2024 |
Oliveira JM, Clark VL, Furlanetto KC, Gibson PG, McDonald VM, 'Core Function In Adults With Severe Asthma and Its Relationship With Breathing Symptoms.', J Allergy Clin Immunol Pract, (2024) [C1]
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2023 |
Williams TD, Kaur A, Warner T, Aslam M, Clark V, Walker R, et al., 'Cardiovascular outcomes of cancer patients in rural Australia', Frontiers in Cardiovascular Medicine, 10 (2023) [C1]
Background: Cancer and heart disease are the two most common health conditions in the world, associated with high morbidity and mortality, with even worse outcomes in regional are... [more]
Background: Cancer and heart disease are the two most common health conditions in the world, associated with high morbidity and mortality, with even worse outcomes in regional areas. Cardiovascular disease is the leading cause of death in cancer survivors. We aimed to evaluate the cardiovascular outcomes of patients receiving cancer treatment (CT) in a regional hospital. Methods: This was an observational retrospective cohort study in a single rural hospital over a ten-year period (17th February 2010 to 19th March 2019). Outcomes of all patients receiving CT during this period were compared to those who were admitted to the hospital without a cancer diagnosis. Results: 268 patients received CT during the study period. High rates of cardiovascular risk factors: hypertension (52.2%), smoking (54.9%), and dyslipidaemia (38.4%) were observed in the CT group. Patients who had CT were more likely to be readmitted with ACS (5.9% vs. 2.8% p = 0.005) and AF (8.2% vs. 4.5% p = 0.006) when compared to the general admission cohort. There was a statistically significant difference observed for all cause cardiac readmission, with a higher rate observed in the CT group (17.1% vs. 13.2% p = 0.042). Patients undergoing CT had a higher rate of mortality (49.5% vs. 10.2%, p = 0.001) and shorter time (days) from first admission to death (401.06 vs. 994.91, p = 0.001) when compared to the general admission cohort, acknowledging this reduction in survival may be driven at least in part by the cancer itself. Conclusion: There is an increased incidence of adverse cardiovascular outcomes, including higher readmission rate, higher mortality rate and shorter survival in people undergoing cancer treatment in rural environments. Rural cancer patients demonstrated a high burden of cardiovascular risk factors.
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Nova |
2022 |
Stubbs MA, Clark VL, Gibson PG, Yorke J, McDonald VM, 'Associations of symptoms of anxiety and depression with health-status, asthma control, dyspnoea, dysfunction breathing and obesity in people with severe asthma', RESPIRATORY RESEARCH, 23 (2022) [C1]
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Nova |
2022 |
McDonald VM, Clark VL, Gibson PG, '"Nothing about us without us'' - What matters to patients with severe asthma?', JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE, 10 890-891 (2022)
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2022 |
Majellano EC, Clark VL, Gibson PG, Foster JM, McDonald VM, 'The needs and well-being of severe asthma and COPD carers: A cross-sectional study', RESPIROLOGY, 27 134-143 (2022) [C1]
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Nova |
2022 |
Pitzner-Fabricius A, Clark VL, Backer V, Gibson PG, McDonald VM, 'Factors associated with 6-min walk distance in severe asthma: A cross-sectional study', Respirology, 27 1025-1033 (2022) [C1]
Background and objective: Exercise capacity is associated with health-related quality of life and symptom control in severe asthma. Thus, interventions targeting exercise capacity... [more]
Background and objective: Exercise capacity is associated with health-related quality of life and symptom control in severe asthma. Thus, interventions targeting exercise capacity are likely to be beneficial. However, clinical and biological factors impacting exercise capacity in severe asthma are sparsely investigated. We aimed to describe the association of selected clinical and biological factors with 6-min walk distance (6MWD) in adults with severe asthma and investigate the impact of sex on these outcomes. Methods: A cross-sectional study in adults with severe asthma was conducted. Exercise capacity was measured by 6-min walk test, and association between 6MWD and predictors were evaluated using multiple linear regression. Results: A total of 137 patients (females, 85; median age, 59 years) were recruited. Overall, asthma control (-15.2 m, 95% CI -22.6 to -7.7; p¿=¿0.0001) and BMI (-3.2¿m, 95% CI -5.1 to -1.3; p¿=¿0.001) were significantly associated with exercise capacity (adjusted variance, adj. R2¿=¿0.425). In females, 5-item Asthma Control Questionnaire (ACQ-5; p¿=¿0.005) and BMI (p¿< 0.001) were significantly associated with 6MWD (adj. R2¿=¿0.423). In males, a 0.5-point increase in ACQ-5 was associated with a decrease in 6MWD by 10.2¿m (95% CI -22.8 to 2.4; p¿=¿0.11), but no clinical nor biological factors reached statistical significance (adj. R2¿=¿0.393). Conclusion: Asthma symptoms and BMI were associated with exercise capacity in the overall population. Optimizing these factors may enhance the ability of patients to improve their exercise capacity and gain the associated positive health outcomes, but further studies are warranted.
