21 research outputs found
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Exploring Meaningful Patient Engagement in ADAPTABLE (Aspirin Dosing: A Patient-centric Trial Assessing Benefits and Long-term Effectiveness).
BackgroundGenuine patient engagement can improve research relevance, impact and is required for studies using the National Patient-Centered Clinical Research Network including major multicenter research projects. It is unclear, however, how best to integrate patients into governance of such projects.MethodsADAPTABLE (Aspirin Dosing: A Patient-centric Trial Assessing Benefits and Long-term Effectiveness) is the first major multicenter research project to be conducted in National Patient-Centered Clinical Research Network. Here, we provide a description of how we implemented patient engagement in ADAPTABLE thus far, including a description of committee structures and composition, first-hand patient testimonials, specific contributions, and lessons learned during the planning and early implementation of ADAPTABLE.ResultsWe recruited 1 patient leader from 6 of the 7 enrolling networks to serve on a Patient Review Board for ADAPTABLE, supported the Board with an experienced patient engagement team including an "investigator-advocate" not otherwise involved in the trial, and facilitated bidirectional communication between the Board and ADAPTABLE Coordinating Center. The Board has reviewed and provided substantial input on the informed consent procedure, recruitment materials, patient portal design, and study policy including compensation of participants. Although it was "too late" for some suggested modifications, most modifications suggested by the patient leaders have been implemented, and they are enthusiastic about the study and their role. The patient leaders also attend Steering and Executive Committee calls; these experiences have been somewhat less productive.ConclusionsWith adequate support, a cadre of committed patient leaders can provide substantial value to design and implementation of a major multicenter clinical trial
The Effectiveness of Internet-Guided Self-help Interventions to Promote Physical Activity Among Individuals With Depression: Systematic Review
BackgroundDepression is a prevalent and debilitating mental disorder and a leading cause of disability worldwide. Physical activity (PA) interventions have been shown to alleviate depressive symptoms. However, not all patients have access to PA programing tailored for depression. Internet-guided self-help (IGSH) interventions may be an effective option for increasing PA among people with depression who cannot or prefer not to access supervised exercise treatment.
ObjectiveWe aimed to evaluate the effectiveness of IGSH interventions in increasing PA and alleviating depressive symptoms in people with depression.
MethodsA systematic literature search was conducted for randomized controlled trials and quasiexperimental studies using 9 electronic databases. The review was registered in PROSPERO (2020 CRD42020221713).
ResultsA total of 4 randomized controlled trials (430 participants) met the inclusion criteria. Of these, 3 were web-based and 1 was app-based. Three studies found IGSH interventions to have medium to large effects on decreasing depressive symptoms but not on increasing PA compared with waitlist or usual care. One study showed increased self-reported PA but no significant difference in depressive symptoms in the intervention group compared with the control group. Goal setting was the most common behavior change technique used in the interventions. Dropout rates within the intervention groups were relatively low (0%-19%).
ConclusionsOur findings suggested that IGSH PA interventions are feasible and have the potential to reduce depressive symptoms in people with depression. More well-designed and tailored interventions with different combinations of behavior change techniques, particularly those targeting the emotion domain, are needed to assess the overall effectiveness and feasibility of using IGSH interventions to increase PA among people with depression.
