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Casey M, Dabkowski E, de Gracia MRL, Moore KA, Kennedy GA, Porter JE, Nasstasia Y, Alvarenga ME. Socioecological factors influencing physical activity engagement for women across the menopausal transition: a systematic review. Menopause 2024; 31:433-446. [PMID: 38595173 DOI: 10.1097/gme.0000000000002337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Abstract
IMPORTANCE Physical activity during menopause can be effective in reducing the physiological changes associated with reproductive aging that increase risks for noncommunicable diseases, yet many women do not meet the recommendations for physical activity. OBJECTIVE This study aimed to synthesize factors influencing physical activity for women across menopausal transition phases using a socioecological approach. EVIDENCE REVIEW The Preferred Reporting Items for Systematic Reviews and Meta-Analysis was used to systematically search 10 databases between 2001 and 2021. A comprehensive search strategy was used to identify studies on physical activity of women in various stages of menopause. A socioecological model was used to categorize the reported barriers and enablers. FINDINGS Twenty studies met the inclusion criteria. The findings highlight several intrapersonal barriers such as existing health complaints versus enablers such as awareness of the health benefits of physical activity during menopause. Ensuring women's safety, preventing injury, and enhancing exercise self-efficacy were important components of programs. Social support was also an important enabler of women's engagement in activities. CONCLUSIONS AND RELEVANCE Several barriers and enablers were identified and can inform practitioners and future interventions to encourage physical activity among women in various stages of menopause. For instance, when encouraging physical activity during menopause, practitioners should consider other health complaints, safety, and injury prevention while discussing the benefits of physical activity related to managing menopausal symptoms. There was a lack of theoretically informed studies exploring the barriers and enablers to physical activity for women in various stages of menopause; thus, research designs may not have fully accounted for influences. Future research that combines socioecological and individual theories of behavior is needed to comprehensively understand the complexity of physical activity among women across the menopausal transition.
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Affiliation(s)
- Meghan Casey
- From the Institute of Health and Wellbeing, Federation University Australia, Ballarat, Victoria, Australia
| | - Elissa Dabkowski
- Collaborative Evaluation & Research Centre, Federation University Australia, Gippsland, Victoria, Australia
| | - Ma Regina L de Gracia
- Institute of Health and Wellbeing, Federation University Australia, Gippsland, Victoria, Australia
| | - Kathleen A Moore
- Institute of Health and Wellbeing, Federation University Australia, Gippsland, Victoria, Australia
| | | | - Joanne E Porter
- Director of the Collaborative Evaluation & Research Centre, Federation University Australia, Gippsland, Victoria, Australia
| | - Yasmina Nasstasia
- Institute of Health and Wellbeing, Federation University Australia, Mount Helen, Victoria, Australia
| | - Marlies E Alvarenga
- Institute of Health and Wellbeing, Federation University Australia, Berwick, Victoria, Australia
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Zhao FY, Spencer SJ, Kennedy GA, Zheng Z, Conduit R, Zhang WJ, Xu P, Yue LP, Wang YM, Xu Y, Fu QQ, Ho YS. Acupuncture for primary insomnia: Effectiveness, safety, mechanisms and recommendations for clinical practice. Sleep Med Rev 2024; 74:101892. [PMID: 38232645 DOI: 10.1016/j.smrv.2023.101892] [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: 08/23/2023] [Revised: 11/07/2023] [Accepted: 12/06/2023] [Indexed: 01/19/2024]
Abstract
Primary insomnia (PI) is an increasing concern in modern society. Cognitive-behavioral therapy for insomnia is the first-line recommendation, yet limited availability and cost impede its widespread use. While hypnotics are frequently used, balancing their benefits against the risk of adverse events poses challenges. This review summarizes the clinical and preclinical evidence of acupuncture as a treatment for PI, discussing its potential mechanisms and role in reliving insomnia. Clinical trials show that acupuncture improves subjective sleep quality, fatigue, cognitive impairments, and emotional symptoms with minimal adverse events. It also positively impacts objective sleep processes, including prolonging total sleep time, improving sleep efficiency, reducing sleep onset latency and wake after sleep onset, and enhancing sleep architecture/structure, including increasing N3% and REM%, and decreasing N1%. However, methodological shortcomings in some trials diminish the overall quality of evidence. Animal studies suggest that acupuncture restores circadian rhythms in sleep-deprived rodents and improves their performance in behavioral tests, possibly mediated by various clinical variables and pathways. These may involve neurotransmitters, brain-derived neurotrophic factors, inflammatory cytokines, the hypothalamic-pituitary-adrenal axis, gut microbiota, and other cellular events. While the existing findings support acupuncture as a promising therapeutic strategy for PI, additional high-quality trials are required to validate its benefits.
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Affiliation(s)
- Fei-Yi Zhao
- Department of Nursing, School of International Medical Technology, Shanghai Sanda University, Shanghai, 201209, China; Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, 200071, China
| | - Sarah J Spencer
- School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, 3083, Australia
| | - Gerard A Kennedy
- School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, 3083, Australia; Institute of Health and Wellbeing, Federation University, Mount Helen, Victoria, Australia; Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, 3084, Australia
| | - Zhen Zheng
- School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, 3083, Australia
| | - Russell Conduit
- School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, 3083, Australia
| | - Wen-Jing Zhang
- Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, 200071, China
| | - Peijie Xu
- School of Computing Technologies, RMIT University, Melbourne, VIC, 3000, Australia
| | - Li-Ping Yue
- Department of Nursing, School of International Medical Technology, Shanghai Sanda University, Shanghai, 201209, China
| | - Yan-Mei Wang
- Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, 200071, China
| | - Yan Xu
- Department of Nursing, School of International Medical Technology, Shanghai Sanda University, Shanghai, 201209, China.
| | - Qiang-Qiang Fu
- Yangpu Hospital, School of Medicine, Tongji University, Shanghai, 200090, China.
| | - Yuen-Shan Ho
- School of Nursing, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China.
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Isaac F, Toukhsati SR, Klein B, Di Benedetto M, Kennedy GA. Differences in Anxiety, Insomnia, and Trauma Symptoms in Wildfire Survivors from Australia, Canada, and the United States of America. Int J Environ Res Public Health 2023; 21:38. [PMID: 38248503 PMCID: PMC10815777 DOI: 10.3390/ijerph21010038] [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: 10/05/2023] [Revised: 12/17/2023] [Accepted: 12/22/2023] [Indexed: 01/23/2024]
Abstract
Many survivors of wildfires report elevated levels of psychological distress following the trauma of wildfires. However, there is only limited research on the effects of wildfires on mental health. This study examined differences in anxiety, depression, insomnia, sleep quality, nightmares, and post-traumatic stress disorder (PTSD) symptoms following wildfires in Australia, Canada, and the United States of America (USA). One hundred and twenty-six participants from Australia, Canada, and the USA completed an online survey. The sample included 102 (81%) women, 23 (18.3%) men, and one non-binary (0.8%) individual. Participants were aged between 20 and 92 years (M age = 52 years, SD = 14.4). They completed a demographic questionnaire, the Disturbing Dream and Nightmare Severity Index (DDNSI), Generalized Anxiety Disorder Questionnaire (GAD-7), the Insomnia Severity Index (ISI), Patient Health Questionnaire (PHQ-9), the Pittsburgh Sleep Quality Index (PSQI), and PTSD Checklist (PCL-5). Results showed that participants from the USA scored significantly higher on the GAD-7 (p = 0.009), ISI (p = 0.003), and PCL-5 (p = 0.021) than participants from Australia and Canada. The current findings suggest a need for more international collaboration to reduce the severity of mental health conditions in Australia, Canada, and the USA.
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Affiliation(s)
- Fadia Isaac
- Institute of Health and Wellbeing, Federation University, Mt Helen, VIC 3350, Australia (G.A.K.)
| | - Samia R. Toukhsati
- Institute of Health and Wellbeing, Federation University, Mt Helen, VIC 3350, Australia (G.A.K.)
| | - Britt Klein
- Health Innovation and Transformation Centre, Federation University, Mt Helen, VIC 3350, Australia;
- Biopsychosocial & eHealth Research & Innovation (BeRI) Hub, Federation University, Mt Helen, VIC 3350, Australia
| | | | - Gerard A. Kennedy
- Institute of Health and Wellbeing, Federation University, Mt Helen, VIC 3350, Australia (G.A.K.)
- School of Health and Biomedical Sciences, RMIT University, Melbourne, VIC 3083, Australia
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Melbourne, VIC 3084, Australia
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Zhao FY, Kennedy GA, Xu P, Conduit R, Wang YM, Zhang WJ, Wang HR, Yue LP, Huang YL, Wang Y, Xu Y, Fu QQ, Zheng Z. Identifying complementary and alternative medicine recommendations for anxiety treatment and care: a systematic review and critical assessment of comprehensive clinical practice guidelines. Front Psychiatry 2023; 14:1290580. [PMID: 38152358 PMCID: PMC10751921 DOI: 10.3389/fpsyt.2023.1290580] [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] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 11/08/2023] [Indexed: 12/29/2023] Open
Abstract
Background Clinical practice guidelines (CPGs) are used to guide decision-making, especially regarding complementary and alternative medicine (CAM) therapies that are unfamiliar to orthodox healthcare providers. This systematic review aimed to critically review and summarise CAM recommendations associated with anxiety management included in the existing CPGs. Methods Seven databases, websites of six international guidelines developing institutions, and the National Centre for Complementary and Integrative Health website were systematically searched. Their reporting and methodological quality were evaluated using the Reporting Items for practice Guidelines in Healthcare checklist and the Appraisal of Guidelines for Research and Evaluation (2nd version) instrument, respectively. Results Ten CPGs were included, with reporting rates between 51.4 and 88.6%. Seven of these were of moderate to high methodological quality. Seventeen CAM modalities were implicated, involving phytotherapeutics, mind-body practice, art therapy, and homeopathy. Applied relaxation was included in 70% CPGs, which varied in degree of support for its use in the treatment of generalised anxiety disorder. There were few recommendations for other therapies/products. Light therapy was not recommended for use in generalised anxiety disorder, and St John's wort and mindfulness were not recommended for use in social anxiety disorder in individual guidelines. Recommendations for the applicability of other therapies/products for treating a specific anxiety disorder were commonly graded as "unclear, unambiguous, or uncertain". No CAM recommendations were provided for separation anxiety disorder, specific phobia or selective mutism. Conclusion Available guidelines are limited in providing logically explained graded CAM recommendations for anxiety treatment and care. A lack of high-quality evidence and multidisciplinary consultation during the guideline development are two major reasons. High quality and reliable clinical evidence and the engagement of a range of interdisciplinary stakeholders are needed for future CPG development and updating. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022373694, identifier CRD42022373694.
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Affiliation(s)
- Fei-Yi Zhao
- Department of Nursing, School of International Medical Technology, Shanghai Sanda University, Shanghai, China
- Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Gerard A. Kennedy
- Institute of Health and Wellbeing, Federation University, Mount Helen, VIC, Australia
- School of Health and Biomedical Sciences, RMIT University, Bundoora, VIC, Australia
- Institute for Breathing and Sleep, Austin Health, Heidelberg, VIC, Australia
| | - Peijie Xu
- School of Computing Technologies, RMIT University, Melbourne, VIC, Australia
| | - Russell Conduit
- School of Health and Biomedical Sciences, RMIT University, Bundoora, VIC, Australia
| | - Yan-Mei Wang
- Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Wen-Jing Zhang
- Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Hui-Ru Wang
- Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Li-Ping Yue
- Department of Nursing, School of International Medical Technology, Shanghai Sanda University, Shanghai, China
| | - Yu-Ling Huang
- Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yin Wang
- Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yan Xu
- Department of Nursing, School of International Medical Technology, Shanghai Sanda University, Shanghai, China
| | - Qiang-Qiang Fu
- Yangpu Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Zhen Zheng
- School of Health and Biomedical Sciences, RMIT University, Bundoora, VIC, Australia
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Zhao FY, Xu P, Zheng Z, Conduit R, Xu Y, Yue LP, Wang HR, Wang YM, Li YX, Li CY, Zhang WJ, Fu QQ, Kennedy GA. Managing depression with complementary and alternative medicine therapies: a scientometric analysis and visualization of research activities. Front Psychiatry 2023; 14:1288346. [PMID: 38034915 PMCID: PMC10684695 DOI: 10.3389/fpsyt.2023.1288346] [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] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 10/25/2023] [Indexed: 12/02/2023] Open
Abstract
Background Complementary and Alternative Medicine (CAM) interventions may prove to be an attractive option for the treatment of depression. The aim of this scientometric analysis is to determine the global scientific output of research regarding managing depression with CAM and identify the hotspots and frontiers within this theme. Methods Publications regarding the utilization of CAM for treating depression were collected from the Web of Science Core Collection from 1993 to 2022, and analyzed and visualized by Bibliometrix R-package, VOSviewer, and CiteSpace. Results A total of 1,710 publications were acquired. The number of annual publications showed an overall rapid upward trend, with the figure peaking at 179 in 2021. The USA was the leading research center. Totally 2,323 distinct institutions involving 7,638 scholars contributed to the research theme. However, most of the cooperation was limited to within the same country, institution or research team. The Journal of Alternative and Complementary Medicine was the most productive periodical. The CAM therapies of most interest to researchers were acupuncture and body-mind techniques, such as yoga, meditation and mindfulness. Systematic review and meta-analysis are commonly used methods. "Inflammation," "rating scale" and "psychological stress" were identified as the most studied trend topics recently. Conclusion Managing depression with evidence-based CAM treatment is gaining attention globally. Body-mind techniques and acupuncture are growing research hotspots or emerging trending topics. Future studies are predicted to potentially investigate the possible mechanisms of action underlying CAM treatments in reducing depression in terms of modulation of psychological stress and inflammation levels. Cross-countries/institutes/team research collaborations should be encouraged and further enhanced.
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Affiliation(s)
- Fei-Yi Zhao
- Department of Nursing, School of International Medical Technology, Shanghai Sanda University, Shanghai, China
- Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Peijie Xu
- School of Computing Technologies, RMIT University, Melbourne, VIC, Australia
| | - Zhen Zheng
- School of Health and Biomedical Sciences, RMIT University, Bundoora, VIC, Australia
| | - Russell Conduit
- School of Health and Biomedical Sciences, RMIT University, Bundoora, VIC, Australia
| | - Yan Xu
- Department of Nursing, School of International Medical Technology, Shanghai Sanda University, Shanghai, China
| | - Li-Ping Yue
- Department of Nursing, School of International Medical Technology, Shanghai Sanda University, Shanghai, China
| | - Hui-Ru Wang
- Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yan-Mei Wang
- Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yuan-Xin Li
- Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Chun-Yan Li
- Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Wen-Jing Zhang
- Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Qiang-Qiang Fu
- Yangpu Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Gerard A. Kennedy
- School of Health and Biomedical Sciences, RMIT University, Bundoora, VIC, Australia
- Institute of Health and Wellbeing, Federation University, Mount Helen, VIC, Australia
- Institute for Breathing and Sleep, Austin Health, Heidelberg, VIC, Australia
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Meaklim H, Rehm IC, Junge MF, Monfries M, Kennedy GA, Bucks RS, Meltzer LJ, Jackson ML. Development of a Novel Behavioral Sleep Medicine Education Workshop Designed to Increase Trainee Psychologists' Knowledge and Skills in Insomnia Management. Behav Sleep Med 2023; 21:787-801. [PMID: 36606306 DOI: 10.1080/15402002.2022.2164766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVES Despite the clear influence of poor sleep on mental health, sleep education has been neglected in psychology training programs. Here, we develop a novel behavioral sleep medicine (BSM) education workshop, the Sleep Psychology Workshop, designed for integration within graduate psychology programs. We also examined the potential efficacy and acceptability of the workshop to upskill trainee psychologists in sleep and insomnia management. METHODS The Sleep Psychology Workshop was developed using a modified Delphi Method. Eleven trainee psychologists completing their Master of Psychology degrees (90% female, 24.4 ± 1.6 years old) attended the workshop, delivered as three, two-hour lectures (total of six hours). Sleep knowledge, attitudes, and practice assessments were completed pre-and post-intervention using the GradPsyKAPS Questionnaire. A focus group and 6-month follow-up survey captured feedback and qualitative data. RESULTS Trainees' sleep knowledge quiz scores (% correct) increased from 60% to 79% pre- to post-workshop (p = .002). Trainees' self-efficacy to use common sleep-related assessment instruments and empirically supported interventions to manage sleep disturbances increased, along with their confidence to manage insomnia (all p < .02). Participant feedback was positive, with 91% of trainees rating the workshop as "excellent" and qualitative data highlighting trainees developing practical skills in BSM. Six months post-intervention, 100% of trainees endorsed routinely asking their clients about sleep, with 82% reporting improvements in their own sleep. CONCLUSIONS The Sleep Psychology Workshop is a potentially effective and acceptable introductory BSM education program for trainee psychologists, ready for integration within the graduate psychology curriculum.
