLUSIONS These results suggest that regular consumption of LNCS-sweetened water similar to doses consumed in daily life over 4 wk had no significant effect on glycemic response, insulin sensitivity, GLP-1 release, and body weight in healthy individuals. This trial was registered at www. CLINICALTRIALS gov as NCT04904133.
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Affiliation(s)
- Saziye E Orku
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey; Department of Nutrition and Dietetics, Institute of Health Sciences, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey.
| | - Guldal Suyen
- Department of Physiology, School of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Murat Bas
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
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10
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Xue M, Sun H, Xue J, Zhou J, Qu J, Ji S, Bu Y, Liu Y. Narrative medicine as a teaching strategy for nursing students to developing professionalism, empathy and humanistic caring ability: a randomized controlled trial. BMC Med Educ 2023; 23:38. [PMID: 36653810 PMCID: PMC9850682 DOI: 10.1186/s12909-023-04026-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 01/12/2023] [Indexed: 06/01/2023]
Abstract
BACKGROUND Narrative medicine has become a solution to cultivate medical students' ability of empathy and humanistic care. However, the role of narrative medicine is lacking in the study of professionalism. The aim of this study was to analyze the effects of narrative medical theory learning and narrative writing on professionalism, empathy and humanistic care ability of nursing students. METHODS This cluster randomized controlled trial was conducted between June 2021 and June 2022 in two universities in Jiangsu, China. The participants of this study were 85 nursing students who were randomly divided into the intervention group (n = 43) or the control group (n = 42). Participants in the intervention group were trained in narrative medical theory learning and narrative writing based on a Web-based platform, while those in the control group were not. Self-report questionnaires of professionalism, empathy and humanistic care ability were used before and after intervention. RESULTS The results showed that the professionalism score of the intervention group was (68.7 ± 6.8 vs. 64.5 ± 7.5; P = 0.005), empathy (99.4 ± 15.7 vs. 92.2 ± 14.6; P = 0.014) and humanistic care ability (127.6 ± 20.0 vs. 113.3 ± 18.8; P = 0.004) were better than the control group. CONCLUSION The results of this quantitative study suggest that narrative medical theory education and narrative writing based on the network platform can promote the development of professionalism, empathy and humanistic care ability of nursing undergraduates.
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Affiliation(s)
- Mengxin Xue
- School of Nursing and Public Health, Yangzhou University, Yangzhou, Jiangsu Province, China
| | - Huiping Sun
- School of Nursing and Public Health, Yangzhou University, Yangzhou, Jiangsu Province, China
| | - Jin Xue
- Guangling College, Yangzhou University, Yangzhou, Jiangsu Province, China
| | - Jingxin Zhou
- School of Nursing and Public Health, Yangzhou University, Yangzhou, Jiangsu Province, China
| | - Junchao Qu
- School of Nursing and Public Health, Yangzhou University, Yangzhou, Jiangsu Province, China
| | - Siqi Ji
- School of Nursing and Public Health, Yangzhou University, Yangzhou, Jiangsu Province, China
| | - Yuan Bu
- School of Nursing and Public Health, Yangzhou University, Yangzhou, Jiangsu Province, China
| | - Yongbing Liu
- School of Nursing and Public Health, Yangzhou University, Yangzhou, Jiangsu Province, China.
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11
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Joseph AP, Wallman M, Scott E, Ilchef R, Harris N, Jackson A, Bryant RA. A proof-of-concept randomized controlled trial of follow-up mental health care for traumatic injury patients following hospital discharge. Injury 2023; 54:1362-1368. [PMID: 36858896 DOI: 10.1016/j.injury.2023.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 12/14/2022] [Accepted: 01/01/2023] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Traumatic injuries account for a huge burden of disease. Many patients develop persistent mental health problems in the months following hospital discharge. This proof-of-concept trial investigated whether Stepped Care comprising follow-up assessment telephone calls and appropriate referral information would lead to better mental health and functioning in traumatic injury patients. METHODS Patients admitted to the Trauma Service at Royal North Shore Hospital were randomized to either Stepped Care (n = 84) or Treatment as Usual (n = 90). All patients were assessed for anxiety, depression, and posttraumatic stress prior to hospital discharge. Those in Stepped Care received a telephone call at 1-month and 3-months after hospital discharge in which they were administered a brief assessment; patients who reported mental health or pain difficulties were provided with information for local specialists to address their specific problem. All patients were independently assessed by telephone interview 9- months after hospital discharge for posttraumatic stress disorder (PTSD) (primary outcome), as well as for anxiety, depression, disability, and pain. RESULTS There were 58 (73%) patients that could be contacted at either the 1-month or 3-month assessments. Of those contacted, 28 patients (48% of those contacted) were referred for specialist assistance. There were no differences between treatment arms on PTSD symptoms at follow-up [F1,95 = 0.55, p = 0.46]. At the 9-month assessment, patients in the Stepped Care condition reported significantly less anxiety [F1,95 = 5.07, p = 0.03] and disability [F1,95 = 4.37, p = 0.04] relative to those in Treatment as Usual. At 9 months there was no difference between conditions on depression [F1,95 = 1.03, p = 0.31]. There were no differences between conditions on self-reported pain difficulties. CONCLUSIONS This proof-of-concept trial suggests that brief screening assessments of traumatic injury patients following hospital discharge, combined with appropriate referral information, may lead to better functional outcomes. Further research is needed with larger sample sizes and greater verification of referral uptake to validate this finding.
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Affiliation(s)
- Anthony P Joseph
- Trauma Service, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia.
| | - Matthew Wallman
- Trauma Service, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia
| | - Elliot Scott
- Trauma Service, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia
| | - Ralf Ilchef
- Department of Psychiatry, Royal North Shore Hospital, St Leonards, NSW 2065
| | - Newman Harris
- Department of Pain Management, Royal North Shore Hospital, St Leonards, NSW 2065
| | - Alicia Jackson
- Trauma Service, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia
| | - Richard A Bryant
- School of Psychology, University of New South Wales, Sydney, NSW, 2052, Australia
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12
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Keyan D, Dawson K, Azevedo S, Yadav S, Choi-Christou J, Maliakkal DJ, Pillai MK, Thomas E, George TS, Bryant RA. Videoconferencing-delivered psychological intervention for the treatment of COVID-19 related psychological distress in University students: study protocol for a randomised controlled trial in India. BMC Psychiatry 2022; 22:808. [PMID: 36539730 DOI: 10.1186/s12888-022-04471-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The mental health impacts of the COVID-19 pandemic have been profound. This paper outlines the study protocol for a trial that tests the efficacy of a brief group-based psychological intervention (Coping with COVID; CWC), relative to Supportive Counselling, to reduce distress associated with COVID-19 in a young adult population in Bangalore, India. METHODS A single-blind, parallel, randomized controlled trial will be carried out via video conferencing in a small group format. Following informed consent, adults that screen positive for levels of psychological distress (Kessler 10 (K-10 score ≥ 20) and have access to a videoconferencing platform will be randomised to an adapted version of CWC (n = 90) or Supportive Counselling (SC) (n = 90). The primary outcome will be reduction in psychological distress including anxiety and depression at 2-months post treatment. Secondary outcomes include worry, positive wellbeing, and stress in relation to COVID-19. DISCUSSION This treatment trial will assess whether CWC will result in reduced distress relative to Supportive Counselling in a young adult population in Bangalore, India. This study will yield important insights into the role of nonspecific factors versus the intervention's components in impacting COVID-19 related distress. TRIAL REGISTRATION This trial was prospectively registered on the Australian New Zealand Clinical Trials Registry (ACTRN12621001064897). ETHICS AND DISSEMINATION Ethics approval has been obtained from the participating institution, CHRIST University in Bangalore. Results of the trial will be submitted for publication in peer reviewed journals and findings presented at scientific conferences and to key service providers and policy makers.
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13
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Jacobowitz O, Schwartz AR, Lovett EG, Ranuzzi G, Malhotra A. Design and rationale for the treating Obstructive Sleep Apnea using Targeted Hypoglossal Nerve Stimulation (OSPREY) trial. Contemp Clin Trials 2022; 119:106804. [PMID: 35613672 PMCID: PMC9420766 DOI: 10.1016/j.cct.2022.106804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 05/15/2022] [Accepted: 05/18/2022] [Indexed: 02/03/2023]
Abstract
Obstructive sleep apnea (OSA) affects nearly 1 billion people worldwide, including approximately 35 million US residents. OSA has detrimental cardiovascular and neurocognitive consequences. Positive airway pressure corrects sleep disordered breathing but is not always tolerated or used sufficiently. Oral appliances and surgery provide alternatives in select populations but are variably effective. Hypoglossal nerve stimulation can effectively treat obstructive sleep apnea. Targeted hypoglossal nerve stimulation (THN) is simpler than incumbent technology with no sensor and an easier, proximal electrode implantation. The third clinical study of THN, THN3, was the first randomized, controlled trial of hypoglossal nerve stimulation to demonstrate significant improvement of sleep disordered breathing in OSA. The present investigation reports the design of a novel trial of targeted stimulation to provide additional Level 1 evidence in moderate to severe obstructive apnea. OSPREY is a randomized, parallel-arm, 13-month trial wherein all subjects are implanted, 2/3 are activated at Month 1 ("Treatment") and 1/3 are activated at Month 7 ("Control"). The primary endpoint is the difference in apnea-hypopnea index response rates between Treatment and Control groups at Month 7. Secondary endpoints include quality of life and oximetry metrics. OSPREY follows an adaptive "Goldilocks" design which optimizes the number of subjects with the need for high-confidence results. A maximum of 150 subjects is allowed, at which study power of >95% is predicted. Interim analyses begin once 50 patients are randomized and recur after each 20 additional randomizations to detect early success or futility. OSPREY is a unique, efficient trial that should provide high-confidence confirmation of the safety and efficacy of targeted hypoglossal nerve stimulation for moderate to severe obstructive sleep apnea.
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Affiliation(s)
- Ofer Jacobowitz
- Sleep Department, ENT and Allergy Associates, New York, NY, United States of America,Corresponding author at: ENT and Allergy Associates, 18 E48th St, 2nd floor, New York, NY 10017, United States of America. (O. Jacobowitz)
| | - Alan R. Schwartz
- Department of Otorhinolaryngology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania and Vanderbilt University School of Medicine, Nashville, TN, United States of America
| | - Eric G. Lovett
- Clinical and Medical Affairs, LivaNova PLC, Minneapolis, MN, United States of America
| | | | - Atul Malhotra
- Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of California San Diego, La Jolla, CA, United States of America
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14
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Austrian K, Soler-Hampejsek E, Kangwana B, Maddox N, Diaw M, Wado YD, Abuya B, Muluve E, Mbushi F, Mohammed H, Aden A, Maluccio JA. Impacts of Multisectoral Cash Plus Programs on Marriage and Fertility After 4 Years in Pastoralist Kenya: A Randomized Trial. J Adolesc Health 2022; 70:885-894. [PMID: 35168885 DOI: 10.1016/j.jadohealth.2021.12.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 11/12/2021] [Accepted: 12/06/2021] [Indexed: 01/03/2023]
Abstract
PURPOSE Early marriage has multiple drivers including cultural and social norms alongside lack of educational and economic opportunities. This complexity may explain why few programs have demonstrated marriage delays and suggests multisectoral interventions are necessary. This study examined a 2-year multisectoral program designed to delay marriage in a marginalized setting. METHODS The study used a prospective 80-cluster randomized trial following up 2,147 girls aged 11-14 years from 2015 to 2019. Interventions included community dialogs about inequitable gender norms (violence prevention), a conditional cash transfer (education), weekly group meetings with health and life skills training (health), and financial literacy training (wealth creation). Villages were randomized to one of four study arms: (1) violence prevention only (V-only); (2) violence prevention and education (VE); (3) VE and health (VEH); or (4) all four interventions (VEHW). We used analysis of covariance to estimate intent-to-treat impacts of each study arm with an education component, as well as a pooled study arm combining the VE, VEH, and VEHW arms, in reference to V-only, 2 years after the intervention ended, when girls were 15-18 years old. RESULTS There were small but insignificant reductions on primary outcomes in unadjusted analyses that were larger and significant in adjusted analyses. Effects were particularly large for girls not in school at baseline-the pooled study arm reduced marriage by 18.0 and pregnancy by 15.6 percentage points, a relative reduction of 34% and 43%, respectively. DISCUSSION The article demonstrates the potential for multisectoral interventions with education components to delay early marriage in an impoverished, socially conservative, pastoral setting.