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Nova |
2022 |
McDonald VM, Harrington J, Clark VL, Gibson PG, 'Multidisciplinary care in chronic airway diseases: the Newcastle model.', ERJ open research, 8 215-2022 (2022) [C1]
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Nova |
2022 |
Majellano EC, Clark VL, McLoughlin RF, Gibson PG, McDonald VM, 'Using a knowledge translation framework to identify health care professionals perceived barriers and enablers for personalised severe asthma care', PLoS ONE, 17 (2022) [C1]
Background Whilst multidimensional assessment enables the detection of treatable traits in severe asthma and has the potential to improve patient outcomes, healthcare disparities ... [more]
Background Whilst multidimensional assessment enables the detection of treatable traits in severe asthma and has the potential to improve patient outcomes, healthcare disparities exist, and little is known about the factors influencing optimal management in severe asthma. This study aimed to explore perceived barriers, and enablers to implementing personalised care in severe asthma, from the healthcare professionals¿ perspective. Methods A descriptive, qualitative study involving a single focus group (n = 7) and semi-structured interviews (n = 33) with multidisciplinary healthcare professionals involved in severe asthma care was conducted. A hybrid thematic and content analysis was undertaken to identify themes, which were then deductively mapped to the Theoretical Domains Framework (TDF). Results Overall, three emergent themes were identified: (1) Barriers- (2) Enablers- to optimal management; (3) Desired model of care. Across all TDF domains, 6 constructs influenced development and implementation of optimal care: (1) belief about consequences, (2) environmental context and resources, (3) belief about capabilities, (4) social/professional role and identity, (5) goals and (6) knowledge. Conclusion Implementation of personalised care in severe asthma is complex and non-linear. The use of a theory-based approach effectively demonstrated how a variety of behaviours could be targeted to optimise and promote personalised care in different clinical setting.
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Nova |
2022 |
Hiles S, Clark V, Gibson P, McDonald V, 'Stress-induced asthma Key insights for prevention and management', Medicine Today: the peer reviewed journal of clinical practice, 23 16-23 (2022) [C1]
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2022 |
McLoughlin RF, Clark VL, Urroz PD, Gibson PG, McDonald VM, 'Increasing physical activity in severe asthma: a systematic review and meta-analysis', EUROPEAN RESPIRATORY JOURNAL, 60 (2022) [C1]
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Nova |
2021 |
Clark VL, Gibson PG, McDonald VM, 'The Patients' Experience of Severe Asthma Add- On Pharmacotherapies: A Qualitative Descriptive Study This', JOURNAL OF ASTHMA AND ALLERGY, 14 245-258 (2021) [C1]
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Nova |
2021 |
Clark VL, Gibson PG, McDonald VM, 'What matters to people with severe asthma? Exploring add-on asthma medication and outcomes of importance', ERJ Open Research, 7 00497-2020 (2021) [C1]
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Nova |
2021 |
Majellano EC, Clark VL, Foster JM, Gibson PG, McDonald VM, '"It's like being on a roller coaster": the burden of caring for people with severe asthma.', ERJ open research, 7 812-2020 (2021) [C1]
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Nova |
2021 |
Stubbs MA, Clark VL, Cheung MMY, Smith L, Saini B, Yorke J, et al., 'The Experience of Living with Severe Asthma, Depression and Anxiety: A Qualitative Art-Based Study', JOURNAL OF ASTHMA AND ALLERGY, 14 1527-1537 (2021) [C1]
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Nova |
2020 |
McDonald VM, Clark VL, Cordova-Rivera L, Wark PAB, Baines KJ, Gibson PG, 'Targeting treatable traits in severe asthma: a randomised controlled trial', EUROPEAN RESPIRATORY JOURNAL, 55 (2020) [C1]
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Nova |
2020 |
Maltby S, Gibson PG, Reddel HK, Smith L, Wark PAB, King GG, et al., 'Severe Asthma Toolkit: an online resource for multidisciplinary health professionals-needs assessment, development process and user analytics with survey feedback', BMJ OPEN, 10 (2020) [C1]
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Nova |
2019 |
Majellano EC, Clark VL, Winter NA, Gibson PG, McDonald VM, 'Approaches to the assessment of severe asthma: barriers and strategies', JOURNAL OF ASTHMA AND ALLERGY, 12 235-251 (2019) [C1]
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Nova |
2019 |
Clark V, Conrad AM, Lewin TJ, Baker AL, Halpin SA, Sly KA, Todd J, 'Addiction Vulnerability: Exploring Relationships Among Cigarette Smoking, Substance Misuse, and Early Psychosis', Journal of Dual Diagnosis, 14 78-88 (2019) [C1]
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Nova |
2019 |
