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Barakat A, Blankers M, Cornelis JE, Lommerse NM, Beekman AT, Dekker JJ. Prescriptive factors for intensive home treatment in acute psychiatry: a secondary analysis of a randomised controlled trial. Int J Ment Health Syst 2024; 18:2. [PMID: 38172935 PMCID: PMC10763431 DOI: 10.1186/s13033-023-00619-1] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 12/11/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Intensive home treatment (IHT) aims to prevent psychiatric hospitalisation. Although this intervention is well tested, it is still unknown for whom this intervention works best. Therefore, this study aims to explore prescriptive factors that moderate the effect of IHT compared to care as usual (CAU) on symptom severity. METHODS Using data from a randomised controlled trial, 198 participants that experience an exacerbation of acute psychiatric symptoms were included in this secondary analysis. In order to maximise clinical relevance, generally available environmental and clinical baseline factors were included as tentative moderators: age, gender, employment status, domestic situation, psychiatric disorders, psychological symptoms, psychosocial functioning, alcohol and other substance use. The outcome variable symptom severity was measured using the Brief Psychiatric Rating Scale (BPRS) and collected at 26 and 52 weeks post-randomisation. Multiple regression analysis was used to examine which participants' characteristics moderate the effect of IHT on the total BPRS score. RESULTS Our results suggest that being employed (B = 0.28, SE = 0.13, 95% CI = 0.03-0.53, p = 0.03) at baseline seems to have a moderation effect, which result in lower symptom severity scores at 26 weeks follow-up for patients who received IHT. This effect was not found at 52 weeks. CONCLUSIONS On the basis of the number of factors tested, there is no evidence for robust outcome moderators of the effect of IHT versus CAU. Our conclusion is therefore that IHT can be offered to a diverse target population with comparable clinical results. TRIAL REGISTRATION This trial is registered (date of registration: 2016-11-23) at the international clinical trials registry platform (NTR6151).
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Affiliation(s)
- Ansam Barakat
- Department of Research, Arkin Institute for Mental Health Care, Amsterdam, The Netherlands.
- Department of Psychiatry Amsterdam UMC/VUmc, Amsterdam Public Health research institute Amsterdam UMC, Amsterdam, The Netherlands.
| | - Matthijs Blankers
- Department of Research, Arkin Institute for Mental Health Care, Amsterdam, The Netherlands
- Trimbos-Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
- Department of Psychiatry Amsterdam UMC/AMC, Amsterdam Public Health research institute Amsterdam UMC, Amsterdam, The Netherlands
| | - Jurgen E Cornelis
- Department of Research, Arkin Institute for Mental Health Care, Amsterdam, The Netherlands
- Department of Emergency Psychiatry, Arkin Institute for Mental Health Care, Amsterdam, The Netherlands
| | - Nick M Lommerse
- Department of Research, Arkin Institute for Mental Health Care, Amsterdam, The Netherlands
| | - Aartjan Tf Beekman
- Department of Psychiatry Amsterdam UMC/VUmc, Amsterdam Public Health research institute Amsterdam UMC, Amsterdam, The Netherlands
- Department of Research and Innovation, GGZ InGeest Specialized Mental Health Care, Amsterdam, The Netherlands
| | - Jack Jm Dekker
- Department of Research, Arkin Institute for Mental Health Care, Amsterdam, The Netherlands
- Department of Clinical Psychology, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute Amsterdam UMC, Amsterdam, The Netherlands
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Baek E, Luo W. Modeling multiple dependent variables in meta-analysis of single-case experimental design using multilevel modeling. Behav Res Methods 2023; 55:3760-3771. [PMID: 36253594 DOI: 10.3758/s13428-022-01987-1] [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] [Accepted: 09/22/2022] [Indexed: 11/08/2022]
Abstract
Although meta-analyses of single-case experimental design (SCED) often include multiple types of dependent variables (DVs), multiple DVs are rarely considered within models in the analysis. Baek et al. (Journal of Experimental Education, 90(4), 934-961, 2022) identified several statistical issues that arise when researchers fail to model multiple DVs in meta-analyses of SCED data. However, the degree to which non-modeling of multiple DVs impacts the results of the meta-analysis of SCED has not been fully examined. In this simulation study, we have systematically investigated the impact of non-modeling of multiple DVs when analyzing meta SCED data using multilevel modeling. The result demonstrates that modeling multiple DVs has advantages over the non-modeling option for meta-analysis of SCED. Modeling multiple DVs enables the determination of precise effects from different DVs in addition to the unbiased and accurate average effect and accurate estimates and inferences for the error variances at the study level as well as the observation level. The current study also reveals potential factors (i.e., the number of DVs, degree of heterogeneity in the level-1 error variances and autocorrelation, and presence of the moderator effect) that impact the precision and accuracy of the variance parameters.
