231 research outputs found
Effectiveness and cost-effectiveness of a telehealth intervention to support the management of long-term conditions: study protocol for two linked randomized controlled trials
Background: As the population ages, more people are suffering from long-term health conditions (LTCs). Health
services around the world are exploring new ways of supporting people with LTCs and there is great interest in the
use of telehealth: technologies such as the Internet, telephone and home self-monitoring.
Methods/Design: This study aims to evaluate the effectiveness and cost-effectiveness of a telehealth intervention
delivered by NHS Direct to support patients with LTCs. Two randomized controlled trials will be conducted in parallel,
recruiting patients with two exemplar LTCs: depression or raised cardiovascular disease (CVD) risk. A total of 1,200
patients will be recruited from approximately 42 general practices near Bristol, Sheffield and Southampton, UK.
Participants will be randomly allocated to either usual care (control group) or usual care plus the NHS Direct
Healthlines Service (intervention group). The intervention is based on a conceptual model incorporating promotion of
self-management, optimisation of treatment, coordination of care and engagement of patients and general
practitioners. Participants will be provided with tailored help, combining telephone advice from health information
advisors with support to use a range of online resources. Participants will access the service for 12 months. Outcomes
will be collected at baseline, four, eight and 12 months for the depression trial and baseline, six and 12 months for
the CVD risk trial. The primary outcome will be the proportion of patients responding to treatment, defined in the
depression trial as a PHQ-9 score <10 and an absolute reduction in PHQ-9 ≥5 after 4 months, and in the CVD risk
trial as maintenance or reduction of 10-year CVD risk after 12 months. The study will also assess whether the
intervention is cost-effective from the perspective of the NHS and personal social services. An embedded qualitative
interview study will explore healthcare professionals’ and patients’ views of the intervention.
Discussion: This study evaluates a complex telehealth intervention which combines evidence-based components and
is delivered by an established healthcare organisation. The study will also analyse health economic information. In
doing so, the study hopes to address some of the limitations of previous research by demonstrating the effectiveness
and cost-effectiveness of a real world telehealth interventio
Prenatal Stress and Balance of the Child's Cardiac Autonomic Nervous System at Age 5-6 Years
Objective: Autonomic nervous system (ANS) misbalance is a potential causal factor in the development of cardiovascular disease. The ANS may be programmed during pregnancy due to various maternal factors. Our aim is to study maternal prenatal psychosocial stress as a potential disruptor of cardiac ANS balance in the child. Methods: Mothers from a prospective birth cohort (ABCD study) filled out a questionnaire at gestational week 16 [IQR 12– 20], that included validated instruments for state anxiety, depressive symptoms, pregnancy-related anxiety, parenting daily hassles and job strain. A cumulative stress score was also calculated (based on 80 th percentiles). Indicators of cardiac ANS in the offspring at age 5–6 years are: pre-ejection period (PEP), heart rate (HR), respiratory sinus arrhythmia (RSA) and cardiac autonomic balance (CAB), measured with electrocardiography and impedance cardiography in resting supine and sitting positions. Results: 2,624 mother-child pairs, only single births, were available for analysis. The stress scales were not significantly associated with HR, PEP, RSA and CAB (p0.07). Conclusion: Results did not support the hypothesis that prenatal maternal psychosocial stress deregulates cardiac AN
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