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Motl RW, Russell DI, Pilutti LA, Metse AP, Marck CH, Chan B, Zheng P, Learmonth YC. Drop-out, adherence, and compliance in randomized controlled trials of exercise training in multiple sclerosis: Short report. Mult Scler 2024; 30:605-611. [PMID: 38333909 DOI: 10.1177/13524585241229332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
We documented reporting and rates of drop-out, adherence, and compliance from 40 randomized controlled trials (RCTs) included in our meta-analysis on safety of exercise training (ET) in MS. We adopted definitions and metrics of adherence and compliance provided by the MoXFo adherence group. Drop-out was reported in 100% of the RCTs and approximated 10% for intervention and control conditions. Adherence and compliance were reported in approximately 50% and 10% of the RCTs, respectively, and approximated 80% and 70%, respectively. Standardized metrics for reporting adherence and compliance are important in future RCTs for understanding the impact on outcomes and translation of research evidence into practice.
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Affiliation(s)
- Robert W Motl
- Department of Kinesiology and Nutrition, University of Illinois Chicago, Chicago, IL, USA
| | - Daniel I Russell
- School of Psychology, Murdoch University, Murdoch, WA, Australia
| | - Lara A Pilutti
- Interdisciplinary School of Health Sciences, Brain and Mind Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Alexandra P Metse
- Discipline of Psychology, School of Health, University of the Sunshine Coast, Sippy Downs, QLD, Australia
- School of Psychological Sciences, College of Engineering, Science and Environment, The University of Newcastle, Callaghan, NSW, Australia
| | - Claudia H Marck
- Disability and Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Bryan Chan
- Murdoch University Library, Murdoch, WA, Australia
- Discipline of Libraries, Archives, Records and Information Science, School of Media, Creative Arts and Social Inquiry, Faculty of Humanities, Curtin University, Perth, WA, Australia
| | - Peixuan Zheng
- Department of Kinesiology and Nutrition, University of Illinois Chicago, Chicago, IL, USA
| | - Yvonne C Learmonth
- School of Allied Health (Exercise Science), Murdoch University, Murdoch, WA, Australia; Perron Institute for Neurological and Translational Science, Perth, WA, Australia
- Centre for Molecular Medicine and Innovative Therapeutics, Health Futures Institute, Murdoch University, Murdoch, WA, Australia
- Centre for Healthy Ageing, Health Futures Institute, Murdoch University, Murdoch, WA, Australia
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Learmonth YC, P Herring M, Russell DI, Pilutti LA, Day S, Marck CH, Chan B, Metse AP, Motl RW. Safety of exercise training in multiple sclerosis: An updated systematic review and meta-analysis. Mult Scler 2023; 29:1604-1631. [PMID: 37880997 PMCID: PMC10637110 DOI: 10.1177/13524585231204459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 05/25/2023] [Accepted: 06/18/2023] [Indexed: 10/27/2023]
Abstract
BACKGROUND A review of the safety profile of exercise training in multiple sclerosis (MS) has not been conducted since 2013. OBJECTIVE We undertook a systematic review and meta-analysis of randomised controlled trials (RCTs) of exercise training published since 2013 and quantified estimated population risks of clinical relapse, adverse events (AE) and serious adverse event (SAE). METHODS Articles reporting safety outcomes from comparisons of exercise training with non-exercise among persons with MS were identified. The risk of bias was established from study's internal validity assessed using Physiotherapy Evidence Database (PEDro). Rates and estimated mean population relative risks (RRs; 95% confidence interval (CI)) of safety outcomes were calculated, and random-effects meta-analysis estimated the mean RR. RESULTS Forty-six interventions from 40 RCTs (N = 1780) yielded 46, 40 and 39 effects for relapse, AE, adverse effects and SAE, respectively. The mean population RRs ((95% CI), p-value) for relapse, AE and SAE were 0.95 ((0.61, 1.48), p = 0.82), 1.40 ((0.90, 2.19), p = 0.14) and 1.05 ((0.62, 1.80), p = 0.85), respectively. No significant heterogeneity is observed for any outcome. CONCLUSION In studies that reported safety outcomes, there was no higher risk of relapse, AE, adverse effects or SAE for exercise training than the comparator. Exercise training may be promoted as safe and beneficial to persons with MS.
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Affiliation(s)
- Yvonne C Learmonth
- School of Allied Health (Exercise Science), Murdoch University, Murdoch, WA, Australia
- Perron Institute for Neurological and Translational Science, Perth, WA, Australia
- Centre for Molecular Medicine and Innovative Therapeutics, Health Futures Institute, Murdoch University, Murdoch, WA, Australia
- Centre for Healthy Ageing, Health Futures Institute, Murdoch University, Murdoch, WA, Australia
| | - Matthew P Herring
- Physical Activity for Health Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
- Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland
| | - Daniel I Russell
- Discipline of Psychology, Murdoch University, Murdoch, WA, Australia
| | - Lara A Pilutti
- Interdisciplinary School of Health Sciences, Brain and Mind Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Sandra Day
- Discipline of Psychology, Murdoch University, Murdoch, WA, Australia
| | - Claudia H Marck
- Disability and Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Bryan Chan
- Murdoch University Library, Murdoch, WA, Australia
- Discipline of Libraries, Archives, Records and Information Science, School of Media, Creative Arts and Social Inquiry, Faculty of Humanities, Curtin University, Perth, WA, Australia
| | - Alexandra P Metse
- Discipline of Psychology, School of Health, University of the Sunshine Coast, Sunshine Coast, QLD, Australia
- School of Psychological Sciences, College of Engineering, Science and Environment, The University of Newcastle, Australia, Newcastle, NSW, Australia
| | - Robert W Motl
- Department of Kinesiology and Nutrition, University of Illinois Chicago, Chicago, IL, USA
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Scott JJ, Vernon L, Metse AP. The International Framework for School Health Promotion: Supporting Young People Through and After the COVID-19 Pandemic. J Sch Health 2023; 93:920-929. [PMID: 37434426 DOI: 10.1111/josh.13369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 06/05/2023] [Accepted: 06/22/2023] [Indexed: 07/13/2023]
Abstract
BACKGROUND The worldwide COVID-19 government restrictions imposed on young people to limit virus spread have precipitated a growing and long-term educational and health crisis. CONTRIBUTIONS TO THE THEORY This novel study used Sen's Capabilities Approach as a theoretical framework to examine the current health and educational impacts of COVID-19 on youth, referencing emerging literature. The objective was to inform the design of an internationally relevant framework for school health promotion to support young people through and after the COVID-19 pandemic. Mapping of existing health resources, internal/external conversion factors and capabilities were used to identify classroom, school and system level strategies that will enable young people to flourish. Four central enablers were identified and used in the design of the International Framework for School Health Promotion (IFSHP). IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE AND EQUITY The IFSHP can be used by educational institutions, school leaders and teachers to innovate existing health promotion programs, policies and practices to support young people through and after the COVID-19 pandemic. CONCLUSIONS School systems, schools and teachers are encouraged to utilize the IFSHP to review and innovate existing school health programs to ensure they meet the increased physical and mental health needs of young people.