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Affiliation(s)
- Eunkyeng Baek
- Educational Psychology, Texas A&M University, 718E Harrington Tower, 4225 TAMU, College Station, TX, 77843-4225, USA.
| | - Wen Luo
- Educational Psychology, Texas A&M University, 718E Harrington Tower, 4225 TAMU, College Station, TX, 77843-4225, USA
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Carver A, Cerin E, Akram M, Sallis JF, Cain KL, Frank LD, Geremia CM, Conway TL, Glanz K, Saelens BE. Associations of home and neighborhood environments with children's physical activity in the U.S.-based Neighborhood Impact on Kids (NIK) longitudinal cohort study. Int J Behav Nutr Phys Act 2023; 20:9. [PMID: 36732765 PMCID: PMC9896701 DOI: 10.1186/s12966-023-01415-3] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 01/24/2023] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION Physical activity is important for children's health and well-being. Supportiveness for physical activity of home and neighborhood environments may affect children's PA, but most studies are cross-sectional. We examined environmental predictors of change in children's physical activity over two years. METHODS Data were from the longitudinal, observational cohort study, 'Neighborhood Impact on Kids'. Participants were children (initially aged 6-12 years) and their parent/caregiver (n = 727 dyads) living in neighborhoods throughout San Diego County, California and King County (Seattle area), Washington, USA. Children's moderate-to-vigorous physical activity (MVPA) was measured using accelerometers at T1 (Time 1 or baseline, 2007-2009) and T2, the two-year follow-up. At T1, parents survey-reported on physical activity (PA) equipment at home and demographics. Neighborhood environment was measured using spatial data in Geographic Information Systems (intersection density; park availability) and in-person audits (informal play space near home; park-based PA facilities; land use; support for walking/cycling). Generalized additive mixed models estimated total effects, then direct effects, of environmental attributes on MVPA at T1. Two-way moderating effects of child's sex and age were examined at T1. To examine associations of environmental exposures with changes in MVPA, we estimated interaction effects of environmental attributes on the association between time and MVPA. RESULTS On average, children accumulated 146 min/day (standard deviation or SD = 53) of MVPA at T1, and 113 (SD = 58) min/day at T2. There were no significant total or direct effects of environmental attributes on MVPA at T1, and no significant two-way interaction effects of child's age and sex for T1 MVPA. Having informal play spaces proximal to home with more amenities was associated with less MVPA decline from T1 to T2. Higher residential density, higher land use mix, and higher number of PA facilities in nearby parks were unexpectedly associated with greater MVPA decline. CONCLUSION Higher quality informal play spaces close to home may help offset declines in MVPA during middle childhood, as they may promote unstructured active play with opportunities for parental or neighbor surveillance. Unexpectedly, environmental factors consistent with higher walkability were associated with greater declines in children's MVPA. As physical activity differs across the lifespan, so may environmental factors that facilitate it.
