6,838 research outputs found
A tailored psychological intervention for anxiety and depression management in people with chronic obstructive pulmonary disease: TANDEM RCT and process evaluation
Background: People with chronic obstructive pulmonary disease have high levels of anxiety and depression, which is associated with increased morbidity and poor uptake of effective treatments, such as pulmonary rehabilitation. Cognitive-behavioural therapy improves mental health of people with long-term conditions and could potentially increase uptake of pulmonary rehabilitation, enabling synergies that could enhance the mental health of people with chronic obstructive pulmonary disease. Aim: Our aim was to develop and evaluate the clinical effectiveness and cost effectiveness of a tailored cognitive-behavioural approach intervention, which links into, and optimises the benefits of, routine pulmonary rehabilitation. Design: We carried out a pragmatic multicentre randomised controlled trial using a 1.25 : 1 ratio (intervention : control) with a parallel process evaluation, including assessment of fidelity. Setting: Twelve NHS trusts and five Clinical Commissioning Groups in England were recruited into the study. The intervention was delivered in participant\u27s own home or at a local NHS facility, and by telephone. Participants: Between July 2017 and March 2020 we recruited adults with moderate/very severe chronic obstructive pulmonary disease and mild/moderate anxiety and/or depression, meeting eligibility criteria for assessment for pulmonary rehabilitation. Carers of participants were invited to participate. Intervention: The cognitive-behavioural approach intervention (i.e. six to eight 40- to 60-minute sessions plus telephone support throughout pulmonary rehabilitation) was delivered by 31 trained respiratory healthcare professionals to participants prior to commencing pulmonary rehabilitation. Usual care included routine pulmonary rehabilitation referral. Main outcome measures: Co-primary outcomes were Hospital Anxiety and Depression Scale - anxiety and Hospital Anxiety and Depression Scale - depression at 6 months post randomisation. Secondary outcomes at 6 and 12 months included health-related quality of life, smoking status, uptake of pulmonary rehabilitation and healthcare use. Results: We analysed results from 423 randomised participants (intervention, n = 242; control, n = 181). Forty-three carers participated. Follow-up at 6 and 12 months was 93% and 82%, respectively. Despite good fidelity for intervention delivery, mean between-group differences in Hospital Anxiety and Depression Scale at 6 months ruled out clinically important effects (Hospital Anxiety and Depression Scale - anxiety mean difference -0.60, 95% confidence interval -1.40 to 0.21; Hospital Anxiety and Depression Scale - depression mean difference -0.66, 95% confidence interval -1.39 to 0.07), with similar results at 12 months. There were no between-group differences in any of the secondary outcomes. Sensitivity analyses did not alter these conclusions. More adverse events were reported for intervention participants than for control participants, but none related to the trial. The intervention did not generate quality-of-life improvements to justify the additional cost (adjusted mean difference \ua3770.24, 95% confidence interval -\ua327.91 to \ua31568.39) to the NHS. The intervention was well received and many participants described positive affects on their quality of life. Facilitators highlighted the complexity of participants\u27 lives and considered the intervention to be of potential valuable; however, the intervention would be difficult to integrate within routine clinical services. Our well-powered trial delivered a theoretically designed intervention with good fidelity. The respiratory-experienced facilitators were trained to deliver a low-intensity cognitive-behavioural approach intervention, but high-intensity cognitive-behavioural therapy might have been more effective. Our broad inclusion criteria specified objectively assessed anxiety and/or depression, but participants were likely to favour talking therapies. Randomisation was concealed and blinding of outcome assessment was breached in only 15 participants. Conclusions: The tailored cognitive-behavioural approach intervention delivered with fidelity by trained respiratory healthcare professionals to people with chronic obstructive pulmonary disease was neither clinically effective nor cost-effective. Alternative approaches that are integrated with routine long-term condition care are needed to address the unmet, complex clinical and psychosocial needs of this group of patients. Trial registration: This trial is registered as ISRCTN59537391. Funding: This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 13/146/02) and is published in full in Health Technology Assessment; Vol. 28, No. 1. See the NIHR Funding and Awards website for further award information.People with long-standing lung problems, such as chronic obstructive pulmonary disease, often also have anxiety and depression, which further reduces their quality of life. Two existing treatments could help. Pulmonary rehabilitation (a programme of exercise and education) improves both the physical and mental health of people with chronic obstructive pulmonary disease. Cognitiveābehavioural therapy (a talking therapy) may reduce anxiety and depression. The TANDEM [Tailored intervention for Anxiety and Depression Management in chronic obstructive pulmonary disease (COPD)] intervention linked these two treatments by providing talking therapy based on cognitiveābehavioural therapy during the waiting time following referral for pulmonary rehabilitation. The TANDEM treatment was delivered by respiratory healthcare professionals (e.g. nurses or physiotherapists) trained to deliver the talking therapy in six to eight weekly sessions. The sessions were conducted in the participantās home (or another convenient location), with brief telephone support during the pulmonary rehabilitation. Of 423 participants recruited to the study, 242 participants received TANDEM talking therapy and 181 participants received usual care (including a referral to pulmonary rehabilitation). We