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Affiliation(s)
- Joseph J Scott
- School of Education and Tertiary Access, University of the Sunshine Coast; Sippy Downs, QLD, 4556, Australia; School of Education, Edith Cowan University, Mount Lawley, WA, 6050, Australia
| | - Lynette Vernon
- School of Education, Edith Cowan University, Mount Lawley, WA, 6050, Australia
| | - Alexandra P Metse
- School of Health, University of the Sunshine Coast, Sippy Downs, QLD 4556, Australia; School of Psychology, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
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Russell DI, Reynolds AC, Appleton SL, Adams RJ, Correia H, Bowman JA, Gill TK, Metse AP. Use of Insomnia Treatments and Discussions About Sleep with Health Professionals Among Australian Adults with Mental Health Conditions. Nat Sci Sleep 2023; 15:623-637. [PMID: 37577358 PMCID: PMC10417743 DOI: 10.2147/nss.s412468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 07/20/2023] [Indexed: 08/15/2023] Open
Abstract
Background Insomnia is a common issue among individuals with mental health conditions, yet the frequency of insomnia treatment remains unclear. The purpose of this study was to investigate the prevalence of probable insomnia, discussions regarding sleep with health professionals, and the utilisation of commonly delivered insomnia treatments in Australian adults diagnosed with mental health conditions. Methods This study represents a secondary analysis of data collected through a cross-sectional, national online survey conducted in 2019. A subset included participants (n = 624, age 18-85y) who self-reported a diagnosis of depression, bipolar disorder, anxiety, panic disorder, or post-traumatic stress disorder. Participants were classed as having probable insomnia based on self-reported symptoms and a minimum availability of 7.5 hours in bed. Results Among individuals with probable insomnia (n = 296, 47.4%), 64.5% (n = 191) reported discussing sleep with one or more health professionals, predominantly with general practitioners (n = 160, 83.8%). However, 35.4% (n = 105) of people with probable insomnia had not discussed their sleep with a health professional. Additionally, 35.1% (n = 104) used prescribed medication for sleep, while only 15.9% (n = 47) had used the first line recommended treatment of cognitive-behavioral therapy for insomnia in the last 12 months. Conclusion Although most participants who met the criteria for probable insomnia had engaged in discussions about sleep with health professionals, utilisation of first line recommended treatment was low. Interventions that promote routine assessment of sleep and first line treatment for insomnia by health professionals would likely benefit people with mental health conditions.
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Affiliation(s)
- Daniel I Russell
- College of Science, Health, Engineering and Education (SHEE), Murdoch University, Murdoch, Western Australia, 6150, Australia
| | - Amy C Reynolds
- Flinders Health and Medical Research Institute (Sleep Health), College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Sarah L Appleton
- Flinders Health and Medical Research Institute (Sleep Health), College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
- The Freemasons Centre for Male Health & Wellbeing, The University of Adelaide, Adelaide, South Australia, 5005, Australia
| | - Robert J Adams
- Flinders Health and Medical Research Institute (Sleep Health), College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
- The Freemasons Centre for Male Health & Wellbeing, The University of Adelaide, Adelaide, South Australia, 5005, Australia
| | - Helen Correia
- Psychological Sciences, Australian College of Applied Professions Perth, Northbridge, Western Australia, 6003, Australia
| | - Jenny A Bowman
- School of Psychological Sciences, University of Newcastle, Callaghan, New South Wales, 2308, Australia
- Hunter Medical Research Institute (HMRI), New Lambton Heights, NSW, 2305, Australia
| | - Tiffany K Gill
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, 5005, Australia
| | - Alexandra P Metse
- School of Psychological Sciences, University of Newcastle, Callaghan, New South Wales, 2308, Australia
- Hunter Medical Research Institute (HMRI), New Lambton Heights, NSW, 2305, Australia
- School of Health, University of the Sunshine Coast, Sippy Downs, Queensland, 4556, Australia
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Metse AP, Eastwood P, Ree M, Lopresti A, Scott JJ, Bowman J. Sleep health of young adults in Western Australia and associations with physical and mental health: A population-level cross-sectional study. Aust N Z J Public Health 2023; 47:100070. [PMID: 37474415 DOI: 10.1016/j.anzjph.2023.100070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 05/09/2023] [Accepted: 05/19/2023] [Indexed: 07/22/2023] Open
Abstract
OBJECTIVES This article aims to report on the sleep health characteristics of a population-level sample of young Australian adults and examine associations with measures of physical and mental health. METHODS A cross-sectional study using data from the Raine Study. Data from participants (n = 1234) born into the study (Generation 2) at the 22-year follow-up were used, including data from a self-report questionnaire and polysomnography. RESULTS The highest prevalence of suboptimal sleep health was seen on measures of sleep duration (30%), onset latency (18%), satisfaction (25%) and regularity (60%). Dissatisfaction with sleep (physical health: β =0.08; mental health: β =0.34) and impaired daytime alertness (physical health: β =0.09; mental health: β =0.08) were significantly associated with poorer physical and mental health and inadequate polysomnography-measured sleep duration was associated poorer mental health (β =0.07) (all ps<0.05). CONCLUSIONS Satisfaction with sleep and daytime alertness, both of which are assessed via self-report, are essential aspects of sleep health for young adults. IMPLICATIONS FOR PUBLIC HEALTH Findings could inform public health interventions, including screening guidelines, to improve the sleep health and, in turn, the physical and mental health of young adults in Australia.
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Affiliation(s)
- Alexandra P Metse
- School of Health, University of the Sunshine Coast, QLD, 4556, Australia; School of Psychological Sciences, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.
| | - Peter Eastwood
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Bedford Park, SA, 5042, Australia
| | - Melissa Ree
- School of Psychological Sciences, University of Western Australia, Crawley, WA, 6009, Australia
| | - Adrian Lopresti
- College of Health and Education, Murdoch University, Murdoch, WA, 6150, Australia
| | - Joseph J Scott
- School of Education and Tertiary Access, University of the Sunshine Coast, QLD, 4556, Australia; School of Education, Edith Cowan University, Mount Lawley, WA, 6050, Australia
| | - Jenny Bowman
- School of Psychological Sciences, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia; Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
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Treacy C, Levenstein JM, Jefferies A, Metse AP, Schaumberg MA, Villani A, Boucas AP, Hermens DF, Lagopoulos J, Andrews SC. The LEISURE Study: A Longitudinal Randomized Controlled Trial Protocol for a Multi-Modal Lifestyle Intervention Study to Reduce Dementia Risk in Healthy Older Adults. J Alzheimers Dis 2023; 94:841-856. [PMID: 37334601 DOI: 10.3233/jad-230193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2023]
Abstract
Dementia is understood to arise from a mixed etiology, enveloping chronic inflammatory and vascular impacts on the brain, driven by a constellation of modifiable risk factors which are largely mediated by lifestyle-related behaviors. These risk factors manifest over a prolonged preclinical period and account for up to 40% of the population attributable risk for dementia, representing viable targets for early interventions aimed at abating disease onset and progression. Here we outline the protocol for a 12-week randomized control trial (RCT) of a multimodal Lifestyle Intervention Study for Dementia Risk Reduction (LEISURE), with longitudinal follow-up at 6-months and 24-months post-intervention. This trial integrates exercise, diet, sleep, and mindfulness to simultaneously target multiple different etiopathogenetic mechanisms and their interplay in a healthy older adult population (aged 50-85 years), and assesses dementia risk reduction as the primary endpoint. The LEISURE study is located in the Sunshine Coast region of Australia, which has one of the nation's highest proportions of adults aged over 50 years (36.4%), and corresponding dementia prevalence. This trial is novel in its inclusion of mindfulness and sleep as multidomain lifestyle targets, and in its comprehensive suite of secondary outcomes (based on psychological, physical health, sleep activity, and cognitive data) as well as exploratory neuroimaging (magnetic resonance imaging and electroencephalography) and molecular biology measures. These measures will provide greater insights into the brain-behavioral underpinnings of dementia prevention, as well as the predictors and impacts of the proposed lifestyle intervention. The LEISURE study was prospectively registered (ACTRN12620000054910) on 19 January 2020.
