Internet Based Interventions and Patient Generated Bio- and Self-monitoring Data: How to Use them for Self-management in Affective Disorders

2017 ◽  
Vol 41 (S1) ◽  
pp. S22-S23
Author(s):  
U. Hegerl ◽  
C. Sander ◽  
N. Koburger
Keyword(s):  
Behavioral Therapy ◽  
Bipolar Disorders ◽  
Treatment Decision ◽  
Developed Countries ◽  
Management Tool ◽  
Self Management ◽  
Comparable Efficacy ◽  
Consistent Finding ◽  
Regular Treatment ◽  
Face To Face

Even in developed countries only a small minority of patients with depression and bipolar disorders receives treatment according to guidelines and the treatment gaps are especially pronounced concerning psychotherapy.A variety of digital and internet based interventions have been developed mainly building on the principles of Cognitive Behavioral Therapy (CBT). A quite consistent finding is superiority compared to control groups with largest effect sizes when compared to waiting list controls, however the evidence provided by such studies is questionable. More support for efficacy is provided by studies showing a comparable efficacy compared to face-to-face CBT, however sufficiently powered non-inferiority studies compared to antidepressants or face-to-face therapy are needed. Such studies are necessary for deciding whether digital intervention should be integrated in the health care system mainly as a self-management tool or as an alternative to regular treatment with psychotherapy or pharmacotherapy.A dynamic new area of research explores the value for self-management and treatment decision of longitudinal data generated by the patient via self-ratings, wearables and other biosensors as well as the pattern of smartphone use. Within the BMBF-funded study STEADY a platform will be developed which allows the individual patient to securely store and integrate these data and to analyze them using analytic tools involving time series analyses. An overview will be given of similar approaches started in the last years within mental health.Disclosure of interestWithin the last three years, Prof. Hegerl was an advisory board member for Lundbeck, Takeda Pharmaceuticals, Servier and Otsuka Pharma a consultant for Bayer Pharma and a speaker for Medice Arzneimittel, Novartis and Roche Pharma.

scholarly journals Towards personalising treatment: a systematic review and meta-analysis of face-to-face efficacy moderators of cognitive-behavioral therapy and interpersonal psychotherapy for major depressive disorder

2019 ◽  
Vol 49 (16) ◽  
pp. 2657-2668
Author(s):  
Aoife Whiston ◽  
Claudi L. H. Bockting ◽  
Maria Semkovska
Keyword(s):  
Systematic Review ◽  
Antidepressant Treatment ◽  
Behavioral Therapy ◽  
Meta Analysis ◽  
Combined Treatment ◽  
Interpersonal Psychotherapy ◽  
Cochrane Library ◽  
Comparable Efficacy ◽  
Face To Face ◽  
Analytic Review

AbstractBackgroundConsistent evidence suggests that face-to-face cognitive-behavioural therapy (CBT) and interpersonal psychotherapy (IPT) may be equally effective depression treatments. Current clinical research focuses on detecting the best predictors-moderators of efficacy to guide treatment personalisation. However, individual moderator studies show inconsistent findings. This systematic review and meta-analysis aimed to compare the efficacy of CBT and IPT, including combined treatment with antidepressants for depression, and evaluate the predictive power of demographic, clinical presentation and treatment characteristics moderators for both therapies.MethodsPsycArticles, PsycINFO, PubMed and Cochrane Library were systematically searched through December 2017 for studies that have assessed individuals with major depression receiving either CBT or IPT in a face-to-face format both at pre- and post-treatment. Random-effects moderator meta-analyses were conducted.ResultsIn total 168 samples from 137 studies including 11 374 participants qualified for the meta-analytic review. CBT and IPT were equally effective across all but one prespecified moderators. For psychotherapy delivered without concomitant antidepressant treatment [antidepressant medications (ADMs)], CBT was superior to IPT (g = 1.68, Qbetweenp = 0.037). Within-CBT moderator analyses showed that increased CBT efficacy was associated with lower age, high initial depression severity, individual format of administration and no adjunctive ADMs. Within-IPT analyses showed comparable efficacy across all moderators.ConclusionsClinical guidance around combined treatment (psychotherapy plus ADMs) should be reconsidered. CBT alone is superior to IPT alone and to combined treatment, while IPT alone is non-inferior to combined treatment. More research is needed to assess the moderating effect of older age and number of previous episodes on IPT efficacy.