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Affiliation(s)
- Karen Austrian
- Poverty, Gender and Youth Program, Population Council - Kenya, Nairobi, Kenya.
| | | | - Beth Kangwana
- Poverty, Gender and Youth Program, Population Council - Kenya, Nairobi, Kenya
| | - Nicole Maddox
- Department of Social and Political Sciences, Bocconi University, Milan, Italy
| | - Maryama Diaw
- Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, New York
| | - Yohannes D Wado
- African Population and Health Research Center, Nairobi, Kenya
| | - Benta Abuya
- African Population and Health Research Center, Nairobi, Kenya
| | - Eva Muluve
- Poverty, Gender and Youth Program, Population Council - Kenya, Nairobi, Kenya
| | - Faith Mbushi
- Poverty, Gender and Youth Program, Population Council - Kenya, Nairobi, Kenya
| | | | | | - John A Maluccio
- Department of Economics, Middlebury College, Middlebury, Vermont
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15
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van Leuven L, Lalouni M, Enebrink P, Sorjonen K, Forster M. Feasibility and implementation of Safer Kids - A parenting program to reduce child abuse. Child Abuse Negl 2022; 123:105434. [PMID: 34894587 DOI: 10.1016/j.chiabu.2021.105434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 10/19/2021] [Accepted: 12/02/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Child abuse is a world-wide problem causing long-term suffering for children and large costs to society. Parent-training programs have been shown to reduce harsh parenting but more research on parenting programs specifically addressing child abuse is needed. OBJECTIVE This study aimed at assessing the feasibility, implementation, and preliminary effectiveness of Safer Kids (SK); a structured parent-training program delivered immediately after parents are reported for child abuse. PARTICIPANTS AND SETTING Caregivers were eligible if they had been reported for child abuse to the Swedish social services and their child was 3-12 years old. METHODS Families were allocated to SK or intervention as usual (IAU) through a quasi-experimental design. Multilevel analyses and a Cox Proportional Hazard Model were used to assess between-group differences in risk factors for abuse and further child welfare reports. RESULTS In total, 67 families participated. SK was successfully implemented as an early-start intervention and most families completed the intervention. All agencies continued working with SK two years after the study, indicating sustainability of implementation. SK was more effective than IAU in reducing further child welfare reports up to 18 months from baseline. However, analyses of parent and child rated risk factors of re-abuse (abuse potential, wellbeing, and parent-child relationships) indicate none to small differences between conditions. CONCLUSIONS SK can be successfully implemented within the social services and may be effective in reducing occurrence of further child welfare reports. The effects of SK need to be further evaluated in a randomized controlled trial.
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Affiliation(s)
- Livia van Leuven
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Nobels väg 9, 171 65 Solna, Sweden.
| | - Maria Lalouni
- Department of Clinical Neuroscience, Division of Neuro, Karolinska Institutet, Nobels väg 9, 171 65 Solna, Sweden, Sweden
| | - Pia Enebrink
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Nobels väg 9, 171 65 Solna, Sweden
| | - Kimmo Sorjonen
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Nobels väg 9, 171 65 Solna, Sweden
| | - Martin Forster
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Nobels väg 9, 171 65 Solna, Sweden
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16
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Cherrier MM, Higano CS, Gray HJ. Cognitive skill training improves memory, function, and use of cognitive strategies in cancer survivors. Support Care Cancer 2022; 30:711-720. [PMID: 34368888 PMCID: PMC8639759 DOI: 10.1007/s00520-021-06453-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 07/19/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Cancer survivors commonly report symptoms of impaired cognition. This project examined effectiveness of a behavioral skills training intervention to improve cognition and reduce cognitive dysfunction symptoms in cancer survivors. METHODS Participants were randomly assigned to group-based workshops focused on learning new cognitive skills (skills treatment-TX) or an active control of education workshops (education control-EC) or a passive control of wait list (WL). Participants were evaluated pre- and post intervention with subjective mood and symptom questionnaires and objective neurocognitive tests. RESULTS One hundred twenty-eight participants (mean age 59 years), average 4.6 years (+ / - 5.5 years) post cancer treatment with various cancer types (breast, bladder, prostate, colon, uterine), were enrolled. Analysis of all participants who attended workshop(s) revealed improvement in the TX workshop completers on all objective cognitive measures (attention, concentration, declarative, and working memory) save one test of selective attention, and improvement on a single measure (verbal memory) and decline (selective attention) in the EC group. TX workshop completers also improved on all symptom and mood measures, in contrast to EC group which improved on a single subscale of a symptom measure, but increased on an anxiety measure. TX group alone improved on a quantified measure of each participants' unique, "top three," self-described cognitive symptoms. CONCLUSION Improvement from behavioral skills training was evident from objective cognitive tests, subjective symptom measures, and quantified, individual patient-specific symptoms. Behavioral skill training is an effective treatment for cognitive dysfunction in cancer survivors, and should be considered as a treatment option by health care providers.
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Affiliation(s)
- Monique M. Cherrier
- Department of Psychiatry and Behavioral Sciences, University of Washington, Box 356560, Seattle, WA 98195, USA,Fred Hutchinson Cancer Consortium, Seattle, WA 98195, USA,Corresponding author
| | - Celestia S. Higano
- Department of Medicine, Division of Oncology, University of Washington, Seattle, WA 98195, USA,Fred Hutchinson Cancer Research Center, Seattle, WA 98195, USA
| | - Heidi J. Gray
- Fred Hutchinson Cancer Consortium, Seattle, WA 98195, USA,Department of Medicine, Division of Oncology, University of Washington, Seattle, WA 98195, USA,Department of Obstetrics and Gynecology, University of Washington, Seattle, WA 98195, USA
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17
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Bryant RA, Dawson KS, Keyan D, Azevedo S, Yadav S, Tran J, Rawson N, Harvey S. Effectiveness of a Videoconferencing-Delivered Psychological Intervention for Mental Health Problems during COVID-19: A Proof-of-Concept Randomized Clinical Trial. Psychother Psychosom 2022; 91:63-72. [PMID: 34875669 PMCID: PMC8820421 DOI: 10.1159/000520283] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 10/16/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Anxiety and depression have increased markedly during the COVID-19 pandemic. There is a lack of evidence-based strategies to address these mental health needs during the pandemic. OBJECTIVE We aim to conduct a proof-of-concept trial of the efficacy of a brief group-based psychological intervention delivered via videoconferencing for adults in Australia distressed by the pandemic. METHODS In this single-blind, parallel, randomised controlled trial, adults who screened positive for COVID-related psychological distress across Australia were randomly allocated to either a 6-session group-based program based on behavioural principles (n = 120) or enhanced usual care (EUC, n = 120). Primary outcome was total score on the Hospital Anxiety and Depression (HADS) anxiety and depression subscales assessed at baseline, 1 week posttreatment, 2 months (primary outcome time point), and 6 months after treatment, as well as secondary outcome measures of worry, sleep impairment, anhedonia, mood, and COVID-19-related stress. RESULTS Between May 20, 2020, and October 20, 2020, 240 patients were enrolled into the trial. Relative to EUC, at 2 months participants receiving intervention showed greater reduction on anxiety (mean difference, 1.4 [95% CI, 0.3 to 2.6], p = 0.01; effect size, 0.4 [95% CI, 0.1 to 0.7]) and depression (mean difference, 1.6 [95% CI, 0.4 to 2.8], p = 0.009; effect size, 0.4 [95% CI, 0.2 to 0.7]) scales. These effects were maintained at 6 months. There were also greater reductions of worry, anhedonia, COVID-19-related fears, and contamination fears. CONCLUSIONS This trial provides initial evidence that brief group-based behavioural intervention delivered via videoconferencing results in moderate reductions in common psychological problems arising during the COVID-19 pandemic. This program may offer a viable and scalable means to mitigate the rising mental health problems during the pandemic.
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Affiliation(s)
- Richard A. Bryant
- University of New South Wales, Sydney, New South Wales, Australia,Westmead Institute for Medical Research, Sydney, New South Wales, Australia,Black Dog Institute, University of New South Wales, Sydney, New South Wales, Australia,*Richard A. Bryant,
| | - Katie S. Dawson
- University of New South Wales, Sydney, New South Wales, Australia
| | - Dharani Keyan
- University of New South Wales, Sydney, New South Wales, Australia
| | - Suzanna Azevedo
- University of New South Wales, Sydney, New South Wales, Australia
| | - Srishti Yadav
- University of New South Wales, Sydney, New South Wales, Australia
| | - Jenny Tran
- University of New South Wales, Sydney, New South Wales, Australia
| | - Natasha Rawson
- University of New South Wales, Sydney, New South Wales, Australia
| | - Samuel Harvey
- University of New South Wales, Sydney, New South Wales, Australia,Black Dog Institute, University of New South Wales, Sydney, New South Wales, Australia
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Martin L, Stein K, Kubera K, Troje NF, Fuchs T. Movement markers of schizophrenia: a detailed analysis of patients' gait patterns. Eur Arch Psychiatry Clin Neurosci 2022; 272:1347-1364. [PMID: 35362775 PMCID: PMC9508056 DOI: 10.1007/s00406-022-01402-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 03/14/2022] [Indexed: 11/25/2022]
Abstract
Motor abnormalities occur in the majority of persons with schizophrenia but are generally neglected in clinical care. Psychiatric diagnostics fail to include quantifiable motor variables and few assessment tools examine full-body movement. We assessed full-body movement during gait of 20 patients and 20 controls with motion capture technology, symptom load (PANSS, BPRS) and Neurological Soft Signs (NSS). In a data-driven analysis, participants' motion patterns were quantified and compared between groups. Resulting movement markers (MM) were correlated with the clinical assessment. We identified 16 quantifiable MM of schizophrenia. While walking, patients and controls display significant differences in movement patterns related to posture, velocity, regularity of gait as well as sway, flexibility and integration of body parts. Specifically, the adjustment of body sides, limbs and movement direction were affected. The MM remain significant when controlling for medication load. They are systematically related to NSS. Results add assessment tools, analysis methods as well as theory-independent MM to the growing body of research on motor abnormalities in schizophrenia.
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Affiliation(s)
- Lily Martin
- Department of Psychology, Faculty of Behavioural and Cultural Studies, Heidelberg University, Heidelberg, Germany.
- Department of General Psychiatry, Centre for Psychosocial Medicine, Academic Medical Center, Heidelberg University, Voßstr., 69115, Heidelberg, Germany.
| | - Kevin Stein
- Optimization, Robotics and Biomechanics, ZITI-Institute of Computer Engineering, Heidelberg University, Heidelberg, Germany
| | - Katharina Kubera
- Department of General Psychiatry, Centre for Psychosocial Medicine, Academic Medical Center, Heidelberg University, Voßstr., 69115, Heidelberg, Germany
| | - Nikolaus F Troje
- BioMotionLab, Department of Biology, Centre for Vision Research, York University, Toronto, Canada
| | - Thomas Fuchs
- Department of General Psychiatry, Centre for Psychosocial Medicine, Academic Medical Center, Heidelberg University, Voßstr., 69115, Heidelberg, Germany
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Tice LC, Eagle DE, Rash JA, Larkins JS, Labrecque SM, Platt A, Yao J, Proeschold-Bell RJ. The Selah study protocol of three interventions to manage stress among clergy: a preference-based randomized waitlist control trial. Trials 2021; 22:892. [PMID: 34886896 PMCID: PMC8655493 DOI: 10.1186/s13063-021-05845-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 11/18/2021] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Like many helping professionals in emotional labor occupations, clergy experience high rates of mental and physical comorbidities. Regular stress management practices may reduce stress-related symptoms and morbidity, but more research is needed into what practices can be reliably included in busy lifestyles and practiced at a high enough level to meaningfully reduce stress symptoms. METHODS AND ANALYSIS The overall design is a preference-based randomized waitlist control trial. United Methodist clergy in North Carolina will be eligible to participate. The intervention and waitlist control groups will be recruited by email. The interventions offered are specifically targeted to clergy preference and include mindfulness-based stress reduction, Daily Examen, and stress inoculation training. Surveys will be conducted at 0, 12, and 24 weeks with heart rate data collected at 0 and 12 weeks. The primary outcomes for this study are self-reported symptoms of stress and heart rate at week 12 for each intervention compared to waitlist control; the secondary outcome is symptoms of anxiety comparing each intervention vs waitlist control. ETHICS AND DISSEMINATION Ethical approval was obtained from the Duke University Campus IRB (2019-0238). The results will be made available to researchers, funders, and members of the clergy community. STRENGTHS AND LIMITATIONS OF THIS STUDY While evidence-based stress reduction practices such as mindfulness-based stress reduction (MBSR) exist, a wider variety of practices should be tested to appeal to different individuals. Clergy in particular may prefer, and consequently enact, spiritual practices like the Daily Examen, and individuals such as clergy who spend most of their time thinking and feeling may prefer experiential-based practices like stress inoculation training. If efficacious, the Daily Examen and stress inoculation training practices have high feasibility in that they require few minutes per day. This study is limited by the inclusion of Christian clergy of only one denomination. TRIAL REGISTRATION ClinicalTrials.gov NCT04625777 . November 12, 2020.
