Randomised controlled non-inferiority trial of primary care-based facilitated access to an alcohol reduction website: cost-effectiveness analysis

To evaluate the 12-month costs and quality-adjusted life years (QALYs) gained to the Italian National Health Service of facilitated access to a website for hazardous drinkers compared with a standard face-to-face brief intervention (BI)

Download Your Doctor: Implementation of a Digitally Mediated Personal Physician Presence to Enhance Patient Engagement With a Health-Promoting Internet Application.

BACKGROUND: Brief interventions delivered in primary health care are effective in reducing excessive drinking; online behavior-changing technique interventions may be helpful. Physicians may actively encourage the use of such interventions by helping patients access selected websites (a process known as "facilitated access"). Although the therapeutic working alliance plays a significant role in the achievement of positive outcomes in face-to-face psychotherapy and its development has been shown to be feasible online, little research has been done on its impact on brief interventions. Strengthening patients' perception of their physician's endorsement of a website could facilitate the development of an effective alliance between the patient and the app. OBJECTIVE: We describe the implementation of a digitally mediated personal physician presence to enhance patient engagement with an alcohol-reduction website as part of the experimental online intervention in a noninferiority randomized controlled trial. We also report the feedback of the users on the module. METHODS: The Download Your Doctor module was created to simulate the personal physician presence for an alcohol-reduction website that was developed for the EFAR-FVG trial conducted in the Italian region of Friuli-Venezia-Giulia. The module was designed to enhance therapeutic alliance and thus improve outcomes in the intervention group (facilitated access to the website). Participating general and family practitioners could customize messages and visual elements and upload a personal photo, signature, and video recordings. To assess the perceptions and attitudes of the physicians, a semistructured interview was carried out 3 months after the start of the trial. Participating patients were invited to respond to a short online questionnaire 12 months following recruitment to investigate their evaluation of their online experiences. RESULTS: Nearly three-quarters (23/32, 72%) of the physicians interviewed chose to customize the contents of the interaction with their patients using the provided features and acknowledged the ease of use of the online tools. The majority of physicians (21/32, 57%) customized at least the introductory photo and video. Barriers to usage among those who did not customize the contents were time restrictions, privacy concerns, difficulties in using the tools, and considering the approach not useful. Over half (341/620, 55.0%) of participating patients completed the optional questionnaire. Many of them (240/341, 70.4%) recalled having noticed the personalized elements of their physicians, and the majority of those (208/240, 86.7%) reacted positively, considering the personalization to be of either high or the highest importance. CONCLUSIONS: The use of a digitally mediated personal physician presence online was both feasible and welcomed by both patients and physicians. Training of the physicians seems to be a key factor in addressing perceived barriers to usage. Further research is recommended to study the mechanisms behind this approach and its impact. TRIAL REGISTRATION: Clinicaltrials.gov NCT 01638338; https://clinicaltrials.gov/ct2/show/NCT01638338 (Archived by WebCite at http://www.webcitation.org/6f0JLZMtq)

Randomised controlled non-inferiority trial of primary care-based facilitated access to an alcohol reduction website

Background: Brief interventions (BIs) delivered in primary care have been shown to be effective in reducing risky drinking, but implementation is limited. Facilitated access to a digital application offers a novel alternative to face-to-face intervention, but its relative effectiveness is unknown.Methods: Primary care-based, non-inferiority, randomised controlled trial comparing general practitioner (GP) facilitated access to an interactive alcohol reduction website (FA) with face-to-face BI for risky drinking. Patients screening positive on the short Alcohol Use Disorders Identification Test (AUDIT-C) were invited to participate in the trial. Assessment at baseline, 3 months and 12 months was carried out using AUDIT and EQ-5D-5L questionnaires. Findings: 58 participating GPs approached 9080 patients of whom 4529 (49.9%) logged on, 3841 (84.8%) undertook screening, 822 (21.4%) screened positive and 763 (19.9%) were recruited. 347 (45.5%) were allocated to FA and 416 (54.5%) to BI. At 3 months, subjects in FA group with an AUDIT score of ≥8 reduced from 95 (27.5%) to 85 (26.8%) while those in BI group increased from 123 (20.6%) to 141 (37%). Differences between groups were principally due to responses to AUDIT question 10. Analysis of primary outcome indicated non-inferiority of FA compared with BI, and prespecified subgroup analysis indicated benefits for older patients and those with higher levels of computer literacy and lower baseline severity. Additional analyses undertaken to take account of bias in response to AUDIT question 10 failed to support non-inferiority within the prespecified 10% boundary.Interpretation: Prespecified protocol-driven analyses of the trial indicate that FA is non-inferior to BI; however, identified bias in the outcome measure and further supportive analyses question the robustness of this finding. It is therefore not possible to draw firm conclusions from this trial, and further research is needed to determine whether the findings can be replicated using more robust outcome measures.Trial registration number NCT01638338; Results