measured mental health, quality of life, social life, attendance at pulmonary rehabilitation and healthcare use in both groups at 6 and 12 months. Forty-three carers joined the study and we assessed their mental well-being. We interviewed patients, carers and health professionals to find out their views and experience of the TANDEM treatment. We also examined whether or not the TANDEM treatment was good value for money. The TANDEM treatment did not improve the mental or the physical health of people with chronic obstructive pulmonary disease. In addition, the TANDEM treatment cost the NHS an extra \ua3770 per patient, which was not good value for money. The TANDEM treatment was well received, and many participants told us how it had helped them. Heath-care professionals noted how participants did not just have chronic obstructive pulmonary disease, but were coping with many physical, mental and social problems. The TANDEM intervention was not effective and, therefore, other strategies will be needed to help people with chronic obstructive pulmonary disease and mental health problems live with their condition
A First Course in Causal Inference
I developed the lecture notes based on my ``Causal Inference'' course at the
University of California Berkeley over the past seven years. Since half of the
students were undergraduates, my lecture notes only require basic knowledge of
probability theory, statistical inference, and linear and logistic regressions
Differences in well-being:the biological and environmental causes, related phenotypes, and real-time assessment
Well-being is a complex, and multifaceted construct that includes feeling good and functioning well. There is a growing global recognition of well-being as an important research topic and public policy goal. Well-being is related to less behavioral and emotional problems, and is associated with many positive aspects of daily life, including longevity, higher educational achievement, happier marriage, and more productivity at work. People differ in their levels of well-being, i.e., some people are in general happier or more satisfied with their lives than others. These individual differences in well-being can arise from many different factors, including biological (genetic) influences and environmental influences. To enhance the development of future mental health prevention and intervention strategies to increase well-being, more knowledge about these determinants and factors underlying well-being is needed. In this dissertation, I aimed to increase the understanding of the etiology in a series of studies using different methods, including systematic reviews, meta-analyses, twin designs, and molecular genetic designs. In part I, we brought together all published studies on the neural and physiological factors underlying well-being. This overview allowed us to critically investigate the claims made about the biology involved in well-being. The number of studies on the neural and physiological factors underlying well-being is increasing and the results point towards potential correlates of well-being. However, samples are often still small, and studies focus mostly on a single biomarker. Therefore, more well-powered, data-driven, and integrative studies across biological categories are needed to better understand the neural and physiological pathways that play a role in well-being. In part II, we investigated the overlap between well-being and a range of other phenotypes to learn more about the etiology of well-being. We report a large overlap with phenotypes including optimism, resilience, and depressive symptoms. Furthermore, when removing the genetic overlap between well-being and depressive symptoms, we showed that well-being has unique genetic associations with a range of phenotypes, independently from depressive symptoms. These results can be helpful in designing more effective interventions to increase well-being, taking into account the overlap and possible causality with other phenotypes. In part III, we used the extreme environmental change during the COVID-19 pandemic to investigate individual differences in the effects of such environmental changes on well-being. On average, we found a negative effect of the pandemic on different aspects of well-being, especially further into the pandemic. Whereas most previous studies only looked at this average negative effect of the pandemic on well-being, we focused on the individual differences as well. We reported large individual differences in the effects of the pandemic on well-being in both chapters. This indicates that one-size-fits-all preventions or interventions to maintain or increase well-being during the pandemic or lockdowns will not be successful for the whole population. Further research is needed for the identification of protective factors and resilience mechanisms to prevent further inequality during extreme environmental situations. In part IV, we looked at the real-time assessment of well-being, investigating the feasibility and results of previous studies. The real-time assessment of well-being, related variables, and the environment can lead to new insights about well-being, i.e., results that we cannot capture with traditional survey research. The real-time assessment of well-being is therefore a promising area for future research to unravel the dynamic nature of well-being fluctuations and the interaction with the environment in daily life. Integrating all results in this dissertation confirmed that well-being is a complex human trait that is influenced by many interrelated and interacting factors. Future directions to understand individual differences in well-being will be a data-driven approach to investigate the complex interplay of neural, physiological, genetic, and environmental factors in well-being
Short-term outcomes of physical activity counseling in in-patients with Major Depressive Disorder: Results from the PACINPAT randomized controlled trial