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Affiliation(s)
- Logan C. Tice
- Duke Global Health Institute, Duke Center for Health Policy & Inequalities Research, Duke University, 310 Trent Drive, Durham, NC 27710 USA
| | - David E. Eagle
- Duke Global Health Institute, Duke Center for Health Policy & Inequalities Research, Duke University, 310 Trent Drive, Durham, NC 27710 USA
| | - Joshua A. Rash
- Department of Psychology, Memorial University of Newfoundland, St. John’s, Canada
| | - Jessie S. Larkins
- Duke Global Health Institute, Duke Center for Health Policy & Inequalities Research, Duke University, 310 Trent Drive, Durham, NC 27710 USA
| | - Sofia M. Labrecque
- Duke Global Health Institute, Duke Center for Health Policy & Inequalities Research, Duke University, 310 Trent Drive, Durham, NC 27710 USA
| | - Alyssa Platt
- Duke Global Health Institute, Duke Center for Health Policy & Inequalities Research, Duke University, 310 Trent Drive, Durham, NC 27710 USA
| | - Jia Yao
- Duke Global Health Institute, Duke Center for Health Policy & Inequalities Research, Duke University, 310 Trent Drive, Durham, NC 27710 USA
| | - Rae Jean Proeschold-Bell
- Duke Global Health Institute, Duke Center for Health Policy & Inequalities Research, Duke University, 310 Trent Drive, Durham, NC 27710 USA
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McIsaac W, Kukan S, Huszti E, Szadkowski L, O'Neill B, Virani S, Ivers N, Lall R, Toor N, Shah M, Alvi R, Bhatt A, Nakamachi Y, Morris AM. A pragmatic randomized trial of a primary care antimicrobial stewardship intervention in Ontario, Canada. BMC Fam Pract 2021; 22:185. [PMID: 34525972 PMCID: PMC8442308 DOI: 10.1186/s12875-021-01536-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 09/01/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND More than 90% of antibiotics are prescribed in primary care, but 50% may be unnecessary. Reducing unnecessary antibiotic overuse is needed to limit antimicrobial resistance. We conducted a pragmatic trial of a primary care provider-focused antimicrobial stewardship intervention to reduce antibiotic prescriptions in primary care. METHODS Primary care practitioners from six primary care clinics in Toronto, Ontario were assigned to intervention or control groups to evaluate the effectiveness of a multi-faceted intervention for reducing antibiotic prescriptions to adults with respiratory and urinary tract infections. The intervention included provider education, clinical decision aids, and audit and feedback of antibiotic prescribing. The primary outcome was total antibiotic prescriptions for these infections. Secondary outcomes were delayed prescriptions, prescriptions longer than 7 days, recommended antibiotic use, and outcomes for individual infections. Generalized estimating equations were used to estimate treatment effects, adjusting for clustering by clinic and baseline differences. RESULTS There were 1682 encounters involving 54 primary care providers from January until May 31, 2019. In intervention clinics, the odds of any antibiotic prescription was reduced 22% (adjusted Odds Ratio (OR) = 0.78; 95% Confidence Interval (CI) = 0.64.0.96). The odds that a delay in filling a prescription was recommended was increased (adjusted OR=2.29; 95% CI=1.37, 3.83), while prescription durations greater than 7 days were reduced (adjusted OR=0.24; 95% CI=0.13, 0.43). Recommended antibiotic use was similar in control (85.4%) and intervention clinics (91.8%, p=0.37). CONCLUSIONS A community-based, primary care provider-focused antimicrobial stewardship intervention was associated with a reduced likelihood of antibiotic prescriptions for respiratory and urinary infections, an increase in delayed prescriptions, and reduced prescription durations. TRIAL REGISTRATION clinicaltrials.gov ( NCT03517215 ).
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Affiliation(s)
- Warren McIsaac
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada.
- Ray D. Wolfe Department of Family Medicine, Mount Sinai Hospital, Sinai Health, 60 Murray St, Toronto, ON, M5T 3L9, Canada.
| | - Sahana Kukan
- Ray D. Wolfe Department of Family Medicine, Mount Sinai Hospital, Sinai Health, 60 Murray St, Toronto, ON, M5T 3L9, Canada
| | - Ella Huszti
- Biostatistics Research Unit, University Health Network, Toronto, Canada
| | - Leah Szadkowski
- Biostatistics Research Unit, University Health Network, Toronto, Canada
| | - Braden O'Neill
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
- Department of Family and Community Medicine, St. Michael's Hospital, Toronto, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
| | - Sophia Virani
- Ray D. Wolfe Department of Family Medicine, Mount Sinai Hospital, Sinai Health, 60 Murray St, Toronto, ON, M5T 3L9, Canada
| | - Noah Ivers
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
- Department of Family Medicine, and Women's College Research Institute, Women's College Hospital, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Rosemarie Lall
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
- Platinum Medical, Scarborough Health Network Teaching Unit, Toronto, Canada
| | - Navsheer Toor
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
- Southlake Academic Family Health Team, Southlake Regional Health Centre, Newmarket, Toronto, Ontario, Canada
| | - Mruna Shah
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
- West Durham Family Health Team, Pickering, Toronto, Ontario, Canada
| | - Ruby Alvi
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
- Summerville Family Health Team, Mississauga, Ontario, Canada
| | - Aashka Bhatt
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
| | - Yoshiko Nakamachi
- Antimicrobial Stewardship Program, University Health Network, Toronto, Canada
| | - Andrew M Morris
- Antimicrobial Stewardship Program, University Health Network, Toronto, Canada
- Department of Medicine, Division of Infectious Diseases, Sinai Health, University Health Network, and University of Toronto, Toronto, Canada
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Jamison RN, Curran S, Wan L, Ross EL, Gilligan CJ, Edwards RR. Higher Pain Sensitivity Predicts Efficacy of a Wearable Transcutaneous Electrical Nerve Stimulation Device for Persons With Fibromyalgia: A Randomized Double-Blind Sham- Controlled Trial. Neuromodulation 2021; 25:1410-1420. [PMID: 34056781 DOI: 10.1111/ner.13463] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 04/27/2021] [Accepted: 04/28/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES This study investigated the efficacy of a transcutaneous electrical nerve stimulation (TENS) device (Quell®) for persons with symptoms due to fibromyalgia (FM). MATERIALS AND METHODS One hundred nineteen (N = 119) subjects were randomly assigned to use an active (N = 62) or sham (N = 57) TENS for three months. All subjects completed baseline questionnaires and were administered quantitative sensory testing (QST). Subjects completed the Patients' Global Impression of Change (PGIC, primary outcome measure) and other mailed questionnaires (secondary outcome measures) at six weeks and three months. RESULTS The subjects averaged 50.4 ± 13.5 years of age, 93.3% were female, and 79.8% were Caucasian. Most showed benefit from using the TENS, but no differences between groups were found on the primary outcome measure after three months (active 3.87 ± 1.85, sham 3.73 ± 1.80, 95% confidence interval [CI] [-0.60, 0.88], p = 0.707). Those with more hypersensitivity showed most improvement on the PGIC at six weeks (0.22, 95% CI [0.01, 0.43], p = 0.042) and three months (0.20, 95% CI [0.00, 0.41], p = 0.049) and among those with higher sensitivity based on QST, the active TENS group showed the most benefit with TENS compared with the sham treatment (1.20, 95% CI [0.22, 2.18], p = 0.017). No TENS-related serious adverse events were reported. Subjects in the sham group correctly identified their treatment 87.5% of the time, while, surprisingly, subjects in the active group correctly identified their treatment only 17.4% of the time. CONCLUSION This study found no differences between those who were exposed to maximal-frequency active stimulation or minimal-frequency sham stimulation from a wearable TENS in reducing FM-related symptoms. However, those with greater hypersensitivity showed most benefit from TENS. Additional studies to help determine the role individual differences play in the use of TENS in managing FM-related symptoms are needed.
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Affiliation(s)
- Robert N Jamison
- Pain Management Center, Brigham and Women's Hospital, Harvard Medical School, Chestnut Hill, MA, USA
| | - Samantha Curran
- Pain Management Center, Brigham and Women's Hospital, Harvard Medical School, Chestnut Hill, MA, USA
| | - Limeng Wan
- Pain Management Center, Brigham and Women's Hospital, Harvard Medical School, Chestnut Hill, MA, USA
| | - Edgar L Ross
- Pain Management Center, Brigham and Women's Hospital, Harvard Medical School, Chestnut Hill, MA, USA
| | - Christopher J Gilligan
- Pain Management Center, Brigham and Women's Hospital, Harvard Medical School, Chestnut Hill, MA, USA
| | - Robert R Edwards
- Pain Management Center, Brigham and Women's Hospital, Harvard Medical School, Chestnut Hill, MA, USA
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Keyan D, Dawson K, Azevado S, Yadav S, Tran J, Bryant RA. Brief videoconferencing psychological intervention for reducing COVID-19 related distress: study protocol for a randomized controlled trial. BMC Public Health 2021; 21:474. [PMID: 33750351 PMCID: PMC7942517 DOI: 10.1186/s12889-021-10529-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 02/28/2021] [Indexed: 12/23/2022] Open
Abstract
Background Globally COVID-19 has had a profound impact on the psychological wellbeing of millions of people, and there is an urgent imperative to address elevated levels of distress during the COVID-19 pandemic. The World Health Organization (WHO) has developed Problem Management Plus (PM+), a low intensity psychological intervention for adults experiencing psychological distress. This paper outlines the study protocol for a trial that tests the effectiveness of an adapted version of PM+ to reduce distress associated with COVID-19. Methods A single-blind, parallel, randomized controlled trial will be carried out for distressed people across Australia. via video conferencing on a small group basis. Following informed consent, adults that screen positive for levels of psychological distress (General Health Questionnaire-12 (GHQ-12 score ≥ 3) and have access to videoconferencing platform will be randomised to an adapted version of gPM+ (n = 120) or enhanced treatment as usual (ETAU) (n = 120). The primary outcome will be reduction in psychological distress including anxiety and depression at 2-months post treatment. Secondary outcomes include worry, sleep problems, anhedonia, social support, and stress in relation to COVID-19. Discussion The trial aims assess whether an adapted version of videoconferencing PM+ that is specifically designed to target COVI-19 related distress will result in reduced distress relative to enhanced usual care. Trial registration This trial was prospectively registered on the ANZCTR on 14/4/20 (ACTRN12620000468921).
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Affiliation(s)
- Dharani Keyan
- School of Psychology, University of New South Wales, Sydney, NSW, 2052, Australia
| | - Katie Dawson
- School of Psychology, University of New South Wales, Sydney, NSW, 2052, Australia
| | - Suzanna Azevado
- School of Psychology, University of New South Wales, Sydney, NSW, 2052, Australia
| | - Srishti Yadav
- School of Psychology, University of New South Wales, Sydney, NSW, 2052, Australia
| | - Jenny Tran
- School of Psychology, University of New South Wales, Sydney, NSW, 2052, Australia
| | - Richard A Bryant
- School of Psychology, University of New South Wales, Sydney, NSW, 2052, Australia.
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Rimmele DL, Schrage T, Brettschneider C, Engels A, Gerloff C, Härter M, Rosenkranz M, Schmidt H, Kriston L, Thomalla G. Rationale and design of an interventional study of cross-sectoral, coordinated treatment of stroke patients with patient-orientated outcome measurement (StroCare). Neurol Res Pract 2021; 3:7. [PMID: 33526148 PMCID: PMC7850714 DOI: 10.1186/s42466-021-00107-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Accepted: 01/13/2021] [Indexed: 01/23/2023] Open
Abstract
INTRODUCTION Stroke has a long-term impact on functional status and quality of life in multiple health domains. A well-coordinated managed care program for stroke patients is crucial for ameliorating patients' health and cost-efficient use of resources. The aim of this study is the implementation and evaluation of an optimised cross-sectoral, coordinated and managed care program for stroke patients bridging secondary and tertiary care. METHODS In this multi-center mixed method sequentially controlled intervention study, stroke patients with ischemic stroke (I63), transient ischemic attack and related syndromes (G45), or intracerebral haermorrhage (I64) will be invited to participate. For a 12-months period, 235 consecutive patients are expected to be enrolled and assigned standard of care treatment as an active control group. During the following 12 months, 235 consecutive patients will be enrolled and assigned to a post stroke intervention program. The StroCare intervention consists of repeated outpatient visits with specialized stroke teams, the implementation of a case manager, the use of an electronical tool for communication between acute care, rehabilitation facilities, and out-patient care, and the definition of individualized treatment targets. Patients will be followed up for 24 months. The primary outcome is health-related quality of life measured by the Patient-Reported Outcomes Measurement Information System 10-Question Short Form (PROMIS-10) at 12 months after the index event, i.e. stroke or TIA. For the qualitative survey of the implementation process, 21 patients in the intervention group will be interviewed after implementation of the interventions. In addition, 20 health care providers and staff members will be interviewed before and after implementation. Additionally, economic outcomes will be evaluated after 6 and 12 months. PERSPECTIVE The study will not only provide information about the tested intervention but is likely to be helpful for clinicians, suppliers of reimbursement, and researchers in implementing and evaluating complex interventions in stroke care in general. With this program, the health care system will have a reference model at its disposal for transfer to other regions and settings. TRIAL REGISTRATION The trial is registered at ClinicalTrials.gov ( NCT04159324 ). Approval of the local ethics committee (Ethik-Kommission der Ärztekammer Hamburg, Niedersachsen, Schleswig-Holstein) has been obtained.