Co-Occurring Mood Problems in Autism Spectrum Disorder

2020 ◽  
pp. 27-51
Author(s):  
Virginia Carter Leno ◽  
Emily Simonoff
Keyword(s):  
Autism Spectrum Disorder ◽  
Service Use ◽  
Bipolar Depression ◽  
Behavioral Therapy ◽  
Treatment Options ◽  
Public Health Problem ◽  
Bipolar Disorders ◽  
Unipolar Depression ◽  
Autism Spectrum ◽  
Spectrum Disorder

Recent evidence suggests that individuals with autism spectrum disorder (ASD) experience depression at rates approximately four times greater than the general population. Co-occurring mood problems, including depressive and bipolar disorders, are associated with negative outcomes such as lower quality of life, increased adaptive behavior impairments, and greater service use. This chapter discusses what is known about the presentation of unipolar and bipolar depression in people with ASD and describes challenges to establishing sound prevalence estimates of mood disorders in ASD as they relate to methodological design issues and diagnostic assessment practices. It also provides an overview of potential vulnerability factors in the development of depression in this population; these areas of vulnerability include characteristics such as chronological age, cognitive ability, and ASD symptom severity, as well as those individual differences that may represent more direct mechanisms, for example, maladaptive coping styles, attentional biases, social reward profiles, and predisposition to rumination. The current research on interventions specifically designed to treat mood in people with ASD is very limited. However, promising treatments include adapted cognitive behavioral therapy and mindfulness-based approaches. Though most of this chapter focuses on unipolar depression in ASD as the more well-studied mood disorder, the chapter also summarizes the small research base on bipolar disorder in the context of ASD. It ends with a call for improved screening, assessment, and evidence-based treatment options to address this significant public health problem in this special population.

scholarly journals Effectiveness of an eHealth self-management tool for older adults with multimorbidity (KeepWell): protocol for a hybrid effectiveness–implementation randomised controlled trial

BMJ Open ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. e048350
Author(s):  
Monika Kastner ◽  
Julie Makarski ◽  
Leigh Hayden ◽  
Jemila S Hamid ◽  
Jayna Holroyd-Leduc ◽  
...  
Keyword(s):  
Older Adults ◽  
Chronic Disease ◽  
Randomised Controlled Trial ◽  
Disease Management ◽  
Chronic Conditions ◽  
Controlled Trial ◽  
Management Tool ◽  
Self Management ◽  
Plain Language ◽  
Randomised Controlled

IntroductionIn response to the burden of chronic disease among older adults, different chronic disease self-management tools have been created to optimise disease management. However, these seldom consider all aspects of disease management are not usually developed specifically for seniors or created for sustained use and are primarily focused on a single disease. We created an eHealth self-management application called ‘KeepWell’ that supports seniors with complex care needs in their homes. It incorporates the care for two or more chronic conditions from among the most prevalent high-burden chronic diseases.Methods and analysisWe will evaluate the effectiveness, cost and uptake of KeepWell in a 6-month, pragmatic, hybrid effectiveness–implementation randomised controlled trial. Older adults age ≥65 years with one or more chronic conditions who are English speaking are able to consent and have access to a computer or tablet device, internet and an email address will be eligible. All consenting participants will be randomly assigned to KeepWell or control. The allocation sequence will be determined using a random number generator.Primary outcome is perceived self-efficacy at 6 months. Secondary outcomes include quality of life, health background/status, lifestyle (nutrition, physical activity, caffeine, alcohol, smoking and bladder health), social engagement and connections, eHealth literacy; all collected via a Health Risk Questionnaire embedded within KeepWell (intervention) or a survey platform (control). Implementation outcomes will include reach, effectiveness, adoption, fidelity, implementation cost and sustainability.Ethics and disseminationEthics approval has been received from the North York General Hospital Research and Ethics Board. The study is funded by the Canadian Institutes of Health Research and the Ontario Ministry of Health. We will work with our team to develop a dissemination strategy which will include publications, presentations, plain language summaries and an end-of-grant meeting.Trial registration numberNCT04437238.

scholarly journals Can a prison be self-managed? A study of the informal organisation of a bolivian prison

2021 ◽  
Author(s):  
Antonio Iudici
Keyword(s):  
Developed Countries ◽  
Self Management ◽  
Extreme Conditions ◽  
Social Rehabilitation ◽  
Prison Systems ◽  
Interpersonal Level