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Affiliation(s)
- Hailey Meaklim
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia
- School of Health and Biomedical Sciences, RMIT University, Bundoora, Australia
- Institute for Breathing and Sleep, Austin Health, Victoria, Australia
| | - Imogen C Rehm
- College of Health and Biomedicine, Victoria University, Melbourne, Australia
| | | | - Melissa Monfries
- School of Health and Biomedical Sciences, RMIT University, Bundoora, Australia
| | - Gerard A Kennedy
- School of Health and Biomedical Sciences, RMIT University, Bundoora, Australia
- Institute for Breathing and Sleep, Austin Health, Victoria, Australia
- Institute of Health and Wellbeing, Federation University, Ballarat, Australia
| | - Romola S Bucks
- Schools of Psychological Science and Population and Global Health, University of Western Australia, Western Australia, Australia
| | - Lisa J Meltzer
- Department of Pediatrics, National Jewish Health, Denver, USA
| | - Melinda L Jackson
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia
- Institute for Breathing and Sleep, Austin Health, Victoria, Australia
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Meaklim H, Meltzer LJ, Rehm IC, Junge MF, Monfries M, Kennedy GA, Bucks RS, Graco M, Jackson ML. Disseminating sleep education to graduate psychology programs online: a knowledge translation study to improve the management of insomnia. Sleep 2023; 46:zsad169. [PMID: 37327117 PMCID: PMC10566250 DOI: 10.1093/sleep/zsad169] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 05/14/2023] [Indexed: 06/18/2023] Open
Abstract
STUDY OBJECTIVES Despite the negative impact of poor sleep on mental health, evidence-based insomnia management guidelines have not been translated into routine mental healthcare. Here, we evaluate a state-wide knowledge translation effort to disseminate sleep and insomnia education to graduate psychology programs online using the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) evaluation framework. METHODS Using a non-randomized waitlist control design, graduate psychology students attended a validated 6-hour online sleep education workshop delivered live as part of their graduate psychology program in Victoria, Australia. Sleep knowledge, attitudes, and practice assessments were conducted pre- and post-program, with long-term feedback collected at 12 months. RESULTS Seven out of ten graduate psychology programs adopted the workshop (adoption rate = 70%). The workshop reached 313 graduate students, with a research participation rate of 81%. The workshop was effective at improving students' sleep knowledge and self-efficacy to manage sleep disturbances using cognitive behavioral therapy for insomnia (CBT-I), compared to the waitlist control with medium-to-large effect sizes (all p < .001). Implementation feedback was positive, with 96% of students rating the workshop as very good-to-excellent. Twelve-month maintenance data demonstrated that 83% of students had used the sleep knowledge/skills learned in the workshop in their clinical practice. However, more practical training is required to achieve CBT-I competency. CONCLUSIONS Online sleep education workshops can be scaled to deliver cost-effective foundational sleep training to graduate psychology students. This workshop will accelerate the translation of insomnia management guidelines into psychology practice to improve sleep and mental health outcomes nationwide.
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Affiliation(s)
- Hailey Meaklim
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, VIC, Australia
- Institute for Breathing and Sleep, Austin Health, VIC, Australia
| | - Lisa J Meltzer
- National Jewish Health, Denver, CO, USA
- Nyxeos Consulting, Denver, CO, USA
| | - Imogen C Rehm
- College of Health and Biomedicine, Victoria University, Melbourne, VIC, Australia
| | - Moira F Junge
- Sleep Health Foundation, East Melbourne, VIC, Australia
| | - Melissa Monfries
- School of Health and Biomedical Sciences, RMIT University, Bundoora, VIC, Australia
| | - Gerard A Kennedy
- Institute for Breathing and Sleep, Austin Health, VIC, Australia
- School of Health and Biomedical Sciences, RMIT University, Bundoora, VIC, Australia
- Institute of Health and Wellbeing, Federation University, Ballarat, VIC, Australia
| | - Romola S Bucks
- Schools of Psychological Science and Population and Global Health, University of Western Australia, Perth, WA, Australia
| | - Marnie Graco
- Institute for Breathing and Sleep, Austin Health, VIC, Australia
- Department of Physiotherapy, University of Melbourne, Parkville, VIC, Australia
| | - Melinda L Jackson
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, VIC, Australia
- Institute for Breathing and Sleep, Austin Health, VIC, Australia
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Oraison HM, Loton D, Kennedy GA. The Roles of Depression, Life Control and Affective Distress on Treatment Attendance and Perceived Disability in Chronic Back Pain Sufferers throughout the Duration of the Condition. Int J Environ Res Public Health 2023; 20:6844. [PMID: 37835118 PMCID: PMC10572183 DOI: 10.3390/ijerph20196844] [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: 06/06/2023] [Revised: 09/06/2023] [Accepted: 09/23/2023] [Indexed: 10/15/2023]
Abstract
The aims of this study were to examine psychological factors that predict treatment seeking and disability over the total duration of experiencing back pain. A sample of 201 adults experiencing chronic back pain was recruited through health professionals and completed the Depression, Anxiety and Stress Scale (DASS), the Oswestry Back Pain Disability Questionnaire (ODQ), the McGill Pain Questionnaire (MPQ) and the life control and affective distress variables of the West Haven-Yale Multidimensional Pain Inventory (WHYMP), and participants disclosed the number of treatment sessions attended over the course of the illness. Depression, life control and affective distress were tested as indirect predictors of disability severity that were mediated by treatment attendance. Each unit increase in life control predicted attending nearly 30 more treatment sessions, each unit increase in affective distress predicted attending 16 fewer treatments and each unit increase in depression predicted 4 fewer treatments, together explaining 44% of variance in treatment seeking. The effects of life control and affective distress on disability were explained by treatment attendance, whereas depression retained a direct effect on disability. Treatment attendance had an effect on disability. The findings show that participants with lower life control and higher affective distress and depression had higher levels of pain and disability, in part due to due to their treatment-seeking behaviour.
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Affiliation(s)
- Humberto M. Oraison
- Institute for Health & Sport, Victoria University, Melbourne, VIC 3000, Australia;
| | - Daniel Loton
- Institute for Health & Sport, Victoria University, Melbourne, VIC 3000, Australia;
- Centre for Wellbeing Science, The University of Melbourne, Melbourne, VIC 3010, Australia
| | - Gerard A. Kennedy
- School of Science, Psychology and Sport, Federation University, Ballarat, VIC 3842, Australia;
- Institute for Breathing and Sleep, Austin Health, Heidelberg, VIC 3084, Australia
- School of Health and Biomedical Science, RMIT University, Bundoora, VIC 3083, Australia
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9
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Zhao FY, Xu P, Kennedy GA, Conduit R, Zhang WJ, Wang YM, Fu QQ, Zheng Z. Identifying complementary and alternative medicine recommendations for insomnia treatment and care: a systematic review and critical assessment of comprehensive clinical practice guidelines. Front Public Health 2023; 11:1157419. [PMID: 37397764 PMCID: PMC10308125 DOI: 10.3389/fpubh.2023.1157419] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 05/17/2023] [Indexed: 07/04/2023] Open
Abstract
Background There is a need for evidence-informed guidance on the use of complementary and alternative medicine (CAM) for insomnia because of its widespread utilization and a lack of guidance on the balance of benefits and harms. This systematic review aimed to identify and summarize the CAM recommendations associated with insomnia treatment and care from existing comprehensive clinical practice guidelines (CPGs). The quality of the eligible guidelines was appraised to assess the credibility of these recommendations. Methods Formally published CPGs incorporating CAM recommendations for insomnia management were searched for in seven databases from their inception to January 2023. The NCCIH website and six websites of international guideline developing institutions were also retrieved. The methodological and reporting quality of each included guideline was appraised using the AGREE II instrument and RIGHT statement, respectively. Results Seventeen eligible GCPs were included, and 14 were judged to be of moderate to high methodological and reporting quality. The reporting rate of eligible CPGs ranged from 42.9 to 97.1%. Twenty-two CAM modalities were implicated, involving nutritional or natural products, physical CAM, psychological CAM, homeopathy, aromatherapy, and mindful movements. Recommendations for these modalities were mostly unclear, unambiguous, uncertain, or conflicting. Logically explained graded recommendations supporting the CAM use in the treatment and/or care of insomnia were scarce, with bibliotherapy, Tai Chi, Yoga, and auriculotherapy positively recommended based on little and weak evidence. The only consensus was that four phytotherapeutics including valerian, chamomile, kava, and aromatherapy were not recommended for insomnia management because of risk profile and/or limited benefits. Conclusions Existing guidelines are generally limited in providing clear, evidence-informed recommendations for the use of CAM therapies for insomnia management due to a lack of high-quality evidence and multidisciplinary consultation in CPG development. More well-designed studies to provide reliable clinical evidence are therefore urgently needed. Allowing the engagement of a range of interdisciplinary stakeholders in future updates of CPGs is also warranted. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=369155, identifier: CRD42022369155.
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Affiliation(s)
- Fei-Yi Zhao
- School of Health and Biomedical Sciences, RMIT University, Bundoora, VIC, Australia
- Department of Nursing, School of International Medical Technology, Shanghai Sanda University, Shanghai, China
- Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Peijie Xu
- School of Computing Technologies, RMIT University, Melbourne, VIC, Australia
| | - Gerard A. Kennedy
- School of Health and Biomedical Sciences, RMIT University, Bundoora, VIC, Australia
- Institute of Health and Wellbeing, Federation University, Mount Helen, VIC, Australia
- Institute for Breathing and Sleep, Austin Health, Heidelberg, VIC, Australia
| | - Russell Conduit
- School of Health and Biomedical Sciences, RMIT University, Bundoora, VIC, Australia
| | - Wen-Jing Zhang
- Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yan-Mei Wang
- Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Qiang-Qiang Fu
- Yangpu Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Zhen Zheng
- School of Health and Biomedical Sciences, RMIT University, Bundoora, VIC, Australia
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Zhao FY, Zheng Z, Fu QQ, Conduit R, Xu H, Wang HR, Huang YL, Jiang T, Zhang WJ, Kennedy GA. Acupuncture for comorbid depression and insomnia in perimenopause: A feasibility patient-assessor-blinded, randomized, and sham-controlled clinical trial. Front Public Health 2023; 11:1120567. [PMID: 36815166 PMCID: PMC9939459 DOI: 10.3389/fpubh.2023.1120567] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 01/11/2023] [Indexed: 02/09/2023] Open
Abstract
Background and objective Whilst acupuncture is widely used for treating psychosomatic diseases, there is little high-quality evidence supporting its application in comorbid perimenopausal depression (PMD) and insomnia (PMI) which are common complaints during climacteric. This feasibility, patient-assessor-blinded, randomized, sham-controlled clinical trial addresses this gap by investigating the efficacy and safety of acupuncture on depressed mood and poor sleep in women with comorbid PMD and PMI. Methods Seventy eligible participants were randomly assigned to either real-acupuncture (RA) or sham-acupuncture (SA) groups. Either RA or SA treatment were delivered in 17 sessions over 8 weeks. The primary outcomes for mood and sleep were changes on 17-items Hamilton Depression Rating Scale (HAM-D17) and Pittsburgh Sleep Quality Index (PSQI) scores, from baseline to 16-week follow-up. Secondary outcome measures involved anxiety symptoms, perimenopausal symptoms, quality of life, participants' experience of and satisfaction with the acupuncture treatment. Blood samples were taken to measure reproductive hormone levels. Intention-To-Treat and Per-Protocol analyses were conducted with linear mixed-effects models. The James' and Bang's blinding indices were used to assess the adequacy of blinding. Results Sixty-five participants completed all treatment sessions, and 54 and 41 participants completed the eight- and 16-week follow-ups, respectively. At post-treatment and 8-week follow-up, the RA group showed a significantly greater reduction in PSQI scores than the SA group did; although the reduction of HAM-D17 scores in RA group was significant, the change was not statistically different from that of SA. There were no significant mean differences between baseline and 16-week follow-up in either HAM-D17 or PSQI in either group. There were no significant between-group differences in serum reproductive hormone levels. All treatments were tolerable and no serious adverse events were reported, and the blinding was successful. Conclusion Acupuncture is safe and can contribute to clinically relevant improvements in comorbid PMD and PMI, with satisfactory short-and medium-term effects. Whether the anti-depressive benefit of acupuncture is specific or non-specific remains to be determined. No evidence was found for any longer-term benefit of acupuncture compared to sham at 16 weeks. Further research is required to elucidate mechanisms underlying the short to medium term effects of acupuncture.
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Affiliation(s)
- Fei-Yi Zhao
- School of Health and Biomedical Sciences, RMIT University, Bundoora, VIC, Australia,Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China,Department of Nursing, School of International Medical Technology, Shanghai Sanda University, Shanghai, China
| | - Zhen Zheng
- School of Health and Biomedical Sciences, RMIT University, Bundoora, VIC, Australia,*Correspondence: Zhen Zheng ✉
| | - Qiang-Qiang Fu
- Yangpu Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Russell Conduit
- School of Health and Biomedical Sciences, RMIT University, Bundoora, VIC, Australia,Institute for Breathing and Sleep, Austin Health, Heidelberg, VIC, Australia
| | - Hong Xu
- Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Hui-Ru Wang
- Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yu-Ling Huang
- Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Ting Jiang
- Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Wen-Jing Zhang
- Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China,Wen-Jing Zhang ✉
| | - Gerard A. Kennedy
- School of Health and Biomedical Sciences, RMIT University, Bundoora, VIC, Australia,Institute for Breathing and Sleep, Austin Health, Heidelberg, VIC, Australia,Institute of Health and Wellbeing, Federation University, Mount Helen, VIC, Australia
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Nkhoma G, Lim CX, Kennedy GA, Stupans I. Teaching cultural competence to undergraduate pharmacy students using vignettes (case scenarios) as an innovative teaching intervention. Int J Pharm Pract 2023; 31:225-229. [PMID: 36702578 DOI: 10.1093/ijpp/riac106] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 12/14/2022] [Indexed: 01/28/2023]
Abstract
OBJECTIVE Cultural competence is instrumental in reducing health equities. Addressing cultural competence at higher education level in healthcare students lays a solid cultural competence foundation for professional practice. The use of vignettes as a teaching intervention was effective because it allowed the use of role-modelling in real-life situations.The study aimed to enhance cultural competence in undergraduate pharmacy students using a self-directed online interactive cultural competence module embedded with three vignettes (case scenarios). METHOD This study was an exploratory longitudinal mixed method (survey and written feedback) study and used a convenience sample of 90 pharmacy students at an Australian University. Students' self-perceived transcultural self-efficacy was evaluated pre- and post-intervention using Jeffreys' Transcultural Self-Efficacy Tool (TSET) which is a validated outcome measure. KEY FINDINGS Vignettes were effective in teaching cultural competence as shown by significant (P < 0.0005) changes pre- to post-intervention in cognitive, practical and affective domains scores using TSET. The affective domain had the least positive mean score change. There was no significant association between any of the demographic factors such as age, gender or birthplace/parents' birthplace and changes in any of the three domains. Cronbach's alpha of >0.90 in all domains confirmed the test's internal consistency and reliability. CONCLUSIONS The findings were indicative of the students' positive receptivity to learning cultural competence and that they had a well-developed understanding of cultural competence. Further research is needed to determine why most cultural competence teaching methods produce little or no meaningful change in enhancing the affective domain.