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Affiliation(s)
- David Leander Rimmele
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
| | - Theresa Schrage
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Christian Brettschneider
- Department of Health Economics and Health Care Research, University Medical Center Hamburg Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Alexander Engels
- Department of Health Economics and Health Care Research, University Medical Center Hamburg Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Christian Gerloff
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Martin Härter
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Michael Rosenkranz
- Department of Neurology and Neurological Early Rehabilitation, Albertinen Krankenhaus, Süntelstraße 11A, 22457, Hamburg, Germany
| | - Holger Schmidt
- Department of Neurology, Elbe Klinik Stade, Bremervörderstraße 111, 21682, Stade, Germany
- Department of Neurology, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - Levente Kriston
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Götz Thomalla
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
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Diago-Sempere E, Bueno JL, Sancho-López A, Rubio EM, Torres F, de Molina RM, Fernández-Cruz A, de Diego IS, Velasco-Iglesias A, Payares-Herrera C, Flecha IC, Avendaño-Solà C, Palomino RD, Ramos-Martínez A, Ruiz-Antorán B. Evaluation of convalescent plasma versus standard of care for the treatment of COVID-19 in hospitalized patients: study protocol for a phase 2 randomized, open-label, controlled, multicenter trial. Trials 2021; 22:70. [PMID: 33472681 PMCID: PMC7816149 DOI: 10.1186/s13063-020-05011-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 12/29/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND COVID-19 is a respiratory disease caused by a novel coronavirus (SARS-CoV-2) and causes substantial morbidity and mortality. At the time this clinical trial was planned, there were no available vaccine or therapeutic agents with proven efficacy, but the severity of the condition prompted the use of several pharmacological and non-pharmacological interventions. It has long been hypothesized that the use of convalescent plasma (CP) from infected patients who have developed an effective immune response is likely to be an option for the treatment of patients with a variety of severe acute respiratory infections (SARI) of viral etiology. The aim of this study is to assess the efficacy and safety of convalescent plasma in adult patients with severe COVID-19 pneumonia. METHODS/DESIGN The ConPlas-19 study is a multicenter, randomized, open-label controlled trial. The study has been planned to include 278 adult patients hospitalized with severe COVID-19 infection not requiring mechanical ventilation (invasive or non-invasive). Subjects are randomly assigned in a 1:1 ratio (139 per treatment arm), stratified by center, to receive intravenously administered CP (single infusion) plus SOC or SOC alone, and are to be followed for 30 days. The primary endpoint of the study is the proportion of patients that progress to category 5, 6, or 7 (on the 7-point ordinal scale proposed by the WHO) at day 15. Interim analyses for efficacy and/or futility will be conducted once 20%, 40%, and 60% of the planned sample size are enrolled and complete D15 assessment. DISCUSSION This clinical trial is designed to evaluate the efficacy and safety of passive immunotherapy with convalescent plasma for the treatment of adult patients hospitalized with COVID-19. The results of this study are expected to contribute to establishing the potential place of CP in the therapeutics for a new viral disease. TRIAL REGISTRATION ClinicalTrials.gov NCT04345523 . Registered on 30 March, 2020. First posted date: April 14, 2020.
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Affiliation(s)
- Elena Diago-Sempere
- Clinical Pharmacology Department, Hospital Universitario Puerta de Hierro Majadahonda, Instituto de Investigación Sanitaria Puerta de Hierro - Segovia de Arana, c/ Manuel de Falla 1, 28222 Madrid, Spain
| | - José Luis Bueno
- Hemotherapy & Apheresis Units, Hematology and Hemotherapy Department, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Aránzazu Sancho-López
- Clinical Pharmacology Department, Hospital Universitario Puerta de Hierro Majadahonda, Instituto de Investigación Sanitaria Puerta de Hierro - Segovia de Arana, c/ Manuel de Falla 1, 28222 Madrid, Spain
| | - Elena Múñez Rubio
- Internal Medicine Department, Infectious diseases unit, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Ferrán Torres
- Clinical Pharmacology Department, Hospital Clínic Barcelona, Medical Statistics core facility – IDIBAPS, Barcelona, Spain
| | - Rosa Malo de Molina
- Pneumology Department, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Ana Fernández-Cruz
- Internal Medicine Department, Infectious diseases unit, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Isabel Salcedo de Diego
- Clinical Pharmacology Department, Hospital Universitario Puerta de Hierro Majadahonda, Instituto de Investigación Sanitaria Puerta de Hierro - Segovia de Arana, c/ Manuel de Falla 1, 28222 Madrid, Spain
| | | | - Concepción Payares-Herrera
- Clinical Pharmacology Department, Hospital Universitario Puerta de Hierro Majadahonda, Instituto de Investigación Sanitaria Puerta de Hierro - Segovia de Arana, c/ Manuel de Falla 1, 28222 Madrid, Spain
| | - Inmaculada Casas Flecha
- Flu and Respiratory Virus Unit, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, Spain
| | - Cristina Avendaño-Solà
- Clinical Pharmacology Department, Hospital Universitario Puerta de Hierro Majadahonda, Instituto de Investigación Sanitaria Puerta de Hierro - Segovia de Arana, c/ Manuel de Falla 1, 28222 Madrid, Spain
| | - Rafael Duarte Palomino
- Hematology and Hemotherapy Department, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Antonio Ramos-Martínez
- Internal Medicine Department, Infectious diseases unit, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Belén Ruiz-Antorán
- Clinical Pharmacology Department, Hospital Universitario Puerta de Hierro Majadahonda, Instituto de Investigación Sanitaria Puerta de Hierro - Segovia de Arana, c/ Manuel de Falla 1, 28222 Madrid, Spain
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Martínez-Costa Montero MC, Sánchez Cabeza A. [Effectiveness of constraint-induced movement therapy in upper extremity rehabilitation in patients with cerebral palsy: A systematic review]. Rehabilitacion (Madr) 2020; 55:199-217. [PMID: 33272606 DOI: 10.1016/j.rh.2020.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 08/02/2020] [Accepted: 08/23/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND OBJECTIVE In hemiplegic cerebral palsy, learned non-use may appear. This phenomenon can be reversed by constraint-induced movement therapy in the healthy side. The aim of this article was to review the evidence of the effectiveness of this therapy on upper extremity functioning, the performance of activities of daily living and quality of life. PATIENTS AND METHODS We performed a systematic review between January and April 2019 in the PubMed, COCHRANE, PEDro and TRIPDATABASE databases. We included 14 clinical studies describing their characteristics. RESULTS Most of the studies found significant improvements compared with control groups. Only one article investigated quality of life. CONCLUSIONS Constraint-induced movement therapy seems to have positive effects in the motor rehabilitation of the upper extremity in patients with hemiplegic cerebral palsy. Further studies are needed to assess the individual factors of greatest influence in rehabilitation.
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Affiliation(s)
- M C Martínez-Costa Montero
- Departamento de Fisioterapia, Terapia Ocupacional, Rehabilitación y Medicina Física, Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos, Alcorcón, Madrid, España
| | - A Sánchez Cabeza
- Departamento de Fisioterapia, Terapia Ocupacional, Rehabilitación y Medicina Física, Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos, Alcorcón, Madrid, España.
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Abstract
BACKGROUND Repetitive transcranial magnetic stimulation (rTMS) is effective in treating unipolar depression. However, the efficacy of rTMS in bipolar disorder (BD) is unclear. This meta-analysis aimed to examine the efficacy and tolerability of rTMS for both depressive and manic phases in BD. METHODS MEDLINE, EMBASE, PsycINFO, CENTRAL databases were searched for controlled trials on treatment of BD with rTMS. Primary outcomes included changes in depression or mania scores, response and remission rates. Secondary outcomes included quality of life and functioning assessment. We used random-effects model, Hedge's g, risk differences (RDs) and the number needed to treat (NNT). RESULTS Eleven randomized sham-controlled studies were included, with a total of 345 patients with BD (bipolar depression = 257, mania = 86, mixed affective = 2). Trials of rTMS in bipolar depression (N = 8) demonstrated small but significant improvement in depression scores [standardized mean difference = 0.302, p < 0.05], compared to control group. Furthermore, rTMS brought a higher remission rate than sham-controls [RD = 0.104 ± 0.044, p < 0.05, NNT = 10; and a trend of greater response rate [RD = 0.074 ± 0.039, p = 0.06]. Results were inconclusive for effect of rTMS in mania. In both depressive and manic groups, no serious adverse events were reported. Risk of treatment-emergent mania appeared low. LIMITATIONS There was limited number of eligible primary studies, with variable randomization procedures. CONCLUSION rTMS appears safe and effective in treating bipolar depression. More stringent RCTs are necessary for concrete conclusion about efficacy in mania.
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Affiliation(s)
- Maggie M K Tee
- Department of Psychiatry, Kwai Chung Hospital, 3-15 Kwai Chung Hospital Road, Hong Kong, China.
| | - C H Au
- Department of Psychiatry, Queen Mary Hospital, Hong Kong, China
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Johnson JA, Al Sayah F, Buzinski R, Corradetti B, Davison SN, Elliott MJ, Klarenbach S, Manns B, Schick-Makaroff K, Short H, Thomas C, Walsh M. A cluster randomized controlled trial for the Evaluation of routinely Measured PATient reported outcomes in HemodialYsis care (EMPATHY): a study protocol. BMC Health Serv Res 2020; 20:731. [PMID: 32778102 DOI: 10.1186/s12913-020-05557-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 07/19/2020] [Indexed: 12/22/2022] Open
Abstract
Background Kidney failure requiring dialysis is associated with poor health outcomes and health-related quality of life (HRQL). Patient-reported outcome measures (PROMs) capture symptom burden, level of functioning and other outcomes from a patient perspective, and can support clinicians to monitor disease progression, address symptoms, and facilitate patient-centered care. While evidence suggests the use of PROMs in clinical practice can lead to improved patient experience in some settings, the impact on patients’ health outcomes and experiences is not fully understood, and their cost-effectiveness in clinical settings is unknown. This study aims to fill these gaps by evaluating the effectiveness and cost-effectiveness of routinely measuring PROMs on patient-reported experience, clinical outcomes, HRQL, and healthcare utilization. Methods The EMPATHY trial is a pragmatic multi-centre cluster randomized controlled trial that will implement and evaluate the use of disease-specific and generic PROMs in three kidney care programs in Canada. In-centre hemodialysis units will be randomized into four groups, whereby patients: 1) complete a disease-specific PROM; 2) complete a generic PROM; 3) complete both types of PROMs; 4) receive usual care and do not complete any PROMs. While clinical care pathways are available to all hemodialysis units in the study, for the three active intervention groups, the results of the PROMs will be linked to treatment aids for clinicians and patients. The primary outcome of this study is patient-provider communication, assessed by the Communication Assessment Tool (CAT). Secondary outcomes include patient management and symptoms, use of healthcare services, and the costs of implementing this intervention will also be estimated. The present protocol fulfilled the Standard Protocol Items: Recommendations for Intervention Trials (SPIRIT) checklist. Discussion While using PROMs in clinical practice is supported by theory and rationale, and may engage patients and enhance their role in decisions regarding their care and outcomes, the best approach of their use is still uncertain. It is important to rigorously evaluate such interventions and investments to ensure they provide value for patients and health systems. Trial registration Protocol version (1.0) and trial registration data are available on www.clinicaltrials.gov, identifier: NCT03535922, registered May 24, 2018.
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Ma L, Zhang Y, Huang C, Cui Z. Resilience-oriented cognitive behavioral interventions for depressive symptoms in children and adolescents: A meta-analytic review. J Affect Disord 2020; 270:150-164. [PMID: 32339107 DOI: 10.1016/j.jad.2020.03.051] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Revised: 01/07/2020] [Accepted: 03/20/2020] [Indexed: 12/31/2022]
Abstract
OBJECTIVE The study aimed to evaluate whether resilience-oriented cognitive behavioral interventions (CBIs) which teach cognitive, problem-solving, and social skills are effective for addressing depressive symptoms in the school setting and to investigate factors that could moderate the intervention effects. METHOD Electronic databases Medline, PsycINFO and Cochrane Central were searched to identify potentially relevant trials. The difference of change from baseline in depressive symptoms between intervention and control condition was assessed. Mean effect sizes (Hedges'g) were calculated using random-effects models. Study-specific characteristics relevant to participant demographics (age, gender, and risk status), intervention conditions (program type, intervention duration, group leader type, and use of homework), and study features (sample size, and methodological quality) were evaluated as potential moderators of the effect size. RESULTS 38 controlled studies were identified, including 24,135 individuals. At post-intervention, the mean effect size was considered significantly small (Hedges'g = 0.13) and subgroup analyses revealed significant effect sizes for programs administered to both universal and targeted samples, programs both with and without homework, and programs led by school personnel. The mean effect size was largely maintained at 6 months follow-up and subgroup analyses indicated significant effect sizes for programs administered to targeted samples, programs based on Penn Resiliency Program, programs with homework, and programs led by professional interventionists. CONCLUSION This study reinforces the efficacy of resilience-oriented CBIs for addressing depressive symptoms in the school setting. Although more research is needed to confirm and extend the findings of this study, our findings suggest a range of directions in particular for further investigation.