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Affiliation(s)
- Alison Carver
- Peninsula Clinical School, Monash University, Frankston, VIC Australia
| | - Ester Cerin
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC Australia
- School of Public Health, The University of Hong Kong, Hong Kong, China
| | - Muhammad Akram
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC Australia
| | - James F. Sallis
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC Australia
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, CA USA
| | - Kelli L. Cain
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, CA USA
| | - Lawrence D. Frank
- Dept. of Urban Studies and Planning, University of California, San Diego, La Jolla, CA USA
| | - Carrie M. Geremia
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, CA USA
| | - Terry L. Conway
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, CA USA
| | - Karen Glanz
- Perelman School of Medicine and the School of Nursing, University of Pennsylvania, Philadelphia, PA USA
| | - Brian E. Saelens
- Dept. of Pediatrics, University of Washington and Seattle Children’s Research Institute, Seattle, WA USA
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Williamson SF, Grayling MJ, Mander AP, Noor NM, Savage JS, Yap C, Wason JMS. Subgroup analyses in randomized controlled trials frequently categorized continuous subgroup information. J Clin Epidemiol 2022; 150:72-79. [PMID: 35788399 DOI: 10.1016/j.jclinepi.2022.06.017] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 06/15/2022] [Accepted: 06/28/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND AND OBJECTIVES To investigate how subgroup analyses of published Randomized Controlled Trials (RCTs) are performed when subgroups are created from continuous variables. METHODS We carried out a review of RCTs published in 2016-2021 that included subgroup analyses. Information was extracted on whether any of the subgroups were based on continuous variables and, if so, how they were analyzed. RESULTS Out of 428 reviewed papers, 258 (60.4%) reported RCTs with a subgroup analysis. Of these, 178/258 (69%) had at least one subgroup formed from a continuous variable and 14/258 (5.4%) were unclear. The vast majority (169/178, 94.9%) dichotomized the continuous variable and treated the subgroup as categorical. The most common way of dichotomizing was using a pre-specified cutpoint (129/169, 76.3%), followed by a data-driven cutpoint (26/169, 15.4%), such as the median. CONCLUSION It is common for subgroup analyses to use continuous variables to define subgroups. The vast majority dichotomize the continuous variable and, consequently, may lose substantial amounts of statistical information (equivalent to reducing the sample size by at least a third). More advanced methods that can improve efficiency, through optimally choosing cutpoints or directly using the continuous information, are rarely used.
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Affiliation(s)
- S Faye Williamson
- Biostatistics Research Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Michael J Grayling
- Biostatistics Research Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | | | - Nurulamin M Noor
- Medical Research Council Clinical Trials Unit at University College London (MRC CTU at UCL), London, UK
| | - Joshua S Savage
- Cancer Research UK Clinical Trials Unit (CRCTU), Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Christina Yap
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK
| | - James M S Wason
- Biostatistics Research Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK.
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Akın A. The effectiveness of web-based Mathematics instruction (WBMI) on K-16 students' mathematics learning: a meta-analytic research. Educ Inf Technol (Dordr) 2022; 27:8015-8040. [PMID: 35250352 PMCID: PMC8882714 DOI: 10.1007/s10639-022-10931-x] [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] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 01/31/2022] [Indexed: 06/14/2023]
Abstract
Given the increasing prevalence of web technology, web-based mathematics environments have been increasingly widely used in mathematics education for the past two decades. The COVID-19 pandemic has led to an urgent transition from traditional mathematics instruction (TMI) to web-based mathematics instruction (WBMI) at all levels of mathematics education. At this point, it is crucial to scrutinize the effects of WBMI on K-16 students' mathematics learning comprehensively. This meta-analysis research contained a total of 63 studies with 115 effect sizes, which aimed to investigate the effectiveness of WBMI on K-16 students' mathematics learning by incorporating potential moderators, namely mathematics topics, mathematical content standards, feedback status, type of instructional features, age (i.e., grade level), and assessment methods. Based on findings, WBMI has a significantly strong effect on K-16 students' mathematics learning (g = 1.10, p = 0.01, 95% CI [0.95, 1.27]). Moderator analyses reveal that the effect sizes of WBMI on K-16 students' mathematics learning varied significantly depending on all these potential moderators. Additionally, higher-level mathematical concepts, statistics and probability, WBMI with providing feedback, tutorial systems, undergraduate students, and traditional paper-pencil assessment are the strongest moderators in their context. The most notable results of this research are that WBMI is significantly more effective on students' mathematics learning than TMI, while even in the context of WBMI, traditional paper-pencil assessment is significantly more effective than online assessment. This meta-analytic research provides a comprehensive and up-to-date perspective on the effectiveness of WBMI on K-16 students' mathematics learning.
