Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Informing school sex education using the stages of change construct: sexual behaviour and attitudes towards sexual activity and condom use of children aged 13-16 in England

A survey of 3820 school children in England aged 13-16 years examined sexual activity using the Transtheoretical Model (TTM) Stages of Change. A quarter (26%) of teens were sexually experienced, 44.8 per cent did not use contraception and 48.9 per cent did not use condoms, every time. Past history of condom and contraceptive use, and partner willingness to use condoms were the best predictors of being in Action or Maintenance stage for condom use. Of virgins, 19.82 per cent were in Contemplation or Preparation stages for intercourse, and 85.4 per cent would use condoms every time. Sex education should be tailored to Stage, and signposting to sexual health and contraception services. Copyright © 2007 SAGE Publications

Examining relationships between multiple health risk behaviors, well-being, and productivity

Traditionally, the concept of health promotion has emphasized the reduction of health risk behaviors to reduce disease and impairment. Well-being research expands this focus to include positive constructs such as thriving, productivity, life-evaluation, and emotional and physical health. The objective of the present study was to examine the relationships between health risk behaviors and specific measures of individual well-being. Participants (N = 790) from 49 states completed a one-time online assessment that included the Life-Evaluation Index, Emotional and Physical Health Ladders, the Health Risk Intervention Assessment, and the Work Productivity and Activity Improvement Questionnaire for General Health. Life Evaluation and physical and emotional health were all inversely related to the number of health risk behaviors, with higher well-being scores associated with lower number of risk behaviors. Across the three Life Evaluation categories (Suffering, Struggling, and Thriving) the number of health risk behaviors decreased, productivity loss decreased, and emotional and physical health increased. The results add to previous research on how reducing multiple health risk behaviors can be combined with well-being, i.e., an emphasis on increasing life-evaluation, emotional and physical health, better functioning, and productivity. © Psychological Reports 2014

Longitudinal changes in stages of change for condom use in women

Purpose. This study identifies how women naturally progress through the Transtheoretical Model stages of condom use over a 1 year period, using the longitudinal dynamic methodology of latent transition analysis (LTA). Design. As part of a larger study of human immunodeficiency virus risk in women, participants were assessed for their stage of condom use two times, 1 year apart. Subjects. A total of 491 women who completed both assessments of the study were included in this analysis. Measures. Stage of condom use was assessed using two questions, which placed women into one of five stages of change for condom use (α = .90). Results. Latent transition analysis identified the best-fitting model of naturalistic stage progression, which included both forward and backward movement. Precontemplation and maintenance were found to be the most stable stages (more than 50% of the participants remaining in that stage 1 year later), and the action stage was the least stable (15% remaining in this stage). Transition probabilities for all stages showed a high rate of relapse in the sample. Conclusions. A high proportion of women will remain within their stage of condom use over a 1-year period if no intervention is introduced. Interventions that are aimed at increasing condom use in women need to incorporate relapse prevention. In addition, the transition probabilities for the stages will help establish reasonable rates of change for intervention programs

Online Health Behavior and Disease Management Programs: Are We Ready for Them? Are They Ready for Us?

Advancing the science and practice of health promotion and disease management on the Internet requires a systematic program of research examining the population impact of such programs. With impact described as the combination of effectiveness and participation, such research needs to include the examination of the quality and effectiveness of programs that are available to the general public, as well as descriptive and predictive knowledge about population readiness to participate in such programs. There have been few studies examining the quality of interactive health behavior change (HBC) programs on the Internet, and even fewer investigations of the effectiveness of such programs. Based on the review of over 300 HBC programs on the Internet using the “5 A's” of Health Behavior Change on the Internet (HBC-I Screener), which represent standard minimum guidelines for evaluation, it appears HBC on the Internet is in the early stages of development. As health behavior change on the Internet matures from the provision of health information to meeting the requirements necessary to produce health behavior change, and as program developers take advantage of the interactive nature of the Internet, the basic screening and expanded evaluation criteria developed in this project will provide templates for both consumers and developers of programs. The second component necessary for evaluating the impact of HBC on the Internet is the extent to which the population is ready to participate in such programs. We need to move beyond a narrow focus on early adopters and produce a population perspective that includes those not ready, those getting ready, and those ready to use such programs, as well as those already participating. By understanding participation levels of such programs, and what drives this participation, the development and dissemination of practical tailored and targeted interventions can help maximize population participation in Internet programs for health behavior change

Efficacy and effectiveness trials: Examples from smoking cessation and bullying prevention

If health psychology is to maximize impacts on health, there will need to be a shift from relying primarily on efficacy trials to increasing reliance on effectiveness trials. Efficacy trials use homogeneous, highly motivated samples with minimal complications from a single setting receiving intensive treatments delivered under highly controlled conditions. Two effectiveness trials on bullying prevention illustrate the use of a heterogeneous population from multiple sites receiving a low intensity tailored treatment delivered under highly variable conditions. In spite of considerable noise the effectiveness trials produced robust results (odds ratios of about four) that bode well for population impacts under real-world dissemination. Copyright © 2007 SAGE Publications

Transtheoretical-based bullying prevention effectiveness trials in middle schools and high schools

Background Bullying threatens the physical and mental well-being of students across a broad range of schools. Tailored interventions based on the Transtheoretical model and delivered over the Internet were designed to reduce participation in each of three roles related to bullying (bully, victim and passive bystander). Methods Effectiveness trials were completed in 12 middle schools and 13 high schools in the USA. A diverse sample of 1237 middle (6th-8th grade, with 45.1% in the 7th grade; ages 11-14) and 1215 high school (9th-11th grade, with 41.6% in the 9th grade; ages 14-17) students were available for analyses. Results Analyses showed significant treatment effects for both intervention groups when compared to control for both the middle and high school programs. Conclusions Given the relative ease of dissemination, these programs could be applied as stand-alone practices or as part of more intensive interventions

The Functional Well-Being Scale: A measure of functioning loss due to well-being-related barriers

The objective of this study was to develop the Pro-Change Functional Well-Being Scale, a measure that provides an informative evaluation of general functioning loss due to well-being-related barriers. Exploratory and confirmatory analyses on data from 642 individuals supported a one-factor solution with good model fit. A strong positive correlation existed between the Pro-Change Functional Well-Being Scale and Well-Being Assessment for Productivity. Initial construct validity was demonstrated by predictable relationships between functioning loss and other measures of health and well-being. This initial psychometric evidence suggests that the Pro-Change Functional Well-Being Scale is a reliable and valid assessment of functioning loss due to common well-being-related barriers