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Affiliation(s)
- Liang Ma
- The First Hospital of China Medical University, Shenyang, China.
| | - Yingnan Zhang
- The First Hospital of China Medical University, Shenyang, China
| | - Cong Huang
- Department of Sports and Exercise Science, Zhejiang University, Hangzhou, China; Department of Medicine and Science in Sports and Exercise, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Zeshi Cui
- School of Pharmacy, China Medical University, Shenyang, China
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Savidaki M, Demirtoka S, Rodríguez-Jiménez RM. Re-inhabiting one's body: A pilot study on the effects of dance movement therapy on body image and alexithymia in eating disorders. J Eat Disord 2020; 8:22. [PMID: 32426135 PMCID: PMC7212562 DOI: 10.1186/s40337-020-00296-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 04/17/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Body image disturbance and alexithymia are two core aspects of Eating Disorders (EDs). However, standard treatments for EDs do not include specific techniques to approach these issues on a bodily level. This pilot study evaluated the effects of a Dance Movement Therapy (DMT) intervention on body image and alexithymia in patients with EDs, and also explored their experience of the therapeutic process. METHOD 14 patients with EDs were recruited from a private clinic. Seven were assigned via quasi-randomization to the DMT group and the others (n = 5) continued their treatment as usual. The length of the intervention was 14 weeks. All participants completed the Multidimensional Body Self Relations Questionnaire (MBSRQ) and the Toronto Alexithymia Scale (TAS-20) at the beginning and at the end of the intervention. Additionally, the DMT group wrote reflective diaries about their experience at the end of each session, which were analyzed using qualitative methods. RESULTS Between the pre- and post-intervention, the participants of the DMT group significantly improved in Body Areas Satisfaction (effect size: 0.95) and Appearance Evaluation (effect size: 1.10), and they decreased significantly in Appearance Orientation (effect size: 1.30). A decrease in Overweight Preoccupation was observed (effect size: 0.75), however this was not statistically significant. The control group did not show significant changes in any of the MBSRQ subscales. Neither the DMT group nor the control group improved significantly in the alexithymia scores. The qualitative analysis revealed valuable insights into the participants' processes throughout the sessions. In general, participants received the DMT intervention positively. They reported improvements in their mood states and an increase in their self-awareness. They also appreciated the relationship with the group and the therapist. CONCLUSION These results indicate that DMT might be a complementary treatment option for EDs, as it may be able to address body image issues more effectively than verbal therapies. More studies with larger samples are needed to confirm these promising preliminary results.
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Affiliation(s)
- Maria Savidaki
- Psychology Department, Autonomus University of Barcelona, Plaça Cívica, Barcelona, 08193 Spain
| | - Sezin Demirtoka
- Psychology Department, Autonomus University of Barcelona, Plaça Cívica, Barcelona, 08193 Spain
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Akhtar A, Giardinelli L, Bawaneh A, Awwad M, Naser H, Whitney C, Jordans MJD, Sijbrandij M, Bryant RA. Group problem management plus (gPM+) in the treatment of common mental disorders in Syrian refugees in a Jordanian camp: study protocol for a randomized controlled trial. BMC Public Health 2020; 20:390. [PMID: 32216762 PMCID: PMC7098148 DOI: 10.1186/s12889-020-08463-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 03/05/2020] [Indexed: 02/03/2023] Open
Abstract
Background Accessing quality mental health care poses significant challenges for persons affected by adversity, especially in low- and middle-income countries where resources are scarce. To mitigate this, the World Health Organization has developed group problem management plus (gPM+), a low-intensity psychological intervention for adults experiencing psychological distress. gPM+ is a group-based intervention consisting of five-sessions, and can be delivered by non-specialist providers. This paper outlines the study protocol for a trial of gPM+ in Jordan. Methods We will conduct a single-blind, two-arm, randomized controlled trial in a Syrian refugee camp in Jordan. We aim to enrol 480 adults into the trial. Participants will be eligible for the trial if they screen positive for levels of psychological distress. Following screening, those eligible will be randomly assigned to receive the gPM+ intervention or enhanced treatment as usual. The primary outcome is reduction in levels of psychological distress at 3-months post-treatment. Secondary outcomes include anxiety, depression, prodromal psychotic symptoms, posttraumatic stress disorder, prolonged grief, daily functioning, economic effectiveness, and change in parenting behaviour. Secondary outcomes also include the reduction in psychological distress of the participant’s child. Discussion The trial aims to deliver a template for affordable and scalable psychosocial interventions that can readily be implemented in refugee settings, and that can benefit both the participant and their child. Trial registration Australian New Zealand Clinical Trials Registry, ACTRN12619001386123. Registered prospectively on 10/10/2019.
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Affiliation(s)
- Aemal Akhtar
- School of Psychology, University of New South Wales, Sydney, NSW, 2052, Australia.,Clinical, Neuro and Developmental Psychology, VU University, Amsterdam, The Netherlands
| | | | - Ahmad Bawaneh
- Jordan Country Office, International Medical Corps, Amman, Jordan
| | - Manar Awwad
- Jordan Country Office, International Medical Corps, Amman, Jordan
| | - Hadeel Naser
- Jordan Country Office, International Medical Corps, Amman, Jordan
| | | | - Mark J D Jordans
- Research and Development Department, War Child Holland, Amsterdam, The Netherlands.,Amsterdam Institute of Social Science Research, University of Amsterdam, Amsterdam, The Netherlands
| | - Marit Sijbrandij
- Clinical, Neuro and Developmental Psychology, VU University, Amsterdam, The Netherlands
| | - Richard A Bryant
- School of Psychology, University of New South Wales, Sydney, NSW, 2052, Australia.
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Yilma H, Sedlander E, Rimal RN, Pant I, Munjral A, Mohanty S. The reduction in anemia through normative innovations (RANI) project: study protocol for a cluster randomized controlled trial in Odisha, India. BMC Public Health 2020; 20:203. [PMID: 32033546 PMCID: PMC7007687 DOI: 10.1186/s12889-020-8271-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 01/24/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND More than half of women in India are anemic. Anemia can result in fatigue, poor work productivity, higher risk of pre-term delivery, and maternal mortality. The Indian government has promoted the use of iron-folic acid supplements (IFA) for the prevention and treatment of anemia for the past five decades, but uptake remains low and anemia prevalence high. Current programs target individual-level barriers among pregnant women and adolescents, but a more comprehensive approach that targets multiple levels among all women of reproductive age is needed to increase uptake of IFA and iron-rich foods. METHODS The Reduction in Anemia through Normative Innovations (RANI) project is a norms-based intervention to reduce anemia among women of reproductive age. We will evaluate the intervention through a clustered randomized controlled trial in Odisha, India. We will collect data at three time points (baseline, midline, and end line). For the study, we selected 89 clusters of villages, which we randomized into treatment and control on a 1:1 basis. The treatment arm will receive the RANI project components while the control arm will receive usual care. Fifteen clusters (40-41 villages) were selected and 4000 women (2000 in each arm) living in the selected clusters will be randomly selected to take part in data collection. Women in both study arms will have their hemoglobin concentrations measured. They will also complete in-person surveys about their knowledge, attitudes, perceptions of iron folic acid supplements, and nutritional intake. We will also select a smaller cohort of 300 non-pregnant women (150 in each arm) from this cohort for additional physical activity and cognitive testing. We will conduct both within- and between-group comparisons (treatment and control) at baseline, midline and end line using t-tests. We will also conduct structural equation modeling to examine how much each factor accounts for IFA use and hemoglobin levels. DISCUSSION This RCT will enable us to examine whether a social norms-based intervention can increase uptake of iron folic acid supplements and iron rich foods to reduce anemia. TRIAL REGISTRATION This trial was registered with Clinical Trial Registry- India (CTRI) (CTRI/2018/10/016186) on 29 October 2018.
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Affiliation(s)
- Hagere Yilma
- Department of Prevention and Community Health, George Washington University Milken Institute School of Public Health, Washington, District of Columbia, USA.
| | - Erica Sedlander
- Department of Prevention and Community Health, George Washington University Milken Institute School of Public Health, Washington, District of Columbia, USA
| | - Rajiv N Rimal
- Department of Health, Behavior and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ichhya Pant
- Department of Prevention and Community Health, George Washington University Milken Institute School of Public Health, Washington, District of Columbia, USA
| | - Ashita Munjral
- Department of Social and Economic Empowerment, IPE Global Limited, New Delhi, Delhi, India
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Preiß JC, Schneidereit O, Siegmund B, Hoffmann JC. Improving treatment of patients with inflammatory bowel diseases: a controlled trial of a multifaceted intervention in two German cities. Int J Colorectal Dis 2019; 34:1233-40. [PMID: 31127363 DOI: 10.1007/s00384-019-03317-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/15/2019] [Indexed: 02/04/2023]
Abstract
PURPOSE Many recommendations from clinical practice guidelines are not implemented. We aimed to develop and evaluate a multifaceted strategy for the implementation of guidelines for Crohn's disease (CD) and ulcerative colitis (UC). METHODS In the intervention region (Berlin, Germany), a continuing medical education course was held, brief guidelines for practice were distributed to all family physicians and gastroenterologists, and patient guidelines were distributed to all surveyed patients. Educational outreach visits with local opinion leaders were also conducted. No specific interventions were performed in the control region (Hamburg, Germany). Prior to the intervention and 1 year later, 1900 members of three statutory sickness funds were asked about their treatment according to guidelines with (1) long-term aminosalicylates and (2) immunosuppressants, (3) whether they took long-term glucocorticoids for maintenance of remission, (4) if they smoked, in CD patients, and (5) about the surveillance colonoscopies, in UC patients. RESULTS Response rate after implementation was 20.1%. Responders differed between intervention and control region by age and by distribution between patients with UC or CD. After 1 year, more patients were treated according to clinical practice guidelines in the control region than in the intervention region. More patients in the intervention region took immunosuppressants after 1 year, and fewer had a surveillance colonoscopy. However, no before-after comparison was statistically significant. CONCLUSIONS This implementation strategy of UC and CD guidelines did not result in a statistically significant effect. Future implementation of guidelines for inflammatory bowel disease might need thorough evaluation of barriers and the support of theory-based concepts.
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Husband CJ, Wharf-Higgins J, Rhodes RE. A feasibility randomized trial of an identity-based physical activity intervention among university students. Health Psychol Behav Med 2019; 7:128-146. [PMID: 34040843 PMCID: PMC8114372 DOI: 10.1080/21642850.2019.1600407] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 03/22/2019] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Exercise identity has considerable evidence as a correlate of physical activity (PA), but almost no research has focused on intervention. Theory suggests identity may be formed through indirect means of motivated behaviour change over time or through direct targeting of identity related antecedents. Using a parallel, single blind design, the purpose of this study was to explore the feasibility (recruitment, retention, and satisfaction) of these two types of interventions (indirect, direct) to increase exercise identity and subsequent PA. METHODS Participants between the ages of 18-25 who were not meeting PA guidelines were recruited from the University of Victoria, and randomized at a 1:1 ratio to an indirect or direct intervention group. The indirect intervention group received information on the benefits of PA and behaviour change techniques such as planning. The direct intervention group received the same information, with the addition of identity-specific information. Intervention materials were delivered bi-weekly for 6 weeks. Feasibility and participant satisfaction at the study end-point were assessed using mixed methods, and both PA change and exercise identity change were assessed via self-report. RESULTS Twenty participants were randomized to the direct or indirect intervention group (10 each), with 18 participants completing full study protocol. The recruitment rate was 26% and retention was 90%. Mean scores from the satisfaction survey (five-point scale) were high for both groups (indirect M = 2.69, SD = 0.62; direct M = 2.83, SD = 0.40). Both intervention groups increased their PA (η2 = 0.25), and exercise identity levels (η2 = 0.43) across six weeks. DISCUSSION High feasibility ratings, both through retention, and survey and interview data show that the study could be extended to a full-scale RCT. Modifications to recruitment including oversampling to account for low recruitment rates may be useful. No adverse events were reported.
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Affiliation(s)
- Cassandra J. Husband
- Behavioural Medicine Lab, School of Exercise, Physical, and Health Education, Faculty of Education, University of Victoria, Victoria, Canada
| | - Joan Wharf-Higgins
- Behavioural Medicine Lab, School of Exercise, Physical, and Health Education, Faculty of Education, University of Victoria, Victoria, Canada
| | - Ryan E. Rhodes
- Behavioural Medicine Lab, School of Exercise, Physical, and Health Education, Faculty of Education, University of Victoria, Victoria, Canada
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Eriksson C, Kimber B, Skoog T. Design and implementation of RESCUR in Sweden for promoting resilience in children: a study protocol. BMC Public Health 2018; 18:1250. [PMID: 30419888 PMCID: PMC6233491 DOI: 10.1186/s12889-018-6145-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 10/24/2018] [Indexed: 11/18/2022] Open
Abstract
Background This research program aims to investigate the implementation and effects of a theoretically promising prevention method. It is being developed in a European research collaboration within a Comenius project (2012–2015) between 6 European universities (in Malta, Italy, Greece, Croatia, Portugal and Sweden) with the purpose of enhancing European children’s resilience. Methods/design RESCUR in Sweden consists in a RCT study of the Resilience Curriculum (RESCUR) that is taking place in Sweden 2017–2019. The study is being performed by Junis, IOGT-NTO’s Junior Association, part of IOGT International, in conjunction with researchers at Göteborg, Umeå and Stockholm universities, and is being funded by the Public Health Agency of Sweden. Around 1000 children of the ages 7–12 will, through their schools and associations, or via groups in social services, be acquainted with the material. Children will learn and practice mindfulness, storytelling, group discussions and much more, all designed to strengthen protective factors and increase their resilience. The program also involves parents, who are taking part in the work to reinforce children’s protective factors. Based on the work with groups of children, an effectiveness study including children aged 7–12 in school classes, with randomized and controlled pre- and post-measurements, self-rating questionnaires and group observations is being performed. The program will also be implemented in a non-governmental organization and in groups in social services. The study also investigates forms of implementation. Discussion The design of the study will enable the researchers to answer five research questions by using a mixed-methods approach. Implementation will be studied, which is a necessary prerequisite for an effect study. Moreover, the research procedure has been tailored to the target group, with age-appropriate measures as well as multiple informants, which will produce high-quality data for analysis. A special ethical challenge is the study of young children, and efforts to give children a voice have been included in the program. This project is regarded as having good potential to benefit children in general, and particularly children in vulnerable positions. Trial registration National Institute of Health, ClinicalTrials.gov identifier NCT03655418. Registered August 31, 2018.