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Affiliation(s)
- Gloria Nkhoma
- School of Health and Biomedical Sciences, Royal Melbourne Institute of Technology, Melbourne, Victoria, Australia
| | - Chiao-Xin Lim
- School of Health and Biomedical Sciences, Royal Melbourne Institute of Technology, Melbourne, Victoria, Australia
| | - Gerard A Kennedy
- School of Health and Biomedical Sciences, Royal Melbourne Institute of Technology, Melbourne, Victoria, Australia.,School of Science, Psychology and Sport, Federation University, Ballarat, Victoria, Australia.,Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia
| | - Ieva Stupans
- School of Health and Biomedical Sciences, Royal Melbourne Institute of Technology, Melbourne, Victoria, Australia
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12
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Marthick-Hone D, Doyle AK, Kennedy GA, Vindigni D, Polus BI. The importance of setting and therapeutic relationships when delivering chiropractic care to those living with disadvantage. Chiropr Man Therap 2022; 30:47. [PMID: 36274135 PMCID: PMC9590208 DOI: 10.1186/s12998-022-00456-y] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 10/10/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Chiropractic is a mostly privatised health profession within Australia, with people experiencing disadvantage typically having limited access due to financial barriers. However, some universities within Australia offer community outreach clinics where students provide chiropractic care to people living with disadvantage. This demographic experiences higher rates of chronic conditions including musculoskeletal complaints and requires subsidisation to access privatised care. This need also offers opportunity for the chiropractic profession to work within community healthcare teams. A mixed-methods observational study was used to investigate how the unique setting of a student chiropractic community clinic may influence the experience and outcomes of those who attend. METHODS Three patient-reported outcome measures (PROMs) investigated client outcomes: Measure Yourself Medical Outcome Profile (MYMOP); European Five Domain Five Level Quality of Life Questionnaire (EQ-5D-5L); and the Patient Enablement Instrument. The PROMs data were analysed descriptively and inferentially. Interviews were conducted with clients who had received chiropractic care, chiropractic students, clinical supervisors and staff of the centre. Interview data were coded using thematic analysis, and themes were formed using Bronfenbrenner's socio-ecological systems framework and non-participant observations. RESULTS Thirty-seven participants completed baseline PROMs and 17 completed follow-ups after four treatments. Seventy-two percent of participants nominated their primary complaint as chronic. Significant change was noted in general health and wellbeing for the MYMOP, pain and disability for the EQ-5D-5L and index scores for the EQ-5D-5L suggested improved health and wellbeing. Most clients experienced higher levels of enablement post treatment. Twelve participants were interviewed (four were clients), with five themes emerging from the interview data. Clients reported their lived experiences impacted their health problems and attending the clinic offered benefits beyond improvement of pain and disability. CONCLUSIONS Interview data suggested that these benefits were due to a combination of therapy, the setting and the relationships formed within that setting. Complementing this, PROM data suggested clients experienced better levels of health and wellbeing and decreased levels of pain and disability. Findings indicated that people who experienced disadvantage may receive broader benefits from attending community centres offering chiropractic care. Services such as chiropractic may be complementary in meeting the healthcare needs of those experiencing disadvantage.
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Affiliation(s)
- Dan Marthick-Hone
- Discipline of Chiropractic, School of Health and Biomedical Sciences, RMIT University, Bundoora, Australia.
| | - Aunty Kerrie Doyle
- grid.1029.a0000 0000 9939 5719Indigenous Health School of Medicine, University of Western Sydney, Campbelltown, Australia
| | - Gerard A. Kennedy
- grid.1040.50000 0001 1091 4859Institute of Health and Wellbeing, Federation University, Ballarat, Australia
| | - Dein Vindigni
- grid.1017.70000 0001 2163 3550Discipline of Chiropractic, School of Health and Biomedical Sciences, RMIT University, Bundoora, Australia
| | - Barbara I. Polus
- grid.1017.70000 0001 2163 3550School of Engineering, RMIT University, Bundoora, Australia
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Zhao FY, Kennedy GA, Cleary S, Conduit R, Zhang WJ, Fu QQ, Zheng Z. Knowledge about, attitude toward, and practice of complementary and alternative medicine among nursing students: A systematic review of cross-sectional studies. Front Public Health 2022; 10:946874. [PMID: 35991045 PMCID: PMC9386551 DOI: 10.3389/fpubh.2022.946874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 06/29/2022] [Indexed: 11/24/2022] Open
Abstract
Background The globally growing demand for complementary and alternative medicine (CAM) has attracted educators' attention to integrate CAM into conventional nursing programs. This systematic review aimed to understand the status quo of nursing students (NSs)' overall rated knowledge of, attitude/belief toward, and practice/previous use or experience (KAP) of CAM in surveys, given these factors may influence NSs' receptivity to CAM curricula, and may be of value in guiding the development of effective teaching strategies. Methods Formally published cross-sectional quantitative studies investigating the primary outcome of KAP toward CAM by NSs were searched for from eight databases from their inception through to 28 April 2022. PRISMA 2020 guidelines were followed. Results Twenty-six studies were included for analysis, 25 of which were judged to be of moderate to high quality. Despite limited and poorly informed knowledge of CAM therapies, the majority of NSs generally viewed them in a positive light. Furthermore, NSs usually reported an interest in further learning, and supported and welcomed the integration of CAM curricula, at least as elective modules, into existing nursing programs. Lack of evidence was perceived as a major barrier to the use or integration of CAM. Mass media and the internet were the main sources via which NSs access CAM information. Measurement of KAP in all included studies was via self-designed questionnaires/scales or adapted from previously developed questionnaires/scales. Conclusions The need for integrating and strengthening CAM curricula into current nursing education is identified. Besides theoretical knowledge and matched clinical placement, skills training in literature searching and evidence-based practice are advised to be included in the curricula design. The experiential learning mode is strongly recommended for delivering specific CAM modalities. In addition, a standard instrumentation for determining NSs' KAP toward CAM should be designed and examined for use in different cultural settings. Systematic Review Registration https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=300602, identifier: PROSPERO CRD42022300602.
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Affiliation(s)
- Fei-Yi Zhao
- Department of Nursing, School of International Medical Technology, Shanghai Sanda University, Shanghai, China
- School of Health and Biomedical Sciences, RMIT University, Bundoora, VIC, Australia
- Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Gerard A. Kennedy
- School of Health and Biomedical Sciences, RMIT University, Bundoora, VIC, Australia
- Institute of Health and Wellbeing, Federation University, Mount Helen, VIC, Australia
- Institute for Breathing and Sleep, Austin Health, Heidelberg, VIC, Australia
| | - Sonja Cleary
- School of Health and Biomedical Sciences, RMIT University, Bundoora, VIC, Australia
| | - Russell Conduit
- School of Health and Biomedical Sciences, RMIT University, Bundoora, VIC, Australia
- Institute for Breathing and Sleep, Austin Health, Heidelberg, VIC, Australia
| | - Wen-Jing Zhang
- Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- *Correspondence: Wen-Jing Zhang
| | - Qiang-Qiang Fu
- Yangpu Hospital, School of Medicine, Tongji University, Shanghai, China
- Qiang-Qiang Fu
| | - Zhen Zheng
- School of Health and Biomedical Sciences, RMIT University, Bundoora, VIC, Australia
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Isaac F, Toukhsati SR, DiBenedetto M, Kennedy GA. Cognitive behavioral therapy-based treatments for insomnia and nightmares in adults with trauma symptoms: a systematic review. Curr Psychol 2022; 42:1-11. [PMID: 35891889 PMCID: PMC9303051 DOI: 10.1007/s12144-022-03512-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2022] [Indexed: 11/19/2022]
Affiliation(s)
- Fadia Isaac
- Institute of Health and Wellbeing, Federation University, Office 211, Building HP, Mt Helen Campus, PO Box 663, Ballarat, Victoria 3353 Australia
| | - Samia R. Toukhsati
- Institute of Health and Wellbeing, Federation University, Office 211, Building HP, Mt Helen Campus, PO Box 663, Ballarat, Victoria 3353 Australia
| | | | - Gerard A. Kennedy
- Institute of Health and Wellbeing, Federation University, Office 211, Building HP, Mt Helen Campus, PO Box 663, Ballarat, Victoria 3353 Australia
- School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria Australia
- Institute for Breathing and Sleep, Austin Health, Victoria, Australia
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15
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Singh HK, Kennedy GA, Stupans I. The health coaching competency gap - Analysis of pharmacist competency frameworks from Australia, Canada, New Zealand the United Kingdom and the United States of America. Health Soc Care Community 2022; 30:e921-e932. [PMID: 34245204 DOI: 10.1111/hsc.13494] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 05/13/2020] [Revised: 04/26/2021] [Accepted: 06/07/2021] [Indexed: 06/13/2023]
Abstract
The traditional competency frameworks for coaches, the International Coaching Federation (ICF) and the European Mentoring and Coaching Council (EMCC) disregard the differences in expertise required among the diverse professions that may provide coaching. A recent systematic review has identified competencies specific to health professionals who health coach. There are increasing workload pressures in primary care; pharmacists can potentially shift to the greater provision of health promotion services, such as health coaching. The provision of such services needs to be underpinned by competency frameworks, which support the role of pharmacists as health coaches. This analysis identifies the competency gaps for pharmacists if they are to take on the role of health coaching. The enabling competencies of health coaches were compared to the competency frameworks of pharmacists from Australia (AUS), Canada (CAN), New Zealand (NZ), the United Kingdom (UK) and the United States of America (USA). Correlations between the international pharmacist competency frameworks and the competencies enabling health coaching showed that entry to practice pharmacists from AUS, CAN and NZ all require training enabling the health coaching competency 'demonstrates confidence', whereas competency frameworks for pharmacists from both the UK and the USA included all competencies required to health coach. Although pharmacists from the countries examined had most of the competencies required to health coach, gaps within the international pharmacist competency frameworks were apparent, university curricula addressing these gaps would equip entry to practice pharmacists with the knowledge and understanding to confidently provide emerging professional pharmacy services such as health coaching.
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Affiliation(s)
- Harjit K Singh
- The School of Health and Biomedical Sciences, RMIT University VIC, Bundoora, Vic., Australia
| | - Gerard A Kennedy
- The School of Health and Biomedical Sciences, RMIT University VIC, Bundoora, Vic., Australia
- School of Health and Life Sciences, Federation University, Ballarat, Melbourne, Australia
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Melbourne, Australia
| | - Ieva Stupans
- The School of Health and Biomedical Sciences, RMIT University VIC, Bundoora, Vic., Australia
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16
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Nkhoma G, Lim CX, Kennedy GA, Stupans I. Attitudes and Knowledge of, and Preferences for Learning about Cultural Competence: A Study of Pharmacy Students from One Australian Pharmacy Program. Pharmacy (Basel) 2022; 10:pharmacy10030066. [PMID: 35736780 PMCID: PMC9230435 DOI: 10.3390/pharmacy10030066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 05/09/2022] [Revised: 06/08/2022] [Accepted: 06/16/2022] [Indexed: 02/01/2023] Open
Abstract
Culturally and linguistically diverse populations, particularly asylum seekers, face challenges in accessing healthcare services. Pharmacists need to be capable of identifying and responding appropriately to the needs of diverse population groups. The aims of this study were to clarify student pharmacists’: knowledge of, and attitudes to, asylum seekers; their understanding of themselves with regard to cultural competence; their exposure to culturally and linguistically diverse clinical settings; their potential receptivity to learning opportunities directed towards cultural competence; and the extent to which they interpreted the current curriculum as improving their cultural competence. Pharmacy students’ viewpoints and perspectives were essential as emerging pharmacy professionals. This study employed mixed methods and convenience sampling. There were no significant (p > 0.05) associations between demographics and any of the survey items. Five themes emerged from the interviews: namely, exposure, formal vs. informal, positive views, conflict, and sufficiency. Pharmacy curriculum should ideally provide sufficient knowledge to meet culturally diverse healthcare consumers’ needs, especially asylum seekers. The most efficacious models for teaching cultural competence are as yet still undetermined. Interactive learning in cultural competence was recommended as essential.
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Affiliation(s)
- Gloria Nkhoma
- School of Health and Biomedical Sciences, STEM College, Royal Melbourne Institute of Technology, Bundoora, Melbourne, VIC 3083, Australia; (C.X.L.); (G.A.K.); (I.S.)
- Correspondence:
| | - Chiao Xin Lim
- School of Health and Biomedical Sciences, STEM College, Royal Melbourne Institute of Technology, Bundoora, Melbourne, VIC 3083, Australia; (C.X.L.); (G.A.K.); (I.S.)
| | - Gerard A. Kennedy
- School of Health and Biomedical Sciences, STEM College, Royal Melbourne Institute of Technology, Bundoora, Melbourne, VIC 3083, Australia; (C.X.L.); (G.A.K.); (I.S.)
- Institute of Health and Wellbeing, Federation University, P.O. Box 663, Ballarat, VIC 3353, Australia
- Institute for Breathing and Sleep, Austin Health, 145 Studley Rd., Heidelberg, VIC 3084, Australia
| | - Ieva Stupans
- School of Health and Biomedical Sciences, STEM College, Royal Melbourne Institute of Technology, Bundoora, Melbourne, VIC 3083, Australia; (C.X.L.); (G.A.K.); (I.S.)
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Zhao FY, Kennedy GA, Spencer SJ, Conduit R, Zhang WJ, Fu QQ, Zheng Z. The Role of Acupuncture in the Management of Insomnia as a Major or Residual Symptom Among Patients With Active or Previous Depression: A Systematic Review and Meta-Analysis. Front Psychiatry 2022; 13:863134. [PMID: 35492706 PMCID: PMC9051249 DOI: 10.3389/fpsyt.2022.863134] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 02/28/2022] [Indexed: 11/13/2022] Open
Abstract
Background Due to concerns about risks associated with antidepressants and/or hypnotics, complementary therapies such as acupuncture have been sought by patients with active or previous depression to manage insomnia. This systematic review aimed to clarify if acupuncture is effective and safe enough to be recommended as an alternative or adjuvant therapy to standard care in ameliorating concomitant or residual insomnia, two types of insomnia associated with depression. Methods Randomized controlled trials (RCTs) of depression-related insomnia (DI) treatment via acupuncture vs. waitlist-control or placebo-/sham-acupuncture and RCTs of DI treatment via acupuncture alone or combined with standard care [Western pharmacotherapy and/or cognitive-behavioral therapy (CBT)] vs. standard care alone were searched for from seven databases from inception to December 2021. Cochrane criteria were followed. Results Twenty-one studies involving 1,571 participants were analyzed. For insomnia as a major symptom of active depression, meta-analyses suggested that acupuncture significantly reduced the global scores of both the Pittsburg Sleep Quality Index (PSQI) [MD = -3.12, 95% CI (-5.16, -1.08), p < 0.01] and Hamilton Depression Scale (HAMD) [SMD = -2.67, 95% CI (-3.51, -1.84), p < 0.01], in comparison with placebo-acupuncture. When compared with conventional pharmacotherapy (antidepressants and/or hypnotics), the results favored acupuncture in decreasing PSQI [MD = -1.17, 95% CI (-2.26, -0.08), p = 0.03] and HAMD [SMD = -0.47, 95% CI (-0.91, -0.02), p = 0.04]. Acupuncture was comparable to conventional pharmacotherapy in reducing scores of each domain of PSQI. For insomnia as a residual symptom of previous or partially remitted depression, acupuncture conferred a very limited, non-significant therapeutic advantage against sham-/placebo-acupuncture. Whether acupuncture has an add-on effect to conventional pharmacotherapy in this type of insomnia has not been investigated. Also, no study was available to address the efficacy differences between acupuncture and CBT or the synergistic effect of these two therapies. Conclusions There is a low to moderate level of evidence supporting acupuncture as a safe and effective remedy alternative to or adjuvant to conventional pharmacotherapy (antidepressant and/or hypnotic) in improving insomnia and other depression symptoms among patients with active depression. Furthermore, the patients' complaint of disrupted sleep continuity is most likely to benefit from acupuncture. The benefit of acupuncture on residual insomnia associated with previous or partially remitted depression is limited. Future acupuncture studies need to consider applying optimal dosage and addressing deficiencies in trial quality.Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021269880, PROSPERO, identifier: CRD42021269880.
