Varenicline for smoking cessation and reduction in people with severe mental illnesses : systematic review and meta-analysis

AIMS: To determine the effectiveness and safety of varenicline in treating tobacco dependence in patients with severe mental illness. DESIGN: A systematic review and meta-analysis of randomised controlled trials that compared varenicline with a placebo or an alternative intervention for smoking cessation or reduction. SETTING: Both in-patient and out-patient settings in any country. PARTICIPANTS: Adult patients aged 18 and over with any type of severe mental illness. The systematic review included eight studies comprising 398 participants. MEASURES: Primary outcome measures were (1) smoking cessation (2) smoking reduction measured by changes in the number of cigarettes smoked per day and (3) number of psychiatric adverse events, which were collected at the end of treatment. FINDINGS: The random-effect pooled estimates from the five studies that reported smoking related outcomes found that varenicline is statistically superior to placebo in smoking cessation (risk ratios 4.33; 95% CI: 1.96-9.56), and smoking reduction was higher in varenicline groups (mean reduced daily cigarettes was 6.39; 95% CI: 2.22-10.56). There is no significant difference regarding neuropsychiatric and other adverse events. CONCLUSIONS: Varenicline appears to be significantly more effective than placebo in assisting with smoking cessation and reduction in people with severe mental illness. There appears to be no clear evidence that varenicline was associated with an increased risk of neuropsychiatric or other adverse events compared with placebo. This article is protected by copyright. All rights reserved

How schools can aid children's resilience in disaster settings: The contribution of place attachment, sense of place and social representations theories

Disasters incurred by natural hazards affect young people most. Schools play a vital role in safeguarding the wellbeing of their pupils. Consideration of schools' psychosocial influence on children may be vital to resilience-building efforts in disaster-vulnerable settings. This paper presents an evidence-based conceptualization of how schools are psychosocially meaningful for children and youth in disaster settings. Drawing on Social Representations and Place Attachment Theories, we explore the nature of group-based meaning-making practices and the meanings that emerge concerning school environments in disaster settings. We contribute a novel understanding of how schools may mitigate psychosocial risk for young people by considering how schools are conceptualised at four levels: (1) as physical environment, (2) as social arena, (3) as a place with individual and (4) group-based significance. In each of these domains schools can foster disaster resilience in young people. This paper highlights the evidence concerning the functions of schools beyond their capacity as educational institutions, critically considering their social and physical functions in their communities. This evidence can inform stakeholders involved in disaster resilience building

The Lengthening Transition to Adulthood: Financial Parenting and Recentering during the College-to-Career Transition

Using longitudinal data collected from a college cohort in the United States (N = 922), we examined the associations between systemic and structural factors (gender, race/ethnicity, family SES, and first-generation college status), financial parenting (teaching, and modeling behavior), and emerging adults' financial behavior. We conducted a series of one-way repeated measure ANOVA analyses (GLM) to assess patterns of average change in financial parenting and financial behavior in the first year in college, fourth year in college, and two years after college and found evidence suggestive of recentering-a gradual transfer of responsibility during emerging adulthood from parent-directed behavior to self-directed behavior; however, the decline in financial parenting was not offset by an improvement in emerging adults' financial behavior. Despite similar patterns of change, family socioeconomic status (SES), first-generation college student status, and gender influenced both financial parenting and financial behaviors at each time point. We discuss the findings and the implications on the timing and length of the recentering process.This item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at [email protected]

Adolescent girls’ representations of the role of schools and teachers post-disaster: “second parents, second homes”

Disasters can result in poor psychosocial outcomes for adolescents. One pathway to mitigate these risks and foster resilience is via schools, where teachers can offer students support. However, existing research lacks consideration of the role schools and teachers play from the perspective of students, particularly those from marginalized populations. Therefore, this study examines adolescents’ representations of the role of schools and teachers after a major disaster in Indonesia using a free association interview technique. Thematic analysis of adolescents’ interviews (N = 46) yielded two salient themes: ‘the school as a place of recovery’ and ‘the school as a place of risk’. While the school and teachers were conceptualized positively in that they promoted students’ recovery, students also identified aspects of the post-disaster school environment that produced uncertainty, loss and discomfort thereby heightening their sense of risk. The paper concludes with recommendations for resilience-building, such as ensuring teachers receive relevant training

A structured review of emotional barriers to WASH provision for schoolgirls post-disaster

Pubescent girls face unique emotional barriers to returning to school after a disaster concerning water, sanitation and hygiene (WASH). This paper explores themes of WASH, gender violence, the lack of dignity and sense of shame arising from inadequate WASH facilities for girls in disaster settings. We conducted a structured literature review of 126 sources to investigate the emotional constraints facing pubescent girls concerning WASH in schools in Indonesia, a region prone to frequent disasters. Findings are synthesised into four major themes: psychological experiences of WASH, challenges faced by girls in schools, barriers to inclusive WASH provision and how to create a holistic approach to WASH. Key conclusions include the need for interdisciplinary research, cross sectoral collaboration, more evidence and research in Indonesia, especially regarding menstrual hygiene management, improved toilet design to reduce the physical barriers linked to emotional barriers and inclusive design for those with disabilities.</p

Prolonged Neuromodulation of Cortical Networks Following Low-Frequency rTMS and Its Potential for Clinical Interventions