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Affiliation(s)
- Charli Eriksson
- Department of Public Health Science, Stockholm University, Stockholm, Sweden.
| | - Birgitta Kimber
- Department of Clinical Sciences, Umeå University, Umeå, Sweden
| | - Therése Skoog
- Department of Psychology, Göteborg University, Gothenburg, Sweden
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Scribano ML. Vedolizumab for inflammatory bowel disease: From randomized controlled trials to real-life evidence. World J Gastroenterol 2018; 24:2457-2467. [PMID: 29930467 PMCID: PMC6010939 DOI: 10.3748/wjg.v24.i23.2457] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 05/06/2018] [Accepted: 05/18/2018] [Indexed: 02/06/2023] Open
Abstract
The biologic antitumor necrosis factor alpha (anti-TNFα) agents have revolutionised the treatment of inflammatory bowel disease (IBD). However, some patients experience primary nonresponse, loss of response, or intolerance. Therefore, introducing a newer class of therapy with a mechanism of action that acts on different inflammatory pathways involved in IBD pathogenesis is appealing. Vedolizumab is a fully humanised monoclonal antibody that selectively targets α4β7 integrin. Based on the results of the pivotal clinical GEMINI trials, vedolizumab was approved for the treatment of adult patients with moderately to severely active ulcerative colitis (UC) and Crohn’s disease (CD) refractory or intolerant to either conventional therapy or TNFα inhibitors. This review describes the efficacy, safety, and tolerability of vedolizumab reported in both randomized, controlled, clinical trials and from real-world experience in patients with UC and CD in order to identify its place in treatment algorithms for IBD.
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Rosenblum K, Lawler J, Alfafara E, Miller N, Schuster M, Muzik M. Improving Maternal Representations in High-Risk Mothers: A Randomized, Controlled Trial of the Mom Power Parenting Intervention. Child Psychiatry Hum Dev 2018; 49:372-384. [PMID: 28936602 PMCID: PMC5862741 DOI: 10.1007/s10578-017-0757-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
A key mechanism of risk transmission between maternal risk and child outcomes are the mother's representations. The current study examined the effects of an attachment-based, trauma-informed parenting intervention, the Mom Power (MP) program, in optimizing maternal representations of high-risk mothers utilizing a randomized, controlled trial design (NCT01554215). High-risk mothers were recruited from low-income community locations and randomized to either the MP Intervention (n = 42) or a control condition (n = 33) in a parallel design. Maternal representations were assessed before and after the intervention using the Working Model of the Child Interview. The proportion of women with balanced (secure) representations increased in the MP group but not in the control group. Parenting Reflectivity for mothers in the treatment group significantly increased, with no change in the control condition. Participation in the MP program was associated with improvements in a key indicator of the security of the parent-child relationship: mothers' representations of their children.
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Affiliation(s)
- Katherine Rosenblum
- University of Michigan, Department of Psychiatry, Ann Arbor, MI,University of Michigan, Center for Human Growth and Development, Ann Arbor, MI,Corresponding author: Dr. Maria Muzik, MD, MS; Department of Psychiatry, University of Michigan, Rachel Upjohn Building, 4250 Plymouth Rd Ann Arbor, MI 48109; Phone: 734-232-0206;
| | - Jamie Lawler
- University of Michigan, Department of Psychiatry, Ann Arbor, MI
| | - Emily Alfafara
- University of Michigan, Department of Psychiatry, Ann Arbor, MI
| | - Nicole Miller
- University of Michigan, Department of Psychiatry, Ann Arbor, MI
| | - Melisa Schuster
- University of Michigan, Department of Social Work, Ann Arbor, MI
| | - Maria Muzik
- Department of Psychiatry, University of Michigan, Rachel Upjohn Building, 4250 Plymouth Rd, Ann Arbor, MI, 48109, USA. .,Center for Human Growth and Development, University of Michigan, Ann Arbor, MI, USA.
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Saeki M, Tanaka K, Imatani J, Okamoto H, Watanabe K, Nakamura T, Gotani H, Ohi H, Nakamura R, Hirata H. Efficacy and safety of novel collagen conduits filled with collagen filaments to treat patients with peripheral nerve injury: A multicenter, controlled, open-label clinical trial. Injury 2018; 49:766-74. [PMID: 29566987 DOI: 10.1016/j.injury.2018.03.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Revised: 03/08/2018] [Accepted: 03/12/2018] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The safety and efficacy of using artificial collagen nerve conduits filled with collagen filaments to treat nerve defects has not been fully studied in humans. We conducted a multicenter, controlled, open-label study to compare the safety and efficacy of artificial nerve conduit grafts with those of autologous nerve grafts. METHODS We included patients with a sensory nerve defect of ≤30 mm, at the level of the wrist or a more distal location, with the first-line surgical methods selected according to a patient's preference. We compared sensory recovery using static two-point discrimination and adverse events between the artificial collagen nerve conduit and autologous nerve grafting. RESULTS The artificial nerve conduit group included 49 patients, with a mean age of 42 years and nerve defect of 12.6 mm. The autologous nerve graft group included 7 patients, with historical data of an additional 31 patients, with a mean age of 36 years and nerve defect of 18.7 mm. The rate of recovery of sensory function at 12 months was 75% (36/49) for the artificial nerve conduit group and 73.7% (28/38) in the autologous nerve group. No serious adverse events directly associated with use of the artificial nerve conduit were identified. CONCLUSIONS The treatment of nerve defects ≤30 mm using artificial collagen nerve conduits was not inferior to treatment using autologous nerve grafts. Based on our data, the new artificial collagen nerve conduit can provide an alternative to autologous nerve for the treatment of peripheral nerve defects.
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Osma J, Suso-Ribera C, García-Palacios A, Crespo-Delgado E, Robert-Flor C, Sánchez-Guerrero A, Ferreres-Galan V, Pérez-Ayerra L, Malea-Fernández A, Torres-Alfosea MÁ. Efficacy of the unified protocol for the treatment of emotional disorders in the Spanish public mental health system using a group format: study protocol for a multicenter, randomized, non-inferiority controlled trial. Health Qual Life Outcomes 2018. [PMID: 29530035 PMCID: PMC5848595 DOI: 10.1186/s12955-018-0866-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Background Emotional disorders, which include both anxiety and depressive disorders, are the most prevalent psychological disorders according to recent epidemiological studies. Consequently, public costs associated with their treatment have become a matter of concern for public health systems, which face long waiting lists. Because of their high prevalence in the population, finding an effective treatment for emotional disorders has become a key goal of today’s clinical psychology. The Unified Protocol for the Transdiagnostic Treatment of Emotional Disorders might serve the aforementioned purpose, as it can be applied to a variety of disorders simultaneously and it can be easily performed in a group format. Methods The study is a multicenter, randomized, non-inferiority controlled clinical trial. Participants will be 220 individuals with emotional disorders, who are randomized to either a treatment as usual (individual cognitive behavioral therapy) or to a Unified Protocol condition in group format. Depression, anxiety, and diagnostic criteria are the primary outcome measures. Secondary measures include the assessment of positive and negative affect, anxiety control, personality traits, overall adjustment, and quality of life. An analysis of treatment satisfaction is also conducted. Assessment points include baseline, post-treatment, and three follow-ups at 3, 6, and 12 months. To control for missing data and possible biases, intention-to-treat and per-protocol analyses will be performed. Discussion This is the first randomized, controlled clinical trial to test the effectiveness of a transdiagnostic intervention in a group format for the treatment of emotional disorders in public settings in Spain. Results obtained from this study may have important clinical, social, and economic implications for public mental health settings in Spain. Trial registration Retrospectively registered at https://clinicaltrials.gov/. Trial NCT03064477 (March 10, 2017). The trial is active and recruitment is ongoing. Recruitment is expected to finish by January 2020.
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Affiliation(s)
- Jorge Osma
- University of Zaragoza, Teruel, Spain. .,Instituto de Investigación Sanitaria de Aragón, Zaragoza, Spain. .,Facultad de Ciencias Sociales y Humanas, Universidad de Zaragoza, C/ Ciudad Escolar s/n, 44003, Teruel, Spain.
| | - Carlos Suso-Ribera
- Universitat Jaume I. Edificio de Investigación II, Av. Vicente SosBaynat s/n, 12006, Castellón, Spain
| | - Azucena García-Palacios
- CIBER of Physiopathology of Obesity and Nutrition CIBERobn, CB06/03 Instituto de Salud Carlos III, Castellón, Spain
| | - Elena Crespo-Delgado
- Universitat Jaume I. Edificio de Investigación II, Av. Vicente SosBaynat s/n, 12006, Castellón, Spain
| | - Cristina Robert-Flor
- Unidad de Salud Mental La Fuente de San Luís, C/ Arabista Ambrosio Huici, 30, 46013, Valencia, Spain
| | - Ana Sánchez-Guerrero
- Unidad de Salud Mental La Fuente de San Luís, C/ Arabista Ambrosio Huici, 30, 46013, Valencia, Spain
| | - Vanesa Ferreres-Galan
- Hospital Comarcal de Vinaròs, Avinguda Gil d'Atrosillo, s/n, 12500, Castellón, Spain
| | - Luisa Pérez-Ayerra
- Centro de Salud Mental La Milagrosa, C/ Julián Gayarre, 1A, 31005, Pamplona, Spain
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Russell J, Maguire S, Hunt GE, Kesby A, Suraev A, Stuart J, Booth J, McGregor IS. Intranasal oxytocin in the treatment of anorexia nervosa: Randomized controlled trial during re-feeding. Psychoneuroendocrinology 2018; 87:83-92. [PMID: 29049935 DOI: 10.1016/j.psyneuen.2017.10.014] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 09/29/2017] [Accepted: 10/12/2017] [Indexed: 12/31/2022]
Abstract
BACKGROUND Nutritional rehabilitation in anorexia nervosa (AN) is impeded by fear of food, eating and change leading to treatment resistance. Oxytocin (OT) exerts prosocial effects and modulates trust, fear, anxiety and neuroplasticity. The current placebo-controlled RCT examined the effects of intranasal oxytocin (IN-OT) in AN. The aim was to ascertain whether repeated doses of IN-OT enhance treatment outcomes in AN. METHODS AN patients self-administered 36 IU IN-OT or placebo daily for 4-6 weeks during hospital treatment. The outcome measures were change in the Eating Disorders Examination (EDE) scale, weight gain, cognitive rigidity, social anxiety, obsessive and autistic symptoms. The effects of the first and last doses of IN-OT were assessed relative to placebo before and after a high-energy afternoon snack, to determine potential dampening of cortisol and anxiety levels by OT. RESULTS Weight gain was similar in both groups. The EDE eating concern subscale score was significantly lower after IN-OT treatment as was cognitive rigidity. There were no significant differences in social anxiety or any of the other outcomes at follow-up. After four weeks IN-OT, salivary cortisol levels were significantly lowered in anticipation of an afternoon snack compared to placebo. Morning plasma OT levels did not change after chronic IN-OT or with weight restoration. CONCLUSION IN-OT might enhance nutritional rehabilitation in AN by reducing eating concern and cognitive rigidity. Lower salivary cortisol levels in response to IN-OT suggest diminished neuroendocrine stress responsiveness to food and eating. Such effects require replication with inclusion of more sensitive subjective measures.
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Affiliation(s)
- Janice Russell
- Discipline of Psychiatry, University of Sydney, Sydney, NSW, Australia; Northside Clinic, Greenwich, NSW, Australia; Royal Prince Alfred Hospital, Camperdown, NSW, Australia; Boden Institute, University of Sydney, Sydney, NSW, Australia.
| | - Sarah Maguire
- Royal Prince Alfred Hospital, Camperdown, NSW, Australia; Boden Institute, University of Sydney, Sydney, NSW, Australia.
| | - Glenn E Hunt
- Discipline of Psychiatry, University of Sydney, Sydney, NSW, Australia.
| | - Alice Kesby
- School of Psychology, University of Sydney, Sydney, NSW, Australia.
| | - Anastasia Suraev
- School of Psychology, University of Sydney, Sydney, NSW, Australia.
| | - Jordyn Stuart
- School of Psychology, University of Sydney, Sydney, NSW, Australia.
| | - Jessica Booth
- School of Psychology, University of Sydney, Sydney, NSW, Australia.
| | - Iain S McGregor
- School of Psychology, University of Sydney, Sydney, NSW, Australia.
