Associations of self-reported and device-assessed physical activity with fatigue,quality of life,and sleep quality in adults living with and beyond cancer

Background Greater physical activity is associated with improved outcomes in people living with and beyond cancer.However,most studies in exercise oncology use self-reported measures of physical activity.Few have explored agreement between self-reported and device-based measures of physical activity in people living with and beyond cancer.This study aimed to describe physical activity in adults affected by cancer across self-reported and device-assessed activity,to explore levels of agreement between these measures in terms of their utility for categorizing participants as meeting/not meeting physical activity guidelines,and to explore whether meeting guidelines is associated with fatigue,quality of life,and sleep quality.Methods A total of 1348 adults living with and beyond cancer from the Advancing Survivorship Cancer Outcomes Trial completed a survey assessing fatigue,quality of life,sleep quality,and physical activity.The Godin-Shephard Leisure-Time Physical Activity Questionnaire was used to calculate a Leisure Score Index(LSI)and an estimate of moderate-to-vigorous physical activity(MVPA).Average daily steps and weekly aerobic steps were derived from pedometers worn by participants.Results The percentage of individuals meeting physical activity guidelines was 44.3%using LSI,49.5%using MVPA,10.8%using average daily steps,and 28.5%using weekly aerobic steps.Agreement(Cohen'sκ)between self-reported and pedometer measures ranged from 0.13(LSI vs.average daily steps)to 0.60(LSI vs.MVPA).After adjusting for sociodemographic and health-related covariates,meeting activity guidelines using all measures was associated with not experiencing severe fatigue(odds ratios(ORs):1.43–1.97).Meeting guidelines using MVPA was associated with no quality-of-life issues(OR=1.53).Meeting guidelines using both self-reported measures were associated with good sleep quality(ORs:1.33–1.40).Conclusion Less than half of all adults affected by cancer are meeting physical activity guidelines,regardless of measure.Meeting guidelines is associated with lower fatigue across all measures.Associations with quality of life and sleep differ depending on measure.Future research should consider the impact of physical activity measure on findings,and where possible,use multiple measures.

Randomized control trial of a culturally adapted behavioral activation therapy for Muslim patients with depression in Pakistan

BACKGROUND Behavioral activation therapy(BA)is as effective as cognitive behavior therapy(CBT)in treating depression and can be delivered by practitioners with much less psychological training,making it particularly suitable for low resource settings.BA that is culturally adapted for Muslims(BA-M)is a culturally adapted form of BA that has been found acceptable and feasible for Muslims with depression in the United Kingdom and Turkey;however,this is the first time that its efficacy has been determined through a definitive randomized controlled trial.AIM To compare the effectiveness of BA-M with CBT for Muslim patients with depression in Pakistan.METHODS One hundred and eight patients were randomized 1:1 to treatment arms in a parallel-group randomized controlled trial in hospital or community sites in Lahore,Pakistan.Recruitment followed self-referral or referrals from clinicians,consultants or relevant professionals at each site.Four measures were recorded by blinded assessors:The patient health questionnaire-9(PHQ-9);the BA for depression scale short form(BADS-SF);symptom checklist-revised and the World Health Organization Quality-of-Life Brief Scale.All measures were recorded at baseline and post treatment;PHQ-9 and BADS-SF were also recorded at each session and at three month follow up.The primary analysis was to regress the PHQ-9 score after therapy upon the PHQ-9 score before therapy(baseline)and the type of therapy given,that is,analysis of covariance.In addition,analysis using PHQ-9 scores collected at each therapy session was employed in a 2-level regression model.RESULTS Patients in the BA-M arm experienced greater improvement in PHQ-9 score of 1.95 units compared to the CBT arm after adjusting for baseline values(P=0.006)The key reason behind this improvement was that patients were retained in therapy longer under BA-M,in which patients were retained for an average 0.75 sessions more than CBT patients(P=0.013).Patients also showed significant differences on physical(P<0.001),psychological(P=0.004)and social(P=0.047)domains of Quality of Life(QoL)at post treatment level,indicating an increased QoL in the BA-M group as compared to the treatment as usual group.Some baseline differences were noted in both groups for BA scores and two domains of QoL scale:Physical and environment,which might have influenced the results,though the BA-M group showed more improvement at completion of therapy.CONCLUSION Results proved the efficacy of BA-M in reducing symptoms for depressed patients in Pakistan,indicating BA-M is a promising treatment modality for depression in future,particularly in low resource settings.