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Affiliation(s)
- Fei-Yi Zhao
- School of Health and Biomedical Sciences, RMIT University, Bundoora, VIC, Australia
- Department of Nursing, School of International Medical Technology, Shanghai Sanda University, Shanghai, China
- Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Gerard A. Kennedy
- School of Health and Biomedical Sciences, RMIT University, Bundoora, VIC, Australia
- School of Science, Psychology and Sport, Federation University, Mount Helen, VIC, Australia
- Institute for Breathing and Sleep, Austin Health, Heidelberg, VIC, Australia
| | - Sarah J. Spencer
- School of Health and Biomedical Sciences, RMIT University, Bundoora, VIC, Australia
- ARC Centre of Excellence for Nanoscale Biophotonics, RMIT University, Bundoora, VIC, Australia
| | - Russell Conduit
- School of Health and Biomedical Sciences, RMIT University, Bundoora, VIC, Australia
| | - Wen-Jing Zhang
- Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Qiang-Qiang Fu
- Yangpu Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Zhen Zheng
- School of Health and Biomedical Sciences, RMIT University, Bundoora, VIC, Australia
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Abstract
OBJECTIVE A systematic review was undertaken in order to evaluate the competencies of primary healthcare professionals who are engaged with health coaching patients with chronic health conditions. METHODS The databases CINHAL, EMBASE, PubMed, PsychINFO and SCOPUS were searched to identify peer reviewed papers referring to competencies of health professionals engaged in health coaching. RESULTS Nine key competencies that health professionals met and which resulted in successful patient outcomes from health coaching were identified. Comparisons of the core health coaching competencies to the competencies for coaches established by the International Coaching Federation and European Mentoring and Coaching Council showed considerable overlap. However, the comparison also reiterated the need for competencies specific to health coaches to be made explicit. DISCUSSION Health coaching has been shown to improve the health outcomes in patients with chronic health conditions. As such, there is a need to build an evidenced-based competency framework specific to health coaches. At present, the lack of a competency framework on which to base health coach training could significantly impact the outcomes of patients receiving health coaching. Practical implications include improving regulation and quality of health coaching, and more importantly, the health outcomes of patients receiving the service.
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Affiliation(s)
- Harjit K Singh
- The School of Health and Biomedical Sciences, RMIT University, VIC, Australia
| | - Gerard A Kennedy
- The School of Health and Biomedical Sciences, RMIT University, VIC, Australia
| | - Ieva Stupans
- The School of Health and Biomedical Sciences, RMIT University, VIC, Australia
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Kodsi A, Bullock B, Kennedy GA, Tirlea L. Psychological Interventions to Improve Sleep in Young Adults: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Behav Sleep Med 2022; 20:125-142. [PMID: 33554644 DOI: 10.1080/15402002.2021.1876062] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
INTRODUCTION The effects of impaired sleep on the wellbeing of young adults are profound, and the adverse outcomes for mental health are well documented in the research literature. OBJECTIVE This systematic review and meta-analysis aimed to identify, summarize, and synthesize the available evidence from randomized-controlled trials (RCTs) investigating psychological interventions aimed at improving sleep and related secondary outcomes such as anxiety and depression in healthy young adults. METHOD Nine electronic databases (Cochrane Central Registry of Controlled Trials [CENTRAL], PubMed, Scopus, PsycNET, CINHAL, INFORMIT, Web of Science [Science and Social Citation Index], OpenSigle and EMBASE) were searched, returning 54 full-text papers for assessment, with 13 studies meeting inclusion criteria for the meta-analysis. RESULTS A random effects meta-analysis showed that the combined effect of all interventions was moderate (ES = -0.53, 95% CIs [- 0.69, -0.36], p < .01), reflecting the efficacy of psychological interventions at improving sleep scores at post-intervention. Subgroup analyses of individual interventions showed that cognitive-behavioral interventions improved sleep (ES = -0.67, 95% CIs [-0.77, -0.57], p < .01) and secondary outcomes for anxiety (ES = -0.35, 95% CIs [-0.56, -0.15], p < .01) and depression (ES = -0.41, 95% CIs [-0.70, -0.13], p < .01) at post-intervention. CONCLUSION The results of the current review support the implementation of cognitive and behavioral interventions for sleep among young adults experiencing both sleep and comorbid mental health problems.
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Affiliation(s)
- Ali Kodsi
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia
| | - Ben Bullock
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia
| | - Gerard A Kennedy
- School of Health and Life Sciences, Federation University, Ballarat, Australia.,School of Health and Biomedical Sciences, RMIT University, Melbourne, Australia.,Institute for Breathing and Sleep, Austin Health, Melbourne, Australia
| | - Loredana Tirlea
- Department of Health and Biomedical Sciences, Swinburne University of Technology, Melbourne, Australia
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Alomri RM, Kennedy GA, Wali S, Ahejaili F, Zelko M, Robinson SR. Association between cognitive dysfunction and nocturnal peaks of blood pressure estimated from pulse transit time in obstructive sleep apnoea. Sleep Med 2022; 90:185-191. [DOI: 10.1016/j.sleep.2022.01.005] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 11/18/2021] [Accepted: 01/05/2022] [Indexed: 11/27/2022]
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Isaac F, Toukhsati SR, Di Benedetto M, Kennedy GA. A Systematic Review of the Impact of Wildfires on Sleep Disturbances. Int J Environ Res Public Health 2021; 18:ijerph181910152. [PMID: 34639453 PMCID: PMC8508521 DOI: 10.3390/ijerph181910152] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 09/21/2021] [Accepted: 09/24/2021] [Indexed: 11/21/2022]
Abstract
Wildfires present a serious risk to humans as well as to the environment. Wildfires cause loss of lives, economic losses, expose people to personal as well as collective trauma, and compromise the mental health of survivors. Sleep disturbances are highly prevalent following a traumatic event; however, their prevalence is not well established amongst those confronted by natural disasters such as wildfires. The aim of this systematic review is to synthesise the empirical findings pertaining to wildfires and the prevalence of sleep disturbances in the general community affected by this natural disaster. We searched EBSCO, PsychINFO, Medline, SpringerLink, CINAHL Complete, EMBASE, PubMed, Scopus and Cochrane Library between January 2012 and March 2021. Five studies met the inclusion criteria. Findings from this systematic review suggest that sleep disturbances, assessed one to ten months following the fires, are highly prevalent in wildfire survivors, with insomnia (ranging between 63–72.5%) and nightmares (ranging between 33.3–46.5%), being the most prevalent sleep disturbances reported in this cohort. Results also highlight the significant associations between sleep disturbances and post-traumatic symptoms following the trauma of wildfires. There is a possible link between sleep disturbance prevalence, severity of, and proximity to fires.
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Affiliation(s)
- Fadia Isaac
- School of Science, Psychology and Sport, Federation University, Ballarat, VIC 3350, Australia; (S.R.T.); (G.A.K.)
- Correspondence: ; Tel.: +61-3-5327-6651
| | - Samia R. Toukhsati
- School of Science, Psychology and Sport, Federation University, Ballarat, VIC 3350, Australia; (S.R.T.); (G.A.K.)
| | | | - Gerard A. Kennedy
- School of Science, Psychology and Sport, Federation University, Ballarat, VIC 3350, Australia; (S.R.T.); (G.A.K.)
- School of Health and Biomedical Sciences, RMIT University, Melbourne, VIC 3083, Australia
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Melbourne, VIC 3084, Australia
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22
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Shahin W, Kennedy GA, Stupans I. The association between social support and medication adherence in patients with hypertension: A systematic review. Pharm Pract (Granada) 2021; 19:2300. [PMID: 34221197 PMCID: PMC8234709 DOI: 10.18549/pharmpract.2021.2.2300] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [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: 01/21/2021] [Accepted: 06/06/2021] [Indexed: 11/14/2022] Open
Abstract
Background: Medication adherence is a primary determinant of treatment success in
hypertensive patients. One of the challenges for healthcare providers that
has received little attention is the impact of patients’ social
supports on medication adherence. Objective: This review evaluates the impact of patients’ social supports on
medication adherence in hypertensive patients. Methods: A systematic review methodology was used. Pubmed, CINAHL, Embase, and
PsycINFO databases were searched systematically for relevant articles. The
outcome measure in the studies was medication adherence in hypertension. Results: From 1155 articles, 238 were retained for further assessment, and finally, 14
met the inclusion criteria. Statistically significant positive associations
between medication adherence and social support were found in nine studies
(p<0.05). Conclusions: This review evaluated the impact of social support on medication adherence
and highlighted gaps in the literature regarding the impact of social
support on adherence. Family members or peer support may promote better
adherence in some patient groups. This review suggests that healthcare
providers may need to consider whether patients have appropriate social
supports in place which will assist them adhering to and benefiting from
treatment recommendations.
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Affiliation(s)
- Wejdan Shahin
- School of Health & Biomedical Sciences, RMIT University. Bundoora, VIC (Australia).
| | - Gerard A Kennedy
- School of Health & Biomedical Sciences, RMIT University. Bundoora, VIC (Australia).
| | - Ieva Stupans
- School of Health & Biomedical Sciences, RMIT University. Bundoora, VIC (Australia).
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23
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Singh HK, Kennedy GA, Stupans I. Does the national competency standards framework for pharmacists in Australia support the provision of behaviour change interventions? Health Promot J Austr 2021; 33:480-487. [PMID: 33991372 DOI: 10.1002/hpja.503] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 05/11/2021] [Indexed: 11/11/2022] Open
Abstract
ISSUE ADDRESSED Australian pharmacists are increasingly moving towards the provision of patient-centred professional pharmacy services for chronic disease management. Some of these services are targeted towards improving patients' health and wellbeing through the facilitation of patient-driven health behaviour change. This paper investigates whether the provision of behaviour change interventions by Australian pharmacists is adequately underpinned by the current competency framework. METHODS The foundation and behaviour change competences within each of the domains in the generic health behaviour change competency framework (GHBC-CF), was mapped to the Australian pharmacist competency framework. RESULTS Although the Australian competency framework underpins most of the foundation and behaviour change competences of the GHB-CF required to undertake low-intensity interventions, for medium to high-intensity interventions four specific task-related competences need to be addressed. These are F12 'Ability to recognise barriers to and facilitators of implementing interventions', BC4 'ability to agree on goals for the intervention', BC5 'capacity to implement behaviour change models in a flexible but coherent manner' and BC6 'capacity to select and skilfully apply most appropriate intervention method'. CONCLUSION Additional training is necessary if pharmacists aspire to provide behaviour change interventions for chronic disease management, in particular those that are complex as they involve changes to multiple health behaviours. SO WHAT?: The identification of these gaps is critical and can potentially be addressed in postgraduate training programs and as pharmacy curricula are updated.
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Affiliation(s)
- Harjit K Singh
- School of Health and Biomedical Sciences, RMIT University, Bundoora, VIC, Australia
| | - Gerard A Kennedy
- School of Health and Biomedical Sciences, RMIT University, Bundoora, VIC, Australia.,School of Science, Psychology and Sport, Federation University, Ballarat, Melbourne, Australia.,Institute for Breathing and Sleep, Austin Health, Heidelberg, Melbourne, Australia
| | - Ieva Stupans
- School of Health and Biomedical Sciences, RMIT University, Bundoora, VIC, Australia
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24
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Alomri RM, Kennedy GA, Wali SO, Ahejaili F, Robinson SR. Differential associations of hypoxia, sleep fragmentation, and depressive symptoms with cognitive dysfunction in obstructive sleep apnea. Sleep 2021; 44:5921145. [PMID: 33045082 DOI: 10.1093/sleep/zsaa213] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 08/31/2020] [Indexed: 12/20/2022] Open
Abstract
Obstructive sleep apnea (OSA) is characterized by recurrent episodes of partial or complete cessation of breathing during sleep and increased effort to breathe. This study examined patients who underwent overnight polysomnographic studies in a major sleep laboratory in Saudi Arabia. The study aimed to determine the extent to which intermittent hypoxia, sleep disruption, and depressive symptoms are independently associated with cognitive impairments in OSA. In the sample of 90 participants, 14 had no OSA, 30 mild OSA, 23 moderate OSA, and 23 severe OSA. The findings revealed that hypoxia and sleep fragmentation are independently associated with impairments of sustained attention and reaction time (RT). Sleep fragmentation, but not hypoxia, was independently associated with impairments in visuospatial deficits. Depressive symptoms were independently associated with impairments in the domains of sustained attention, RT, visuospatial ability, and semantic and episodic autobiographical memories. Since the depressive symptoms are independent of hypoxia and sleep fragmentation, effective reversal of cognitive impairment in OSA may require treatment interventions that target each of these factors.
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Affiliation(s)
- Ridwan M Alomri
- School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia.,Department of Psychology, College of Social Sciences, University of Jeddah, Jeddah, Saudi Arabia
| | - Gerard A Kennedy
- School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia.,Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia.,School of Science, Psychology and Sport, Federation University, Ballarat, Victoria, Australia
| | - Siraj Omar Wali
- Sleep Medicine and Research Centre, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Faris Ahejaili
- Sleep Medicine and Research Centre, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Stephen R Robinson
- School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia.,Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia
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25
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Nkhoma G, Lim CX, Kennedy GA, Stupans I. Reducing health inequities for asylum seekers with chronic non-communicable diseases: Australian context. Aust J Prim Health 2021; 27:PY20091. [PMID: 33773608 DOI: 10.1071/py20091] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 11/09/2020] [Indexed: 11/23/2022]
Abstract
Asylum seekers are susceptible to chronic non-communicable diseases pre- and post-arrival due to poor living conditions, unhealthy lifestyles and restrictive and poor access to health services. Despite their need for constant and continuous health care access due to poor health, they face healthcare services access restrictions dependent on their visa conditions in Australia. Some visas only allow access to hospital services with restrictions on primary health services access such as GPs and free or discounted pharmaceutical products. In comparison, disadvantaged host populations have access to free/discounted pharmaceutical products and unrestricted access to primary and secondary health care. Ten professionals who constantly engage with asylum seekers in three large asylum seeker centres in Melbourne were interviewed either face-to-face or over the phone. The interviews were essential to understand how health inequities may be addressed for asylum seekers. Interviews were audio-recorded, transcribed verbatim and analysed using a thematic analysis framework. Their recommendations, based mainly on their experience and evaluation of programs, were: (1) cultural competence training; (2) use of interpreters; (3) free access to health services and medications; (4) use of English learning to promote health literacy and community integration; (5) robust chronic non-communicable diseases screening; and (6) health promotion and accessible food programs.