Trial RegistrationPROSPERO CRD42020221713; https://tinyurl.com/ysaua5b
âYou Canât Go to the Park, You Canât Go Here, You Canât Go Thereâ: Exploring Parental Experiences of COVID-19 and Its Impact on Their Childrenâs Movement Behaviours
The COVID-19 outbreak and related public health guidelines have changed the daily lives of Canadians and restricted opportunities for healthy movement behaviours for children. The purpose of this study was to explore how parents experienced the pandemic-related restrictions and how they impacted their childrenâs movement behaviours. Methods: Twenty-nine semi-structured one-on-one interviews were conducted (JuneâJuly 2020) with parents of children (5â11 years old) in Ontario and British Columbia. Interviews lasted between 24â104 min, were audio-recorded, transcribed verbatim, and thematically analyzed. Results: Findings emphasized various individual (e.g., motivation), interpersonal (e.g., parent work schedule), built (e.g., closure of parks) and natural environment (e.g., weather) factors related to childrenâs movement behaviours. The findings highlighted the loss of structured activities and destinations for childrenâs physical activity, and restricted opportunities for outdoor play exacerbated by shrinking childhood independent mobility. Conclusion: Families are adapting to many pandemic-related challenges including adhering to public health restrictions, parents juggling multiple roles, conducting work and school from home, as well as exacerbating factors like weather. It will be important to continue to encourage outdoor time, support policies and practice that facilitate independent mobility, and develop centralized resources that help families in the maintenance of healthy movement behaviours.Education, Faculty ofMedicine, Faculty ofNon UBCKinesiology, School ofPediatrics, Department ofReviewedFacult
Strange Days : Adult Physical Activity and Mental Health in the First Two Months of the COVID-19 Pandemic
Background: In addition to its physical health benefits, physical activity is increasingly
recognized as a means to support mental health. Regular moderate-to-vigorous physical
activity (MVPA) is associated with improved mental well-being, reduced likelihood of
developing mental illness, and improved symptom management. Despite these benefits,
most people fail to achieve minimum recommended levels of MVPA. Population levels of
physical activity have further declined since the onset of the COVID-19 pandemic and
implementation of public health measures (e.g., shelter-in-place protocols). The potential
impact of this decline on mental heath outcomes warrants ongoing investigation.
Purpose: To investigate associations between changes in MVPA and mental health
(depressive symptoms, anxiety symptoms, and life satisfaction) in adults impacted by
the COVID-19 pandemic.
Method: Research followed a cross-sectional design. English-speaking adults were
invited to complete an online questionnaire. MVPA was assessed retrospectively (before
COVID-19) and currently (during COVID-19) with the International Physical Activity
Questionnaire. Mental health was assessed with the Patient Health Questionnaire, 9-Item
(PHQ-9), the Generalized Anxiety Disorder, 7-Item (GAD-7), and the Satisfaction with Life
Scale (SWLS). Regression was used to assess relationships between MVPA and mental
health. ANOVA with follow-up tests examined whether participants who differed in mental
health status (e.g., no symptoms vs. severe symptoms) differed in their change in MVPA.
T-tests were used to examine differences in mental health symptomatology between
participants who were sufficiently (i.e., achieving MVPA guidelines of â„ 150 min/week)
vs. insufficiently active.
Results: Prior to COVID-19, 68.2% of participants were classified as being sufficiently
active, vs. 60.6% during COVID-19. The majority of participants reported experiencing
some level of depressive symptoms (62.0%) or anxiety symptoms (53.7%). After
controlling for covariates, changes in MVPA accounted for significant variability in the
PHQ-9 (7.7%), GAD-7 (2.5%), and SWLS (1.5 %). Participants with clinically significant
mental health symptomatology reported greater declines in MVPA than those who
reported no symptoms. Conversely, participants who were sufficiently active during
COVID-19 reported significantly lower depression and anxiety, and higher life satisfaction. Conclusion: Participants who experienced the greatest declines in MVPA reported
relatively greater psychological distress and lower life satisfaction. While preliminary, these
findings suggest the importance of maintaining and promoting physical activity during a
period of pandemic.Education, Faculty ofKinesiology, School ofReviewedFacultyPostdoctoralGraduat
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Factors Associated With Access to and Timing of Coronavirus Testing Among US Adults After Onset of Febrile Illness.
