Borderline personality disorder traits and affect reactivity to positive affect induction followed by a stressor

BACKGROUND AND OBJECTIVES: Affective hyperreactivity is a core feature of Borderline Personality Disorder (BPD), yet little is known about reactivity of positive affect (PA). Objectives were to explore the relationship between BPD traits and affect reactivity in response to a personalized PA-induction and a subsequent stressor. Patient status (seeking outpatient treatment for personality-related problems; yes/no), depressive symptoms, and age were examined as alternative predictors of affect reactivity. METHODS: One hundred and eight females (35 patients) reported on their BPD and depressive symptoms. They completed the Best Possible Self-exercise and a modified Trier Social Stress Task. Trajectories of high and low arousal PA (HAP and LAP) and negative affect (NA) were analyzed with mixed regression modelling. RESULTS: Patient status (for HAP) and depressive symptoms (for LAP and NA) predicted affect reactivity better than BPD traits. Patients showed a weaker HAP increase after PA-induction, and a similar HAP decrease after the stressor, compared to non-patients. Higher depressive symptoms predicted stronger improvement of LAP and NA after PA-induction, and less pronounced deterioration of LAP and NA after the stressor, relative to baseline. LIMITATIONS: The sample was a convenience sample amplified with outpatients. Future research should (1) use clinical groups, (2) randomize to neutral vs. PA-induction, and (3) continue to differentiate between HAP and LAP. CONCLUSIONS: Our results do not support models postulating BPD-specific affective hyperreactivity. HAP and LAP have different trajectories, depending on the degree of psychopathology. The resilience-enhancing potential of a PA-focus in psychotherapy needs further research

Norms and screening utility of the Dutch version of the children's depression inventory in clinical and nonclinical youths

This study aimed to (a) assess relationships between the Children's Depression Inventory (CDI) and DSM-oriented depression and anxiety scales of the Youth Self Report, (b) develop reliable norms for the CDI, and (c) determine CDI cutoff scores for selecting youngsters at risk for depression and anxiety. A total of 3,073 nonclinical and 511 clinically referred children and adolescents from The Netherlands and Belgium were included. Results showed that CDI scores were significantly related to DSM-oriented symptoms of both depression and anxiety. CDI scores correlated highly with depression symptoms and moderately with anxiety symptoms. Norms for the CDI were determined by means of multiple regression analysis and depended on sex, age, and country. CDI cutoff scores for selecting individuals at risk for depression and anxiety as measured by the DSM-oriented depression and anxiety scales of the Youth Self Report were determined by means of multiple regression analysis and receiver operating characteristic analysis. A CDI score of 16 was found to have the most optimal balance between sensitivity and specificity for depression, whereas a score of 21 provided the best sensitivity and specificity for anxiety in a subsample of children. We conclude that the CDI is an effective instrument for screening depression and to a lesser extent anxiety in primary and secondary care centers, before applying further assessment of high-risk individuals

JMASM45: A Computer Program for Bayesian D-Optimal Binary Repeated Measurements Designs (Matlab)

Planners of longitudinal studies of binary responses in applied sciences have not yet benefitted from optimal designs, which have been shown to improve precision of model parameter estimates, due to absence of a computer program. An interactive computer program for Bayesian optimal binary repeated measurements designs is presented for this purpose

The impact of educational and environmental interventions in Dutch worksite cafeterias

Environmental interventions as labeling of healthy foods and an increased availability of healthy foods may help consumers to meet the guidelines for a healthy diet. This article describes a study into the effectiveness of two environmental programs to be used in worksite cafeterias along with an educational program. The aim of the interventions was to reduce fat intake and increase fruit and vegetable intake. In the 'Labeling Program', low fat products were labeled. The 'Food Supply Program' comprised an increased availability of low-fat products and fruits and vegetables in worksite cafeterias. The 'Educational Program' consisted of information about healthy nutrition through brochures, table tents, a self help manual and posters. The design consisted of a pretest-posttest experimental control group design, with four conditions: the Educational Program, the Food Supply Program plus Educational Program, the Labeling Program plus Educational Program and a control group. Seventeen worksites were randomly assigned to one of the four research conditions. Total fat, fruit, and vegetable intake was measured with a quantitative, self-administered food frequency questionnaire (35 questions). Intake during lunch was measured by asking respondents to write down which food items they had purchased during their last lunch in the cafeteria. Furthermore, sales data for some targeted product categories were collected (milk, butter, cheese, meat products, desserts). For the whole study population, no significant effects on consumption data were found for any of the programs. The data showed a beneficial significant treatment effect of the Labeling Program on total fat intake, for respondents who believe they eat a high fat diet. Sales data revealed a significant effect of the labeling program on desserts, but not for the other products

Vitalum study design: RCT evaluating the efficacy of tailored print communication and telephone motivational interviewing on multiple health behaviors