High-spin states and band terminations in v 49

High-spin states in 49 V have been studied through the 28 Si(28 Si, α3p) reaction using the EUROBALL γ-ray detector array. The 49 V level scheme has been extended up to 13.1 MeV including 21 new states. Both negative and positive parity states have been interpreted in the framework of theShell Model. The 27/2− and the 31/2+ band termination states have been observed in agreement with theoretical predictions.Fil: Rodrigues Ferreira Maltez, Dario Pablo. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Comisión Nacional de Energía Atómica. Gerencia del Área de Investigación y Aplicaciones No Nucleares. Gerencia Física (Centro Atómico Constituyentes). Proyecto Tandar; Argentina. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Departamento de Física; ArgentinaFil: Hojman, Daniel Leonardo. Comisión Nacional de Energía Atómica. Gerencia del Área de Investigación y Aplicaciones No Nucleares. Gerencia Física (Centro Atómico Constituyentes). Proyecto Tandar; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Lenzi, Silvia M.. Istituto Nazionale Di Fisica Nucleare.; Italia. Università di Padova; ItaliaFil: Cardona, Maria Angelica. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Comisión Nacional de Energía Atómica. Gerencia del Área de Investigación y Aplicaciones No Nucleares. Gerencia Física (Centro Atómico Constituyentes). Proyecto Tandar; Argentina. Universidad Nacional de San Martín. Escuela de Ciencia y Tecnología; ArgentinaFil: Fernea, Enrico. Università di Padova; Italia. Istituto Nazionale Di Fisica Nucleare.; ItaliaFil: Axiotis, M.. Istituto Nazionale Di Fisica Nucleare.; ItaliaFil: Beck, C.. Université de Strasbourg; Francia. Centre National de la Recherche Scientifique; FranciaFil: Bednarczyk, P.. Polish Academy of Sciences; ArgentinaFil: Bizzetti, P. G.. Università di Padova; Italia. Istituto Nazionale Di Fisica Nucleare.; ItaliaFil: Bizzetti Sona, A. M.. Università di Padova; Italia. Istituto Nazionale Di Fisica Nucleare.; ItaliaFil: Della Vedova, F.. Università di Padova; Italia. Istituto Nazionale Di Fisica Nucleare.; ItaliaFil: Grebosz, J.. Polish Academy of Sciences; ArgentinaFil: Haas, F.. Université de Strasbourg; Francia. Centre National de la Recherche Scientifique; FranciaFil: Kmiecik, M.. Polish Academy of Sciences; ArgentinaFil: Maj, A.. Polish Academy of Sciences; ArgentinaFil: Męczyński, W.. Polish Academy of Sciences; ArgentinaFil: Napoli, D. R.. Istituto Nazionale Di Fisica Nucleare.; ItaliaFil: Nespolo, M.. Università di Padova; Italia. Istituto Nazionale Di Fisica Nucleare.; ItaliaFil: Papka, P.. Université de Strasbourg; Francia. Centre National de la Recherche Scientifique; FranciaFil: Sánchez i Zafra, A.. Université de Strasbourg; Francia. Centre National de la Recherche Scientifique; FranciaFil: Styczen, J.. Polish Academy of Sciences; ArgentinaFil: Thummerer, S.. Alfred-Wegener-Institut, Helmholtz-Zentrum für Polar- und Meeresforschung; AlemaniaFil: Ziębliński, M.. Polish Academy of Sciences; Argentin