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Affiliation(s)
- Ayça Akın
- Alumni Association, Yunusemre Campus Student Central, First Floor, Anadolu University, 26470 Tepebaşı/Eskişehir, Turkey
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Krampe H, Danbolt LJ, Haver A, Stålsett G, Schnell T. Locus of control moderates the association of COVID-19 stress and general mental distress: results of a Norwegian and a German-speaking cross-sectional survey. BMC Psychiatry 2021; 21:437. [PMID: 34488667 PMCID: PMC8419811 DOI: 10.1186/s12888-021-03418-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 08/03/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND An internal locus of control (LoC I) refers to the belief that the outcome of events in one's life is contingent upon one's actions, whereas an external locus of control (LoC E) describes the belief that chance and powerful others control one's life. This study investigated whether LoC I and LoC E moderated the relationship between COVID-19 stress and general mental distress in the general population during the early months of the COVID-19 pandemic. METHODS This cross-sectional survey study analysed data from a Norwegian (n = 1225) and a German-speaking sample (n = 1527). We measured LoC with the Locus of Control-4 Scale (IE-4), COVID-19 stress with a scale developed for this purpose, and mental distress with the Patient Health Questionnaire 4 (PHQ-4). Moderation analyses were conducted using the PROCESS macro for SPSS. RESULTS The association between COVID-19 stress and general mental distress was strong (r = .61 and r = .55 for the Norwegian and the German-speaking sample, respectively). In both samples, LoC showed substantial moderation effects. LoC I served as a buffer (p < .001), and LoC E exacerbated (p < .001) the relation between COVID-19 stress and general mental distress. CONCLUSIONS The data suggest that the COVID-19 pandemic is easier to bear for people who, despite pandemic-related strains, feel that they generally have influence over their own lives. An external locus of control, conversely, is associated with symptoms of depression and anxiety. The prevention of mental distress may be supported by enabling a sense of control through citizen participation in policy decisions and transparent explanation in their implementation.
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Affiliation(s)
- Henning Krampe
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Lars Johan Danbolt
- Practical Theology, MF Norwegian School of Theology, Religion and Society, Oslo, Norway
- Centre for Psychology of Religion, Innlandet Hospital Trust, Ottestad, Norway
| | - Annie Haver
- Faculty of Social Sciences, Norwegian School of Hotel Management, University of Stavanger, Stavanger, Norway
- Faculty of Social Sciences, School of Psychology, University of Wollongong, Wollongong, NSW, Australia
| | - Gry Stålsett
- Social Sciences, MF Norwegian School of Theology, Religion and Society, Oslo, Norway
- Modum Bad Psychiatric Center, Vikersund, Norway
| | - Tatjana Schnell
- Social Sciences, MF Norwegian School of Theology, Religion and Society, Oslo, Norway.
- Existential Psychology Lab, Institute of Psychology, University of Innsbruck, Innsbruck, Austria.