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Affiliation(s)
- Gloria Nkhoma
- School of Health and Biomedical Sciences, STEM College, RMIT University, Bundoora, Vic. 3083, Australia; and Corresponding author
| | - Chiao Xin Lim
- School of Health and Biomedical Sciences, STEM College, RMIT University, Bundoora, Vic. 3083, Australia
| | - Gerard A Kennedy
- School of Health and Biomedical Sciences, STEM College, RMIT University, Bundoora, Vic. 3083, Australia; and School of Health and Life Sciences, Federation University, University Drive, Mount Helen, Ballarat, Melbourne, Vic. 3350, Australia; and Institute for Breathing and Sleep, Austin Health, 145 Studley Road, Heidelberg, Melbourne, Vic. 3084, Australia
| | - Ieva Stupans
- School of Health and Biomedical Sciences, STEM College, RMIT University, Bundoora, Vic. 3083, Australia
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26
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Singh HK, Kennedy GA, Stupans I. A pharmacist health coaching trial evaluating behavioural changes in participants with poorly controlled hypertension. BMC Fam Pract 2021; 22:35. [PMID: 33583416 PMCID: PMC7883432 DOI: 10.1186/s12875-021-01385-0] [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] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 02/08/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND To investigate whether pharmacist health coaching improves progression through the stages of change (SOC) for three modifiable health behaviours; diet, exercise, and medication management in participants with poorly controlled hypertension. METHODS In this four-month controlled group study two community-based pharmacists provided three health coaching sessions to 20 participants with poorly controlled hypertension at monthly intervals. Changes in participants' stages of change with respect to the modifiable health behaviours; diet, exercise, and medication management were assessed. To confirm the behaviour change outcomes, SOC were also assessed in a control group over the same period. RESULTS Statistically significant changes in the modifiable health behaviours- medication management (d = 0.19; p = 0.03) and exercise (d = 0.85; p = 0.01) were apparent in participants who received health coaching and were evident through positive changes in the SOC charts. The participants in the control group did not experience significant changes with respect to the SOC. This was parallel to a decrease in mean systolic blood pressure from session one to session four by 7.53 mmHg (p < 0.05, d = - 0.42) in participants who received health coaching. Improvements to medication adherence was also apparent in these participants, evident from the mean scores for the Adherence to Refills and Medications Scale (ARMS), which decreased significantly from a mean of 15.60 to 13.05 (p < 0.05) from session one to four. CONCLUSIONS Pharmacist health coaching produced promising health outcomes in participants with poorly controlled hypertension. Pharmacists were able to facilitate a positive behaviour change in participants. However, larger participant cohorts are needed to explore these findings further. TRIAL REGISTRATION Australia New Zealand Clinical Trials Registry ACTRN12618001839291 . Date of registration 12/11/2018.
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Affiliation(s)
- Harjit K Singh
- Discipline of Pharmacy, The School of Health and Biomedical Sciences, RMIT University VIC, Bundoora, VIC, 3083, Australia.
| | - Gerard A Kennedy
- Discipline of Pharmacy, The School of Health and Biomedical Sciences, RMIT University VIC, Bundoora, VIC, 3083, Australia.,School of Health and Life Sciences, Federation University, University Drive, Mount Helen, Ballarat, Melbourne, Australia.,Institute for Breathing and Sleep, Austin Health, 145 Studley Road, Heidelberg, Melbourne, Australia
| | - Ieva Stupans
- Discipline of Pharmacy, The School of Health and Biomedical Sciences, RMIT University VIC, Bundoora, VIC, 3083, Australia
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27
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Zhao FY, Fu QQ, Kennedy GA, Conduit R, Zhang WJ, Wu WZ, Zheng Z. Can acupuncture improve objective sleep indices in patients with primary insomnia? A systematic review and meta-analysis. Sleep Med 2021; 80:244-259. [PMID: 33610071 DOI: 10.1016/j.sleep.2021.01.053] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [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] [Received: 10/05/2020] [Revised: 01/20/2021] [Accepted: 01/27/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND The efficacy of acupuncture for treating primary insomnia (PI) has been explored in several meta-analyses where the outcomes measures were based on subjective self-reported sleep rating scales. Sleep state misperception is common in PI and self-reports underestimate sleep duration and quality. No systematic reviews or meta-analyses have investigated the efficacy of acupuncture in improving objective sleep measures in PI. OBJECTIVE To perform a systematic review to determine whether objective sleep parameters are improved by acupuncture in patients with PI. METHODS Randomized controlled trials treating PI via verum-acupuncture versus sham-/placebo-acupuncture or waitlist control were searched for in English [MEDLINE (via PubMed), Sciverse ScienceDirect, Cochrane Central Register of Controlled Trials (CENTRAL), AMED, Springer, EMBASE (Elsevier), Ebsco Medline, and PsycINFO (ProQuest)] and Chinese (SinoMed, CNKI, Wanfang and CQVIP) databases, from the dates of the databases' inception to January 2020. The parameters of polysomnography (PSG), actigraphy, or micromovement sensitive mattress/pillow sleep monitoring systems were considered as the primary outcome measures. Revman 5.3 and Stata 16.0 software were used to conduct the meta-analysis. Heterogeneity was examined by using I2 statistics and publication bias was assessed via Egger's test. RESULTS Eleven studies involving 775 patients met the inclusion criteria. The results of meta-analysis suggested that acupuncture can increase total sleep time [MD = 55.29, 95%CI (29.16, 81.42), p < 0.01], increase sleep efficiency [MD = 8.96, 95%CI (3.97, 13.95), p < 0.01], decrease wake after sleep onset [MD = -49.54, 95%CI (-82.98, -16.09), p < 0.01], and reduce number of awakening times [MD = -6.29, 95%CI (-10.75, -1.82), p < 0.01] compared with either sham-/placebo-acupuncture or waitlist control. Subsequent analysis indicated a superior effect for verum-acupuncture in comparison with sham-/placebo-acupuncture or waitlist-control when the recommended lowest threshold dosage (12 sessions) was met. Despite positive outcomes, most studies reviewed were heterogeneous and at risk of bias due to methodological issues. CONCLUSIONS Despite limited evidence, acupuncture was significantly associated with improvements in several objective sleep parameters (increases in total sleep time and sleep efficiency, and reductions in wake after sleep onset and number of awakening times) as well as subjective sleep quantity and quality in patients with PI. A minimum therapeutic threshold dosage (≥12 sessions) is recommended. Well-designed RCTs using PSG are required to clarify the influence of acupuncture on sleep architecture/structure and to promote better application of acupuncture as a treatment for PI.
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Affiliation(s)
- Fei-Yi Zhao
- School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, 3083, Australia; Department of Nursing, School of International Medical Technology, Shanghai Sanda University, Shanghai, China
| | - Qiang-Qiang Fu
- Yangpu Hospital, Tongji University School of Medicine, Shanghai, China
| | - Gerard A Kennedy
- School of Science, Psychology and Sport, Federation University, Mount Helen, Victoria, 3350, Australia; School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, 3083, Australia; Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, 3084, Australia
| | - Russell Conduit
- School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, 3083, Australia
| | - Wen-Jing Zhang
- Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Wen-Zhong Wu
- Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu China
| | - Zhen Zheng
- School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, 3083, Australia.
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28
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Khan WAA, Jackson ML, Kennedy GA, Conduit R. A field investigation of the relationship between rotating shifts, sleep, mental health and physical activity of Australian paramedics. Sci Rep 2021; 11:866. [PMID: 33441601 PMCID: PMC7806923 DOI: 10.1038/s41598-020-79093-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [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: 05/05/2020] [Accepted: 11/27/2020] [Indexed: 12/29/2022] Open
Abstract
Paramedics working on a rotating shift are at an increased risk of developing chronic health issues due to continuous circadian rhythm disruption. The acute effects of shift rotation and objectively measured sleep have rarely been reported in paramedics. This study investigated the relationships between a rotating shift schedule and sleep (using actigraphy), subjective reports of sleepiness, mood, stress and fatigue. Galvanic Skin Response, energy expenditure and physical activity (BodyMedia SenseWear Armband) were also recorded across the shift schedule. Paramedics were monitored for a period of eight consecutive days across pre-shift, day shift, night shift, and 2 days off. Fifteen paramedics (M age = 39.5 and SD = 10.7 years) who worked rotational shifts experienced sleep restriction during night shift compared to pre-shift, day shift and days off (p < 0.001). Night shift was also associated with higher levels of stress (p < 0.05), fatigue (p < 0.05), and sleepiness (p < 0.05). One day off was related to a return to pre-shift functioning. Such shift-related issues have a compounding negative impact on an already stressful occupation with high rates of physical and mental health issues. Therefore, there is an urgent need to investigate methods to reduce rotating shift burden on the health of paramedics. This could be through further research aimed at providing recommendations for shift work schedules with sufficient periods for sleep and recovery from stress.
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Affiliation(s)
- Wahaj Anwar A Khan
- Occupational Health Department, Faculty of Public Health and Health Informatics, Umm Al-Qura University, Makkah, Saudi Arabia.,Psychology Discipline, School of Health and Biomedical Sciences, College of Science, Engineering and Health, RMIT University, PO Box 71, Bundoora, VIC, 3083, Australia
| | - Melinda L Jackson
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Australia.,Institute for Breathing and Sleep, Austin Health, Melbourne, Australia
| | - Gerard A Kennedy
- Institute for Breathing and Sleep, Austin Health, Melbourne, Australia.,School of Health and Life Sciences, Federation University, Ballarat, Australia.,Psychology Discipline, School of Health and Biomedical Sciences, College of Science, Engineering and Health, RMIT University, PO Box 71, Bundoora, VIC, 3083, Australia
| | - Russell Conduit
- Institute for Breathing and Sleep, Austin Health, Melbourne, Australia. .,Psychology Discipline, School of Health and Biomedical Sciences, College of Science, Engineering and Health, RMIT University, PO Box 71, Bundoora, VIC, 3083, Australia.
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29
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Zhao FY, Fu QQ, Spencer SJ, Kennedy GA, Conduit R, Zhang WJ, Zheng Z. Acupuncture: A Promising Approach for Comorbid Depression and Insomnia in Perimenopause. Nat Sci Sleep 2021; 13:1823-1863. [PMID: 34675729 PMCID: PMC8520448 DOI: 10.2147/nss.s332474] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 09/24/2021] [Indexed: 12/12/2022] Open
Abstract
Comorbid depression and insomnia are ubiquitous mental complaints among women going through the perimenopausal stage of life and can result in major decline in quality of life. Antidepressive agents combined with/without hypnotics, and/or hormone therapy are currently the most common treatment for perimenopausal depression (PMD) and insomnia (PMI). Balancing the benefits of these pharmacotherapies against the risk of adverse events (AEs) is a difficult task for both clinicians and women. There has been a growing body of research regarding the utilization of acupuncture for treatment of PMD or PMI, whereas no studies of acupuncture for comorbid PMD and PMI have appeared. In this review, we summarize the clinical and preclinical evidence of acupuncture as a treatment for PMD or PMI, and then discuss the potential mechanisms involved and the role of acupuncture in helping women during this transition. Most clinical trials indicate that acupuncture ameliorates not only PMD/PMI but also climacteric symptoms with minimal AEs. It also regulates serum hormone levels. The reliability of trials is however limited due to methodological flaws in most studies. Rodent studies suggest that acupuncture prolongs total sleep time and reduces depression-like behavior in PMI and PMD models, respectively. These effects are possibly mediated through multiple mechanisms of action, including modulating sex hormones, neurotransmitters, hypothalamic-pituitary-adrenal axis/hypothalamic-pituitary-ovary axis, oxidative stress, signaling pathways, and other cellular events. In conclusion, acupuncture is a promising therapeutic strategy for comorbid depression and insomnia during perimenopause. Neuroendocrine modulation is likely to play a major role in mediating those effects. High-quality trials are required to further validate acupuncture's effectiveness.
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Affiliation(s)
- Fei-Yi Zhao
- School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, 3083, Australia.,Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, 200071, People's Republic of China.,Department of Nursing, School of International Medical Technology, Shanghai Sanda University, Shanghai, 201209, People's Republic of China
| | - Qiang-Qiang Fu
- Yangpu Hospital, School of Medicine, Tongji University, Shanghai, 200090, People's Republic of China
| | - Sarah J Spencer
- School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, 3083, Australia.,ARC Centre of Excellence for Nanoscale Biophotonics, RMIT University, Bundoora, Victoria, 3083, Australia
| | - Gerard A Kennedy
- School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, 3083, Australia.,School of Science, Psychology and Sport, Federation University, Mount Helen, Victoria, Australia.,Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, 3084, Australia
| | - Russell Conduit
- School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, 3083, Australia
| | - Wen-Jing Zhang
- Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, 200071, People's Republic of China
| | - Zhen Zheng
- School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, 3083, Australia
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30
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Zhao FY, Zhang WJ, Kennedy GA, Conduit R, Zheng Z, Fu QQ. The Role of Acupuncture in Treating Perimenopausal Insomnia: An Overview and Quality Assessment of Systematic Reviews and Meta-Analyses. Neuropsychiatr Dis Treat 2021; 17:3325-3343. [PMID: 34795484 PMCID: PMC8593691 DOI: 10.2147/ndt.s337504] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 10/22/2021] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE To summarize and critically assess the reliability of the methodological quality and outcome measures from systematic reviews (SRs)/meta-analyses (MAs) and provide an overall verdict about the therapeutic value of acupuncture for perimenopausal insomnia (PMI). METHODS We conducted a comprehensive literature search for SRs/MAs of seven major databases (English and Chinese). For each included review, the methodological quality was appraised according to the Assessing the Methodological Quality of Systematic Reviews 2 (AMSTAR-2), the evidence quality was classified on the basis of the Grading of Recommendations, Assessment, Development and Evaluation (GRADE), and reporting quality was evaluated complying with Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2009 (PRISMA-2009). Veritas plots were used to quantify the quality of included SRs/MAs. RESULTS Nine SRs/MAs were deemed eligible for the present overview. Considering the assessment of results from the AMSTAR-2 checklist, the methodological quality of one SR/MA was considered low, and the remaining eight were critically low. Major methodological deficiencies were concentrated on item 2 (the lack of protocol and/or registration information), item 7 (the lack of a list of excluded studies), and item 10 (the lack of reports on funding sources for individual studies included in the SRs/MAs). For the GRADE system, of the 25 outcomes, only three (12%) were rated as moderate-quality, while the remaining 22 were rated between low- and very low-quality. The PRISMA-2009 statement indicated three major reporting quality limitations in most SRs/MAs, namely: 1) only search terms without specific retrieval strategy; 2) incomplete descriptions for study characteristics, particularly the specific dosage and frequency of interventions in treatment/control groups; and 3) inadequate investigation and explanation of the source of high heterogeneity among original randomized control trials included. According to Veritas plots, quality rank scores of included SRs/MAs ranged from 3.3 to 8.3, with an average score of 6.4 ± 1.7. CONCLUSION Acupuncture appears to be beneficial for PMI management, but the quality of evidence is weakened by the unsatisfactory quality of both SRs/MAs and original trials included.
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Affiliation(s)
- Fei-Yi Zhao
- School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, 3083, Australia.,Department of Nursing, School of International Medical Technology, Shanghai Sanda University, Shanghai, 201209, People's Republic of China.,Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, 200071, People's Republic of China
| | - Wen-Jing Zhang
- Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, 200071, People's Republic of China
| | - Gerard A Kennedy
- School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, 3083, Australia.,School of Science, Psychology and Sport, Federation University, Mount Helen, Victoria, Australia.,Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, 3084, Australia
| | - Russell Conduit
- School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, 3083, Australia
| | - Zhen Zheng
- School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, 3083, Australia
| | - Qiang-Qiang Fu
- Department of General Practice, Yangpu Hospital, School of Medicine, Tongji University, Shanghai, 200090, People's Republic of China
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31
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Zhao FY, Fu QQ, Kennedy GA, Conduit R, Zhang WJ, Zheng Z. Acupuncture as an Independent or Adjuvant Management to Standard Care for Perimenopausal Depression: A Systematic Review and Meta-Analysis. Front Psychiatry 2021; 12:666988. [PMID: 34122180 PMCID: PMC8192720 DOI: 10.3389/fpsyt.2021.666988] [Citation(s) in RCA: 4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 04/06/2021] [Indexed: 12/20/2022] Open
Abstract
Background: Many women with perimenopausal depression (PMD) have sought alternative therapies such as acupuncture because of concerns about risks associated with antidepressant and hormone replacement therapy (HRT). This systematic review aimed to clarify if acupuncture is effective for PMD compared with waitlist control or placebo/sham acupuncture, and if acupuncture alone or combined with standard care (antidepressant and/or HRT) is more effective in ameliorating PMD in comparison with standard care alone. Methods: Randomized controlled trials (RCTs) of PMD treatment via acupuncture vs. waitlist control or placebo/sham acupuncture, and RCTs of PMD treatment via acupuncture alone or combined with Western pharmacotherapy vs. Western pharmacotherapy were searched for from seven databases from inception to December 2020. Cochrane criteria were followed. Results: Twenty-five studies involving 2,213 women were analyzed. Meta-analyses indicated that acupuncture significantly reduced the global scores of Hamilton Depression Scale (HAMD) [standardized mean difference (SMD) = -0.54, 95% CI (-0.91, -0.16), p < 0.01], compared with standard care. The therapeutic effect of acupuncture maintained at 2-, 4-, and 12-week follow-ups. Acupuncture combined with standard care was more effective than standard care alone in decreasing HAMD scores [SMD = -0.82, 95% CI (-1.07, -0.58), p < 0.01]. Too few RCTs were available to assess the clinical efficacy differences between acupuncture and placebo/sham acupuncture or HRT alone. Acupuncture also showed better effects in decreasing Kupperman index (KI) scores, whether compared with antidepressant alone [MD = -4.55, 95% CI (-8.46, -0.65), p = 0.02] or antidepressant combined with HRT [MD = -0.89, 95% CI (-1.34, -0.43), p < 0.01]. Conclusions: In comparison with standard care, acupuncture alone or combined with standard care was associated with significant improvements in PMD and reductions of other menopausal symptoms. This finding suggests that acupuncture may be a useful addition to treatment for PMD.
