IMPORTANCEPatients with residual depressive symptoms face a gap in care because few resources, to date, are available to manage the lingering effects of their illness.OBJECTIVE To evaluate the effectiveness for treating residual depressive symptoms with Mindful Mood Balance (MMB), a web-based application that delivers mindfulness-based cognitive therapy, plus usual depression care compared with usual depression care only. DESIGN, SETTING, AND PARTICIPANTSThis randomized clinical trial was conducted in primary care and behavioral health clinics at Kaiser Permanente Colorado, Denver. Adults identified with residual depressive symptoms were recruited between March 2, 2015, and November 30, 2018. Outcomes were assessed for a 15-month period, comprising a 3-month intervention interval and a 12-month follow-up period.INTERVENTIONS Patients were randomized to receive usual depression care (UDC; n = 230) or MMB plus UDC (n = 230), which included 8 sessions delivered online for a 3-month interval plus minimal phone or email coaching support.MAIN OUTCOMES AND MEASURES Primary outcomes were reduction in residual depressive symptom severity, assessed using the Patient Health Questionaire-9 (PHQ-9); rates of depressive relapse (PHQ-9 scores Ն15); and rates of remission (PHQ-9 scores <5). Secondary outcomes included depression-free days, anxiety symptoms (General Anxiety Disorder-7 Item Scale), and functional status (12-Item Short Form Survey). RESULTS Among 460 randomized participants (mean [SD] age, 48.30 [14.89] years; 346 women [75.6%]), data were analyzed for the intent-to-treat sample, which included 362 participants (78.7%) at 3 months and 330 (71.7%) at 15 months. Participants who received MMB plus UDC had significantly greater reductions in residual depressive symptoms than did those receiving UDC only (mean [SE] PHQ-9 score, 0.95 [0.39], P < .02). A significantly greater proportion of patients achieved remission in the MMB plus UDC group compared with the UDC only group (PHQ-9 score, <5: β [SE], 0.38 [0.14], P = .008), and rates of depressive relapse were significantly lower in the MMB plus UDC group compared with the UDC only group (hazard ratio, 0.61; 95% CI, 0.39-0.95; P < .03). Compared with the UDC only group, the MMB plus UDC group had decreased depression-free days (mean [SD], 281.14 [164.99] days vs 247.54 [158.32] days; difference, days; t = −2.33; P = .02), decreased anxiety (mean [SE] General Anxiety Disorder-7 Item Scale score, 1.21 [0.42], P = .004), and improved mental functioning (mean [SE] 12-Item Short Form Survey score, −5.10 [1.37], P < .001), but there was no statistically significant difference in physical functioning.CONCLUSIONS AND RELEVANCE Use of MMB plus UDC resulted in significant improvement in depression and functional outcomes compared with UDC only. The MMB web-based treatment may offer a scalable approach for the management of residual depressive symptoms.
HIV-infected children, now maturing into adolescence and adulthood, must cope not only with adolescent developmental issues, but also with a chronic, socially stigmatised and sexually transmittable illness. Little research on this first generation of survivors has focused on romantic involvement and sexuality. This study, which employs a mixed-method embedded strategy (qualitative supported by quantitative), describes the perspectives of youth living with HIV since birth concerning: (1) romantic involvement and sexuality; and (2) risk management including the risk of HIV transmission and partner serostatus disclosure. Eighteen adolescents aged 13-22 from Montreal, Canada, participated in individual semi-structured interviews and completed self-report questionnaires. Most youths participated in non-penetrative sexual activities. Ten participants reported having had vaginal and three anal intercourses, at an average age of 14 for girls and 15 for boys. All sexually active youth reported having used a condom at least once. Of those who reported that their first sexual relationship was protected, over half had taken risks in subsequent relationships (e.g., unprotected sex, multiple partners, etc.). Interviews conducted with sexually inactive youths illustrate the interrelatedness of romantic involvement, sexual initiation and potential serostatus disclosure. Involvement in a sexual relationship would not be conceivable unless the partner was informed of their serostatus. For sexually active participants, risk management implies HIV transmission and partner disclosure. These youths have emotional issues regarding disclosure in romantic relationships and few risked potential rejection by disclosing. Condom use acts as a reminder of the infection and a barrier to intimacy. The narratives illustrate how risk perception changes and becomes relative with time and experience, especially when the viral load is undetectable and when past experience has convinced the adolescent that his/her partner might not become infected. Findings reinforce the need to prioritise sexual health issues for young people with perinatally acquired HIV.