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Affiliation(s)
- Ciara Treacy
- Thompson Institute, University of the Sunshine Coast, Maroochydore DC, QLD, Australia
| | - Jacob M Levenstein
- Thompson Institute, University of the Sunshine Coast, Maroochydore DC, QLD, Australia
| | - Annelise Jefferies
- Thompson Institute, University of the Sunshine Coast, Maroochydore DC, QLD, Australia
| | - Alexandra P Metse
- School of Health, University of the Sunshine Coast, Maroochydore DC, QLD, Australia
- School of Psychological Sciences, University of Newcastle, University Drive, Callaghan, NSW, Australia
| | - Mia A Schaumberg
- School of Health, University of the Sunshine Coast, Maroochydore DC, QLD, Australia
- School of Human Movement and Nutrition Sciences, The University of Queensland, St Lucia, QLD, Australia
- Sunshine Coast Health Institute, Sunshine Coast Hospital and Health Service, Birtinya, QLD, Australia
- Manna Institute, University of the Sunshine Coast, QLD, Australia
| | - Anthony Villani
- School of Health, University of the Sunshine Coast, Maroochydore DC, QLD, Australia
| | - Ana P Boucas
- Thompson Institute, University of the Sunshine Coast, Maroochydore DC, QLD, Australia
| | - Daniel F Hermens
- Thompson Institute, University of the Sunshine Coast, Maroochydore DC, QLD, Australia
| | - Jim Lagopoulos
- Thompson Institute, University of the Sunshine Coast, Maroochydore DC, QLD, Australia
| | - Sophie C Andrews
- Thompson Institute, University of the Sunshine Coast, Maroochydore DC, QLD, Australia
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Lopresti AL, Smith SJ, Metse AP, Drummond PD. A randomized, double-blind, placebo-controlled trial investigating the effects of an Ocimum tenuiflorum (Holy Basil) extract (HolixerTM) on stress, mood, and sleep in adults experiencing stress. Front Nutr 2022; 9:965130. [PMID: 36185698 PMCID: PMC9524226 DOI: 10.3389/fnut.2022.965130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 08/18/2022] [Indexed: 11/18/2022] Open
Abstract
Background In Ayurveda, Ocimum tenuiflorum (Holy Basil) is referred to as “the elixir of life” and is believed to promote longevity and general wellbeing. Although limited, there are clinical trials to suggest Ocimum tenuiflorum has anti-stress effects. Purpose Examine the effects of a standardized Ocimum tenuiflorum extract (HolixerTM) on subjective and objective measures of stress and sleep quality in adults experiencing stress. Study design Two-arm, parallel-group, 8-week, randomized, double-blind, placebo-controlled trial. Australian and New Zealand Clinical Trials Registry trial registration number ACTRN12621000609853. Methods One hundred volunteers aged 18–65 years received either 125 mg of Ocimum tenuiflorum twice daily or a placebo. Outcome measures included the Perceived Stress Scale (PSS) (primary outcome measure), Profile of Mood States, Athens Insomnia Scale (AIS), Restorative Sleep Questionnaire, and the Patient-Reported Outcomes Measurement Information System-29. Sleep quality was also assessed using a wrist-worn sleep tracker (Fitbit), and stress changes were examined by measuring between-group differences in hair cortisol and stress responses after exposure to an experiment stress procedure known as the Maastricht Acute Stress Test (MAST). Results Compared to the placebo, Ocimum tenuiflorum supplementation was associated with greater improvements in PSS (p = 0.003) and AIS (p = 0.025) scores; and at week 8, concentrations in hair cortisol were also lower (p = 0.025). Moreover, Ocimum tenuiflorum supplementation was associated with a buffered stress responses after exposure to the MAST as demonstrated by significantly lower concentrations in salivary cortisol (p = 0.001), salivary amylase (p = 0.001), systolic (p = 0.010) and diastolic (p = 0.025) blood pressure, and subjective stress ratings (p < 0.001). Ocimum tenuiflorum supplementation was well-tolerated with no reports of major adverse effects. Conclusion The results from this trial suggest that 8 weeks of supplementation with an Ocimum tenuiflorum extract (HolixerTM) may reduce objective and subjective measures of stress, and improve subjective measures of sleep quality. However, further research using gold-standard objective sleep measures will be required to substantiate the sleep-related findings. Clinical trial registration https://www.anzctr.org.au/ACTRN12621000609853p.aspx, identifier: ACTRN12621000609853p.
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Affiliation(s)
- Adrian L. Lopresti
- Clinical Research Australia, Perth, WA, Australia
- Healthy Ageing Research Centre and Discipline of Psychology, College of Science, Health, Engineering and Education, Murdoch University, Perth, WA, Australia
- *Correspondence: Adrian L. Lopresti
| | - Stephen J. Smith
- Clinical Research Australia, Perth, WA, Australia
- Healthy Ageing Research Centre and Discipline of Psychology, College of Science, Health, Engineering and Education, Murdoch University, Perth, WA, Australia
| | - Alexandra P. Metse
- School of Health and Behavioural Sciences, University of the Sunshine Coast, Sippy Downs, QLD, Australia
- School of Psychology, University of Newcastle, University Drive, Callaghan, NSW, Australia
| | - Peter D. Drummond
- Healthy Ageing Research Centre and Discipline of Psychology, College of Science, Health, Engineering and Education, Murdoch University, Perth, WA, Australia
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Learmonth YC, Pilutti LA, Herring MP, Motl RW, Chan B, Metse AP. Safety of exercise training in multiple sclerosis: a protocol for an updated systematic review and meta-analysis. Syst Rev 2021; 10:208. [PMID: 34284811 PMCID: PMC8293520 DOI: 10.1186/s13643-021-01751-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 06/23/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There has been an exponential growth in the number of clinical research studies regarding exercise training in multiple sclerosis, and literature reviews and meta-analyses have documented the many benefits of exercise training. This research further requires careful review for documenting the safety of exercise training in multiple sclerosis, as clarity on safety represents a major hurdle in the clinical prescription of exercise behaviour. OBJECTIVES To enhance understanding of the feasibility of exercise in multiple sclerosis, we (1) provide a protocol of a systematic review and meta-analysis that summarises rates and risks of clinical relapse, adverse events (i.e., an unfavourable outcome that occurs during the intervention delivery time period), and serious adverse events (i.e., an untoward occurrence that results in death or is life threatening, requires hospitalisation, or results in disability during the intervention delivery time period), as well as retention, adherence, and compliance, from randomised controlled trials of exercise training in persons with multiple sclerosis; and (2) identify moderators of relapse, adverse events, and serious adverse event rates. METHODS Eight field-relevant databases will be searched electronically. Studies that involve a randomised controlled trial of exercise training (with non-exercise, non-pharmacological, comparator), report on safety outcomes, and include adults with multiple sclerosis will be included. Rates and relative risks of the three primary outcomes (relapse, adverse event, and serious adverse event) will be calculated and reported each with standard error and 95% confidence interval. Random-effects meta-analysis will estimate mean population relative risk for outcomes. Potential sources of variability, including participant characteristics, features of the exercise stimulus, and comparison condition, will be examined with random-effects meta-regression with maximum likelihood estimation. DISCUSSION The results from this systematic review and meta-analysis will inform and guide healthcare practitioners, researchers, and policymakers on the safety of exercise training in persons with multiple sclerosis. Where possible, we will identify the impact of exercise type, exercise delivery style, participant disability level, and the prescription of exercise guidelines, on the safety of exercise training. The result will identify critical information on the safety of exercise in persons with multiple sclerosis, while also identifying gaps in research and setting priorities for future enquiries. SYSTEMATIC REVIEW REGISTRATION PROSPERO 2020 CRD42020190544.