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Kapser S, Abdelrahman M, Bernecker T. Autonomous delivery vehicles to fight the spread of Covid-19 - How do men and women differ in their acceptance? Transp Res Part A Policy Pract 2021; 148:183-198. [PMID: 33776251 PMCID: PMC7988474 DOI: 10.1016/j.tra.2021.02.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 02/26/2021] [Accepted: 02/26/2021] [Indexed: 05/20/2023]
Abstract
Covid-19 seriously impacts and endangers lives of millions worldwide. To fight the spread of the virus, governments have taken various restricting measures including stay at home orders. Ultimately, the home delivery volume increased significantly, which still bears the risk of human-human infection during the final delivery. From a logisticians perspective, autonomous delivery vehicles (ADVs), which are a contactless delivery solution, have the potential to radically change the way groceries are delivered to customer homes and help to stop the spread of the virus. However, to date, research on user acceptance of ADVs is rare. This paper theoretically extends the Unified Theory of Acceptance and Use of Technology (UTAUT2) including gender as a moderator. The study is based on quantitative data collected in Germany through an online questionnaire (n = 501). Data were analysed using structural equation modelling. The results indicate that trust in technology, price sensitivity, innovativeness, performance expectancy, hedonic motivation, social influence, and perceived risk determine behavioural intention. However, some constructs are only significant for women. The findings of this paper have theoretical, managerial and policy contributions and implications within the areas of last-mile delivery and technology acceptance.
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Affiliation(s)
- Sebastian Kapser
- Cooperative State University Baden-Wuerttemberg Mannheim, Coblitzallee 1-9, 68163 Mannheim, Germany
| | - Mahmoud Abdelrahman
- Northumbria University Newcastle Business School, City Campus East, NE1 8ST, United Kingdom
| | - Tobias Bernecker
- Heilbronn University of Applied Sciences, L.6.18. Bildungscampus, Max-Planck-Str. 39, 74081 Heilbronn, Germany
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White LM, Aalsma MC, Salyers MP, Hershberger AR, Anderson VR, Schwartz K, Dir AL, McGrew JH. Behavioral Health Service Utilization Among Detained Adolescents: A Meta-Analysis of Prevalence and Potential Moderators. J Adolesc Health 2019; 64:700-708. [PMID: 31122506 DOI: 10.1016/j.jadohealth.2019.02.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 01/27/2019] [Accepted: 02/07/2019] [Indexed: 11/18/2022]
Abstract
PURPOSE Utilization of behavioral health treatment services among adolescents who have been detained or incarcerated within the juvenile justice system is poorly understood, with estimated utilization rates varying widely across studies. This meta-analysis was conducted to review and synthesize the literature on the prevalence of service utilization among this population. METHODS Data from 27 studies of 28 distinct samples were abstracted and coded. A meta-analysis was conducted to calculate individual prevalence estimates of behavioral health service utilization, which were combined using random effects models. A moderator analysis was also conducted. RESULTS Prevalence effect sizes (pr) for service utilization were low, with effect sizes pr = 33.1% for mental health services, pr = 27.95% for substance use-related services, and pr = 45.32% for unspecified services. The moderator analysis showed significant heterogeneity in prevalence of behavioral health service utilization. CONCLUSIONS The findings suggest limited service utilization by adolescents who had been detained or incarcerated, whether assessed before, during, or after confinement. Future research should focus on assessing the quality of, and youth access to, behavioral health services within and outside of juvenile justice facilities. Improved programs to ensure consistent treatment for previously detained or incarcerated adolescents are warranted.
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Affiliation(s)
- Laura M White
- Department of Psychiatry, University of Utah, Salt Lake City, Utah
| | - Matthew C Aalsma
- Adolescent Behavioral Health Research Program, Division of Adolescent Medicine, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indianapolis.