IntroductionA physical activity counseling intervention based on a motivation-volition model was developed and delivered to in-patients with Major Depressive Disorders with the aim of increasing lifestyle physical activity. The aim of this study is to evaluate the short-term outcomes of this intervention.MethodsA multi-center randomized controlled trial was conducted in four Swiss psychiatric clinics. Adults who were initially insufficiently physically active and were diagnosed with Major Depressive Disorder according to ICD-10 were recruited. The sample consisted of 113 participants in the intervention group (Mage = 42 years, 56% women) and 107 in the control group (Mage = 40 years, 49% women). Motivation and volition determinants of physical activity were assessed with questionnaires. Implicit attitudes were assessed with an Implicit Association Test. Physical activity was self-reported and measured with hip-worn accelerometers over 7 consecutive days starting on the day following the data collection.ResultsAccording to accelerometer measures, step count decreased on average 1,323 steps less per day (95% CI = ā2,215 to ā431, p < 0.01) over time in the intervention group compared to the control group. A trend was recognized indicating that moderate-to-vigorous physical activity decreased on average 8.37 min less per day (95% CI = ā16.98 to 0.23, p < 0.06) over time in the intervention group compared to the control group. The initial phase of the intervention does not seem to have affected motivational and volitional determinants of and implicit attitudes toward physical activity.ConclusionPhysical activity counseling may be considered an important factor in the transition from in-patient treatment. Methods to optimize the intervention during this period could be further explored to fulfill the potential of this opportunity.Clinical trial registrationhttps://www.isrctn.com/ISRCTN10469580, identifier ISRCTN10469580
āHave patients with chronic skin diseases needs been met?ā:A thesis on psoriasis and eczema patient care in dermatology service
Background: Common chronic skin diseases such as eczema and psoriasis usually require long term medical care. They are often associated with psychological and metabolic comorbidities, which can impact on patient quality of life (QOL) and on the self-management of these diseases. Regular assessment of patient needs, comorbidities and feedback is a critical step in the development of decision-analytic models. Currently, no intervention is available to regularly assess such patientsā needs and comorbidities and support their involvement in the decision-making and self-management of their morbidity and comorbidities. The aim of this research is to involve the patients in decision making of their care and to support their self-management by the use of a paper questionnaire (study tool) at each consultation. Objective: To explore the acceptability and potential of a self-developed paper questionnaire that constituted a study tool for addressing the needs, comorbidities, and feedback of patients with psoriasis and eczema and supporting their involvement in decision making and self-management of their chronic conditions. Method: A mixed method study was conducted and included a postal survey on adult male and female patients with psoriasis and eczema, using the study tool, which is a paper questionnaire and contains the Dermatology Life Quality Index (DLQI) and seven supplementary open-ended questions to capture patientsā views, feedback, comorbidities, coping status and needs. The survey was followed by semi-structured face-to-face interviews with a sample of the patients who had participated in the survey. The aims of the interviews were two-fold: 1. to gain a deeper understanding of their experience of living with and managing their skin disease; and 2. to gather patient feedback on the service they received as well as their views on using the new study tool or any alternative intervention to address and support their self-management. The final study was a pilot which involved presenting a proposal of an online version of the study tool to a group of healthcare experts asking them to critically review the extent to which the online model responded to patients expressed needs. Results: Of the 114 patients who participated in the postal survey 108 (94.7%) of them expressed physical, metabolic and psychological comorbidities. Stress was identified as the dominant disease-triggering factor in 72 (63%) participants. Thirty-three (28.9%) of participants reported that they could not cope with their chronic illness. Eighteen (15.7%) participants suffered from anxiety, and 12 (10.5%) had depression and suicidal thoughts. Twenty-nine (25%) participants addressed their needs for support at home, and 16 (14%) of them asked for support at work. In the patient feedback section, 21 (18.4%) and 9 (7.8%) participants rated the service they received from their general practitioner (GP) and dermatologist as poor, respectively. In the interviews, all the participants 22 (100%) welcomed the use of the study tool on a regular basis to address their needs, comorbidities and feedback. Nineteen (86.3%) of them suggested that they would prefer using an online version of the tool or patient portal system as a convenient way of remote and interactive communication with the healthcare provider, particularly during the worsening of their skin condition. In the final pilot study, the healthcare experts agreed that the proposed online version of the study tool could be a convenient platform for such patients to support their self-management. They discussed the potential importance of such a tool if it provided them with access to supportive services such as patient information on skin diseases and self-management, access to local mental health service and other relevant psoriasis and eczema patientsā support groups and charities. Conclusion: This novel mixed method research identified knowledge gaps in managing patients with psoriasis and eczema. It provided a new tool that has the potential to regularly engage and assess patientsā unmet needs, comorbidities and feedback. The tool can involve patients in decision-making and offers them the autonomy to disclose heterogeneous needs that may support their self-management. All the interviewees welcomed regular use of the study tool and the majority of them suggested that they would prefer using an online version of the tool if it was available. Future research is needed to assess the impact of the study tool in filling important gaps in patient self-management and in health service improvement