Evaluation is a major challenge in the field of health promotion and health education. Since the degree to which a project is planned often guarantees its potential success, the evaluation process should make it possible to answer different questions related to stages of project implementation. The goal of this study was to develop a planning tool to help health professionals and community workers judge the potential success of health education interventions based on the extent to which they are planned and to test the tool in real intervention evaluations. Educational interventions examined in this study were targeted primarily at the promotion and adoption of behaviour reducing the risk of human immunodeficiency virus (HIV) transmission. The conceptual framework of "intervention mapping" served as the basis for developing the tool. Experts were consulted to identify criteria that would make it possible to evaluate the extent to which different stages of the model were accomplished. The tool was tested for reliability. Data from 123 projects were then collected and analyzed. The process for the development of the tool made it possible to identify 40 planning criteria, broken down into the 19 tasks of intervention mapping model. Reliability test results were highly satisfactory. The overall average score for project planning was 12.7 out of 40. The degree to which different stages were planned varied considerably. For example, only 15% of projects had developed their objective matrices properly, whereas 80% were assured proper support for their implementation. Thirty-nine percent of the projects were satisfactorily available for evaluation. This exercise made it possible to construct an interesting tool for identifying strengths and weaknesses of intervention planning. Various promoters might find this tool useful for increasing the potential success of their initiatives.
ObjectiveTo determine energy expenditure in kilocalories (kcal) during sexual activity in young healthy couples in their natural environment and compare it to a session of endurance exercise.MethodsThe study population consisted of twenty one heterosexual couples (age: 22.6 ± 2.8 years old) from the Montreal region. Free living energy expenditure during sexual activity and the endurance exercise was measured using the portable mini SenseWear armband. Perceived energy expenditure, perception of effort, fatigue and pleasure were also assessed after sexual activity. All participants completed a 30 min endurance exercise session on a treadmill at a moderate intensity.ResultsMean energy expenditure during sexual activity was 101 kCal or 4.2 kCal/min in men and 69.1 kCal or 3.1 kCal/min in women. In addition, mean intensity was 6.0 METS in men and 5.6 METS in women, which represents a moderate intensity. Moreover, the energy expenditure and intensity during the 30 min exercise session in men was 276 kCal or 9.2 kCal/min and 8.5 METS, respectively and in women 213 kCal or 7.1 kCal/min and 8.4 METS, respectively. Interestingly, the highest range value achieved by men for absolute energy expenditure can potentially be higher than that of the mean energy expenditure of the 30 min exercise session (i.e. 306.1 vs. 276 kCal, respectively) whereas this was not observed in women. Finally, perceived energy expenditure during sexual activity was similar in men (100 kCal) and in women (76.2 kCal) when compared to measured energy expenditure.ConclusionThe present study indicates that energy expenditure during sexual activity appears to be approximately 85 kCal or 3.6 kCal/min and seems to be performed at a moderate intensity (5.8 METS) in young healthy men and women. These results suggest that sexual activity may potentially be considered, at times, as a significant exercise.
We present detailed surface elevation measurements for the McMurdo Dry Valleys, Antarctica derived from aerial lidar surveys flown in the austral summer of 2014-2015 as part of an effort to understand geomorphic changes over the past decade. Lidar return density varied from 2 to > 10 returns m −2 with an average of about 5 returns m −2. Vertical and horizontal accuracies are estimated to be 7 and 3 cm, respectively. In addition to our intended targets, other ad hoc regions were also surveyed including the Pegasus flight facility and two regions on Ross Island, McMurdo Station, Scott Base (and surroundings), and the coastal margin between Cape Royds and Cape Evans.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.