McDonald VM, Fingleton J, Agusti A, Hiles SA, Clark VL, Holland AE, et al., 'Treatable traits: a new paradigm for 21st century management of chronic airway diseases: Treatable Traits Down Under International Workshop report.', The European respiratory journal, 53 (2019) [C1]
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Nova |
2019 |
Stubbs MA, Clark VL, McDonald VM, 'Living well with severe asthma', Breathe, 15 e40-e49 (2019) [C1]
Living well with severe asthma can be challenging. People with severe asthma can be refractory to treatment, can experience poor symptom control and are at a heightened risk of de... [more]
Living well with severe asthma can be challenging. People with severe asthma can be refractory to treatment, can experience poor symptom control and are at a heightened risk of death. Patients experience symptoms of shortness of breath, chest tightness, cough and wheeze. These symptoms influence many aspects of an individual¿s life, resulting in emotional, financial, functional and medication-related burdens that negatively impact quality of life. Quality of life is known to be influenced by individual levels of satisfaction that stem from real-life treatment experiences. This experience is portrayed through the lens of the patient, which is commonly referred to as the patient perspective. The patient perspective is only one element of the patient experience. It influences health status, which, in severe asthma, is commonly assessed using validated health-related quality of life measures. A positive patient perspective may be achieved with implementation of management strategies tailored to individual needs. Management strategies developed in partnership between the patient, the severe asthma multidisciplinary team and the general practitioner may minimise disease-related impairment, allowing patients to live well with severe asthma.
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Nova |
2018 |
Stain H, Halpin S, Baker A, Startup M, Carr V, Schall U, et al., 'The impact of rurality and substance use on young people at ultra-high risk for psychosis', Early Intervention in Psychiatry, 12 1173-1180 (2018) [C1]
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Nova |
2018 |
Baker AL, Richmond R, Kay-Lambkin FJ, Filia SL, Castle D, Williams JM, et al., 'Randomised controlled trial of a healthy lifestyle intervention among smokers with psychotic disorders: Outcomes to 36 months', Australian and New Zealand Journal of Psychiatry, 52 239-252 (2018) [C1]
Objective: People living with psychotic disorders (schizophrenia spectrum and bipolar disorders) have high rates of cardiovascular disease risk behaviours, including smoking, phys... [more]
Objective: People living with psychotic disorders (schizophrenia spectrum and bipolar disorders) have high rates of cardiovascular disease risk behaviours, including smoking, physical inactivity and poor diet. We report cardiovascular disease risk, smoking cessation and other risk behaviour outcomes over 36 months following recruitment into a two-arm randomised controlled trial among smokers with psychotic disorders. Methods: Participants (N = 235) drawn from three sites were randomised to receive nicotine replacement therapy plus (1) a Healthy Lifestyles intervention delivered over approximately 9 months or (2) a largely telephone-delivered intervention (designed to control for nicotine replacement therapy provision, session frequency and other monitoring). The primary outcome variables were 10-year cardiovascular disease risk and smoking status, while the secondary outcomes included weekly physical activity, unhealthy eating, waist circumference, psychiatric symptomatology, depression and global functioning. Results: Significant reductions in cardiovascular disease risk and smoking were detected across the 36-month follow-up period in both intervention conditions, with no significant differences between conditions. One-quarter (25.5%) of participants reported reducing cigarettes per day by 50% or more at multiple post-treatment assessments; however, few (8.9%) managed to sustain this across the majority of time points. Changes in other health behaviours or lifestyle factors were modest; however, significant improvements in depression and global functioning were detected over time in both conditions. Participants experiencing worse ¿social discomfort¿ at baseline (e.g. anxiety, mania, poor self-esteem and social disability) had on average significantly worse global functioning, lower scores on the 12-Item Short Form Health Survey physical scale and significantly greater waist circumference. Conclusion: Although the telephone-delivered intervention was designed as a comparison condition, it achieved excellent retention and comparable outcomes. Telephone-delivered smoking cessation support may potentially help to reduce smoking rates among people with psychotic disorders. Discomfort in social situations may also be a useful target for future health interventions, addressing confidence and social skills, and promoting social networks that reduce inactivity.