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Totton SC, Cullen JN, Sargeant JM, O'Connor AM. The reporting characteristics of bovine respiratory disease clinical intervention trials published prior to and following publication of the REFLECT statement. Prev Vet Med 2017; 150:117-125. [PMID: 29406078 DOI: 10.1016/j.prevetmed.2017.12.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 12/09/2017] [Accepted: 12/23/2017] [Indexed: 11/19/2022]
Abstract
The goal of the REFLECT Statement (Reporting guidElines For randomized controLled trials in livEstoCk and food safeTy) (published in 2010) was to provide the veterinary research community with reporting guidelines tailored for randomized controlled trials for livestock and food safety. Our objective was to determine the prevalence of REFLECT Statement reporting of items 1-19 in controlled trials published in journals between 1970 and 2017 examining the comparative efficacy of FDA-registered antimicrobials against naturally acquired BRD (bovine respiratory disease) in weaned beef calves in Canada or the USA, and to compare the prevalence of reporting before and after 2010, when REFLECT was published. We divided REFLECT Statement, items 3, 5, 10, and 11 into subitems, because each dealt with multiple elements requiring separate assessment. As a result, 28 different items or subitems were evaluated independently. We searched MEDLINE® and CABI (CAB Abstracts® and Global Health®) (Web of Science™) in April 2017 and screened 2327 references. Two reviewers independently assessed the reporting of each item and subitem. Ninety-five references were eligible for the study. The reporting of the REFLECT items showed a point estimate for the prevalence ratio >1 (i.e. a higher proportion of studies published post-2010 reported this item compared to studies published pre-2010), apart from items 10.3, i.e., item 10, subitem 3 (who assigned study units to the interventions), 13 (the flow of study units through the study), 16 (number of study units in analysis), 18 (multiplicity), and 19 (adverse effects). Fifty-three (79%) of 67 studies published before 2010 and all 28 (100%) papers published after 2010 reported using a random allocation method in either the title, abstract, or methods (Prevalence ratio = 1.25; 95% CI (1.09,1.43)). However, 8 studies published prior to 2010 and 7 studies published post-2010 reported the term "systematic randomization" or variations of this term (which is not true randomization) to describe the allocation procedure. Fifty-five percent (37/67) of studies published pre-2010 reported blinding status (blinded/not blinded) of outcome assessors, compared to 24/28 (86%) of studies published post-2010 (Prevalence ratio = 1.5, 95% CI (1.19, 2.02)). The reporting of recommended items in journal articles in this body of work is generally improving; however, there is also evidence of confusion about what constitutes a random allocation procedure, and this suggests an educational need. As this study is observational, this precludes concluding that the publication of the REFLECT Statement was the cause of this trend.
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Affiliation(s)
- Sarah C Totton
- 63 College Avenue West, Guelph, Ontario, N1G 1S1, Canada.
| | - Jonah N Cullen
- Department of Veterinary Diagnostic and Production Animal Medicine, College of Veterinary Medicine, Iowa State University, Ames, IA, 50011-3619, USA
| | - Jan M Sargeant
- Department of Population Medicine, Ontario Veterinary College, University of Guelph, 50 Stone Road East, Guelph, Ontario, N1G 2W1, Canada; Centre for Public Health and Zoonoses, University of Guelph, 50 Stone Road East, Guelph, Ontario, N1G 2W1, Canada; Arrell Food Institute, University of Guelph ,50 Stone Road East, Guelph, Ontario, N1G 2W1, Canada
| | - Annette M O'Connor
- Department of Veterinary Diagnostic and Production Animal Medicine, College of Veterinary Medicine, Iowa State University, Ames, IA, 50011-3619, USA
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Peltzer K, Weiss SM, Soni M, Lee TK, Rodriguez VJ, Cook R, Alcaide ML, Setswe G, Jones DL. A cluster randomized controlled trial of lay health worker support for prevention of mother to child transmission of HIV (PMTCT) in South Africa. AIDS Res Ther 2017; 14:61. [PMID: 29248014 PMCID: PMC5732507 DOI: 10.1186/s12981-017-0187-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 12/11/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND We evaluate the impact of clinic-based PMTCT community support by trained lay health workers in addition to standard clinical care on PMTCT infant outcomes. METHODS In a cluster randomized controlled trial, twelve community health centers (CHCs) in Mpumalanga Province, South Africa, were randomized to have pregnant women living with HIV receive either: a standard care (SC) condition plus time-equivalent attention-control on disease prevention (SC; 6 CHCs; n = 357), or an enhanced intervention (EI) condition of SC PMTCT plus the "Protect Your Family" intervention (EI; 6 CHCs; n = 342). HIV-infected pregnant women in the SC attended four antenatal and two postnatal video sessions and those in the EI, four antenatal and two postnatal PMTCT plus "Protect Your Family" sessions led by trained lay health workers. Maternal PMTCT and HIV knowledge were assessed. Infant HIV status at 6 weeks postnatal was drawn from clinic PCR records; at 12 months, HIV status was assessed by study administered DNA PCR. Maternal adherence was assessed by dried blood spot at 32 weeks, and infant adherence was assessed by maternal report at 6 weeks. The impact of the EI was ascertained on primary outcomes (infant HIV status at 6 weeks and 12 months and ART adherence for mothers and infants), and secondary outcomes (HIV and PMTCT knowledge and HIV transmission related behaviours). A series of logistic regression and latent growth curve models were developed to test the impact of the intervention on study outcomes. RESULTS In all, 699 women living with HIV were recruited during pregnancy (8-24 weeks), and assessments were completed at baseline, at 32 weeks pregnant (61.7%), and at 6 weeks (47.6%), 6 months (50.6%) and 12 months (59.5%) postnatally. Infants were tested for HIV at 6 weeks and 12 months, 73.5% living infants were tested at 6 weeks and 56.7% at 12 months. There were no significant differences between SC and EI on infant HIV status at 6 weeks and at 12 months, and no differences in maternal adherence at 32 weeks, reported infant adherence at 6 weeks, or PMTCT and HIV knowledge by study condition over time. CONCLUSION The enhanced intervention administered by trained lay health workers did not have any salutary impact on HIV infant status, ART adherence, HIV and PMTCT knowledge. Trial registration clinicaltrials.gov: number NCT02085356.
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Schmidt RL, Colbert-Getz JM, Milne CK, Vargo DJ, Hussong JW, Hoidal JR, Markewitz BA, Walker BS, Kawamoto K. Impact of Laboratory Charge Display Within the Electronic Health Record Across an Entire Academic Medical Center: Results of a Randomized Controlled Trial. Am J Clin Pathol 2017; 148:513-522. [PMID: 29165570 DOI: 10.1093/ajcp/aqx110] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To determine the impact of systemwide charge display on laboratory utilization. METHODS This was a randomized controlled trial with a baseline period and an intervention period. Tests were randomized to a control arm or an active arm. The maximum allowable Medicare reimbursement rate was displayed for tests in the active arm during the intervention period. Total volume of tests in the active arm was compared with those in the control arm. Residents were surveyed before and after the intervention to assess charge awareness. RESULTS Charge display had no effect on order behavior. This result held for patient type (inpatient vs outpatient) and for insurance category (commercial, government, self-pay). Residents overestimated the charges of tests both before and after the intervention. Many residents failed to notice the charge display in the computerized order entry system. CONCLUSIONS The impact of charge display depends on context. Charge display is not always effective.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Kensaku Kawamoto
- Department of Biomedical Informatics, University of Utah, Salt Lake City
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Jiang S, Wu L, Gao X. Beyond face-to-face individual counseling: A systematic review on alternative modes of motivational interviewing in substance abuse treatment and prevention. Addict Behav 2017; 73:216-35. [PMID: 28554033 DOI: 10.1016/j.addbeh.2017.05.023] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 05/17/2017] [Accepted: 05/19/2017] [Indexed: 11/23/2022]
Abstract
OBJECTIVES This systematic review aimed to synthesize the evidence on the effectiveness of motivational interviewing (MI), delivered in modes other than face-to-face individual counseling, in preventing and treating substance abuse related behaviors. METHODS Four databases (PubMed/MEDLINE, PsycINFO, ISI Web of Science and Cochrane Library) were searched for randomised clinical trials (RCTs) that evaluated the effectiveness of alternative modes of MI (other than face-to-face individual counseling) in preventing and treating substance abuse. Eligible studies were rated on methodological quality and their findings were qualitatively synthesized. RESULTS A total of 25 articles (on 22 RCTs) were eligible for this review. Beyond face-to-face counseling, telephone was the most frequently used medium for delivering MI (11 studies), followed by Internet communication (4 studies) and short message service (SMS) (2 studies). Mail was incorporated as a supplement in one of the studies for telephone MI. In contrast to one-to-one individual counseling, group MI was adopted in 5 studies. The effectiveness of telephone MI in treating substance abuse was supported by all of the published RCTs we located. Internet-based MI was effective in preventing and treating alcoholism, but its outcome appeared to be inconsistent for smoking cessation and poor for abstinence from illicit drugs. SMS-based MI appeared to be useful for controlling tobacco and drinking. Group MI was attempted for quitting alcohol and drugs, with mixed findings on its outcomes. CONCLUSIONS Collectively, the studies reviewed indicate that telephone MI is a promising mode of intervention in treating and preventing substance abuse. The effectiveness of other alternative modes (SMS-based MI, Internet-based MI and group MI) remains inconclusive given the controversial findings and a limited number of studies. By synthesizing the currently available evidence, this systematic review suggested that telephone MI might be considered as an alternative to face-to-face MI for treating and preventing substance abuse. Further research is needed to investigate the effectiveness of SMS-based MI, Internet MI, group MI and other alternative modes. Studies with methodological rigor and incorporating MI fidelity measures have great potential to advance the understanding in this field.
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Boyce JM, Guercia KA, Sullivan L, Havill NL, Fekieta R, Kozakiewicz J, Goffman D. Prospective cluster controlled crossover trial to compare the impact of an improved hydrogen peroxide disinfectant and a quaternary ammonium-based disinfectant on surface contamination and health care outcomes. Am J Infect Control 2017; 45:1006-1010. [PMID: 28431849 DOI: 10.1016/j.ajic.2017.03.010] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 03/11/2017] [Accepted: 03/12/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND Quaternary ammonium-based (Quat) disinfectants are widely used, but they have disadvantages. METHODS This was a 12-month prospective cluster controlled crossover trial. On 4 wards, housekeepers performed daily cleaning using a disinfectant containing either 0.5% improved hydrogen peroxide (IHP) or Quat. Each month, 5-8 high-touch surfaces in several patient rooms on each ward were tagged with a fluorescent marker and cultured before and after cleaning. Hand hygiene compliance rates and antimicrobial usage on study wards were obtained from hospital records. Outcomes included aerobic colony counts (ACCs), percent of wiped surfaces yielding no growth after cleaning, and a composite outcome of incidence densities of nosocomial acquisition and infection caused by vancomycin-resistant enterococci, methicillin-resistant Staphylococcus aureus, and Clostridium difficile infection. Statistical analysis was performed using χ2 test, Fisher exact test, Welch test, and logistic regression methods. RESULTS Mean ACCs per surface after cleaning were significantly lower with IHP (14.0) than with Quat (22.2) (P = .003). The proportion of surfaces yielding no growth after cleaning was significantly greater with IHP (240/500; 48%) than with Quat (182/517; 35.2%) (P < .0001). Composite incidence density of nosocomial colonization or infection with IHP (8.0) was lower than with Quat (10.3) (incidence rate ratio, 0.77; P = .068; 95% confidence interval, 0.579-1.029). CONCLUSIONS Compared with a Quat disinfectant, the IHP disinfectant significantly reduced surface contamination and reduced a composite colonization or infection outcome.
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Affiliation(s)
- John M Boyce
- Quality Improvement Support Services, Yale New-Haven Hospital, New Haven, CT.
| | - Kerri A Guercia
- Department of Laboratory Medicine, Yale New-Haven Hospital, New Haven, CT
| | - Linda Sullivan
- Quality Improvement Support Services, Yale New-Haven Hospital, New Haven, CT
| | - Nancy L Havill
- Accreditation, Safety and Regulatory Affairs, Yale New-Haven Hospital, New Haven, CT
| | - Renee Fekieta
- Quality Improvement Support Services, Yale New-Haven Hospital, New Haven, CT
| | | | - David Goffman
- Pharmacy Services, Yale-New Haven Hospital, New Haven, CT
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Meng K, Peters S, Faller H. Effectiveness of a standardized back school program for patients with chronic low back pain after implementation in routine rehabilitation care. Patient Educ Couns 2017; 100:1161-1168. [PMID: 28110954 DOI: 10.1016/j.pec.2017.01.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 12/22/2016] [Accepted: 01/13/2017] [Indexed: 05/06/2023]
Abstract
OBJECTIVE To evaluate the effectiveness of a standardized, patient-oriented, biopsychosocial back school after implementation in inpatient orthopedic rehabilitation. METHODS A multi-center, quasi-experimental controlled study of patients with low back pain (n=535) was conducted. Patients in the control group received the traditional back school before implementation of the new program (usual care); patients in the intervention group received the new standardized back school after implementation into routine care. Patients' illness knowledge and conduct of back exercises (primary outcomes) and secondary self-management outcomes and treatment satisfaction were obtained at admission, discharge, and 6 and 12 months after rehabilitation. RESULTS We found a significant small between-group intervention effect on patients' illness knowledge in medium- to long term (6 months: η2=0.015; 12 months: η2=0.013). There were trends for effects on conduct of back exercises among men (6 and 12 months: η2=0.008 both). Furthermore, significant small effects were observed for treatment satisfaction at discharge and physical activity after 6 months. CONCLUSIONS The standardized back school seems to be more effective in certain outcomes than a usual care program despite heterogeneous program implementation. PRACTICE IMPLICATIONS Further dissemination within orthopedic rehabilitation may be encouraged to foster self-management outcomes.
