The impact of technology systems and level of support in digital mental health interventions: a secondary meta-analysis

BACKGROUND

The majority of people with a chronic disease (e.g., diabetes, hypertension, COPD) have more than one concurrent condition and are also at higher risk for developing comorbidities in mental health, including anxiety and depression. There is an urgent need for more relevant and accurate data on digital interventions in this area to prepare for an increase demand for mental health services. The aim of this study was to conduct a meta-analysis of the digital mental health interventions for people with comorbid physical and mental chronic diseases to compare the effect of technology systems and level of support.

METHODS

This secondary meta-analysis follows a rapid review of systematic reviews, a virtual workshop with knowledge users to identify research questions and a modified Delphi study to guide research methods: What types of digital health interventions (according to a recognized categorization) are the most effective for the management of concomitant mental health and chronic disease conditions in adults? We conducted a secondary analysis of the primary studies identified in the rapid review. Two reviewers independently screened the titles and abstracts and applied inclusion criteria: RCT design using a digital mental health intervention in a population of adults with another chronic condition, published after 2010 in French or English, and including an outcome measurement of anxiety or depression.

RESULTS

Seven hundred eight primary studies were extracted from the systematic reviews and 84 primary studies met the inclusion criteria Digital mental health interventions were significantly more effective than in-person care for both anxiety and depression outcomes. Online messaging was the most effective technology to improve anxiety and depression scores; however, all technology types were effective. Interventions partially supported by healthcare professionals were more effective than self-administered.

CONCLUSIONS

While our meta-analysis identifies digital intervention's characteristics are associated with better effectiveness, all technologies and levels of support could be used considering implementation context and population.

TRIAL REGISTRATION

The protocol for this review is registered in the National Collaborating Centre for Methods and Tools (NCCMT) COVID-19 Rapid Evidence Service (ID 75).

Digital health interventions for the management of mental health in people with chronic diseases: a rapid review

OBJECTIVE

Determine the effectiveness of digital mental health interventions for individuals with a concomitant chronic disease.

DESIGN

We conducted a rapid review of systematic reviews. Two reviewers independently conducted study selection and risk of bias evaluation. A standardised extraction form was used. Data are reported narratively.

INTERVENTIONS

We included systematic reviews of digital health interventions aiming to prevent, detect or manage mental health problems in individuals with a pre-existing chronic disease, including chronic mental health illnesses, published in 2010 or after.

MAIN OUTCOME MEASURE

Reports on mental health outcomes (eg, anxiety symptoms and depression symptoms).

RESULTS

We included 35 reviews, totalling 702 primary studies with a total sample of 50 692 participants. We structured the results in four population clusters: (1) chronic diseases, (2) cancer, (3) mental health and (4) children and youth. For populations presenting a chronic disease or cancer, health provider directed digital interventions (eg, web-based consultation, internet cognitive-behavioural therapy) are effective and safe. Further analyses are required in order to provide stronger recommendations regarding relevance for specific population (such as children and youth). Web-based interventions and email were the modes of administration that had the most reports of improvement. Virtual reality, smartphone applications and patient portal had limited reports of improvement.

CONCLUSIONS

Digital technologies could be used to prevent and manage mental health problems in people living with chronic conditions, with consideration for the age group and type of technology used.

User-Centered Design for Promoting Patient Engagement in Chronic Diseases Management: The Development of CONCERTO

Multimorbidity increases care needs among people with chronic diseases. In order to support communication between patients, their informal caregivers and their healthcare teams, we developed CONCERTO+, a patient portal for chronic disease management in primary care. A user-centered design comprising 3 iterations with patients and informal caregivers was performed. Clinicians were also invited to provide feedback on the feasibility of the solution. Several improvements were brought to CONCERTO+, and it is now ready to be implemented in real-life setting.

Optimising patient active role with a user-centred eHealth platform (CONCERTO+) in chronic diseases management: a study protocol for a pilot cluster randomised controlled trial

INTRODUCTION

Multimorbidity increases care needs and primary care use among people with chronic diseases. The Concerto Health Program (CHP) has been developed to optimise chronic disease management in primary care services. However, in its current version, the CHP primarily targets clinicians and does not aim to answer directly patients' and their informal caregivers' needs for chronic disease management. Various studies have shown that interventions that increase patient activation level are associated with better health outcomes. Furthermore, educational tools must be adapted to patients and caregivers in terms of health literacy and usability. This project aims to develop, implement and evaluate a user-centred, multifunctional and personalised eHealth platform (CONCERTO+) to promote a more active patient role in chronic disease management and decision-making.