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Affiliation(s)
- Y C Learmonth
- Discipline of Exercise Science, Murdoch University, Murdoch, WA, Australia. .,Perron Institute for Neurological and Translational Science, Perth, WA, Australia. .,Centre for Molecular Medicine and Innovative Therapeutics, Health Futures Institute, Murdoch University, Murdoch, WA, Australia. .,Centre for Healthy Ageing, Health Futures Institute, Murdoch University, Murdoch, WA, Australia.
| | - L A Pilutti
- Interdisciplinary School of Health Sciences, Brain and Mind Research Institute, University of Ottawa, Ottawa, Canada
| | - M P Herring
- Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland.,Physical Activity for Health Research Cluster, Health Research Institute, University of Limerick, Limerick, Ireland
| | - R W Motl
- Department of Physical Therapy, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA
| | - B Chan
- University Library, Murdoch University, Murdoch, WA, Australia
| | - A P Metse
- Discipline of Libraries, Archives, Records & Information Science, School of Media, Creative Arts & Social Inquiry, Faculty of Humanities, Curtin University, Perth, WA, Australia.,Discipline of Psychology, School of Health and Behavioural Sciences, University of the Sunshine Coast, Sippy Downs, QLD, Australia.,School of Psychology, Faculty of Science, University of Newcastle, Callaghan, NSW, Australia
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9
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Lopresti AL, Smith SJ, Metse AP, Drummond PD. Effects of saffron on sleep quality in healthy adults with self-reported poor sleep: a randomized, double-blind, placebo-controlled trial. J Clin Sleep Med 2021; 16:937-947. [PMID: 32056539 DOI: 10.5664/jcsm.8376] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
STUDY OBJECTIVES Herbal medicines are frequently used by adults with sleep difficulties. However, evidence of their efficacy is limited. Therefore, the goal of this study was to examine the sleep-enhancing effects of a standardized saffron extract (affron). METHODS This was a 28-day, parallel-group, double-blind, randomized controlled trial. Sixty-three healthy adults aged 18-70 with self-reported sleep problems were recruited and randomized to receive either saffron extract (affron; 14 mg twice daily) or a placebo. Outcome measures included the Insomnia Severity Index (ISI; primary outcome measure) collected at baseline and days 7, 14, 21, and 28 and the Restorative Sleep Questionnaire (RSQ) and the Pittsburgh Sleep Diary (PSD) collected on days -1, 0, 3, 7, 14, 27, and 28. RESULTS Based on data collected from 55 participants, saffron was associated with greater improvements in ISI total score (P = .017), RSQ total score (P = .029), and PSD sleep quality ratings (P = .014) than the placebo. Saffron intake was well tolerated with no reported adverse effects. CONCLUSIONS Saffron intake was associated with improvements in sleep quality in adults with self-reported sleep complaints. Further studies using larger samples sizes, treatment periods, objective outcome measures, and volunteers with varying demographic and psychographic characteristics are required to replicate and extend these findings. CLINICAL TRIAL REGISTRATION Registry: Australian New Zealand Clinical Trials Registry; Name: Effects of Saffron on Sleep Quality in Healthy Adults with Self-Reported Unsatisfactory Sleep; URL: https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=377781; Identifier: ACTRN12619000863134.
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Affiliation(s)
- Adrian L Lopresti
- College of Science, Health, Engineering, and Education, Murdoch University, Perth, Western Australia, Australia.,Clinical Research Australia, Perth, Western Australia, Australia
| | - Stephen J Smith
- College of Science, Health, Engineering, and Education, Murdoch University, Perth, Western Australia, Australia.,Clinical Research Australia, Perth, Western Australia, Australia
| | - Alexandra P Metse
- College of Science, Health, Engineering, and Education, Murdoch University, Perth, Western Australia, Australia
| | - Peter D Drummond
- College of Science, Health, Engineering, and Education, Murdoch University, Perth, Western Australia, Australia
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Metse AP, Fehily C, Clinton-McHarg T, Wynne O, Lawn S, Wiggers J, Bowman JA. Self-reported suboptimal sleep and receipt of sleep assessment and treatment among persons with and without a mental health condition in Australia: a cross sectional study. BMC Public Health 2021; 21:463. [PMID: 33676472 PMCID: PMC7937198 DOI: 10.1186/s12889-021-10504-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 02/25/2021] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Poor sleep and poor mental health go hand in hand and, together, can have an adverse impact on physical health. Given the already disproportionate physical health inequities experienced by people with a mental health condition worldwide, the need to consider and optimise sleep has been highlighted as a means of improving both physical and mental health status. Sleep recommendations recently developed by the United States' National Sleep Foundation incorporate a range of sleep parameters and enable the identification of 'suboptimal' sleep. Among community-dwelling persons with and without a 12-month mental health condition in Australia, this study reports: [1] the prevalence of 'suboptimal' sleep and [2] rates of sleep assessment by a health care clinician/service and receipt of and desire for sleep treatment. METHODS A descriptive study (N = 1265) was undertaken using self-report data derived from a cross-sectional telephone survey of Australian adults, undertaken in 2017. RESULTS Fifteen per cent (n = 184) of participants identified as having a mental health condition in the past 12 months. Across most (7 of 8) sleep parameters, the prevalence of suboptimal sleep was higher among people with a mental health condition, compared to those without (all p < 0.05). The highest prevalence of suboptimal sleep for both groups was seen on measures of sleep duration (36-39% and 17-20% for people with and without a mental health condition, respectively). In terms of sleep assessment and treatment, people with a mental health condition were significantly more likely to: desire treatment (37% versus 16%), have been assessed (38% versus 12%) and have received treatment (30% versus 7%). CONCLUSIONS The prevalence of suboptimal sleep among persons with a mental health condition in Australia is significantly higher than those without such a condition, and rates of assessment and treatment are low for both groups, but higher for people with a mental health condition. Population health interventions, including those delivered as part of routine health care, addressing suboptimal sleep are needed.
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Affiliation(s)
- Alexandra P. Metse
- University of Newcastle, University Drive, Callaghan, NSW 2308 Australia
- University of the Sunshine Coast, 90 South Street, Murdoch, WA 6150 Australia
- Hunter Medical Research Institute, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW 2305 Australia
- Murdoch University, 90 Sippy Downs Drive, Sippy Downs, QLD 4556 Australia
| | - Caitlin Fehily
- University of Newcastle, University Drive, Callaghan, NSW 2308 Australia
- Hunter Medical Research Institute, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW 2305 Australia
| | - Tara Clinton-McHarg
- University of Newcastle, University Drive, Callaghan, NSW 2308 Australia
- Hunter Medical Research Institute, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW 2305 Australia
| | - Olivia Wynne
- University of Newcastle, University Drive, Callaghan, NSW 2308 Australia
- Hunter Medical Research Institute, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW 2305 Australia
| | - Sharon Lawn
- Flinders University, Sturt Rd, Bedford Park, SA 5042 Australia
| | - John Wiggers
- University of Newcastle, University Drive, Callaghan, NSW 2308 Australia
- Hunter Medical Research Institute, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW 2305 Australia
- Hunter New England Population Health, Longworth Avenue, Wallsend, NSW 2287 Australia
| | - Jenny A. Bowman
- University of Newcastle, University Drive, Callaghan, NSW 2308 Australia
- Hunter Medical Research Institute, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW 2305 Australia
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11
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Lopresti AL, Smith SJ, Metse AP, Foster T, Drummond PD. The Feasibility and Efficacy of a Brief Integrative Treatment for Adults With Depression and/or Anxiety: A Randomized Controlled Trial. J Evid Based Integr Med 2020; 25:2515690X20937997. [PMID: 32638615 PMCID: PMC7359645 DOI: 10.1177/2515690x20937997] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
The aim of this study was to investigate the efficacy and suitability of a brief integrative intervention, Personalized Integrative Therapy (PI Therapy), for the treatment of adult depression and/or anxiety. In this 6-week, 3-arm, parallel-group, randomized trial, PI Therapy delivered alone or with nutritional supplements (PI Therapy + Supps) was compared to cognitive behavior therapy (CBT) in 48 adults with depression and/or anxiety. All treatments were delivered as a 1-day workshop plus 6 weeks of reminder phone text messages to reinforce topics and skills covered in the workshop. Affective symptoms decreased significantly and to the same extent in all 3 conditions. At the end of treatment, 33% to 58% of participants reported levels of depressive symptoms in the normal range, and 50% to 58% reported nonclinical levels of anxiety. Compared to CBT and PI Therapy, PI Therapy + Supps was associated with significantly greater improvements in sleep quality. These findings suggest that a brief integrative intervention with or without supplements was comparable to CBT in reducing affective symptoms in adults with depression and/or anxiety. However, sleep quality improved only in the PI Therapy + Supps condition. These findings will require replication with a larger cohort.