AbstractThe purpose of this study is to investigate the unique prisons of Bolivia. Their main features include the presence of wives and children, self-management of activities within the prison and the opportunity for inmates to take part in various activities. In particular, the general organisation of the prisons and the inmates’ experience, especially on an interpersonal level, is described in this study. The obtained data shows that functional and effective experiences of social rehabilitation can be promoted even under extreme conditions and, in some cases, this provides important insights into the prison systems of most developed countries.

scholarly journals Towards the Development of Sustainable Tourism in Pakistan: A Study of the Role of Tour Operators

2021 ◽  
Vol 13 (9) ◽  
pp. 4902
Author(s):  
Zia Ullah ◽  
Rana Tahir Naveed ◽  
Atta Ur Rehman ◽  
Naveed Ahmad ◽  
Miklas Scholz ◽  
...  
Keyword(s):  
Sustainable Tourism ◽  
Developed Countries ◽  
Least Developed Countries ◽  
Face To Face ◽  
Phone Calls ◽  
The Government ◽  
Social Environmental ◽  
Sole Criterion ◽  
Depth Interviews

The literature on sustainable tourism is scant, particularly in the least developed countries. Very few studies touch upon the concept and no holistic theoretical or conceptual frameworks around the idea of sustainable tourism have been formulated. This study aims at exploring the role of tour operators in developing sustainable tourism in Pakistan and how the tour operators (TOs) conceive their role in this regard. TOs were reached through phone calls, emails, and virtual sources as face-to-face interviews were not possible due to COVID-19 pandemic and restrictions on travel by the government. In-depth interviews were conducted to gather data. Results suggest that the TOs although realize the importance of social, environmental, and economic dimensions of tourism on the communities but have no management systems in place to cater accordingly. There are no incentives in place by the government facilitate TOs to design and implement such systems. The TOs do not select a destination based on Global Sustainable Tourism Council criterion, but rather the selection of destination is mostly demand-based and profit-oriented. The study suggests that corporate profit motive is the sole criterion for decision making and is one of the major causes impeding sustainable tourism in Pakistan. The role of TOs in developing sustainable tourism is vague as the TOs do not have any systems in place to implement sustainable models. The study recommends that efforts need to be put in place to incentivize sustainable tourism in Pakistan and proper laws should be set forth by the authorities to comply by the TOs. The role of TOs is important and understood, however, there is a need to put proper systems in place.

scholarly journals Effects of self-management education programmes on self-efficacy for osteoarthritis of the knee: a systematic review of randomised controlled trials

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Daisuke Uritani ◽  
Hitoshi Koda ◽  
Sho Sugita
Keyword(s):  
Health Professionals ◽  
Self Efficacy ◽  
Randomised Controlled Trials ◽  
Management Education ◽  
Self Management ◽  
Controlled Trials ◽  
Face To Face ◽  
Knee Oa ◽  
Wide Range ◽  
Randomised Controlled

Abstract Background Enhancing self-efficacy to manage symptoms and functions is an important aspect of self-management for patients with knee osteoarthritis (OA). Many reports have investigated the effects of self-management education programmes for arthritis patients. However, a study that exclusively focuses on patients with OA in the same joints is required to clarify the effects of self-management programmes because individuals with knee OA experience physical and psychological difficulties different from those experienced by individuals with other arthritis diseases. Furthermore, previous studies have reported a wide range of delivery styles of self-management education programmes. This systematic review aimed to evaluate the effects of group-based and face-to-face self-management education programmes conducted by health professionals targeting self-efficacy for knee OA exclusively. Methods The MEDLINE, CENTRAL, EMBASE, CINAHL, Web of Science, and PEDro databases were searched to identify quantitative measures used in randomised controlled trials (RCTs) to assess the effects of self-management education programmes targeting self-efficacy in patients with knee OA. We included studies in which medical professional-delivered self-management education programmes were conducted in a group-based and face-to-face manner in community or outpatient settings. Results Seven RCTs from five countries were included in this review. Our retrieved studies included various types of self-management education programmes such as cognitive behavioural counselling, pain management education, physical education, weight management education, and arthritis self-efficacy management education, and control arms. They assessed various aspects of self-efficacy, including pain, physical function, arthritis symptoms excluding pain, weight management, mobility, and self-regulation. The total score of the Arthritis Self-Efficacy Scale was also measured. Some studies have reported beneficial effects of group-based and face-to-face self-management education programmes on self-efficacy for management of pain and other symptoms and for self-regulatory, knee OA. However, the results of the included studies were varied and inconsistent. Conclusions The current review only included seven studies, and there was a wide range of clinical heterogeneity among these studies. Thus, the effects of group-based and face-to-face self-management education programmes conducted by health professionals on self-efficacy for knee OA exclusively are inconclusive to date. Therefore, high-quality studies are required to provide significant information on clinicians, patients, and healthcare professionals in the future.