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Affiliation(s)
- Fei-Yi Zhao
- School of Health and Biomedical Sciences, RMIT University, Bundoora, VIC, Australia.,Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China.,Department of Nursing, School of International Medical Technology, Shanghai Sanda University, Shanghai, China
| | - Qiang-Qiang Fu
- Yangpu Hospital, Tongji University School of Medicine, Shanghai, China
| | - Gerard A Kennedy
- School of Health and Biomedical Sciences, RMIT University, Bundoora, VIC, Australia.,School of Science, Psychology and Sport, Federation University, Mount Helen, VIC, Australia.,Institute for Breathing and Sleep, Austin Health, Heidelberg, VIC, Australia
| | - Russell Conduit
- School of Health and Biomedical Sciences, RMIT University, Bundoora, VIC, Australia
| | - Wen-Jing Zhang
- Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Zhen Zheng
- School of Health and Biomedical Sciences, RMIT University, Bundoora, VIC, Australia
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Rajoo Y, Wong J, Raj IS, Kennedy GA. Perceived barriers and enablers to physical activity participation in people with Alopecia Areata: a constructivist grounded theory study. BMC Psychol 2020; 8:132. [PMID: 33303012 PMCID: PMC7731756 DOI: 10.1186/s40359-020-00502-5] [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] [Received: 04/22/2020] [Accepted: 12/04/2020] [Indexed: 12/05/2022] Open
Abstract
Background Alopecia Areata (AA) is an autoimmune disease that is characterised by hair loss. Individuals diagnosed with it often describe feelings of trauma and social rejection due to cosmetic repercussions and are at high risk of experiencing psychological distress. Physical activity (PA) participation has been associated with better mental health outcomes in diverse populations. A preliminary study of individuals with AA indicated that severe hair loss is associated with symptomatic depression, anxiety and stress, which negatively impacted PA participation. While strategies to increase PA participation in the general population have been established, little is known about PA participation in people with AA. This study aimed to understand barriers and enablers to PA participation in people with AA to inform the development of evidence-based interventions.
Methods The study used a grounded theory (GT) methodology, relying on an iterative and simultaneous process of data collection, coding, theory development, and data comparisons to explore the perceived barriers and enablers to PA. Data were collected through a focus group (8 participants [33.38 ± 10.81 years]) and individual telephone interviews (8 participants [33.89 ± 11.87 years]). The study was conducted in Melbourne, Australia. Interview data were recorded digitally, transcribed verbatim and analysed. Recruitment continued until theoretical saturation was achieved. Results The constructivist grounded theory method used has assisted to develop an explanatory model which is used to explain the themes for barriers and enablers to PA participation. The four phases in the explanatory model are as follows (1) onset of AA; (2) reaction towards the condition; (3) adjustment; and (4) acceptance. Conclusion The findings highlighted perceived barriers and enablers to PA participation in people with AA. Future interventions could consider addressing these barriers specifically to maximise effectiveness and to improve mental health status based on the phases of the explanatory model.
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Affiliation(s)
- Yamuna Rajoo
- School of Health and Biomedical Science, RMIT University, Bundoora Campus, Bundoora, Melbourne, VIC, 3083, Australia.
| | - J Wong
- School of Education, RMIT University, Melbourne, Australia
| | - I S Raj
- School of Health and Biomedical Science, RMIT University, Bundoora Campus, Bundoora, Melbourne, VIC, 3083, Australia
| | - G A Kennedy
- School of Health and Biomedical Science, RMIT University, Bundoora Campus, Bundoora, Melbourne, VIC, 3083, Australia.,School of Health and Life Sciences, Federation University, Ballarat, Australia.,Institute for Breathing and Sleep, Austin Health, Heidelberg, Australia
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Meaklim H, Abbott JM, Kennedy GA, Murray G, Klein B, Rehm I. Lessons learned from delivering an internet intervention for insomnia in an Australian public hospital outpatient setting. Australian Psychologist 2020. [DOI: 10.1111/ap.12374] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Hailey Meaklim
- National eTherapy Centre, Centre for Mental Health, Swinburne University of Technology, Hawthorn, Victoria, Australia
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia
- School of Health and Biomedical Sciences, RMIT University Bundoora, Victoria, Australia
| | - Jo‐anne M. Abbott
- National eTherapy Centre, Centre for Mental Health, Swinburne University of Technology, Hawthorn, Victoria, Australia
| | - Gerard A. Kennedy
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia
- School of Health and Biomedical Sciences, RMIT University Bundoora, Victoria, Australia
| | - Greg Murray
- National eTherapy Centre, Centre for Mental Health, Swinburne University of Technology, Hawthorn, Victoria, Australia
| | - Britt Klein
- Centre for Biopsychosocial and eHealth Research & Innovation & the DVC‐R Portfolio, Federation University Australia, Ballarat, Victoria, Australia
| | - Imogen Rehm
- National eTherapy Centre, Centre for Mental Health, Swinburne University of Technology, Hawthorn, Victoria, Australia
- School of Health and Biomedical Sciences, RMIT University Bundoora, Victoria, Australia
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Apel S, Hudson R, Coleman GJ, Rödel HG, Kennedy GA. Regulation of the rabbit's once-daily pattern of nursing: a circadian or hourglass-dependent process? Chronobiol Int 2020; 37:1151-1162. [PMID: 32869679 DOI: 10.1080/07420528.2020.1805459] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The European rabbit Oryctolagus cuniculus has an unusual pattern of nursing behavior. After giving birth in a nursery burrow (or laboratory nest box), the mother immediately leaves the young and only returns to nurse for a few minutes once approximately every 24 h. It has been assumed this schedule, like a variety of other functions in the rabbit, is under circadian control. This assumption has been largely based on findings from mothers only permitted restricted access to their young once every 24 h. However, in nature and in the laboratory, mothers with free access to young show nursing visits with a periodicity shorter than 24 h, that does not correspond to other behavioral and physiological rhythms entrained to the prevailing 24 h light/dark (LD) cycle. To investigate how this unusual, apparently non-circadian pattern might be regulated, we conducted two experiments using female Dutch-belted rabbits housed individually in cages designed to automatically register feeding activity and nest box visits. In Experiment 1 we recorded the behavior of 17 mothers with free access to their young under five different LD cycles with long photo and short scotoperiods, spanning the limits of entrainment of the rabbit's circadian system. Whereas feeding rhythms were entrained by LD cycles within the rabbit's circadian range of entrainment, nursing visits showed a consistently shorter periodicity regardless of the LD regimen, largely independent of the circadian system. In Experiment 2 we tested further 12 mothers under more conventional LD 16:8 cycles but "trained" by having access to the nest box restricted to 1 h at the same time each day for the first 7 d of nursing. Mothers were then allowed free access either when their young were left in the box (n = 6), or when the litter had been permanently removed (n = 6). Mothers with pups still present returned to nurse them on the following days according to a similarly advancing pattern to the mothers of Experiment 1 despite the previous 7 d of "training" to an experimentally enforced 24 h nursing schedule as commonly used in previous studies of rabbit maternal behavior. Mothers whose pups had been removed entered the box repeatedly several times on the first day of unrestricted access, but on subsequent days did so only rarely, and at times of day apparently unrelated to the previously scheduled access. We conclude that the pattern of the rabbit's once-daily nursing visits has a periodicity largely independent of the circadian system, and that this is reset at each nursing. When nursing fails to occur nest box visits cease abruptly, with mothers making few or no subsequent visits. Together, these findings suggest that the rabbit's once-daily pattern of nursing is regulated by an hourglass-type process with a period less than 24 h that is reset at each nursing, rather than by a circadian oscillator. Such a mechanism might be particularly adaptive for rhythms of short duration that should end abruptly with a sudden change in context such as death or weaning of the young.
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Affiliation(s)
- Sabine Apel
- School of Psychological Sciences, Faculty of Medicine, Nursing and Health Science, Monash University , Victoria, Australia
| | - Robyn Hudson
- Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México , Ciudad de México, Mexico
| | - Grahame J Coleman
- Veterinary Clinical Sciences, Faculty of Veterinary and Agricultural Sciences, University of Melbourne , Melbourne, Australia
| | - Heiko G Rödel
- Laboratoire d'Ethologie Expérimentale et Comparée UR 4443, Université Sorbonne Paris Nord , Villetaneuse, France
| | - Gerard A Kennedy
- School of Science, Psychology and Sport, Federation University , Ballarat, Australia.,School of Health and Biomedical Sciences, College of Science, Engineering and Health, RMIT University , Bundoora, Australia.,Institute for Breathing and Sleep, Austin Health , Heidelberg, Australia
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Singh H, Kennedy GA, Stupans I. Does the Modality Used in Health Coaching Matter? A Systematic Review of Health Coaching Outcomes. Patient Prefer Adherence 2020; 14:1477-1492. [PMID: 32904668 PMCID: PMC7457552 DOI: 10.2147/ppa.s265958] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 08/04/2020] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE The purpose of this review was to evaluate the modalities (e.g., face-to-face, telephone or electronic) of pharmacist health coaching providing the greatest improvement in patient outcomes, to enable a more comprehensive evaluation to be done and quality decision-making around health coaching modalities to be undertaken by pharmacists. METHODS This systematic review followed the PRISMA guidelines. CINHAL, EMBASE, PubMed, PsychINFO and SCOPUS were searched (2000-2019). Included articles were reviewed for the modality used to health coach, the training provided, and the outcomes. RESULTS Twelve papers met the eligibility criteria. A majority of studies included involved a combination of modalities of pharmacist health coaching. Four papers referred to face-to-face sessions, and one study used telephone coaching. In each paper, coaching led to an improvement in clinical and non-clinical health outcomes. CONCLUSION The training provided to health coaches varied and in some cases was not reported. Inconsistencies in reports led to difficulties when comparing study outcomes. Therefore, conclusions about the modality providing the greatest improvement in patient outcomes and the most pragmatic health coaching modality are not possible. Studies that document the training, the modality, the outcomes and the cost benefits of coaching by pharmacists are warranted to enable a more comprehensive evaluation to be done and quality decision-making around health coaching modalities to be undertaken by pharmacists.
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Affiliation(s)
- Harjit Singh
- The School of Health and Biomedical Sciences, RMIT University, Melbourne, VIC, Australia
| | - Gerard A Kennedy
- The School of Health and Biomedical Sciences, RMIT University, Melbourne, VIC, Australia
- School of Science, Psychology and Sport, Federation University, Melbourne, VIC, Australia
- Institute for Breathing and Sleep, Austin Health, Melbourne, VIC, Australia
| | - Ieva Stupans
- The School of Health and Biomedical Sciences, RMIT University, Melbourne, VIC, Australia
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Singh HK, Kennedy GA, Stupans I. Pharmacist health coaching in Australian community pharmacies: What do pharmacy professionals think? Health Soc Care Community 2020; 28:1190-1198. [PMID: 32020737 DOI: 10.1111/hsc.12952] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 07/30/2019] [Revised: 11/27/2019] [Accepted: 01/14/2020] [Indexed: 06/10/2023]
Abstract
Health coaching is a service provided to patients by healthcare professionals for the purposes of disease management and health risk prevention. Internationally, pharmacist health coaching services provided to patients with chronic health conditions have produced beneficial health outcomes. Despite this, the service is not currently provided within Australian community pharmacies. This study evaluates the knowledge, opinions and attitudes of leaders within the pharmacy profession about the concept of health coaching as a service in community pharmacy. Semi-structured interviews with leaders in the pharmacy profession were carried out. Pharmacy leaders were interviewed until data saturation was reached; 10 pharmacists were interviewed. The interviews were transcribed verbatim and analysed thematically; extracts from the transcripts were compared and categorised to establish themes and subcategories. Analysis of the transcripts indicated the emergence of two main themes and 10 subcategories. The main themes were as follows: 'positive view of health coaching in Australian community pharmacy' and 'barriers to integrating health coaching into Australian community pharmacy'. There was an overall perception that health coaching within community pharmacies would be valued by the Australian community. Interviewees held differing perceptions of pharmacists' capability to effectively coach pharmacy clients and suggested that the main impediments to its introduction related to remuneration for the service. The findings indicated that there is a potential for pharmacists to provide a health coaching service in community pharmacies, but that remuneration is a fundamental barrier. The research also indicated the need to clearly identify the knowledge, skills and attitudes needed to health coach and to identify whether potential gaps in the competencies of Australian community pharmacists exist.
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Affiliation(s)
- Harjit K Singh
- The School of Health and Biomedical Sciences, RMIT University, Melbourne, VIC, Australia
| | - Gerard A Kennedy
- The School of Health and Biomedical Sciences, RMIT University, Melbourne, VIC, Australia
| | - Ieva Stupans
- The School of Health and Biomedical Sciences, RMIT University, Melbourne, VIC, Australia
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Khan WAA, Conduit R, Kennedy GA, Abdullah Alslamah A, Ahmad Alsuwayeh M, Jackson ML. Sleep and Mental Health among Paramedics from Australia and Saudi Arabia: A Comparison Study. Clocks Sleep 2020; 2:246-257. [PMID: 33089203 PMCID: PMC7445850 DOI: 10.3390/clockssleep2020019] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [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: 04/29/2020] [Accepted: 06/04/2020] [Indexed: 11/24/2022] Open
Abstract
Paramedics face many challenges while on duty, one of which is working different types of shifts. Shift work has been linked to a number of health issues such as insomnia, depression, and anxiety. Besides shift work, Saudi paramedics, a group that has not been investigated for sleep or mental health issues previously, may be facing more demands than Australian paramedics due to lower numbers of paramedics in comparison to the general population. The aim of this study was to investigate the prevalence of sleep and mental health disorders among paramedics in Saudi Arabia and Australia. Paramedics were invited to complete a survey to assess stress, post-traumatic stress disorder (PTSD), depression, anxiety, daytime sleepiness, insomnia, sleep quality, shift work disorder, obstructive sleep apnoea, fatigue, and general health. A total of 104 males Saudi paramedics (M age = 32.5 ± 6.1 years) and 83 males paramedics from Australia (M age = 44.1 ± 12.1 years) responded to the survey. Significantly higher rates of depression, PTSD, insomnia, and fatigue, along with significantly poorer physical functioning were observed among Saudi paramedics in comparison with Australian paramedics. However, Australian paramedics reported significantly poorer sleep quality and general health in comparison to Saudi paramedics. After removing the effect of driving and working durations, outcomes were no longer significant. The higher burden of depression and PTSD among Saudi paramedics may be explained by longer hours spent driving and longer work durations reported by this group. Taking into consideration the outcomes reported in this study, more investigations are needed to study their possible effects on paramedics' cognition, performance, and safety.