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Affiliation(s)
- Adrian L Lopresti
- Murdoch University, Perth, Western Australia, Australia.,Clinical Research Australia, Perth, Western Australia, Australia
| | - Stephen J Smith
- Murdoch University, Perth, Western Australia, Australia.,Clinical Research Australia, Perth, Western Australia, Australia
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12
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Bailey JM, Bartlem KM, Wiggers JH, Wye PM, Stockings EA, Hodder RK, Metse AP, Regan TW, Clancy R, Dray JA, Tremain DL, Bradley T, Bowman JA. Systematic review and meta-analysis of the provision of preventive care for modifiable chronic disease risk behaviours by mental health services. Prev Med Rep 2019; 16:100969. [PMID: 31497500 PMCID: PMC6718945 DOI: 10.1016/j.pmedr.2019.100969] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Revised: 07/05/2019] [Accepted: 08/09/2019] [Indexed: 01/10/2023] Open
Abstract
People with mental illness experience increased chronic disease burden, contributed to by a greater prevalence of modifiable chronic disease risk behaviours. Policies recommend mental health services provide preventive care for such risk behaviours. Provision of such care has not previously been synthesised. This review assessed the provision of preventive care for modifiable chronic disease risk behaviours by mental health services. Four databases were searched from 2006 to 2017. Eligible studies were observational quantitative study designs conducted in mental health services, where preventive care was provided to clients for tobacco smoking, harmful alcohol consumption, inadequate nutrition, or inadequate physical activity. Two reviewers independently screened studies, conducted data extraction and critical appraisal. Results were pooled as proportions of clients receiving or clinicians providing preventive care using random effects meta-analyses, by risk behaviour and preventive care element (ask/assess, advise, assist, arrange). Subgroup analyses were conducted by mental health service type (inpatient, outpatient, other/multiple). Narrative synthesis was used where meta-analysis was not possible. Thirty-eight studies were included with 26 amenable to meta-analyses. Analyses revealed that rates of assessment were highest for smoking (78%, 95% confidence interval [CI]:59%–96%) and lowest for nutrition (17%, 95% CI:1%–35%); with variable rates of care provision for all behaviours, care elements, and across service types, with substantial heterogeneity across analyses. Findings indicated suboptimal and variable provision of preventive care for modifiable chronic disease risk behaviours in mental health services, but should be considered with caution due to the very low quality of cumulative evidence. PROSPERO registration: CRD42016049889. First meta-analysis of chronic disease preventive care provided by mental health service settings Assessed preventive care for smoking, alcohol, nutrition, and physical activity in mental health settings Provision of preventive care varied across risk behaviours, care elements, and service types. Findings indicate suboptimal provision of preventive care for health risk behaviours.
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Affiliation(s)
- Jacqueline M. Bailey
- School of Psychology, Faculty of Science and Information Technology, The University of Newcastle, NSW, Australia
- Hunter Medical Research Institute, Clinical Research Centre, NSW, Australia
- Corresponding author at: School of Psychology, Faculty of Science and Information Technology, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia.
| | - Kate M. Bartlem
- School of Psychology, Faculty of Science and Information Technology, The University of Newcastle, NSW, Australia
- Hunter Medical Research Institute, Clinical Research Centre, NSW, Australia
- Population Health, Hunter New England Local Health District, NSW, Australia
| | - John H. Wiggers
- Hunter Medical Research Institute, Clinical Research Centre, NSW, Australia
- Population Health, Hunter New England Local Health District, NSW, Australia
- School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, NSW, Australia
| | - Paula M. Wye
- School of Psychology, Faculty of Science and Information Technology, The University of Newcastle, NSW, Australia
| | - Emily A.L. Stockings
- School of Psychology, Faculty of Science and Information Technology, The University of Newcastle, NSW, Australia
- National Drug and Alcohol Research Centre, University of New South Wales, NSW, Australia
| | - Rebecca K. Hodder
- Hunter Medical Research Institute, Clinical Research Centre, NSW, Australia
- Population Health, Hunter New England Local Health District, NSW, Australia
- School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, NSW, Australia
| | - Alexandra P. Metse
- School of Psychology, Faculty of Science and Information Technology, The University of Newcastle, NSW, Australia
- School of Psychology and Exercise Science, Murdoch University, WA, Australia
| | - Tim W. Regan
- School of Psychology, Faculty of Science and Information Technology, The University of Newcastle, NSW, Australia
| | - Richard Clancy
- School of Psychology, Faculty of Science and Information Technology, The University of Newcastle, NSW, Australia
- Hunter Medical Research Institute, Clinical Research Centre, NSW, Australia
- Hunter New England Health, Mental Health and Substance Use Service, NSW, Australia
| | - Julia A. Dray
- School of Psychology, Faculty of Science and Information Technology, The University of Newcastle, NSW, Australia
- Population Health, Hunter New England Local Health District, NSW, Australia
| | - Danika L. Tremain
- Population Health, Hunter New England Local Health District, NSW, Australia
- School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, NSW, Australia
| | - Tegan Bradley
- School of Psychology, Faculty of Science and Information Technology, The University of Newcastle, NSW, Australia
- Hunter Medical Research Institute, Clinical Research Centre, NSW, Australia
| | - Jenny A. Bowman
- School of Psychology, Faculty of Science and Information Technology, The University of Newcastle, NSW, Australia
- Hunter Medical Research Institute, Clinical Research Centre, NSW, Australia
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13
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Stockings E, Black N, Bartlem KM, Metse AP, Regan T, Bailey JM, Wolfenden L, Wiggers J, Bowman JA. Outpatient interventions for smoking cessation and reduction for adults with a mental disorder. Hippokratia 2019. [DOI: 10.1002/14651858.cd013286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Emily Stockings
- University of New South Wales; National Drug and Alcohol Research Centre (NDARC); Sydney Australia
| | - Nicola Black
- University of New South Wales; National Drug and Alcohol Research Centre (NDARC); Sydney Australia
| | - Kate M Bartlem
- University of Newcastle; School of Psychology; University Drive Callaghan New South Wales Australia 2308
| | - Alexandra P Metse
- University of Newcastle; School of Psychology; University Drive Callaghan New South Wales Australia 2308
| | - Tim Regan
- Hunter New England Local Health District; Hunter New England Population Health; Locked Bag 10 Wallsend NSW Australia 2287
| | - Jacqueline M Bailey
- University of Newcastle; School of Psychology; University Drive Callaghan New South Wales Australia 2308
| | - Luke Wolfenden
- University of Newcastle; School of Medicine and Public Health; Callaghan NSW Australia 2308
| | - John Wiggers
- Hunter New England Local Health District; Hunter New England Population Health; Locked Bag 10 Wallsend NSW Australia 2287
| | - Jennifer A Bowman
- University of Newcastle; School of Psychology; University Drive Callaghan New South Wales Australia 2308
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14
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Metse AP, Hizam NAN, Wiggers J, Wye P, Bowman JA. Factors associated with retention in a smoking cessation trial for persons with a mental illness: a descriptive study. BMC Med Res Methodol 2018; 18:177. [PMID: 30587149 PMCID: PMC6307187 DOI: 10.1186/s12874-018-0640-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 12/10/2018] [Indexed: 01/06/2023] Open
Abstract
Background Exploring factors associated with retention in randomised trials provides insight into potential threats to internal and external study validity, and may inform the development of interventions to increase retention in future trials. Given a paucity of existing research in the field, a study was conducted to explore factors associated with retention in a smoking intervention trial involving persons with a mental illness, considering demographic and smoking characteristics, treatment condition and engagement in prior follow-up assessments. Method A descriptive study was undertaken using data derived from a RCT of a smoking cessation intervention initiated in four adult psychiatric inpatient units in New South Wales (NSW), Australia. Retention assessment was undertaken at 1, 6 and 12-months post-discharge. A Generalised Linear Mixed Model was adopted to explore associations between retention at any follow up time point and demographic and smoking characteristics. Chi square analyses explored the association between retention at all follow up time points and treatment condition, and binary logistic regression analyses assessed for relationships between retention at 12-month follow up and engagement in prior follow up assessments. Results Retention rates were 63, 56 and 60% at the 1, 6 and 12-month assessments, respectively. No association was found between retention at any follow-up time point and 13 of 15 demographic and smoking characteristics. Younger participants and those who identified to be Aboriginal and/or Torres Strait Islander were more likely to be retained (both ps > 0.05). Retention rates did not vary according to treatment condition at any follow-up time point. Participants who completed a prior assessment were more likely to complete the 12 month assessment (both prior assessments: OR 10.7, p < 0.001; 6 month assessment: OR 6.01, p < 0.001; and 1 month assessment: OR 1.8, p = 0.002). Conclusion The underrepresentation of younger participants and those identifying to be Aboriginal and/or Torres Strait Islander may limit the generalisability of findings. Findings suggest that inclusion of multiple contacts during a trial follow up period may increase retention at the final assessment. Interventions to improve retention, overall and for those sub-groups less likely to be retained, in smoking trials involving persons with a mental illness are needed. Further assessment of sample characteristics, and also trial design factors, associated with retention in this field is warranted.