Non-invasive brain stimulation safely induces persistent large-scale neural modulation in functionally connected brain circuits. Interruption models of repetitive transcranial magnetic stimulation (rTMS) capitalize on the acute impact of brain stimulation, which decays over minutes. However, rTMS also induces longer-lasting impact on cortical functions, evident by the use of multi-session rTMS in clinical population for therapeutic purposes. Defining the persistent cortical dynamics induced by rTMS is complicated by the complex balance of excitation and inhibition among functionally connected networks. Nonetheless, it is these neuronal dynamic responses that are essential for the development of new neuromodulatory protocols for translational applications. We will review evidence of prolonged changes of cortical response, tens of minutes following one session of low frequency rTMS over the cortex. We will focus on the different methods which resulted in prolonged behavioral and brain changes, such as the combination of brain stimulation techniques, and individually tailored stimulation protocols. We will also highlight studies which apply these methods in multi-session stimulation practices to extend stimulation impact into weeks and months. Our data and others’ indicate that delayed cortical dynamics may persist much longer than previously thought and have potential as an extended temporal window during which cortical plasticity may be enhanced

Smoking Cessation Intervention for Severe Mental Ill Health Trial (SCIMITAR+) : study protocol for a randomised controlled trial

BACKGROUND: Smoking is highly prevalent among people who have experience of severe mental ill health, contributing to their poor physical health. Despite the 'culture' of smoking in mental health services, people with severe mental ill health often express a desire to quit smoking; however, the services currently available to aid quitting are those which are widely available to the general population and may not be suitable or effective for people with severe mental ill health. The aim of this study is to explore the effectiveness and cost-effectiveness of a bespoke smoking-cessation intervention specifically targeted at people with severe mental ill health. METHODS/DESIGN: SCIMITAR+ is a multicentre, pragmatic, two-arm, parallel-group, individually randomised controlled trial. We aim to recruit 400 participants aged 18 years and above with a documented diagnosis of bipolar disorder, schizophrenia or schizoaffective disorder who smoke. Potentially eligible participants identified in primary or secondary care will be screened, and baseline data collected. Eligible, consenting participants will be randomly allocated to one of two groups. In the intervention arm, the participant will be assigned a mental health professional trained to deliver smoking-cessation interventions who will work with the participant and participant's GP or mental health specialist to provide an individually tailored smoking-cessation service. The comparator arm will be usual care - following current NICE guidelines for smoking cessation, in line with general guidance that is offered to all smokers, with no specific adaptation or enhancement in relation to severe mental ill health. The primary outcome will be self-reported smoking cessation at 12 months verified by expired carbon monoxide (CO) measurement. Secondary outcome measures include Body Mass Index at 12 months, the Fagerström Test for Nicotine Dependence, Motivation to Quit questionnaire, SF-12, PHQ-9, GAD-7, EQ-5D-5 L, and health service utilisation at 6 and 12 months. The economic evaluation at 12 months will be conducted in the form of an incremental cost-effectiveness analysis. DISCUSSION: SCIMITAR+ trial is the largest trial to our knowledge to investigate the effectiveness of a bespoke smoking-cessation service for people with severe mental ill health. TRIAL REGISTRATION: International Standard Randomised Controlled Trials Number, ISRCTN72955454 . Registered on 16 January 2015

Standard smoking cessation services in sites participating in the SCIMITAR+ trial for people with severe mental ill health

Aims and method: SCIMITAR+ trial was commissioned to evaluate the effectiveness of a bespoke smoking cessation intervention for people with severe mental ill health compared to usual services. It is difficult to define what constitutes ‘usual care’ in stop smoking services. We aimed to define what this was during the trial. Twenty-two NHS healthcare providers participated in a bespoke survey asking about usual care in their area. Results: All sites offered smoking cessation support, however, service provider and service type varied substantially. In some cases services were not streamlined, meaning that people received smoking cessation counselling from one organisation and smoking cessation medication from another. Clinical implications: To better implement the NICE guideline PH48, clearer referral pathways need to be implemented and communicated to patients, staff and carers. People with SMI need to be able to access services that combine Nicotine Replacement Therapy and behavioural support in a streamlined manner

Supporting physical activity through co-production in people with severe mental ill health (SPACES): protocol for a randomised controlled feasibility trial.

Background Severe mental ill health (SMI) includes schizophrenia, bipolar disorder and schizoaffective disorder and is associated with premature deaths when compared to people without SMI. Over 70% of those deaths are attributed to preventable health conditions, which have the potential to be positively affected by the adoption of healthy behaviours, such as physical activity. People with SMI are generally less active than those without and face unique barriers to being physically active. Physical activity interventions for those with SMI demonstrate promise, however, there are important questions remaining about the potential feasibility and acceptability of a physical activity intervention embedded within existing NHS pathways. Method This is a two-arm multi-site randomised controlled feasibility trial, assessing the feasibility and acceptability of a co-produced physical activity intervention for a full-scale trial across geographically dispersed NHS mental health trusts in England. Participants will be randomly allocated via block, 1:1 randomisation, into either the intervention arm or the usual care arm. The usual care arm will continue to receive usual care throughout the trial, whilst the intervention arm will receive usual care plus the offer of a weekly, 18-week, physical activity intervention comprising walking and indoor activity sessions and community taster sessions. Another main component of the intervention includes one-to-one support. The primary outcome is to investigate the feasibility and acceptability of the intervention and to scale it up to a full-scale trial, using a short proforma provided to all intervention participants at follow-up, qualitative interviews with approximately 15 intervention participants and 5 interventions delivery staff, and data on intervention uptake, attendance, and attrition. Usual care data will also include recruitment and follow-up retention. Secondary outcome measures include physical activity and sedentary behaviours, body mass index, depression, anxiety, health-related quality of life, healthcare resource use, and adverse events. Outcome measures will be taken at baseline, three, and six-months post randomisation. Discussion This study will determine if the physical activity intervention is feasible and acceptable to both participants receiving the intervention and NHS staff who deliver it. Results will inform the design of a larger randomised controlled trial assessing the clinical and cost effectiveness of the intervention. Trial registration ISRCTN: ISRCTN83877229. Registered on 09.09.2022