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Nova |
2018 |
McDonald VM, Hiles SA, Jones KA, Clark VL, Yorke J, 'Health-related quality of life burden in severe asthma', MEDICAL JOURNAL OF AUSTRALIA, 209 S28-S33 (2018) [C1]
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Nova |
2017 |
Clark V, Baker A, Lewin T, Richmond R, Kay-Lambkin F, Filia S, et al., 'Self-Reported Reasons for Smoking: Predicting Abstinence and Implications for Smoking Cessation Treatments Among Those With a Psychotic Disorder', Journal of Dual Diagnosis, 13 6-14 (2017) [C1]
Objectives: People living with a psychotic illness have higher rates of cigarette smoking and face unique barriers to quitting compared to the general population. We examined whet... [more]
Objectives: People living with a psychotic illness have higher rates of cigarette smoking and face unique barriers to quitting compared to the general population. We examined whether self-reported reasons for smoking are useful predictors of successful quit attempts among people with psychosis. Methods: As part of a randomized controlled trial addressing smoking and cardiovascular disease risk behaviors among people with psychosis, self-reported reasons for smoking were assessed at baseline (n = 235), 15 weeks (n = 151), and 12 months (n = 139). Three factors from the Reasons for Smoking Questionnaire (Coping, Physiological, and Stimulation/Activation) were entered into a model to predict short- and long-term abstinence. The relationship between these factors and mental health symptoms were also assessed. Results: Participants scoring higher on the Stimulation/Activation factor (control of weight, enjoyment, concentration, and ¿peps me up¿) at baseline were just less than half as likely to be abstinent at 15 weeks. Female participants were five times more likely to abstinent at 15 weeks, and those with a higher global functioning at baseline were 5% more likely to be abstinent. There was a positive correlation between changes over time in the Stimulation/Activation factor from baseline to 12-month follow-up and the Brief Psychiatric Rating Scale total score at 12-month follow-up. This indicates that increasingly higher endorsement of the factor was associated with more psychological symptoms. There was also a negative correlation between the change over time in the Stimulation/Activation factor and global functioning at 12 months, indicating that increasingly higher endorsement of the factor led to lower global assessment of functioning. Conclusions: The Stimulation/Activation factor may be particularly important to assess and address among smokers with psychosis. It is recommended that further research use the Reasons for Smoking Questionnaire among smokers with psychosis as a clinical tool to identify specific quit barriers. Further research into why females have higher smoking cessation rates in the short term and relapse prevention interventions seem worthy of further investigation.