A Comprehensive Review of Data-Driven Co-Speech Gesture Generation
Gestures that accompany speech are an essential part of natural and efficient
embodied human communication. The automatic generation of such co-speech
gestures is a long-standing problem in computer animation and is considered an
enabling technology in film, games, virtual social spaces, and for interaction
with social robots. The problem is made challenging by the idiosyncratic and
non-periodic nature of human co-speech gesture motion, and by the great
diversity of communicative functions that gestures encompass. Gesture
generation has seen surging interest recently, owing to the emergence of more
and larger datasets of human gesture motion, combined with strides in
deep-learning-based generative models, that benefit from the growing
availability of data. This review article summarizes co-speech gesture
generation research, with a particular focus on deep generative models. First,
we articulate the theory describing human gesticulation and how it complements
speech. Next, we briefly discuss rule-based and classical statistical gesture
synthesis, before delving into deep learning approaches. We employ the choice
of input modalities as an organizing principle, examining systems that generate
gestures from audio, text, and non-linguistic input. We also chronicle the
evolution of the related training data sets in terms of size, diversity, motion
quality, and collection method. Finally, we identify key research challenges in
gesture generation, including data availability and quality; producing
human-like motion; grounding the gesture in the co-occurring speech in
interaction with other speakers, and in the environment; performing gesture
evaluation; and integration of gesture synthesis into applications. We
highlight recent approaches to tackling the various key challenges, as well as
the limitations of these approaches, and point toward areas of future
development.Comment: Accepted for EUROGRAPHICS 202
Impaired risk avoidance in bipolar disorder and substance use disorders
Comorbid substance use disorders (SUDs) are highly prevalent in bipolar disorder (BD), with up to 60% of individuals with BD developing an SUD at some point in their lifetime. In addition, research suggests that individuals with this comorbid presentation (BD+SUD) typically have worse outcomes -- including increased mortality, morbidity, and functional impairment -- than individuals with BD alone. Given the increased illness burden associated with BD+SUD, I conducted a systematic review evaluating existing psychosocial treatments for individuals with these comorbidities. Results from this review indicated that no existing psychosocial treatments for these comorbid conditions effectively target both the substance use and mood domain of symptoms. An alternative path to treatment development is to identify mechanisms that underlie BD+SUD that can subsequently be targeted in treatment. Accordingly, I evaluated impairments in risk avoidance (a tendency to engage in a persistent pattern of problematic behaviors despite negative outcomes resulting from such behaviors) as a potential mechanism underlying negative illness outcomes in BD+SUD. Participants with BD (n = 45) or BD+SUD (n = 31) in a relatively euthymic mood state completed clinical risk behavior assessments, laboratory-based risk avoidance assessments, and neurocognitive assessments in a single study session. I hypothesized that the BD+SUD group would exhibit increased clinical risk behaviors, increased impairments on laboratory-based measures of risk avoidance, and increased deficits on neurocognitive assessments relative to the bipolar disorder alone group. Contrary to my hypotheses, results indicated a lack of notable between-group differences in clinical risk behaviors, laboratory-based risk avoidance assessments, and neurocognitive assessments, with the exception of self-reported executive dysfunction which was elevated among individuals with BD+SUD. Collapsing across group, I found that increased discounting of delayed rewards, older age, and an earlier age of (hypo)mania onset predicted increased clinical risk behaviors. These findings underscore the potential importance of delay discounting as a mechanistic target for reducing clinical risk behaviors among individuals with BD both with and without comorbid SUDs. I also discuss the neurocognitive correlates of delay discounting and interventions for addressing delay discounting as potential new directions for treating the disability associated with BD
A Cognitive Intervention for Everyday Executive Function in Female Survivors of Intimate Partner Violence Related Traumatic Brain Injury, A Single-Case Experimental Design (SCED)
An estimated 31,500,000 females have experienced at least one intimate partner violence (IPV) related traumatic brain injury (TBI), or IPV-TBI in their lifetime in the United States of America (USA) alone. Survivors often experience executive function (EF) impairments, resulting in numerous functional and psychological challenges. Despite this, there are currently no studies into EF interventions for IPV-TBI survivors available. Compensatory cognitive rehabilitation and EF coaching have shown positive outcomes for EF in TBI. The current study aimed to investigate the effects of an intervention, combining cognitive rehabilitation and EF coaching for female survivors of IPV-TBI with EF impairments. A multiple baseline single case experimental design (MB-SCED) was used. Two female participants (age M=51.5, range=44-59) completed the study. The independent variable was a four-week cognitive intervention, the dependent variables were everyday executive function, goal attainment, and health-related quality of life (HRQoL). Analysis revealed that the intervention may have benefits for EF goal attainment, self-reported EF and HRQoL. However, these should be interpreted with caution due to the study limitations. The study highlights the need for further clinical interventions and research for IPV-TBI survivors
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