Abstract Background A large proportion of adults fail to meet public health guidelines for physical activity as well as fruit, vegetable and fat intake. Interventions are needed to improve these health behaviors. Both computer tailoring and motivational interviewing have shown themselves to be promising techniques for health behavior change. The Vitalum project aims to compare the efficacy of these techniques in improving the health behaviors of adults aged 45–70. This paper describes the design of the Vitalum study. Methods/Design Dutch general medical practices (N = 23) were recruited via a registration network or by personal invitation. The participants were then enrolled through these general practices using an invitational letter. They (n = 2,881) received a written baseline questionnaire to assess health behaviors, and potential psychosocial and socio-demographic behavioral determinants. A power analysis indicated that 1,600 participants who were failing to meet the guidelines for physical activity and either fruit or vegetable consumption were needed. Eligible participants were stratified based on hypertension status and randomized into one of four intervention groups: tailored print communication, telephone motivational interviewing, combined, and control. The first two groups either received four letters or took part in four interviews, whereas the combined group received two letters and took part in two interviews in turns at 5, 13, 30 and 43 weeks after returning the baseline questionnaire. Each letter and interview focused on physical activity or nutrition behavior. The participants also took part in a telephone survey 25 weeks after baseline to gather new information for tailoring. There were two follow-up questionnaires, at 47 and 73 weeks after baseline, to measure short- and long-term effects. The control group received a tailored letter after the last posttest. The process, efficacy and cost-effectiveness of the interventions will be examined by means of multilevel mixed regression, cost-effectiveness analyses and process evaluation. Discussion The Vitalum study simultaneously evaluates the efficacy of tailored print communication and telephone motivational interviewing, and their combined use for multiple behaviors and people with different motivational stages and education levels. The results can be used by policymakers to contribute to evidence-based prevention of chronic diseases. Trial Registration Dutch Trial Register NTR1068http://deepblue.lib.umich.edu/bitstream/2027.42/112919/1/12889_2008_Article_1186.pd

Effectiveness of the Assessment of Burden of Chronic Obstructive Pulmonary Disease (ABC) tool: Study protocol of a cluster randomised trial in primary and secondary care

Abstract Background Chronic Obstructive Pulmonary Disease (COPD) is a growing worldwide problem that imposes a great burden on the daily life of patients. Since there is no cure, the goal of treating COPD is to maintain or improve quality of life. We have developed a new tool, the Assessment of Burden of COPD (ABC) tool, to assess and visualize the integrated health status of patients with COPD, and to provide patients and healthcare providers with a treatment algorithm. This tool may be used during consultations to monitor the burden of COPD and to adjust treatment if necessary. The aim of the current study is to analyse the effectiveness of the ABC tool compared with usual care on health related quality of life among COPD patients over a period of 18 months. Methods/Design A cluster randomised controlled trial will be conducted in COPD patients in both primary and secondary care throughout the Netherlands. An intervention group, receiving care based on the ABC tool, will be compared with a control group receiving usual care. The primary outcome will be the change in score on a disease-specific-quality-of-life questionnaire, the Saint George Respiratory Questionnaire. Secondary outcomes will be a different questionnaire (the COPD Assessment Test), lung function and number of exacerbations. During the 18 months follow-up, seven measurements will be conducted, including a baseline and final measurement. Patients will receive questionnaires to be completed at home. Additional data, such as number of exacerbations, will be recorded by the patients’ healthcare providers. A total of 360 patients will be recruited by 40 general practitioners and 20 pulmonologists. Additionally, a process evaluation will be performed among patients and healthcare providers. Discussion The new ABC tool complies with the 2014 Global Initiative for Chronic Obstructive Lung Disease guidelines, which describe the necessity to classify patients on both their airway obstruction and a comprehensive symptom assessment. It has been developed to classify patients, but also to provide visual insight into the burden of COPD and to provide treatment advice. Trial registration Netherlands Trial Register, NTR3788

Tailored Print Communication and Telephone Motivational Interviewing Are Equally Successful in Improving Multiple Lifestyle Behaviors in a Randomized Controlled Trial

Background: Computer tailoring and motivational interviewing show promise in promoting lifestyle change, despite few head-to-head comparative studies. Purpose: Vitalum is a randomized controlled trial in which the efficacy of these methods was compared in changing physical activity and fruit and vegetable consumption in middle-aged Dutch adults. Methods: Participants (n?=?1,629) were recruited via 23 general practices and randomly received either four tailored print letters, four motivational telephone calls, two of each type of intervention, or no information. The primary outcomes were absolute change in self-reported physical activity and fruit and vegetable consumption. Results: All three intervention groups (i.e., the tailored letters, the motivational calls, and the combined version) were equally and significantly more effective than the control group in increasing physical activity (hours/day), intake of fruit (servings/day), and consumption of vegetables (grams/day) from baseline to the intermediate measurement (week 25), follow-up 1 (week 47) and 2 (week 73). Effect sizes (Cohen's d) ranged from 0.15 to 0.18. Participants rated the interventions positively; interviews were more positively evaluated than letters. Conclusions: Tailored print communication and telephone motivational interviewing or their combination are equally successful in changing multiple behaviors. © 2010 The Author(s)

Efficient treatment allocation in two-way nested designs

The usual treatment allocation in randomized trials and their factorial and nested extensions is balanced, that is, with equal sample size in each treatment arm. This is optimal only when the variances and study costs are the same in both treatment arms, or when the ratio of treatment-specific variances is equal to the ratio of treatment-specific costs. Focusing on 2x2 cluster randomized trials with a quantitative outcome, this entry shows the effects of heterogeneity of variance and costs on the optimal treatment allocation. Essentially, that allocation assigns a larger part of the sample to the treatment arm with the larger variance and the lower costs. Since outcome variances are unknown in the design stage of a trial, references are given to robust design