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Affiliation(s)
- Wahaj Anwar A Khan
- Psychology Discipline, College of Science, Engineering & Health, School of Health and Biomedical Sciences, RMIT University, P.O. Box 71, Bundoora, VIC 3083, Australia; (R.C.); (G.A.K.)
- Occupational Health Department, Faculty of Public Health and Health Informatics, Umm Al-Qura University, Makkah, P.O. Box 715, Saudi Arabia
| | - Russell Conduit
- Psychology Discipline, College of Science, Engineering & Health, School of Health and Biomedical Sciences, RMIT University, P.O. Box 71, Bundoora, VIC 3083, Australia; (R.C.); (G.A.K.)
| | - Gerard A Kennedy
- Psychology Discipline, College of Science, Engineering & Health, School of Health and Biomedical Sciences, RMIT University, P.O. Box 71, Bundoora, VIC 3083, Australia; (R.C.); (G.A.K.)
- Psychology, Federation University Australia, Ballarat, VIC 3353, Australia
- Institute for Breathing and Sleep, Austin Health, Melbourne, VIC 3084, Australia;
| | - Ahmed Abdullah Alslamah
- General Supervisor of Emergency Medical Services Affairs, Saudi Red Crescent Authority, Riyadh 11129, Saudi Arabia;
| | - Mohammad Ahmad Alsuwayeh
- General Director of Training Department, Saudi Red Crescent Authority, Riyadh 11129, Saudi Arabia;
| | - Melinda L Jackson
- General Director of Training Department, Saudi Red Crescent Authority, Riyadh 11129, Saudi Arabia;
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, VIC 3800, Australia
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Khan WAA, Conduit R, Kennedy GA, Jackson ML. The relationship between shift-work, sleep, and mental health among paramedics in Australia. Sleep Health 2020; 6:330-337. [PMID: 32223969 DOI: 10.1016/j.sleh.2019.12.002] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 11/13/2019] [Accepted: 12/01/2019] [Indexed: 10/24/2022]
Abstract
OBJECTIVES This study aimed to investigate the prevalence of sleep and mental health issues, the role of chronotype, and the relationship between these variables in Australian paramedics. DESIGN A cross-sectional study. SETTINGS Cross-sectional survey. MEASUREMENTS Paramedics were invited to complete an online survey to assess stress, posttraumatic stress disorder (PTSD), depression, anxiety, daytime sleepiness, insomnia, sleep quality, shift-work disorder, bruxism, obstructive sleep apnea, narcolepsy, chronotype, fatigue, and well-being. PARTICIPANTS A total of 136 paramedics responded to the survey (age, 39.1 ± 12.1 years; 45.8% men and 54.2% women; 85.4% rotating shift-workers, 7% rural shift-workers, and 7.6% fixed rosters). RESULTS Paramedics reported significantly higher levels of depression symptoms, anxiety symptoms, fatigue, PTSD symptoms, insomnia symptoms, narcolepsy, and significantly poorer sleep quality and general well-being than norms from the general population of Australia and Western countries (all p < .05). From regression analyses, insomnia explained the greatest amount of variance in depression and anxiety scores, followed by fatigue and PTSD (adjusted R-squared for depression and anxiety models = .58 and = .44, respectively, p < .001). The majority of participants were intermediate chronotype (57%), followed by morning (32%) and evening type (11%). Evening chronotypes showed significantly higher depression scores (p < .001), anxiety (p < .05), PTSD symptoms (p < .05), poorer sleep quality (p < .05), and general well-being (p < .001) compared with morning types. CONCLUSION Addressing sleep issues and matching chronotype to shift preference in paramedics may help to reduce depression, anxiety, and improve well-being.
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Affiliation(s)
- Wahaj Anwar A Khan
- Psychology Discipline, School of Health and Biomedical Sciences, RMIT University, Bundoora, Australia; Occupational Health Department, Faculty of Public Health and Health Informatics, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Russell Conduit
- Psychology Discipline, School of Health and Biomedical Sciences, RMIT University, Bundoora, Australia.
| | - Gerard A Kennedy
- Psychology Discipline, School of Health and Biomedical Sciences, RMIT University, Bundoora, Australia
| | - Melinda L Jackson
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Australia; Institute for Breathing and Sleep, Austin Health, Melbourne, Australia
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Shahin W, Kennedy GA, Cockshaw W, Stupans I. The role of refugee and migrant migration status on medication adherence: Mediation through illness perceptions. PLoS One 2020; 15:e0227326. [PMID: 31923264 PMCID: PMC6953853 DOI: 10.1371/journal.pone.0227326] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 12/17/2019] [Indexed: 01/20/2023] Open
Abstract
Background Illness perceptions may vary between different populations. This raises the question as to whether refugees and migrants of the same ethnic background have different perceptions. Understanding differences may have a significant impact on enhancing medication adherence in these groups. Objective The study examined the associations and differences between illness perceptions, and medication adherence in hypertensive Middle Eastern migrants and refugees. Methods Middle Eastern refugees and migrants (≥30 years old), with hypertension were recruited from Arabic community groups in Australia and asked to complete a cross-sectional survey. The survey consisted of basic socio-demographic and clinical profile, self-reported illness perceptions, and self-reported medication adherence. The outcome measure was the Medication Adherence Questionnaire. Simple mediation modelling was applied to examine the role of illness perceptions as a mediator between different migration statuses, and medication adherence. Results A total of 320 participants were recruited; 168 refugees, and 152 migrants. Educational level was found to be positively significantly associated with medication adherence in refugees, p = 0.003, while employed migrants were more likely to report higher adherence to hypertensive medication, p = 0.005. In both groups, there was a significant association between illness perceptions and medication adherence p = 0.0001. Significant differences were found between both groups regarding adherence and illness perceptions variables. Refugees had more negative illness perceptions and were less adherent than migrants. Illness perception was a mediator in the relationship between migration status and medication adherence; the unstandardized indirect effect was 0.24, and the 95% confidence interval ranged from (0.21–0.36). Conclusions To achieve better adherence to medications in vulnerable populations such as refugees, illness perceptions need to be understood, and differentiated from other populations, such as migrants from similar backgrounds. Patients’ education about illnesses and medications should be specific and targeted to each population. Interventional studies are recommended to modify refugees’ and migrants’ illness perceptions, to enhance medication adherence and wellbeing.
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Affiliation(s)
- Wejdan Shahin
- School of Health & Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia
- * E-mail:
| | - Gerard A. Kennedy
- School of Health & Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia
| | - Wendell Cockshaw
- School of Health & Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia
| | - Ieva Stupans
- School of Health & Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia
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Shahin W, Kennedy GA, Cockshaw W, Stupans I. The Role of Medication Beliefs on Medication Adherence in Middle Eastern Refugees and Migrants Diagnosed with Hypertension in Australia. Patient Prefer Adherence 2020; 14:2163-2173. [PMID: 33173283 PMCID: PMC7648560 DOI: 10.2147/ppa.s274323] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 10/06/2020] [Indexed: 12/12/2022] Open
Abstract
PURPOSE The study assessed the association between medication beliefs and adherence in Middle Eastern refugees and migrants in Australia, and also examined differences between the two groups regarding beliefs and adherence to medication. PATIENTS AND METHODS A total of 319 Middle Eastern refugees and migrants with hypertension were approached via various social groups in Australia and asked to complete Arabic versions of the Beliefs about Medicine Questionnaire (BMQ) and the Medication Adherence Questionnaire. BMQ scores (necessity and concerns scales) were classified as "accepting", "indifferent", "ambivalent" or "skeptical". Multiple mediation modelling was applied to examine the role of necessity and concerns scales as mediators between migration status and medication adherence. RESULTS There were significant associations between medication adherence and medication beliefs scores (necessity and concerns scales) (p=0.0001). Necessity and concern were mediators in the relationship between migration status and medication adherence. Significant differences were found between refugees and migrants for medication adherence and medication beliefs. Refugees were likely to have less necessity, and more concern beliefs than migrants, and were also less likely to adhere to medications. Almost 30% of refugees could be classified as skeptical and 40% as ambivalent. In contrast, 50% of migrants had accepting beliefs, and around 35% held ambivalent beliefs. Refugees and migrants with "accepting" beliefs reported the highest adherence to medication and those holding "skeptical" beliefs reported the lowest adherence. CONCLUSION Medication beliefs are potentially modifiable and are reasonable targets for clinical interventions designed to improve medication adherence. Understanding these beliefs and the likely differences between refugees and migrants is crucial to provide specific and targeted advice to each group independently in order to improve medication adherence and overall health.
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Affiliation(s)
- Wejdan Shahin
- School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria3083, Australia
- Correspondence: Wejdan Shahin RMIT University, PO Box 71, Bundoora, Victoria3083, Australia Email
| | - Gerard A Kennedy
- School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria3083, Australia
- School of Science, Psychology and Sport, Federation University, Ballarat, Melbourne, Australia
- Institute for Breathing and Sleep, Austin Health, Melbourne, Australia
| | - Wendell Cockshaw
- School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria3083, Australia
| | - Ieva Stupans
- School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria3083, Australia
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Abstract
BACKGROUND Chronic back pain is characterized by its duration and poor response to medical interventions and is a major health problem. Treatment up-take, adherence, and social support are key issues and are vital for recovery and functionality. However, there is limited research on the role of social support and treatment uptake and adherence for chronic back pain. AIM The aim of this study was to explore the impact of social support in terms of treatment uptake and adherence in chronic back pain patients in Australia. METHODS Two hundred and one adult men and women completed a battery of questionnaires that assessed levels of social support and disability and treatment uptake and adherence. RESULTS Stepwise multiple regression predicting treatment participation, produced a significant model that included participant's age and level of social support and accounted for 14% of the variance, F(2,179) = 14.10, p < 0.001, adj R2 = 0.14. Life control, affective distress and level of social support scores accounted for 26% of the variance in disability levels F(3,179) = 21.42, p < 0.001, adj R2 = 0.26. CONCLUSION The findings indicated that age, social support had a significant positive effect on the number of treatment sessions attended by participants and that life control, affective distress, and level of social support were negatively related to disability levels. The findings support interdisciplinary approaches, including social interventions as important part of any chronic back pain treatment.Implications for rehabilitationChronic back pain does not respond well to traditional rehabilitation methods based on the Medical Model.Social support has a significant impact on treatment adherence and disability. This study measures perceived social support from an emotional and instrumental perspective.Social support interventions as part of a multidisciplinary approach would be beneficial in the experience of chronic back pain.
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Affiliation(s)
| | - Gerard A Kennedy
- School of Health and Biomedical Sciences, College of Science Engineering and Health RMIT University, Bundoora, Australia
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Rajoo Y, Wong J, Cooper G, Raj IS, Castle DJ, Chong AH, Green J, Kennedy GA. The relationship between physical activity levels and symptoms of depression, anxiety and stress in individuals with alopecia Areata. BMC Psychol 2019; 7:48. [PMID: 31337438 PMCID: PMC6651906 DOI: 10.1186/s40359-019-0324-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 11/15/2018] [Accepted: 07/17/2019] [Indexed: 01/28/2023] Open
Abstract
Background Alopecia Areata (AA) is an autoimmune condition that is characterised by non-scarring hair loss. Its aesthetic repercussions can lead to profound changes in psychological well-being. Although physical activity (PA) has been associated with better mental health outcomes in diverse populations, the association in individuals with AA has not been established. The aim of this study was to examine the associations between PA and mental health outcomes in individuals with AA to inform intervention strategies for this specific population. Methods A cross-sectional study was conducted among individuals who were diagnosed with AA. A total of 83 respondents aged (40.95 ± 13.24 years) completed a self-report questionnaire consisting of International Physical Activity Questionnaire-Short Form (IPAQ-SF) and the Depression and Anxiety Stress Scale (DASS-21). Three-way contingency Chi-square analyses were used to determine the associations between PA, mental health outcomes and participants with hair loss of more than 50% on the scalp. Results 81.9% of the participants did not meet PA guidelines. Participants with hair loss of more than 50% on the scalp, and who did not meet PA guidelines, were significantly more likely to experience symptoms of severe depression (p = .003), moderate anxiety (p = .04) and mild stress (p = .003) than those who met guidelines Conclusion Findings suggest that increased PA participation in AA individuals with severe hair loss is associated with improved mental health status. Intervention efforts for this specific population should consider barriers and enablers to PA participation as they face challenges that differ from the general population.
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Affiliation(s)
- Y Rajoo
- School of Health and Biomedical Sciences, RMIT University, Melbourne, Australia.
| | - J Wong
- School of Health and Biomedical Sciences, RMIT University, Melbourne, Australia.,School of Education, RMIT University, Melbourne, Australia
| | - G Cooper
- School of Education, RMIT University, Melbourne, Australia
| | - I S Raj
- School of Health and Biomedical Sciences, RMIT University, Melbourne, Australia
| | - D J Castle
- Department of Psychological Sciences and Psychiatry, University of Melbourne, Melbourne, Victoria, Australia.,Department of Psychiatry, St. Vincent's Mental Health, Melbourne, Victoria, Australia
| | - A H Chong
- Department of Medicine (Dermatology), St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - J Green
- Western Dermatology, Melbourne, Victoria, Australia
| | - G A Kennedy
- School of Health and Biomedical Sciences, RMIT University, Melbourne, Australia.,Institute for Breathing and Sleep, Austin Hospital, Melbourne, Victoria, Australia
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Shahin W, Kennedy GA, Stupans I. The impact of personal and cultural beliefs on medication adherence of patients with chronic illnesses: a systematic review. Patient Prefer Adherence 2019; 13:1019-1035. [PMID: 31303749 PMCID: PMC6611718 DOI: 10.2147/ppa.s212046] [Citation(s) in RCA: 92] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 06/04/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Patients' adherence to therapeutic regimes may be influenced by subjective beliefs about chronic conditions. One of the challenges for health professionals in enhancing adherence is taking patients' understanding into account when giving health advice and/or providing medical treatment. PURPOSE This review aimed to evaluate the consequent effects of personal and cultural beliefs on medication adherence, in patients with chronic conditions such as hypertension, diabetes mellitus, chronic obstructive pulmonary disease and asthma. METHOD A systematic review methodology was used. PubMed, CINAHL, EMBASE and PsychINFO, databases were searched for relevant articles. The main terms analyzed were illness perceptions, health beliefs, cultural beliefs, chronic conditions and medication adherence. RESULTS From 2,646 articles, 127 were retained for further assessment, and finally 25 met the inclusion criteria. A cross-sectional questionnaire survey research design was conducted in all included articles. Of these most (n=22) targeted hypertension or diabetes mellitus. A number of personal and cultural based factors were identified as being associated with adherence to medication regimes - 40% of articles (n=10) examined perception of illness, 20% (n=5) health literacy, 16% (n=4) cultural beliefs, 12% (n=3) self-efficacy, 16% (n=4) spiritual and religious beliefs, as well as 20% (n=5) illness knowledge. Statistically significant associations between medication adherence and these personal and cultural factors were found in 80% (n=20) of the included studies. However, the direction of associations varied between studies depending on the factor that was examined. CONCLUSION This review has evaluated the impact of personal and cultural factors on medication adherence and highlighted the gaps in literature regarding adherence. Further research is required to fully identify the associations between religious beliefs, control beliefs and illness knowledge and medication adherence.