Bridging the mental health treatment gap:effects of a collaborative care intervention(matrix support)in the detection and treatment of mental disorders in a Brazilian city

Objective To analyse temporal trends in diagnosis and treatment of mental disorders in primary care following implementation of a collaborative care intervention(matrix support).Design Dynamic cohort design with retrospective time-series analysis.Structured secondary data on medical visits to general practitioners of all study clinics were extracted from the municipal electronic records database.Annual changes in the odds of mental disorders diagnoses and antidepressants prescriptions were estimated by multiple logistic regression at visit and patient-year levels with diagnoses or prescriptions as outcomes.Annual changes during two distinct stages of the intervention(stage 1 when it was restricted to mental health(2005-2009),and stage 2 when it was expanded to other areas(2010-2015))were compared by adding year-period interaction terms to each model.Setting 49 primary care clinics in the city of Florianópolis,Brazil.Participants All adults attending primary care clinics of the study setting between 2005 and 2015.Results 3131983 visits representing 322100 patients were analysed.At visit level,the odds of mental disorder diagnosis increased by 13%per year during stage 1(OR 1.13,95%CI 1.11 to 1.14,p<0.001)and decreased by 5%thereafter(OR 0.95,95%CI 0.94 to 0.95,p<0.001).The odds of incident mental disorder diagnoses decreased by 1%per year during stage 1(OR 0.99,95%CI 0.98 to 1.00,p=0.012)and decreased by 7%per year during stage 2(OR 0.93,95%CI 0.92 to 0.93,p<0.001).The odds of antidepressant prescriptions in patients with a mental disorder diagnosis increased by 7%per year during stage 1(OR 1.07,95%CI 1.05 to 1.20,p<0.001);this was driven by selective serotonin reuptake inhibitor prescriptions which increased 14%per year during stage 1(OR 1.14,95%CI 1.12 to 1.18,p<0.001)and 9%during stage 2(OR 1.09,95%CI 1.08 to 1.10,p<0.001).The odds of incident antidepressant prescriptions did not increase during stage 1(OR 1.00,95%CI 0.97 to 1.02,p=0.665)and increased by 3%during stage 2(OR 1.03,95%CI 1.00 to 1.04,p<0.001).Changes per year were all significantly greater during stage 1 than stage 2(p values for interaction terms<0.05),except for antidepressant prescriptions during visits(p=0.172).

Using no-cost mobile phone reminders to improve attendance for HIV test results: a pilot study in rural Swaziland

Background:Mobile technology has great potential to improve adherence and treatment outcomes in healthcare settings.However,text messaging and phone calls are unaffordable in many resource-limited areas.This study investigates the use of a no-cost alternative mobile phone technology using missed calls(‘buzzing’)to act as a patient reminder.The use of missed calls as a patient reminder was evaluated for feasibility and effectiveness as an appointment reminder in the follow-up of newly-diagnosed human immunodeficiency virus(HIV)positive patients in an HIV testing and counselling department in rural Swaziland.Methods:This pilot study uses a before-and-after operational research study design,with all patients with mobile phones being offered the intervention.The primary outcome was the rate of attendance at the HIV testing and counselling department for collection of results in those with mobile phones before and after the introduction of the intervention.Results:Over two-thirds,71.8%(459/639),of patients had a mobile phone.All patients with a mobile phone consented to being buzzed.There was no difference in attendance for follow-up at the clinic before and after the intervention was implemented(80.1%versus 83.3%,p=0.401),or after adjusting for confounding factors(OR 1.13,p=0.662).Conclusion:This pilot study illustrates that mobile technology may be feasible in rural,resource-poor settings as there are high rates of mobile phone ownership and the intervention had a 100%uptake rate,with positive feedback from staff and patients.In this particular setting,the intervention did not improve attendance rates.However,further research is planned to investigate the impact on adherence to appointments and medications in other settings,such as HIV chronic care follow-up and as part of an enhanced package to improve adherence.

设计和开展随机实施试验:研究者指南

实施科学是一门研究方法的学科,旨在实践和政策中促进循证干预措施的系统实施,进而改善健康。尽管实施研究需要高质量的证据,但实施策略的随机试验往往存在较为严重的局限性。这些局限性包括存在偏倚风险、缺乏理论运用、缺乏描述实施策略标准术语、局限于实施结局以及不充分报告。本文旨在对实施策略随机试验的设计、实施和报告提供指导,以提升循证实施科学。由研究人员、卫生政策制订者和实践者组成的国际小组整合了构建随机试验方法的重要文献和实施科学的最新进展。本文为实施策略随机试验的主要内容提供指导,包括试验目的阐明、试验中人员招募和保留策略、随机设计的选择、实施科学理论和框架的使用、测量(结局指标)、样本量计算、伦理审查和试验报告。本文也关注了实施试验中需要特别重视或调整的主题。为了推进实施策略随机试验的严格开展和报告,我们建议将本指南作为研究人员、卫生保健和公共卫生政策制订者或实践者、研究资助者和期刊编辑的参考资料。

儿童便秘

一名2岁男孩排便费力且排便困难,这让他的父母很担心。他们用了2个星期的聚乙二醇治疗,但是因为苦恼用药会弄脏裤子,就很快停药了。

临床更新 临终谵妄和躁动

谵妄现象在生命的最后几周或几天很常见 1,这对于患者及其周围的人来说可能很痛苦。由于大多数患者希望在生命结束之时保持清醒,因此成功的谵妄治疗包括排除导致谵妄的可逆性原因,权衡可能引起或控制谵妄的药物。

易于漏诊？老年人硬膜下血肿

一名84岁的女性病人，有体位性低血压病史，经常跌倒。因两个星期以来意识模糊和精神错乱就诊，她的尿液试纸检查有白细胞和亚硝酸盐，全科医生诊断为继发尿路感染后的谵妄，给予口服抗生素治疗没有好转，为进一步诊治而收入院。