People with Alcohol Use Disorders in Specialized Care in Eight Different European Countries

Aim: To provide a description of patients receiving alcohol treatment in eight different European countries, including the level of comorbidities and functional limitations. Methods: Drinking behaviours, DSM-IV alcohol use disorder (AUD), mental and somatic comorbidities, disability and health services utilization of 1767 patients from various specialized treatment settings were assessed as representative for regions of eight European countries. Severity of alcohol dependence (AD) in terms of drinking level was compared with a large representative US sample. Results: Patients in specialized care for AUDs showed high levels of consumption [average level of daily ethanol intake: 141.1 g, standard deviation (SD): 116.0 g], comorbidity [e.g. liver problems: 19.6%, 95% confidence interval (CI): 17.5-21.6%; depression: 43.2%, 95% CI: 40.7-45.8%; anxiety: 50.3%, 95% CI: 47.8-52.9%], disability and health services utilization (average number of nights spent in hospital(s) during the last 6 months: 8.8, SD: 19.5 nights). Severity of AD was similar to the US sample, but European men consumed on average more alcohol daily. Conclusions: High levels of consumption, somatic and mental comorbidities, disability and functional losses were found in this representative treatment sample, indicating that treatment was initiated only at severe stages of AUDs. Earlier initiation of treatment could help avoid some of the health and social burde

The Edinburgh Postnatal Depression Scale in routine screening: errors and cautionary advice.

The manuscript reports some critical comments on a paper by Venkatesh et al. (2016) regarding the implementation of routine antenatal and postnatal screening for depression for women in the perinatal period in Massachusetts, using the EdinburghPostnatal Depression Scale (EPDS) (Cox et al., 1987).Venkatesh et al. used the same EPDS cut-off score for the antenatal and postnatal periods, without commenting on the research showing that different cut-off scores are required for the 2 time periods.It is important that services know that there is considerable evidence that different cut-off scores on the EPDS are required for women (and men) from different cultures

VALUTAZIONE DELLE COMPETENZE MOTORIE E DELLA INTEGRAZIONE VISUOMOTORIA IN UNA POPOLAZIONE DI SOGGETTI ENURETICI

Premessa: l'enuresi notturna primaria monosintomatica (PMNE) è un problema comune in età evolutiva, che consiste nella perdita involontaria di urina durante la notte nei bambini oltre i 5 anni di età.[1] Diverse osservazioni cliniche hanno suggerito la presenza di anomalie aspecifiche in motricità, sviluppo del linguaggio, capacità di apprendimento, accrescimento fisico e maturazione scheletrica dei bambini affetti da PMNE.[2] Lo scopo del presente studio è valutare la prevalenza della anomalie nella coordinazione motoria fine e nella integrazione visuo-motoria nei bambini prepuberi con PMNE. Metodi: La popolazione in studio è composta da 31 bambini (16 maschi, 15 femmine) (età media 8,14 ± 1,36 anni) e il gruppo di controllo da 61 bambini sani (32 maschi, 29 femmine, età media ± 8,03 1,44 anni). L'intera popolazione è stata sottoposta a valutazione clinica per valutare il quoziente intellettivo totale (IQ), le capacità di integrazione visuo-motoria, e la coordinazione motoria. Risultati: I due gruppi risultano confrontabili per età (p = 0,725), genere (p = 0,886), z-BMI (p = 0,149) e QI (p = 0,163). Il gruppo PMNE mostra una più alta prevalenza di prestazioni borderline nella coordinazione motoria (p <0,001) e prestazioni patologiche per le capacità globali di integrazione visuo-motoria (p <0,001). Differenze non significative tra i due gruppi di studio sono state rilevate per prestazioni patologiche al M-ABC (p = 0.07), al subitem di percezione visiva del VMI (p = 0,793) e al subitem di coordinazione motoria del VMI (p = 0,213).[3] Conclusioni: I nostri risultati dimostrano che la PMNE non dovrebbe essere considerata esclusivamente come un disturbo minzionale, ma che al contrario i bambini affetti andrebbero probabilmente indirizzati a specifici programmi riabilitativi rivolti al miglioramento della coordinazione motoria e della integrazione visuo-motori