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Nova |
2017 |
Clark VL, Gibson PG, Genn G, Hiles SA, Pavord ID, McDonald VM, 'Multidimensional assessment of severe asthma: A systematic review and meta-analysis', Respirology, 22 1262-1275 (2017) [C1]
The management of severe asthma is complex. Multidimensional assessment (MDA) of specific traits has been proposed as an effective strategy to manage severe asthma, although it is... [more]
The management of severe asthma is complex. Multidimensional assessment (MDA) of specific traits has been proposed as an effective strategy to manage severe asthma, although it is supported by few prospective studies. We aimed to systematically review the literature published on MDA in severe asthma, to identify the traits included in MDA and to determine the effect of MDA on asthma-related outcomes. We identified 26 studies and classified these based on study type (cohort/cross-sectional studies; experimental/outcome studies; and severe asthma disease registries). Study type determined the comprehensiveness of the assessment. Assessed traits were classified into three domains (airways, co-morbidities and risk factors). The airway domain had the largest number of traits assessed (mean ± SD = 4.2 ± 1.7) compared with co-morbidities (3.6 ± 2.2) and risk factors (3.9 ± 2.1). Bronchodilator reversibility and airflow limitation were assessed in 92% of studies, whereas airway inflammation was only assessed in 50%. Commonly assessed co-morbidities were psychological dysfunction, sinusitis (both 73%) and gastro-oesophageal reflux disease (GORD; 69%). Atopic and smoking statuses were the most commonly assessed risk factors (85% and 86%, respectively). There were six outcome studies, of which five concluded that MDA is effective at improving asthma-related outcomes. Among these studies, significantly more traits were assessed than treated. MDA studies have assessed a variety of different traits and have shown evidence of improved outcomes. This promising model of care requires more research to inform which traits should be assessed, which traits should be treated and what effect MDA has on patient outcomes.
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Nova |
2016 |
Sankaranarayanan A, Clark V, Baker A, Palazzi K, Lewin TJ, Richmond R, et al., 'Reducing smoking reduces suicidality among individuals with psychosis: Complementary outcomes from a Healthy Lifestyles intervention study', Psychiatry Research, 243 407-412 (2016) [C1]
This study sought to explore the impact of smoking reduction on suicidality (suicide ideation and behaviour) among people with a psychotic disorder (n=235) who participated in a r... [more]
This study sought to explore the impact of smoking reduction on suicidality (suicide ideation and behaviour) among people with a psychotic disorder (n=235) who participated in a randomized trial of a healthy lifestyle intervention trial. Suicidality, measured by item -4 of the Brief Psychiatric Rating Scale (BPRS) was the main variable of interest. Measures were collected by research assistants blind to treatment allocation at baseline, at 15 weeks (mid-intervention) and 12 months after baseline. Mediation analysis, adjusted for confounders, was used to determine the relationship between smoking reduction and suicidality and to explore whether this was mediated through depression. At 12 months, smoking reduction was found to be significantly associated with suicidality change; an association was also seen between smoking reduction and depression and depression and suicidality. After adjusting for depression, the association between smoking reduction and suicidality was attenuated but remained statistically significant; the proportion of the total effect that was mediated through depression was 30%. There was no significant association between suicidality and treatment group (vs. controls) over time. Our study suggests that smoking interventions may have benefits over and above those for improved physical health, by reducing suicidal ideation in people with psychosis.
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Nova |
2016 |
Andrews M, Baker AL, Halpin SA, Lewin TJ, Richmond R, Kay-Lambkin FJ, et al., 'Early therapeutic alliance, treatment retention, and 12-month outcomes in a healthy lifestyles intervention for people with psychotic disorders', Journal of Nervous and Mental Disease, 204 894-902 (2016) [C1]
Engaging and retaining individuals with psychotic disorders in psychosocial treatments is difficult. Early therapeutic alliance, treatment retention, and 12-month outcomes were ex... [more]
Engaging and retaining individuals with psychotic disorders in psychosocial treatments is difficult. Early therapeutic alliance, treatment retention, and 12-month outcomes were examined in a subsample of smokers with a psychotic disorder (N = 178) participating in a healthy lifestyles study comparing a telephone versus face-to-face delivered intervention. Therapeutic alliance was assessed using the Agnew Relationship Measure; primary outcomes were treatment retention and changes in symptoms and health behaviors. Contrary to expectations, early alliance did not predict treatment retention. However, elements of both client- and therapist-rated alliance predicted some clinical outcomes (e.g., higher confidence in the therapeutic alliance at session 1 predicted improvements in 12-month depression). Some modest interactions between early alliance and intervention condition were also identified (e.g., clients initially with lower self-perceived initiative, or higher therapist-perceived bonding benefited preferentially from the telephone-delivered intervention), highlighting the need to further examine the interplay between therapeutic alliance and treatment modality.