ImportanceActive SARS-CoV-2 (coronavirus) transmission continues in the US. It is unclear whether better access to coronavirus testing and more consistent use of testing could substantially reduce transmission.ObjectiveTo describe coronavirus testing in persons with new onset of febrile illness and analyze whether there are changes over time and differences by race and ethnicity.Design, setting, and participantsThis cohort study used data from the COVID-19 Citizen Science Study, launched in March 2020, which recruited participants via press release, word-of-mouth, and partner organizations. Participants completed daily surveys about COVID-19 symptoms and weekly surveys about coronavirus testing. All adults (aged at least 18 years) with a smartphone were eligible to join. For this analysis, US participants with new onset of febrile illness from April 2020 to October 2020 were included. Data analysis was performed from November 2020 to March 2021.Main outcomes and measuresReceipt of a coronavirus test result within 7 days of febrile illness onset.ResultsOf the 2679 participants included in this analysis, the mean (SD) age was 46.3 (13.4) years, 1983 were female (74%), 2017 were college educated (75%), and a total of 3865 distinct new febrile illness episodes were reported (300 episodes [7.8%] from Hispanic participants, 71 episodes [1.8%] from Black participants, and 3494 episodes [90.4%] from not Black, not Hispanic participants) between April 2 and October 23, 2020. In weekly surveys delivered during the 14 days after fever onset, 12% overall (753 participants) indicated receipt of a test result. Using serial survey responses and parametric time-to-event modeling, it was estimated that by 7 days after onset of febrile illness, a total of 20.5% (95% CI, 19.1%-22.0%) had received a test result. This proportion increased from 9.8% (95% CI, 7.5%-12.0%) early in the epidemic to 24.1% (95% CI, 21.5%-26.7%) at the end of July, but testing rates did not substantially improve since then, increasing to 25.9% (95% CI; 21.6%-30.3%) in late October at the start of the winter surge. Black participants reported receiving a test result about half as often as others (7% [7 of 103] of survey responses vs 12% [53 of 461] for Hispanic vs 13% [693 of 5516] for not Black, not Hispanic; Pâ=â.03). This association was not statistically significant in adjusted time-to-event models (hazard ratioâ=â0.59 vs not Black, not Hispanic participants; 95% CI, 0.26-1.34).Conclusions and relevanceSystematic underuse of coronavirus testing was observed in this cohort study through late October 2020, at the beginning of the winter COVID-19 surge, which may have contributed to preventable coronavirus transmission
Self-efficacy for exercise in adults with lifetime depression and low physical activity
People may be more likely to exercise if they have self-efficacy for exercise (SEE). We conducted an exploratory analysis of SEE using data from a clinical trial designed to increase physical activity (NÂ =Â 340). We evaluated correlates of baseline SEE and the relationship between baseline SEE and physical activity. Low SEE at baseline was correlated with lower well-being, physical activity, and higher depression at baseline. Participants with high (vs. low) baseline SEE had higher physical activity (but no differential change in activity) over time. These data highlight the potential role of SEE in psychological health and physical activity
Improvement in Blood Pressure Control in Safety Net Clinics Receiving 2 Versions of a Scalable Quality Improvement Intervention: BP MAP A Pragmatic Cluster Randomized Trial
Background Uncontrolled blood pressure (BP) remains a leading cause of death in the United States. The American Medical Association developed a quality improvement program to improve BP control, but it is unclear how to efficiently implement this program at scale across multiple health systems. Methods and Results We conducted BP MAP (Blood Pressure Measure Accurately, Act Rapidly, and Partner With Patients), a comparative effectiveness trial with clinicâlevel randomization to compare 2 scalable versions of the quality improvement program: Full Support (with support from quality improvement expert) and SelfâGuided (using only online materials). Outcomes were clinicâlevel BP control (<140/90âmmâHg) and other BPârelated process metrics calculated using electronic health record data. Differenceâinâdifferences were used to compare changes in outcomes from baseline to 6 months, between intervention arms, and to a nonrandomized Usual Care arm composed of 18 health systems. A total of 24 safetyânet clinics in 9 different health systems underwent randomization and then simultaneous implementation. BP control increased from 56.7% to 59.1% in the Full Support arm, and 62.0% to 63.1% in the SelfâGuided arm, whereas BP control dropped slightly from 61.3% to 60.9% in the Usual Care arm. The betweenâgroup differencesâinâdifferences were not statistically significant (Full Support versus SelfâGuided=+1.2% [95% CI, â3.2% to 5.6%], P=0.59; Full Support versus Usual Care=+3.2% [â0.5% to 6.9%], P=0.09; SelfâGuided versus Usual Care=+2.0% [â0.4% to 4.5%], P=0.10). Conclusions In this randomized trial, 2 methods of implementing a quality improvement intervention in 24 safety net clinics led to modest improvements in BP control that were not statistically significant. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT03818659