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Affiliation(s)
- Alexandra P Metse
- Psychology administration office, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia. .,Hunter Medical Research Institute, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia. .,Murdoch University, South Street, Murdoch, WA, 6150, Australia.
| | - Nur Ashikin Noor Hizam
- Psychology administration office, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
| | - John Wiggers
- Psychology administration office, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.,Hunter Medical Research Institute, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia.,Hunter New England Population Health, Longworth Ave, Wallsend, NSW, 2287, Australia
| | - Paula Wye
- Psychology administration office, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.,Hunter Medical Research Institute, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia
| | - Jenny A Bowman
- Psychology administration office, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.,Hunter Medical Research Institute, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia
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15
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Metse AP, Wiggers J, Wye P, Bowman JA. Patient receipt of smoking cessation care in four Australian acute psychiatric facilities. Int J Ment Health Nurs 2018; 27:1556-1563. [PMID: 29573164 PMCID: PMC6686631 DOI: 10.1111/inm.12459] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/23/2018] [Indexed: 11/29/2022]
Abstract
This study aimed to report the receipt of smoking care, and associated clinical and smoking characteristics among smokers admitted to four public psychiatric inpatient facilities in New South Wales, Australia. Between October 2012 and July 2014, adult smokers (N = 236) were surveyed during admission to and 1 month following discharge from the facilities. Measures of smoking care receipt were reported descriptively, and logistic regression analyses were used to explore characteristics associated with care receipt. The majority of participants were offered (78%) and used (78%) nicotine replacement therapy (NRT), with 66% of NRT-users reporting the amount provided was sufficient to reduce cravings. A minority of participants (16%) received information or advice to quit smoking, and 60% reported smoking throughout their admission. Patients not contemplating quitting and those with non-psychotic disorders were more likely to receive an offer of NRT. The findings suggest the provision of smoking care in Australian acute psychiatric units is sub-optimal overall, with an indication that care may be provided selectively to certain patients, rather than systematically to all. Development and dissemination of interventions to increase smoking care provision in inpatient psychiatry are needed.
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Affiliation(s)
- Alexandra P Metse
- University of Newcastle, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - John Wiggers
- University of Newcastle, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia.,Hunter New England Population Health, Wallsend, New South Wales, Australia
| | - Paula Wye
- University of Newcastle, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Jenny A Bowman
- University of Newcastle, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
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16
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Metse AP, Wiggers J, Wye P, Wolfenden L, Freund M, Clancy R, Stockings E, Terry M, Allan J, Colyvas K, Prochaska JJ, Bowman JA. Efficacy of a universal smoking cessation intervention initiated in inpatient psychiatry and continued post-discharge: A randomised controlled trial. Aust N Z J Psychiatry 2017; 51:366-381. [PMID: 28195010 DOI: 10.1177/0004867417692424] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Interventions are required to redress the disproportionate tobacco-related health burden experienced by persons with a mental illness. This study aimed to assess the efficacy of a universal smoking cessation intervention initiated within an acute psychiatric inpatient setting and continued post-discharge in reducing smoking prevalence and increasing quitting behaviours. METHOD A randomised controlled trial was undertaken across four psychiatric inpatient facilities in Australia. Participants ( N = 754) were randomised to receive either usual care ( n = 375) or an intervention comprising a brief motivational interview and self-help material while in hospital, followed by a 4-month pharmacological and psychosocial intervention ( n = 379) upon discharge. Primary outcomes assessed at 6 and 12 months post-discharge were 7-day point prevalence and 1-month prolonged smoking abstinence. A number of secondary smoking-related outcomes were also assessed. Subgroup analyses were conducted based on psychiatric diagnosis, baseline readiness to quit and nicotine dependence. RESULTS Seven-day point prevalence abstinence was higher for intervention participants (15.8%) than controls (9.3%) at 6 months post-discharge (odds ratio = 1.07, p = 0.04), but not at 12 months (13.4% and 10.0%, respectively; odds ratio = 1.03, p = 0.25). Significant intervention effects were not found on measures of prolonged abstinence at either 6 or 12 months post-discharge. Differential intervention effects for the primary outcomes were not detected for any subgroups. At both 6 and 12 months post-discharge, intervention group participants were significantly more likely to smoke fewer cigarettes per day, have reduced cigarette consumption by ⩾50% and to have made at least one quit attempt, relative to controls. CONCLUSIONS Universal smoking cessation treatment initiated in inpatient psychiatry and continued post-discharge was efficacious in increasing 7-day point prevalence smoking cessation rates and related quitting behaviours at 6 months post-discharge, with sustained effects on quitting behaviour at 12 months. Further research is required to identify strategies for achieving longer term smoking cessation.