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Nova |
2016 |
Stain HJ, Bucci S, Baker AL, Carr V, Emsley R, Halpin S, et al., 'A randomised controlled trial of cognitive behaviour therapy versus non-directive reflective listening for young people at ultra high risk of developing psychosis: The detection and evaluation of psychological therapy (DEPTh) trial', Schizophrenia Research, 176 212-219 (2016) [C1]
Background Intervention trials for young people at ultra high risk (UHR) for psychosis have shown cognitive behaviour therapy (CBT) to have promising effects on treating psychotic... [more]
Background Intervention trials for young people at ultra high risk (UHR) for psychosis have shown cognitive behaviour therapy (CBT) to have promising effects on treating psychotic symptoms but have not focused on functional outcomes. We hypothesized that compared to an active control, CBT would: (i) reduce the likelihood of, and/or delay, transition to psychosis; (ii) reduce symptom severity while improving social functioning and quality of life, whether or not transition occurred. Method This was a single-blind randomised controlled trial for young people at UHR for psychosis comparing CBT to an active control condition, Non Directive Reflective Listening (NDRL), both in addition to standard care, with a 6 month treatment phase and 12 months of follow-up. Statistical analysis is based on intention-to-treat and used random effect models to estimate treatment effects common to all time-points. Results Fifty-seven young people (mean age = 16.5 years) were randomised to CBT (n = 30) or NDRL (n = 27). Rate of transition to psychosis was 5%; the 3 transitions occurred in the CBT condition (baseline, 2 months, 5 months respectively). The NDRL condition resulted in a significantly greater reduction in distress associated with psychotic symptoms compared to CBT (treatment effect = 36.71, standard error = 16.84, p = 0.029). There were no significant treatment effects on frequency and intensity of psychotic symptoms, global, social or role functioning. Conclusion Our sample was higher functioning, younger and experiencing lower levels of psychotic like experiences than other trials. The significantly better treatment effect of NDRL on distress associated with psychotic symptoms supports the recommendations for a stepped-care model of service delivery. This treatment approach would accommodate the younger UHR population and facilitate timely intervention. Trial registration: ANZCTR 12606000101583
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Nova |
2015 |
Baker AL, Richmond R, Kay-Lambkin FJ, Filia SL, Castle D, Williams JM, et al., 'Randomized controlled trial of a healthy lifestyle intervention among smokers with psychotic disorders', Nicotine and Tobacco Research, 17 946-954 (2015) [C1]
Introduction: People with severe mental disorders typically experience a range of health problems; consequently, interventions addressing multiple health behaviors may provide an ... [more]
Introduction: People with severe mental disorders typically experience a range of health problems; consequently, interventions addressing multiple health behaviors may provide an efficient way to tackle this major public health issue. This two-arm randomized controlled trial among people with psychotic disorders examined the efficacy of nicotine replacement therapy (NRT) plus either a faceto- face or predominantly telephone delivered intervention for smoking cessation and cardiovascular disease (CVD) risk reduction. Methods: Following baseline assessment and completion of a common, individually delivered 90-minute face-to-face intervention, participants (n = 235) were randomized to receive NRT plus: (1) a "Healthy Lifestyles" intervention for smoking cessation and CVD risk behaviors or (2) a predominantly telephone-based intervention (designed to control for NRT provision, session frequency, and other monitoring activities). Research assistants blind to treatment allocation performed assessments at 15 weeks (mid-intervention) and 12 months after baseline. Results: There were no significant differences between intervention conditions in CVD risk or smoking outcomes at 15 weeks or 12 months, with improvements in both conditions (eg, 12 months: 6.4% confirmed point prevalence abstinence rate; 17% experiencing a 50% or greater smoking reduction; mean reduction of 8.6 cigarettes per day; mean improvement in functioning of 9.8 points). Conclusions: The health disparity experienced by people with psychotic disorders is high. Faceto- face Healthy Lifestyle interventions appear to be feasible and somewhat effective. However, given the accessibility of telephone delivered interventions, potentially combined with lower cost, further studies are needed to evaluate telephone delivered smoking cessation and lifestyle interventions for people with psychotic disorders.
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Nova |