| | - Michelle P Salyers
- Department of Psychology, Purdue School of Science, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana
| | | | | | - Katherine Schwartz
- Adolescent Behavioral Health Research Program, Division of Adolescent Medicine, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indianapolis
| | - Allyson L Dir
- Adolescent Behavioral Health Research Program, Division of Adolescent Medicine, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indianapolis
| | - John H McGrew
- Department of Psychology, Purdue School of Science, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana
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Rudge MVC, Barbosa AMP, Sobrevia L, Gelaleti RB, Hallur RLS, Marcondes JPC, Salvadori DMF, Prudêncio CB, Magalhães CG, Costa R, Abbade JF, Corrente JE, Calderon IMP; Perinatal Diabetes Research Group. Altered maternal metabolism during mild gestational hyperglycemia as a predictor of adverse perinatal outcomes: A comprehensive analysis. Biochim Biophys Acta Mol Basis Dis 2020; 1866:165478. [PMID: 31152867 DOI: 10.1016/j.bbadis.2019.05.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Revised: 05/18/2019] [Accepted: 05/22/2019] [Indexed: 12/20/2022]
Abstract
Mild gestational hyperglycemia (MGH), as assessed using the normal oral glucose tolerance test (OGTT) and detection of an altered glycemic profile, is associated with adverse perinatal outcome. This study described the results of 40 years of research conducted at the Perinatal Diabetes Research Centre at São Paulo State University (UNESP), Brazil, on the maternal MGH environment and placental markers. This study also described the unidirectional relationship between MGH and excessive fetal growth, also supplying moderator analysis. In addition to hyperglycemia, MGH is associated with an increased incidence of hypertension, metabolic syndrome, persistent insulin resistance after pregnancy, and high risk of developing type 2 diabetes mellitus (T2DM) after pregnancy. Structural changes and functional abnormalities resulting from MGH were observed in placenta. The fully adjusted model concluded that the predictor variable (MGH), which creates a complex environment for the fetus, has a direct effect on excessive birth weight and produces a z-score for ratios of birth weight to gestational age of ≥2. Maternal age, pre-pregnancy BMI, number of previous pregnancies, numbers of prenatal visits, and 1 h OGTT are moderator variables that impact MGH and excessive fetal growth. These results show that maternal MGH has some characteristics associated with similar long-term T2DM development and similar adverse perinatal results to those of gestational diabetes mellitus (GDM) mothers, making it an intermediate maternal and placental marker between normoglycemic and GDM mothers.
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Lüdtke T, Westermann S, Pult LK, Schneider BC, Pfuhl G, Moritz S. Evaluation of a brief unguided psychological online intervention for depression: A controlled trial including exploratory moderator analyses. Internet Interv 2018; 13:73-81. [PMID: 30206522 DOI: 10.1016/j.invent.2018.06.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 06/23/2018] [Accepted: 06/25/2018] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND Psychological online interventions (POIs) reduce depression but we know little about factors influencing their effectiveness. We evaluated a new, brief POI for depression and conducted exploratory moderator analyses. METHODS In this online trial (German Clinical Trials Register; DRKS00011045), we allocated participants to treatment as usual (TAU; n = 67) or POI (n = 65). At first, we randomized participants; later we allocated participants based on depression severity in order to counter baseline differences. The unguided POI addressed behavioral activation and depressive thinking in a single module with 25 webpages (including a smartphone application). We did one assessment at baseline and a post-assessment four weeks later. RESULTS At post-assessment, depression (p = .586), behavioral activation (p = .332), and dysfunctional attitudes (p = .499) did not differ between groups. When concurrent treatments (medication/psychotherapy) remained constant/decreased, the POI outperformed TAU (p = .031). POI-participants with lower willingness to change (p = .030) or higher education (p = .017) were less likely to worsen (i.e., experience increased depressive symptoms) compared to TAU. DISCUSSION The targeted sample size was not reached, measurements were self-reported, and randomization failed. The POI's content may have been too limited. Concurrent treatments, which were more often sought out by TAU participants, diminished group differences and should be considered in future studies. Brief POIs may protect against worsening of depressive symptoms among highly educated participants or those with low willingness to change.