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Affiliation(s)
- Karin Meng
- Department of Medical Psychology, Medical Sociology, and Rehabilitation Sciences, University of Würzburg, Würzburg, Germany.
| | - Stefan Peters
- Department of Medical Psychology, Medical Sociology, and Rehabilitation Sciences, University of Würzburg, Würzburg, Germany
| | - Hermann Faller
- Department of Medical Psychology, Medical Sociology, and Rehabilitation Sciences, University of Würzburg, Würzburg, Germany
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Boff RDM, Liboni RPA, Batista IPDA, de Souza LH, Oliveira MDS. Weight loss interventions for overweight and obese adolescents: a systematic review. Eat Weight Disord 2017; 22:211-229. [PMID: 27542161 DOI: 10.1007/s40519-016-0309-1] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 07/26/2016] [Indexed: 01/06/2023] Open
Abstract
PURPOSE To determine what factors contribute to the efficacy of non-drug treatments designed to promote weight loss in overweight and obese adolescents. METHODS Data sources Medline/PubMed; Psychinfo; EMBASE; Web of Science (ISI); and Cochrane Central Register of Controlled Trials. Study selection Randomized clinical trials of treatments for obesity and overweight in adolescents aged 10-19 years with a minimum duration of 2 months. Data extraction 115 of the 12,948 publications retrieved met eligibility criteria and 26 were included in the final sample. Period of extraction January 2004 to November 2014. RESULTS The Delphi list was used to evaluate the methodological quality of the studies (M = 5.58, SD = 1.027). There was considerable variability between the interventions, but they were all multifactorial, with components such as nutritional education, physical activity, family support and psychological therapy. The number of contacts with subjects during the course of the intervention was a predictor of treatment efficacy when the groups were compared. Limitations This systematic review was limited to trials reported in English and by the lack of methodological rigor and shortcomings in reporting in the studies reviewed. CONCLUSIONS Multidisciplinary interventions including family support and guided behavior modification appear to be effective methods of reducing BMI in overweight and obese adolescents.
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Affiliation(s)
- Raquel de Melo Boff
- PUCRS, Pontifícia Universidade Católica do Rio Grande do Sul, Av. Ipiranga, 6681, Prédio 11, 9° Andar, Sala 927-Partenon, Porto Alegre, RS, 90619-900, Brazil.
| | - Ronald Patrick Araujo Liboni
- PUCRS, Pontifícia Universidade Católica do Rio Grande do Sul, Av. Ipiranga, 6681, Prédio 11, 9° Andar, Sala 927-Partenon, Porto Alegre, RS, 90619-900, Brazil
| | - Igor Pacheco de Azevedo Batista
- PUCRS, Pontifícia Universidade Católica do Rio Grande do Sul, Av. Ipiranga, 6681, Prédio 11, 9° Andar, Sala 927-Partenon, Porto Alegre, RS, 90619-900, Brazil
| | | | - Margareth da Silva Oliveira
- PUCRS, Pontifícia Universidade Católica do Rio Grande do Sul, Av. Ipiranga, 6681, Prédio 11, 9° Andar, Sala 927-Partenon, Porto Alegre, RS, 90619-900, Brazil
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Bäuerle K, Feicke J, Scherer W, Spörhase U, Bitzer EM. Evaluation of a standardized patient education program for inpatient asthma rehabilitation: Impact on patient-reported health outcomes up to one year. Patient Educ Couns 2017; 100:957-965. [PMID: 27993435 DOI: 10.1016/j.pec.2016.11.023] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 11/21/2016] [Accepted: 11/27/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES To modify and evaluate a patient education program for adult asthma patients in consideration of quality criteria for teaching. METHODS This was a prospective single-center controlled trial in an inpatient rehabilitation center. The control group (n=215) received the usual lecture-based education program, and the intervention group (n=209) the modified patient education program. Data were assessed at admission, discharge, 6 and 12 months post discharge. The primary outcome was asthma control, the secondary outcomes were asthma knowledge, quality of life, and program acceptance. Analysis of change was performed by ANCOVA for each follow-up, adjusting for baseline values. RESULTS Statistically significant increases in all health outcomes and in asthma control were maintained in both groups at 12 months: CG: +1.9 (95%-CI 1.3-2.6) IG: +1.6 (95%-CI 0.8-2.3). We observed no significant differences between the programs for asthma control and quality of life. Regarding practical asthma knowledge, after 12 months, a group*time interaction emerged with a small effect size (P=0.06, η2=0.01). CONCLUSION The modified program was not superior to traditional patient education concerning asthma control. It permanently increased self-management knowledge. PRACTICAL IMPLICATIONS Structured and behavioral patient education fosters patient's disease management ability. Possible ways of improving asthma control need to be explored.
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Affiliation(s)
- Kathrin Bäuerle
- Department of Everyday Culture, Exercise and Health, University of Education, Freiburg, Germany.
| | - Janine Feicke
- Department of Biology and its Didactics, University of Education, Freiburg, Germany
| | | | - Ulrike Spörhase
- Department of Biology and its Didactics, University of Education, Freiburg, Germany
| | - Eva-Maria Bitzer
- Department of Everyday Culture, Exercise and Health, University of Education, Freiburg, Germany
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Beattie J, Hall H, Biro MA, East C, Lau R. Effects of mindfulness on maternal stress, depressive symptoms and awareness of present moment experience: A pilot randomised trial. Midwifery 2017; 50:174-183. [PMID: 28463789 DOI: 10.1016/j.midw.2017.04.006] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 04/12/2017] [Accepted: 04/20/2017] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To determine the feasibility and acceptability and measure the effects of a mindfulness intervention compared to a pregnancy support program on stress, depressive symptoms and awareness of present moment experience. DESIGN A pilot randomised trial using mixed methods. PARTICIPANTS AND SETTING Forty-eight women attending a maternity service were randomly allocated to a mindfulness-based or pregnancy support program. MEASURES Perceived Stress Scale, Edinburgh Postnatal Depression Scale, Mindfulness Attention Awareness Scale, and Birth Outcomes. Women's perceptions of the impact of the programs were examined via summative evaluation, interviews, diaries and facilitator field notes. FINDINGS Nine women in the mindfulness program and 11 in the pregnancy support program completed post-program measures. There were no statistically significant differences between groups. Of practical significance, was an improvement in measures for both groups with a greater improvement in awareness of present moment experience for the intervention group. The intervention group reported learning how to manage stressors, fear, anxiety, and to regulate their attention to be more present. The control group reported learning how to calm down when stressed which increased their confidence. Intervention group themes were: releasing stress, becoming aware, accepting, having options and choices, connecting and being compassionate. Control group themes were:managing stress, increasing confidence, connecting, focussing, being accepted, preparing. KEY CONCLUSION The feasibility and acceptability of the intervention was confirmed. Programs decreased women's self-reported stress in different ways. Women in the mindfulness program accepted themselves and their experiences as they arose and passed in the present moment, while those in the control group gained acceptance primarily from external sources such as peers. IMPLICATIONS FOR PRACTICE Mindfulness programs can foster an internalised locus of self-acceptance which may result in woman becoming less dependent on others for their wellbeing. Adequately powered RCTs, with an active control, long-term follow up and economic evaluation are recommended.
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Affiliation(s)
- Jill Beattie
- School of Nursing and Midwifery, Monash University, Building E, McMahons Road, Frankston, Victoria 3199, Australia.
| | - Helen Hall
- School of Nursing and Midwifery, Monash University, Building E, McMahons Road, Frankston, Victoria 3199, Australia.
| | - Mary Anne Biro
- School of Nursing and Midwifery, Monash University, Building E, McMahons Road, Frankston, Victoria 3199, Australia.
| | - Christine East
- School of Nursing and Midwifery, Monash University, Building E, McMahons Road, Frankston, Victoria 3199, Australia; Monash Women's Maternity Services, Birth Suite, Monash Medical Centre, 246 Clayton Road, Clayton, Victoria 3168, Australia.
| | - Rosalind Lau
- School of Nursing and Midwifery, Monash University, Building E, McMahons Road, Frankston, Victoria 3199, Australia.
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Välimäki M, Yang M, Normand SL, Lorig KR, Anttila M, Lantta T, Pekurinen V, Adams CE. Study protocol for a cluster randomised controlled trial to assess the effectiveness of user-driven intervention to prevent aggressive events in psychiatric services. BMC Psychiatry 2017; 17:123. [PMID: 28372555 PMCID: PMC5379524 DOI: 10.1186/s12888-017-1266-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 03/11/2017] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND People admitted to psychiatric hospitals with a diagnosis of schizophrenia may display behavioural problems. These may require management approaches such as use of coercive practices, which impact the well-being of staff members, visiting families and friends, peers, as well as patients themselves. Studies have proposed that not only patients' conditions, but also treatment environment and ward culture may affect patients' behaviour. Seclusion and restraint could possibly be prevented with staff education about user-centred, more humane approaches. Staff education could also increase collaboration between patients, family members and staff, which may further positively affect treatment culture and lower the need for using coercive treatment methods. METHODS This is a single-blind, two-arm cluster randomised controlled trial involving 28 psychiatric hospital wards across Finland. Units will be randomised to receive either a staff educational programme delivered by the team of researchers, or standard care. The primary outcome is the incidence of use of patient seclusion rooms, assessed from the local/national health registers. Secondary outcomes include use of other coercive methods (limb restraint, forced injection, and physical restraint), service use, treatment satisfaction, general functioning among patients, and team climate and employee turn-over (nursing staff). DISCUSSION The study, designed in close collaboration with staff members, patients and their relatives, will provide evidence for a co-operative and user-centred educational intervention aiming to decrease the prevalence of coercive methods and service use in the units, increase the functional status of patients and improve team climate in the units. We have identified no similar trials. TRIAL REGISTRATION ClinicalTrials.gov NCT02724748 . Registered on 25th of April 2016.
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Affiliation(s)
- Maritta Välimäki
- Department of Nursing Science, Faculty of Medicine, University of Turku , Turku, Finland
- School of Nursing, Hong Kong Polytechnic University, Hong Kong, China
- Turku University Hospital, Turku, Finland
| | - Min Yang
- West China Research Center for Rural Health Development, Sichuan University Huaxi Medical Center, Sichuan University of China, Administration Building, No 17,Section 3,Ren Ming Nan Lu, Chengdu, Sichuan China
- Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA 02115-5899 USA
| | - Sharon-Lise Normand
- Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA 02115-5899 USA
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Harvard Medical School, 180 Longwood Avenue, Boston, MA 02115-5899 USA
| | - Kate R. Lorig
- Department of Medicine - Med/Immunology & Rheumatology, Stanford University, 1000 WELCH RD. #204, Stanford, CA 94305-5755 USA
| | - Minna Anttila
- Department of Nursing Science, Faculty of Medicine, University of Turku , Turku, Finland
| | - Tella Lantta
- Department of Nursing Science, Faculty of Medicine, University of Turku , Turku, Finland
| | - Virve Pekurinen
- Department of Nursing Science, Faculty of Medicine, University of Turku , Turku, Finland
| | - Clive E. Adams
- Institute of Mental Health, Division of Psychiatry, University of Nottingham, Jubilee Campus, Wollaton Road, Nottingham, NG8 1BB UK
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Gathirua-Mwangi WG, Monahan PO, Stump T, Rawl SM, Skinner CS, Champion VL. Mammography Adherence in African-American Women: Results of a Randomized Controlled Trial. Ann Behav Med 2016; 50:70-8. [PMID: 26416127 DOI: 10.1007/s12160-015-9733-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Breast cancer is the second leading cause of cancer mortality among women in the developed world. Mammography screening is especially important for African-Americans because they experience a greater mortality (OR = 1.38) than Caucasians despite having a lower incidence of breast cancer. PURPOSE The purpose of this study was to compare the effects of two interventions with usual care on mammography adherence among African-American women. METHODS A subsample of African-American women (n = 244) aged 41-65 years who had not had a mammogram in the last 15 months and no history of breast cancer was randomly assigned to receive (1) mailed interactive DVD, (2) computer-tailored telephone counseling, or (3) usual care. RESULTS The DVD intervention was five times more effective than usual care for promoting mammography screening at 6 months follow-up among women who earned less than $30,000 (OR = 5.3). Compared to usual care, neither the DVD nor phone produced significant effects for women with household incomes >$30,000. CONCLUSION Use of a mailed DVD for low-income African-American women may be an effective way to increase mammography adherence.
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