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Affiliation(s)
- Alexandra P Metse
- 1 The University of Newcastle, Australia, Callaghan, NSW, Australia.,2 Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - John Wiggers
- 1 The University of Newcastle, Australia, Callaghan, NSW, Australia.,2 Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.,3 Hunter New England Population Health, Wallsend, NSW, Australia
| | - Paula Wye
- 1 The University of Newcastle, Australia, Callaghan, NSW, Australia.,2 Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.,3 Hunter New England Population Health, Wallsend, NSW, Australia
| | - Luke Wolfenden
- 1 The University of Newcastle, Australia, Callaghan, NSW, Australia.,2 Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.,3 Hunter New England Population Health, Wallsend, NSW, Australia
| | - Megan Freund
- 1 The University of Newcastle, Australia, Callaghan, NSW, Australia.,2 Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Richard Clancy
- 1 The University of Newcastle, Australia, Callaghan, NSW, Australia.,2 Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.,4 Centre for Translational Neuroscience and Mental Health, Calvary Mater Hospital, Waratah, NSW, Australia
| | - Emily Stockings
- 5 National Drug and Alcohol Research Centre, University of New South Wales, Randwick, NSW, Australia
| | - Margarett Terry
- 6 Mental Health and Substance Use Service, Calvary Mater Hospital, Waratah, NSW, Australia
| | - John Allan
- 7 Mental Health Alcohol and Other Drugs Branch, Queensland Health, Fortitude Valley, QLD, Australia
| | - Kim Colyvas
- 1 The University of Newcastle, Australia, Callaghan, NSW, Australia
| | - Judith J Prochaska
- 8 Stanford Prevention Research Center, School of Medicine, Stanford University, Stanford, CA, USA
| | - Jenny A Bowman
- 1 The University of Newcastle, Australia, Callaghan, NSW, Australia.,2 Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
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17
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Metse AP, Wiggers JH, Wye PM, Wolfenden L, Prochaska JJ, Stockings EA, Williams JM, Ansell K, Fehily C, Bowman JA. Smoking and Mental Illness: A Bibliometric Analysis of Research Output Over Time. Nicotine Tob Res 2016; 19:24-31. [PMID: 27980040 DOI: 10.1093/ntr/ntw249] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 09/29/2016] [Indexed: 12/30/2022]
Abstract
INTRODUCTION The prevalence of smoking among persons with a mental illness has remained unchanged, being 2-3 times higher than the general population in high-income countries. Assessment of the volume and characteristics of research output over time can assist in identifying research priorities to promote progress within a field. The aim of this study was to undertake such an assessment in the field of smoking and mental illness. METHODS A descriptive repeat cross-sectional study was conducted of peer-reviewed publications in Medline and PsycINFO for the periods 1993-1995, 2003-2005, and 2013-2015. Publications were classified as data- or non-data-based; data-based publications were further categorized by study type, population, setting, and for intervention-focused publications by level of evidence and research translation phase. RESULTS Included were 547 articles published in 1993-1995 (n = 65), 2003-2005 (n = 153), and 2013-2015 (n = 329). The number and proportion of data-based publications significantly increased over time, although their focus remained predominantly descriptive (≥83%); less than 14% of publications in any period had an intervention focus. The proportion of publications reporting on study populations with multiple diagnostic categories and recruiting from nonmental health settings, significantly increased from 1993-1995 to 2003-2005, however then plateaued by 2013-2015. The level of evidence provided by intervention-focused publications was suggested to increase over time, however there was no evident variation in translation phase. CONCLUSIONS Research has increased over time to characterize smoking among those with a mental illness; however more is needed to inform the development and implementation of effective cessation interventions for this group. IMPLICATIONS This is the first study to examine the volume and characteristics of research publications in the field of smoking and mental illness over time. The number of publications increased fivefold between 1993-1995 and 2013-2015. Between 1993-1995 and 2003-2005, progression was also indicated by increased: data-based publications, diagnostic diversity of samples, and variation in study settings; however further increases in such measures were not evident in 2013-2015. Notably, it continues to be the case that few intervention studies are undertaken. To achieve meaningful changes in the smoking prevalence of this group, a greater focus on research that assesses the effectiveness and implementation of tailored cessation interventions is required.
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Affiliation(s)
- Alexandra P Metse
- School of Psychology, University of Newcastle, Callaghan, Australia; .,Hunter Medical Research Institute, New Lambton Heights, Australia
| | - John H Wiggers
- Hunter Medical Research Institute, New Lambton Heights, Australia.,Hunter New England Population Health, Wallsend, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
| | - Paula M Wye
- School of Psychology, University of Newcastle, Callaghan, Australia.,Hunter Medical Research Institute, New Lambton Heights, Australia.,Hunter New England Population Health, Wallsend, Australia
| | - Luke Wolfenden
- Hunter Medical Research Institute, New Lambton Heights, Australia.,Hunter New England Population Health, Wallsend, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
| | - Judith J Prochaska
- Stanford Prevention Research Center, Department of Medicine, Stanford University, Stanford, CA
| | - Emily A Stockings
- National Drug and Alcohol Research Centre, University of New South Wales, Randwick, Australia
| | - Jill M Williams
- Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ
| | - Kerryn Ansell
- School of Psychology, University of Newcastle, Callaghan, Australia
| | - Caitlin Fehily
- School of Psychology, University of Newcastle, Callaghan, Australia.,Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Jenny A Bowman
- School of Psychology, University of Newcastle, Callaghan, Australia.,Hunter Medical Research Institute, New Lambton Heights, Australia
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Metse AP, Wiggers J, Wye P, Wolfenden L, Freund M, Clancy R, Stockings E, Terry M, Allan J, Colyvas K, Prochaska JJ, Bowman JA. An integrated smoking intervention for mental health patients: a randomised controlled trial. Eur J Public Health 2016. [DOI: 10.1093/eurpub/ckw172.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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19
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Metse AP, Wiggers J, Wye P, Wolfenden L, Prochaska JJ, Stockings E, Williams JM, Ansell K, Fehily C, Bowman JA. Smoking and mental illness: a bibliometric analysis of research output over time. Eur J Public Health 2016. [DOI: 10.1093/eurpub/ckw165.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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20
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Bowrey HE, Metse AP, Leotta AJ, Zeng G, McFadden SA. The relationship between image degradation and myopia in the mammalian eye. Clin Exp Optom 2016; 98:555-63. [PMID: 26769179 DOI: 10.1111/cxo.12316] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Revised: 04/13/2015] [Accepted: 05/15/2015] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND In all species studied, myopia develops if the eye is deprived of detailed vision during development (form deprivation myopia). However, different degrees of spatial image deprivation produce different effects and have not been described in the mammalian eye. Therefore, the effect of image degradation on guinea pig emmetropisation was investigated. METHODS Eighty-one guinea pigs wore a treatment on one eye from 6 to 13 days of age. There were four treatments: a translucent diffuser (no lines or edges were visible through the diffuser); one of five Bangerter foils (BF: 0.8, 0.6, 0.4, 0.2, light perception only), which differed in their cut-off spatial frequencies; a 'ring mount' control with no filter; or one of two neutral density filters that reduced luminance only (ND, optical density grades 0.1 and 0.6). Refractive error and ocular elongation were measured after seven days of treatment. RESULTS The extent of induced myopia and ocular growth were related to the amount of image degradation (mean difference between the treated and untreated eyes changed in a graded manner -7.0 D to -0.2 D and from 85 µm to seven µm respectively, for spatial frequency cut-offs between zero and 24 cycles per degree). Corresponding reductions in luminance from ND filters did not increase eye growth and caused significantly less myopia than the BFs that caused a similar luminance decrement. The greatest myopia occurred when no or limited spatial information was available to the eye, but moderate myopia still occurred with spatial frequency cut-offs of six and 12 cycles per degree, well beyond the visual acuity range of guinea pigs. CONCLUSION Excessive ocular growth and myopia are most robust when induced by spatial frequency reductions within the visual acuity range but can also be induced beyond this. Either the mechanism of ocular growth can detect supra-threshold spatial frequencies, possibly due to aliasing, or it is sensitive to small amounts of contrast degradation.
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Affiliation(s)
- Hannah E Bowrey
- School of Psychology, University of Newcastle, Callaghan, New South Wales, Australia
| | - Alexandra P Metse
- School of Psychology, University of Newcastle, Callaghan, New South Wales, Australia
| | - Amelia J Leotta
- School of Psychology, University of Newcastle, Callaghan, New South Wales, Australia
| | - Guang Zeng
- School of Psychology, University of Newcastle, Callaghan, New South Wales, Australia.,Daqing Oilfield General Hospital, Saertu, Daqing, China
| | - Sally A McFadden
- School of Psychology, University of Newcastle, Callaghan, New South Wales, Australia.