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Scheller E, Peter J, Schumacher LV, Lahr J, Mader I, Kaller CP, Klöppel S. APOE moderates compensatory recruitment of neuronal resources during working memory processing in healthy older adults. Neurobiol Aging 2017; 56:127-37. [PMID: 28528773 DOI: 10.1016/j.neurobiolaging.2017.04.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 03/17/2017] [Accepted: 04/13/2017] [Indexed: 11/20/2022]
Abstract
The APOE ε4 allele increases the risk for sporadic Alzheimer's disease and modifies brain activation patterns of numerous cognitive domains. We assessed cognitively intact older adults with a letter n-back task to determine if previously observed increases in ε4 carriers' working-memory-related brain activation are compensatory such that they serve to maintain working memory function. Using multiple regression models, we identified interactions of APOE variant and age in bilateral hippocampus independently from task performance: ε4 carriers only showed a decrease in activation with increasing age, suggesting high sensitivity of fMRI data for detecting changes in Alzheimer's disease-relevant brain areas before cognitive decline. Moreover, we identified ε4 carriers to show higher activations in task-negative medial and task-positive inferior frontal areas along with better performance under high working memory load relative to non-ε4 carriers. The increased frontal recruitment is compatible with models of neuronal compensation, extends on existing evidence, and suggests that ε4 carriers require additional neuronal resources to successfully perform a demanding working memory task.
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Hain S, Oddo-Sommerfeld S, Bahlmann F, Louwen F, Schermelleh-Engel K. Risk and protective factors for antepartum and postpartum depression: a prospective study. J Psychosom Obstet Gynaecol 2016; 37:119-129. [PMID: 27376660 DOI: 10.1080/0167482x.2016.1197904] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
INTRODUCTION Antepartum risk and protective factors for postpartum depression (PPD; the most common mental disorder after childbirth besides postpartum anxiety), have been frequently investigated in cross-sectional studies, but less often longitudinally. This study examined linear and moderator effects of risk and protective factors for peripartum depression. First, we investigated the predictive power of risk factors (physical problems during pregnancy, pregnancy-related anxiety, stressful life events, dysfunctional self-consciousness (DSC)) and protective factors (resilience, social support) for antepartum depression (APD) and PPD. Second, as DSC plays an important role in major depression, we examined whether the protective factors moderate the association between the risk factors DSC and APD as well as PPD. METHODS We conducted a prospective study with three measurement time points: six weeks antepartum (N = 297), as well as six weeks (N = 278) and twelve weeks (N = 266) postpartum. Direct and moderator effects on APD were analyzed using hierarchical regression analysis. Moderated mediation effects were investigated to explore whether the indirect, long-term effect of DSC on PPD six weeks after birth (PPD-6) and PPD twelve weeks after birth (PPD-12) is moderated by resilience. RESULTS Predictors for APD were high DSC, high concerns about one's appearance, low resilience and low social support. Resilience buffered (weakened) the impact of DSC on APD and affected PPD-6 and PPD-12 indirectly through APD. DISCUSSION The results suggest that PPD-12 is influenced directly and indirectly through PPD-6 by APD, but that this effect depends upon risk and protective factors, especially on the combined effects of resilience and DSC. The key finding of our study is the moderating (i.e. weakening) effect of resilience on the relationship between DSC and depression. Resilience and DSC may be an important issue for depression prevention and treatment programs in the peripartum period.
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Affiliation(s)
- Sarah Hain
- a University of Frankfurt , Institute of Psychology , Frankfurt , Germany.,b Division of Psychology in Obstetrics and Fetomaternal Medicine , University Hospital Frankfurt , Frankfurt , Germany
| | - Silvia Oddo-Sommerfeld
- b Division of Psychology in Obstetrics and Fetomaternal Medicine , University Hospital Frankfurt , Frankfurt , Germany
| | - Franz Bahlmann
- c Department of Gynecology and Obstetrics , Buergerhospital Frankfurt , Frankfurt , Germany
| | - Frank Louwen
- b Division of Psychology in Obstetrics and Fetomaternal Medicine , University Hospital Frankfurt , Frankfurt , Germany
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