METHODS AND ANALYSIS

This project uses a collaborative research approach, aiming at the personalisation of CHP through three phases: (1) the development of one module of an eHealth platform based on scientific evidence and user-centred design; (2) a feasibility study of CONCERTO+ through a pilot cluster randomised controlled trial where patients with chronic diseases from a primary healthcare practice will receive CONCERTO+ during 6 months and be compared to patients from a control practice receiving usual care and (3) an analysis of CONCERTO+ potential for scaling up. To do so, we will conduct two focus groups with patients and informal caregivers and individual interviews with health professionals at the two study sites, as well as health care managers, information officers and representatives of the Ministry of Health.

ETHICS AND DISSEMINATION

This study received ethical approval from Ethics Committee of Université Laval. The findings will be used to inform the effectiveness of CONCERTO+ to improve management care in chronic diseases. We will disseminate findings through presentations in scientific conferences and publication in peer-reviewed journals.

TRIAL REGISTRATION NUMBER

NCT03628963; Pre-results.

Comparative effectiveness and safety of antipsychotic drugs in schizophrenia treatment: a real-world observational study

OBJECTIVE

The objective was to compare, in a real-world setting, the risk of mental and physical health events associated with different antipsychotic drugs (clozapine, olanzapine, risperidone, quetiapine and first-generation antipsychotics) in patients with SZ.

METHODS

This is a retrospective cohort study using administrative data. Outcome measures included any mental health event (suicide, hospitalization or emergency visit for mental disorders) and physical health event (death other than suicide, hospitalization or emergency visit for physical disorders). Cox proportional hazard models were used to estimate the hazard ratios of the events associated with the use of the different antipsychotic drugs.

RESULTS

The cohort included 18 869 adult patients living in the province of Quebec (Canada) with SZ and starting antipsychotic drugs between January 1998 and December 2005. Results show that quetiapine and not using any antipsychotics were associated with an increased risk of mental and physical health events as compared to other drugs. The second finding is the confirmation of better performance of clozapine. The results were robust across sensitivity analyses.

CONCLUSION

Both findings call for an international public health and drug agencies surveillance of 'real-world' antipsychotic medication to ensure the optimal choices in treatment guidelines for SZ.

Spontaneous recovery of hindlimb movement in completely spinal cord transected mice: a comparison of assessment methods and conditions

STUDY DESIGN

To compare results obtained with a variety of locomotor rating scales in Th9/10 spinal cord transected (Tx) mice.

OBJECTIVES

To assess spontaneous recovery with a variety of rating scales to find the most sensitive methods for assessing recovery levels in Tx mice and differences associated with gender and condition.

SETTING

Laval University Medical Center, Neuroscience Unit & Laval University, Department of Anatomy and Physiology, Quebec City, Quebec, Canada.

METHODS

Scales including the Basso, Beattie and Bresnahan (BBB), the Basso Mouse Score (BMS), the Antri, Orsal and Barthe (AOB), the Motor Function Score (MFS) and the Averaged Combined Score (ACOS) were used to assess, in open-field and treadmill conditions, spontaneous locomotor recovery in male and female Tx mice.

RESULTS

The ACOS scale revealed a progressive increase of spontaneous recovery during 5-weeks post-Tx. The other methods detected a progressive increase for the first 2-3 weeks post-Tx without any significant progress in weeks 4 and 5. Generally, scores obtained with each method were nonsignificantly different between males and females or between open-field and treadmill conditions.

CONCLUSION

These results further confirm the existence of a limited but significant increase of locomotor function recovery, occurring without intervention, in Tx animals. Although each method could detect small levels of recovery, the ACOS method was discriminative enough to detect progressive changes up to 5 weeks post-Tx. In conclusion, the ACOS rating scale was the most discriminative method for assessing the spontaneous return of hindlimb movements found in Tx mice, both in open-field and treadmill conditions.