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21
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Metse AP, Wiggers J, Wye P, Clancy R, Moore L, Adams M, Robinson M, Bowman JA. Uptake of smoking cessation aids by smokers with a mental illness. J Behav Med 2016; 39:876-86. [PMID: 27357297 PMCID: PMC5012253 DOI: 10.1007/s10865-016-9757-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Accepted: 06/10/2016] [Indexed: 12/13/2022]
Abstract
Psychiatric inpatient settings represent an opportunity to initiate the provision of tobacco cessation care to smokers with a mental illness. This study describes the use of evidence-based smoking cessation aids proactively and universally offered to a population of psychiatric inpatients upon discharge, and explores factors associated with their uptake. Data derived from the conduct of a randomised controlled trial were analysed in terms of the proportion of participants (N = 378) that utilised cessation aids including project delivered telephone smoking cessation counselling and nicotine replacement therapy (NRT), and Quitline support. Factors associated with uptake of cessation aids were explored using multivariable logistic regression analyses. A large proportion of smokers utilised project delivered cessation counselling calls (89 %) and NRT (79 %), while 11 % used the Quitline. The majority accepted more than seven project delivered telephone cessation counselling calls (52 %), and reported NRT use during more than half of their accepted calls (70 %). Older age, higher nicotine dependence, irregular smoking and seeing oneself as a non-smoker were associated with uptake of behavioural cessation aids. Higher nicotine dependence was similarly associated with use of pharmacological aids, as was NRT use whilst an inpatient. Most smokers with a mental illness took up a proactive offer of aids to support their stopping smoking. Consideration by service providers of factors associated with uptake may increase further the proportion of such smokers who use evidence-based cessation aids and consequently quit smoking successfully.
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Affiliation(s)
- Alexandra P Metse
- University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia. .,Hunter Medical Research Institute, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia.
| | - John Wiggers
- University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.,Hunter Medical Research Institute, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia.,Hunter New England Population Health, Longworth Ave, Wallsend, NSW, 2287, Australia
| | - Paula Wye
- University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.,Hunter Medical Research Institute, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia.,Hunter New England Population Health, Longworth Ave, Wallsend, NSW, 2287, Australia
| | - Richard Clancy
- University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.,Hunter Medical Research Institute, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia.,Centre for Translational Neuroscience and Mental Health, Mater Hospital Cnr Edith and Platt Streets, Waratah, NSW, 2298, Australia
| | - Lyndell Moore
- University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
| | - Maree Adams
- University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
| | - Maryanne Robinson
- University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
| | - Jenny A Bowman
- University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.,Hunter Medical Research Institute, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia
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22
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Metse AP, Wiggers J, Wye P, Moore L, Clancy R, Wolfenden L, Freund M, Van Zeist T, Stockings E, Bowman JA. Smoking and environmental characteristics of smokers with a mental illness, and associations with quitting behaviour and motivation; a cross sectional study. BMC Public Health 2016; 16:332. [PMID: 27080019 PMCID: PMC4832515 DOI: 10.1186/s12889-016-2969-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 03/18/2016] [Indexed: 11/11/2022] Open
Abstract
Background Persons with a mental illness are less likely to be successful in attempts to quit smoking. A number of smoking and environmental characteristics have been shown to be related to quitting behaviour and motivation of smokers generally, however have been less studied among smokers with a mental illness. This study aimed to report the prevalence of smoking characteristics and a variety of physical and social environmental characteristics of smokers with a mental illness, and explore their association with quitting behaviour and motivation. Methods A cross-sectional descriptive study was undertaken of 754 smokers admitted to four psychiatric inpatient facilities in Australia. Multivariable logistic regression analyses were undertaken to explore the association between smoking and environmental characteristics and recent quitting behaviour and motivation. Results Participants were primarily daily smokers (93 %), consumed >10 cigarettes per day (74 %), and highly nicotine dependent (51 %). A third (32 %) lived in a house in which smoking was permitted, and 44 % lived with other smokers. The majority of participants believed that significant others (68–82 %) and health care providers (80–91 %) would be supportive of their quitting smoking. Reflecting previous research, the smoking characteristics examined were variously associated with quitting behaviour and motivation. Additionally, participants not living with other smokers were more likely to have quit for a longer duration (OR 2.02), and those perceiving their psychiatrist to be supportive of a quit attempt were more likely to have had more quit attempts in the past six months (OR 2.83). Conclusions Modifiable characteristics of the physical and social environment, and of smoking, should be considered in smoking cessation interventions for persons with a mental illness.
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Affiliation(s)
- Alexandra P Metse
- University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia. .,Hunter Medical Research Institute, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia.
| | - John Wiggers
- University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.,Hunter Medical Research Institute, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia.,Hunter New England Population Health, Longworth Ave, Wallsend, NSW, 2287, Australia
| | - Paula Wye
- University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.,Hunter Medical Research Institute, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia.,Hunter New England Population Health, Longworth Ave, Wallsend, NSW, 2287, Australia
| | - Lyndell Moore
- University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.,Hunter Medical Research Institute, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia
| | - Richard Clancy
- University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.,Hunter Medical Research Institute, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia.,Centre for Translational Neuroscience and Mental Health, Corner Edith and Platt Streets, Waratah, NSW, 2298, Australia
| | - Luke Wolfenden
- University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.,Hunter Medical Research Institute, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia.,Hunter New England Population Health, Longworth Ave, Wallsend, NSW, 2287, Australia
| | - Megan Freund
- University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.,Hunter Medical Research Institute, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia
| | - Tara Van Zeist
- University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.,Hunter Medical Research Institute, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia
| | - Emily Stockings
- National Drug and Alcohol Research Centre, University of New South Wales, 22-32 King Street, Randwick, NSW, 2031, Australia
| | - Jenny A Bowman
- University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.,Hunter Medical Research Institute, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia
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23
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Metse AP, Bowman JA, Wye P, Stockings E, Adams M, Clancy R, Terry M, Wolfenden L, Freund M, Allan J, Prochaska JJ, Wiggers J. Evaluating the efficacy of an integrated smoking cessation intervention for mental health patients: study protocol for a randomised controlled trial. Trials 2014; 15:266. [PMID: 24996596 PMCID: PMC4091653 DOI: 10.1186/1745-6215-15-266] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Accepted: 06/17/2014] [Indexed: 12/17/2022] Open
Abstract
Background Smoking rates, and associated negative health outcomes, are disproportionately high among people with mental illness compared to the general population. Smoke-free policies within mental health hospitals can positively impact on patients’ motivation and self-efficacy to address their smoking. However, without post-discharge support, preadmission smoking behaviours typically resume. This protocol describes a randomised controlled trial that aims to assess the efficacy of linking mental health inpatients to community-based smoking cessation supports upon discharge as a means of reducing smoking prevalence. Methods/Design Eight hundred participants with acute mental illness will be recruited into the randomised controlled trial whilst inpatients at one of four psychiatric inpatient facilities in the state of New South Wales, Australia. After completing a baseline interview, participants will be randomly allocated to receive either: ‘Supported Care’, a multimodal smoking cessation intervention; or ‘Normal Care’, consisting of existing hospital care only. The ‘Supported Care’ intervention will consist of a brief motivational interview and a package of self-help material for abstaining from smoking whilst in hospital, and, following discharge, 16 weeks of motivational telephone-based counselling, 12 weeks of free nicotine replacement therapy, and a referral to the Quitline. Data will be collected at 1, 6 and 12 months post-discharge via computer-assisted telephone interview. The primary outcomes are abstinence from smoking (7-day point prevalence and prolonged cessation), and secondary outcomes comprise daily cigarette consumption, nicotine dependence, quit attempts, and readiness to change smoking behaviour. Discussion If shown to be effective, the study will provide evidence in support of systemic changes in the provision of smoking cessation care to patients following discharge from psychiatric inpatient facilities. Trial registration Australian New Zealand Clinical Trials Registry ANZTCN:
ACTRN12612001042831. Date registered: 28 September 2012.
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Affiliation(s)
- Alexandra P Metse
- University of Newcastle, University Drive, Callaghan, NSW 2308, Australia.
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