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Affiliation(s)
- Wejdan Shahin
- School of Health & Biomedical Sciences, RMIT University, Bundoora, Victoria3083, Australia
| | - Gerard A Kennedy
- School of Health & Biomedical Sciences, RMIT University, Bundoora, Victoria3083, Australia
| | - Ieva Stupans
- School of Health & Biomedical Sciences, RMIT University, Bundoora, Victoria3083, Australia
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Singh HK, Kennedy GA, Stupans I. Interviews with key stakeholders: opinions about and attitudes to pharmacy health coaching. Res Social Adm Pharm 2019. [DOI: 10.1016/j.sapharm.2019.03.125] [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: 10/26/2022]
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Kennedy GA, Klein KM, Keel PK. Prevalence and predictors of parental concern for children's weight from 2002 to 2012. Public Health 2018; 162:58-62. [PMID: 29975861 DOI: 10.1016/j.puhe.2018.05.021] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 04/04/2018] [Accepted: 05/20/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Public health initiatives to increase parental awareness about children's obesity have become more prominent in the past decade. These initiatives may contribute to increased concern in parents for their children's weight, even if their children are at a healthy weight. The aim of the present study was to document trends in parental (N = 365; 67.9% female) concern for their children's weight from 2002 to 2012 using surveys on health and eating behaviors. STUDY DESIGN Participants (N = 365) were parents who completed surveys in 2002 and were followed up in 2012 as part of a longitudinal epidemiological study of eating attitudes and behavior. METHODS McNemar's test and logistic regression models estimated changes in and predictors of parental concern. RESULTS In 2002, 36.5% of participants indicated concern for their children's weight, which rose to 54.4% in 2012. Parents of overweight children were more likely to report concern than parents of average-weight children at baseline and 10-year follow-up. However, concern increased significantly even among parents of average-weight children, rising from 28.7% to 41.6% (McNemar's test statistic: 8.20, P = .002). Secondary analyses revealed that parents' baseline drive for thinness predicted increased likelihood of concern in these parents (odds ratio: 1.10, P = .04). CONCLUSION Findings support the need for future research to examine consequences of societal messages about pediatric obesity.
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Affiliation(s)
- G A Kennedy
- Department of Psychology, Florida State University, 1107 West Call Street, Tallahassee, FL, 32304, USA
| | - K M Klein
- Department of Psychology, Florida State University, 1107 West Call Street, Tallahassee, FL, 32304, USA
| | - P K Keel
- Department of Psychology, Florida State University, 1107 West Call Street, Tallahassee, FL, 32304, USA.
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Cori JM, Jackson ML, Barnes M, Westlake J, Emerson P, Lee J, Galante R, Hayley A, Wilsmore N, Kennedy GA, Howard M. The Differential Effects of Regular Shift Work and Obstructive Sleep Apnea on Sleepiness, Mood and Neurocognitive Function. J Clin Sleep Med 2018; 14:941-951. [PMID: 29852909 DOI: 10.5664/jcsm.7156] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [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: 10/13/2017] [Accepted: 02/20/2018] [Indexed: 01/05/2023]
Abstract
STUDY OBJECTIVES To assess whether poor sleep quality experienced by regular shift workers and individuals with obstructive sleep apnea (OSA) affects neurobehavioral function similarly, or whether the different etiologies have distinct patterns of impairment. METHODS Thirty-seven shift workers (> 24 hours after their last shift), 36 untreated patients with OSA, and 39 healthy controls underwent assessment of sleepiness (Epworth Sleepiness Scale [ESS]), mood (Beck Depression Index, State Trait Anxiety Inventory [STAI], Profile of Mood States), vigilance (Psychomotor Vigilance Task [PVT], Oxford Sleep Resistance Test [OSLER], driving simulation), neurocognitive function (Logical Memory, Trails Making Task, Digit Span Task, Victoria Stroop Test) and polysomnography. RESULTS Sleepiness (ESS score; median, interquartile range) did not differ between the OSA (10.5, 6.3-14) and shift work (7, 5-11.5) groups, but both had significantly elevated scores relative to the control group (5, 3-6). State anxiety (STAI-S) was the only mood variable that differed significantly between the OSA (35, 29-43) and shift work (30, 24-33.5) groups, however both demonstrated several mood deficits relative to the control group. The shift work and control groups performed similarly on neurobehavioral tasks (simulated driving, PVT, OSLER and neurocognitive tests), whereas the OSA group performed worse. On the PVT, lapses were significantly greater for the OSA group (3, 2-6) than both the shift work (2, 0-3.5) and control (1, 0-4) groups. CONCLUSIONS Shift workers and patients with OSA had similar sleepiness and mood deficits relative to healthy individuals. However, only the patients with OSA showed deficits on vigilance and neurocognitive function relative to healthy individuals. These findings suggest that distinct causes of sleep disturbance likely result in different patterns of neurobehavioral dysfunction.
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Affiliation(s)
- Jennifer M Cori
- Institute for Breathing and Sleep and Austin Health, Heidelberg, Victoria, Australia
| | - Melinda L Jackson
- Institute for Breathing and Sleep and Austin Health, Heidelberg, Victoria, Australia.,School of Health & Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia
| | - Maree Barnes
- Institute for Breathing and Sleep and Austin Health, Heidelberg, Victoria, Australia.,Department of Medicine, University of Melbourne, Parkville, Victoria, Australia
| | - Justine Westlake
- Institute for Breathing and Sleep and Austin Health, Heidelberg, Victoria, Australia
| | - Paul Emerson
- Institute for Breathing and Sleep and Austin Health, Heidelberg, Victoria, Australia
| | - Jacen Lee
- Institute for Breathing and Sleep and Austin Health, Heidelberg, Victoria, Australia.,Hong Kong Clinical Neuropsychology Service, Hong Kong SAR, China
| | - Rosa Galante
- Institute for Breathing and Sleep and Austin Health, Heidelberg, Victoria, Australia.,Department of Psychology, Victoria University, St. Albans, Victoria, Australia
| | - Amie Hayley
- Institute for Breathing and Sleep and Austin Health, Heidelberg, Victoria, Australia.,Centre for Human Psychopharmacology, Faculty of Health Arts and Design, Swinburne University of Technology, Hawthorn, Victoria, Australia.,School of Clinical Sciences at Monash Health, Faculty of Medicine Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Nicholas Wilsmore
- Institute for Breathing and Sleep and Austin Health, Heidelberg, Victoria, Australia.,Department of Respiratory and Sleep Medicine, Eastern Health, Melbourne, Victoria, Australia
| | - Gerard A Kennedy
- Institute for Breathing and Sleep and Austin Health, Heidelberg, Victoria, Australia.,School of Health & Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia
| | - Mark Howard
- Institute for Breathing and Sleep and Austin Health, Heidelberg, Victoria, Australia.,Department of Medicine, University of Melbourne, Parkville, Victoria, Australia
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Alvaro PK, Burnett NM, Kennedy GA, Min WYX, McMahon M, Barnes M, Jackson M, Howard ME. Driver education: Enhancing knowledge of sleep, fatigue and risky behaviour to improve decision making in young drivers. Accid Anal Prev 2018; 112:77-83. [PMID: 29324264 DOI: 10.1016/j.aap.2017.12.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [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: 09/18/2017] [Revised: 11/13/2017] [Accepted: 12/25/2017] [Indexed: 06/07/2023]
Abstract
This study assessed the impact of an education program on knowledge of sleepiness and driving behaviour in young adult drivers and their performance and behaviour during simulated night driving. Thirty-four participants (18-26 years old) were randomized to receive either a four-week education program about sleep and driving or a control condition. A series of questionnaires were administered to assess knowledge of factors affecting sleep and driving before and after the four-week education program. Participants also completed a two hour driving simulator task at 1am after 17 h of extended wakefulness to assess the impact on driving behaviour. There was an increase in circadian rhythm knowledge in the intervention group following the education program. Self-reported risky behaviour increased in the control group with no changes in other aspects of sleep knowledge. There were no significant differences in proportion of intervention and control participants who had microsleeps (p ≤ .096), stopped driving due to sleepiness (p = .107), recorded objective episodes of drowsiness (p = .455), and crashed (p = .761), although there was a trend towards more control participants having microsleeps and stopping driving. Those in the intervention group reported higher subjective sleepiness at the end of the drive [M = 6.25, SD = 3.83, t(31) = 2.15, p = .05] and were more likely to indicate that they would stop driving [M = 3.08, SD = 1.16, t(31) = 2.24, p = .04]. The education program improved some aspects of driver knowledge about sleep and safety. The results also suggested that the education program lead to an increased awareness of sleepiness. Education about sleep and driving could reduce the risk of drowsy driving and associated road trauma in young drivers, but requires evaluation in a broader sample with assessment of real world driving outcomes.
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Affiliation(s)
- Pasquale K Alvaro
- Institute for Breathing & Sleep, Department of Respiratory & Sleep Medicine, Austin Health, Heidelberg, 3084, Victoria, Australia; Monash University, School of Psychological Sciences, Clayton, Victoria, Australia
| | - Nicole M Burnett
- Institute for Breathing & Sleep, Department of Respiratory & Sleep Medicine, Austin Health, Heidelberg, 3084, Victoria, Australia; RMIT University, School of Health and Biomedical Sciences, Bundoora, Australia
| | - Gerard A Kennedy
- Institute for Breathing & Sleep, Department of Respiratory & Sleep Medicine, Austin Health, Heidelberg, 3084, Victoria, Australia; RMIT University, School of Health and Biomedical Sciences, Bundoora, Australia
| | - William Yu Xun Min
- Institute for Breathing & Sleep, Department of Respiratory & Sleep Medicine, Austin Health, Heidelberg, 3084, Victoria, Australia
| | - Marcus McMahon
- Institute for Breathing & Sleep, Department of Respiratory & Sleep Medicine, Austin Health, Heidelberg, 3084, Victoria, Australia
| | - Maree Barnes
- Institute for Breathing & Sleep, Department of Respiratory & Sleep Medicine, Austin Health, Heidelberg, 3084, Victoria, Australia
| | - Melinda Jackson
- Institute for Breathing & Sleep, Department of Respiratory & Sleep Medicine, Austin Health, Heidelberg, 3084, Victoria, Australia; RMIT University, School of Health and Biomedical Sciences, Bundoora, Australia
| | - Mark E Howard
- Institute for Breathing & Sleep, Department of Respiratory & Sleep Medicine, Austin Health, Heidelberg, 3084, Victoria, Australia; University of Melbourne, Department of Medicine, Parkville, Victoria, Australia; Monash University, School of Psychological Sciences, Clayton, Victoria, Australia.
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Schembri R, Spong J, Peters A, Rochford P, Wilksch P, O’Donoghue FJ, Greenwood KM, Barnes M, Kennedy GA, Berlowitz DJ. Light sensors for objective light measurement in ambulatory polysomnography. PLoS One 2017; 12:e0188124. [PMID: 29145507 PMCID: PMC5690677 DOI: 10.1371/journal.pone.0188124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 11/01/2017] [Indexed: 11/18/2022] Open
Abstract
Ambulatory polysomnography (PSG) does not commonly include an objective measure of light to determine the time of lights off (Loff), and thus cannot be used to calculate important indices such as sleep onset latency and sleep efficiency. This study examined the technical specifications and appropriateness of a prototype light sensor (LS) for use in ambulatory Compumedics Somte PSG.Two studies were conducted. The first examined the light measurement characteristics of the LS when used with a portable PSG device, specifically recording trace range, linearity, sensitivity, and stability. This involved the LS being exposed to varying incandescent and fluorescent light levels in a light controlled room. Secondly, the LS was trialled in 24 home and 12 hospital ambulatory PSGs to investigate whether light levels in home and hospital settings were within the recording range of the LS, and to quantify the typical light intensity reduction at the time of Loff. A preliminary exploration of clinical utility was also conducted. Linearity between LS voltage and lux was demonstrated, and the LS trace was stable over 14 hours of recording. The observed maximum voltage output of the LS/PSG device was 250 mV, corresponding to a maximum recording range of 350 lux and 523 lux for incandescent and fluorescent light respectively. At the time of Loff, light levels were within the recording range of the LS, and on average dropped by 72 lux (9–245) in the home and 76 lux (4–348) in the hospital setting. Results suggest that clinical utility was greatest in hospital settings where patients are less mobile. The LS was a simple and effective objective marker of light level in portable PSG, which can be used to identify Loff in ambulatory PSG. This allows measurement of additional sleep indices and support with clinical decisions.
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Affiliation(s)
- Rachel Schembri
- The Institute for Breathing and Sleep, Austin Health, Heidelberg, VIC, Australia
- Department of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, VIC, Australia
- * E-mail:
| | - Jo Spong
- The Institute for Breathing and Sleep, Austin Health, Heidelberg, VIC, Australia
- College of Science, Health and Engineering, La Trobe Rural Health School, La Trobe University, Bendigo, VIC, Australia
| | - Allison Peters
- Melbourne Sleep Disorders Centre, Melbourne, VIC, Australia
| | - Peter Rochford
- The Institute for Breathing and Sleep, Austin Health, Heidelberg, VIC, Australia
| | - Philip Wilksch
- School of Science, RMIT University, Melbourne, VIC, Australia
| | - Fergal J. O’Donoghue
- The Institute for Breathing and Sleep, Austin Health, Heidelberg, VIC, Australia
- Department of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, VIC, Australia
| | | | - Maree Barnes
- The Institute for Breathing and Sleep, Austin Health, Heidelberg, VIC, Australia
- Department of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, VIC, Australia
| | - Gerard A. Kennedy
- The Institute for Breathing and Sleep, Austin Health, Heidelberg, VIC, Australia
- School of Health and Biomedical Sciences, RMIT University, Melbourne, VIC, Australia
| | - David J. Berlowitz
- The Institute for Breathing and Sleep, Austin Health, Heidelberg, VIC, Australia
- Department of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, VIC, Australia
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Abstract
The main sources of stress reported by 423 Australian final-year high school students using the Academic Stress Questionnaire were school-related as expected. The highest sources of this stress were examinations and outcomes, too much to do, worry over future, making choices about career, studying for examinations, amount to learn, need to do well imposed by others, and self-imposed need to do well.
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Scott A, Morris K, Butler J, Mills AK, Kennedy GA. Treatment of aplastic anaemia with lower-dose anti-thymocyte globulin produces similar response rates and survival as per standard dose anti-thymocyte globulin schedules. Intern Med J 2016; 46:1198-1203. [PMID: 27404498 DOI: 10.1111/imj.13175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 02/14/2016] [Revised: 05/30/2016] [Accepted: 06/26/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Aplastic anaemia (AA) is a rare acquired bone marrow failure syndrome resulting from the immune-mediated destruction of haemopoietic stem cells. For adults in whom first-line haemopoietic progenitor cell transplantation is not feasible, combination anti-thymocyte globulin (ATGAM) plus cyclosporine A is standard therapy; however, there are minimal data available regarding the optimal ATGAM dosage in terms of efficacy and survival. AIMS Our institutions have historically used different dosing protocols of ATGAM in the treatment of AA. We aimed to review the outcome of AA patients treated with these protocols and compare them to the published literature. METHODS We conducted a retrospective study of 31 adults who received first-line ATGAM for AA and compared response rates and survival between cohorts who received standard (40 mg/kg/day D1-4) versus lower-dose (15 mg/kg/day D1-5) ATGAM schedules. RESULTS There were similar rates of response (64 vs 71%, P = 1.0), relapse (33 vs 33%, P = 1.0), transformation (14 vs 24%, P = 0.66) or infection (43 vs 47%, P = 1.0), respectively, between standard and lower-dose cohorts. At a median follow up of 24 months, there was no statistical difference between standard and lower-dose cohorts in either event-free (42.2 vs 64.7%, P = 0.91) or overall survival (73.1 vs 88.2%, P = 0.75). CONCLUSION Our experience suggests that lower-dose ATGAM at 15 mg/kg/day D1-5 as treatment of AA produces similar responses and outcomes as per standard-dose ATGAM schedules. Prospective trials comparing ATGAM dose schedules in AA are warranted.
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Affiliation(s)
- A Scott
- Department of Cancer Care Services, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia. .,Department of Haematology, Pathology Queensland, Brisbane, Queensland, Australia. .,School of Medicine, The University of Queensland, Brisbane, Queensland, Australia.
| | - K Morris
- Department of Cancer Care Services, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - J Butler
- Department of Cancer Care Services, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - A K Mills
- Division of Cancer Services, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - G A Kennedy
- Department of Cancer Care Services, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
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