Neuronal injuries induced by perinatal hypoxic-ischemic insults are potentiated by prenatal exposure to lipopolysaccharide: animal model for perinatally acquired encephalopathy

We developed an original rat model for neonatal brain lesions whereby we explored the sequential effects of infectious and hypoxic-ischemic aggressions. We investigated the influence of combined exposure to prenatal infection with neonatal hypoxic-ischemic insult. Infectious effect was produced by administrating lipopolysaccharide (LPS) intraperitoneally to pregnant rats starting on embryonic day 17. Hypoxia-ischemia (H/I) was induced in the pups at postnatal day 1 (P1) by ligature of the right common carotid artery followed by exposure to hypoxia (8% O(2)) for 3.5 h. Animals were randomized into four groups: (1) control group: pups born to mothers subjected to intraperitoneal saline injection; (2) LPS group: pups exposed in utero to LPS; (3) H/I group: pups exposed to postnatal hypoxia after ligation of the right carotid artery, and (4) H/I plus LPS group: in utero exposure to LPS followed by postnatal hypoxia after ligation of the right carotid artery. Neuropathological findings in pups examined at P3 and P8 showed that groups 2, 3, and 4 presented a pattern of neuronal injury similar to those characterized as 'selective neuronal necrosis' within the context of human perinatal encephalopathy. Neuronal cellular injuries were particularly seen in the neocortex, mainly in parasagittal areas. The extent of neuronal cell injury in the brain of rats exposed to postnatal H/I was significantly increased by antenatal exposure to LPS. This animal model provides an experimental means to explore the respective roles of anoxic and infectious components in the pathogenesis of perinatal brain lesions and consequent cerebral palsy.

Anticipatory co-articulation in the speech of young normal and hearing-impaired French Canadians

The anticipatory co-articulation in the speech of a group of 10 normal young French Canadians (5 boys, 5 girls) was compared to that found in age-matched groups of 10 moderately hearing-impaired and 10 profoundly hearing-impaired French Canadians. The speech stimuli were the syllables /ti/, /tu/, /ki/, and /ku/, elicited five times each in random order. Acoustic evidence (F2 and centroid frequency measures) of co-articulation was found for all groups; however, the degree of co-articulation was smaller and less consistent across consonants for the two hearing-impaired groups. In particular, the moderately hearing-impaired subjects exhibited a reversal of the expected pattern for [ki] and [ku] stimuli; the profoundly hearing-impaired subjects did not produce sufficient [ki] and [ku] stimuli to measure co-articulatory effects reliably. In general, the profoundly hearing-impaired subjects exhibited the smallest acoustic changes as a result of the vocalic influence on the preceding consonant. Results are considered in relation to theories of speech production deficits in hearing-impaired speakers.

Spectral characteristics for place of articulation in the speech of young normal, moderately and profoundly hearing-impaired French Canadians

A group of 10 moderately hearing-impaired children aged 7-10 years (five boys, five girls), 10 profoundly hearing-impaired children (five boys, five girls), and 10 age-matched normal control subjects (five boys, five girls), were recorded producing the six occlusives / p t k b d g / before the vowel /a/. Five productions were elicited from each child for a total of 30 potential correct productions each. LPC spectral analyses were performed at the moment of release (the burst) to determine the degree to which Blumstein and Stevens' (1979) spectral place-of-articulation features were present in the speech of these normal and hearing-impaired children, and whether there were differences between groups. A static 'centroid' analysis was also performed. Results reveal that the moderately hearing-impaired children's productions were not significantly different from those of the normal controls, but that some aspects of the profoundly hearing-impaired children's productions did differ from those of the moderately hearing-impaired and normal children. The relationship between degree of hearing loss and severity of speech production deficits is discussed. Implications of the results for remediation are also considered.

[Recurrent nasal polyposis and vidian neurectomy - preliminary report]

A short anatomical and physiological review of the vidian nerve is presented. The authors have described the surgical technique they use which is somewhat similar to the one described by Nomura. Eight cases are presented which had been unsuccessfully treated by multiple radical nasal polypectomies. The results are comparable to those published in the literature and it appears that vidian neurectomy has merit in the treatment of recurrent nasal polyposis but must be used in association with radical polypectomy.

Aminoglycoside antibiotic measurement by bioluminescence, with use of plasmid-coded enzymes

We describe a bioluminescent assay for gentamicin in serum that is applicable to the measurement of other aminoglycosides as well. The assay is based on the measurement of residual ATP with the luciferase reaction after incubation of the antibiotic with a plasmid-coded enzyme. Two aminoglycoside-inactivating enzymes were used: an adenylytransferase and an acetyltransferase coupled to S-acetyl coenzymeA synthetase. We investigated the latter system further because of the good stability of the acetyltransferase, its recovery in high yield from bacteria, and its more favorable ATP/gentamicin mass ratio. Serum ATPases were inactivated at 60 degrees C for 20 min. The operating range of the assay was 0-15 mg of gentamicin per liter. The precision (CV) was 10.1% at a concentration of 2 mg/L and 1.1% at 10 mg/L. The method correlated well with a radio-enzymatic assay for mock unknown sera (r = 0.981). The results were available within 2 h.