scholarly journals A Cognitive Behavioral Therapy-Informed Self-Management Program for Acute Respiratory Failure Survivors: A Feasibility Study

2021 ◽  
Vol 10 (4) ◽  
pp. 872
Author(s):  
Megan M. Hosey ◽  
Stephen T. Wegener ◽  
Caroline Hinkle ◽  
Dale M. Needham
Keyword(s):  
Respiratory Failure ◽  
Acute Respiratory Failure ◽  
Feasibility Study ◽  
Psychological Intervention ◽  
Behavioral Therapy ◽  
Management Program ◽  
Self Management ◽  
Management Intervention ◽  
Clinically Significant ◽  
Score Range

Background: The number of people surviving critical illness is rising rapidly around the globe. Survivorship comes at a cost, with approximately half of patients with acute respiratory failure (ARF) experiencing clinically significant symptoms of anxiety, and 32–40% of survivors having substantial anxiety symptoms in the months or years after hospitalization. Methods: This feasibility study reports on 11 consecutive ARF patients receiving up to six sessions of a psychological intervention for self-management of anxiety. Results: All 11 patients accepted and received the psychological intervention. Four patients did not fully complete all 6 sessions due to death (n = 1, 2 sessions completed), and early hospital discharge (n = 3, patients completed 2, 3 and 5 sessions). The median (IQR) score (range: 0–100; minimal clinically important difference: 13) for the Visual Analog Scale-Anxiety (VAS-A) pre-intervention was 70 (57, 75) points. During the intervention, all 11 patients had a decrease in VAS-A, with a median (IQR) decrease of 44 (19, 48) points. Conclusions: This self-management intervention appears acceptable and feasible to implement among ARF patients during and after an ICU stay.

scholarly journals SPECIAL TUTORIAL CLASSES TO UPGRADE LEARNING ACHIEVEMENT OF STUDENTS ENROLLED IN MATHEMATICS FOR SOCIAL SCIENCE AT STOU

2008 ◽  
Vol 3 (2) ◽  
pp. 122-133
Author(s):  
Sakorn Boondao
Keyword(s):  
Social Science ◽  
Cost Effective ◽  
Developed Countries ◽  
Pass Rate ◽  
Final Exam ◽  
Face To Face ◽  
Tutorial Program ◽  
Significant Difference ◽  
Level Scale ◽  
Teaching Programs

Unlike distance education institutions in developed countries Sukhothai Thammathirat Open University makes very limited use of assignments in its teaching programs. The main means of interaction between tutors and students consists of free face-to-face tutorials conducted three times per semester in provincial centers throughout the country. In courses with low enrolments (less than 1000 students) such tutorials have recently been deemed not to be cost effective. Alternative regional or central intensive programs have been developed. These involve 20 hours of tutorial classes and assignment work over two weekends in the final month of the semester and count for 30% of the assessment. A small charge is made for registration. The Mathematics for Social Science course was affected by this change. Since mathematics is a difficult subject for students, (only about 30% normally passed the course) the special tutorial program was used to help students in the second semester of 2006. Students were more interested in this approach than in the regular face-to-face tutorials. After the project was advertised, 98 students applied. While this was more than three times the number who had attended the free tutorials in the previous semester, it was not sufficient to justify tutorials in the four regions. Instead, three classes were conducted in Bangkok. Only 71 of the original applicants attended. During the program the better students were asked to assist those who needed help. Student questionnaires indicated that more than half identified themselves as weak in mathematics, most had completed year 12 and just over three-quarters had never attended regular face-to-face tutorials. They were asked to rank items about the classes on a five-level scale. The availability of up to 30% of the marks for the course was the major attraction. Most indicated that they were pleased with the classes, and gained more knowledge; while assignments, as well as the solutions given after submission, helped them understand the contents. Having classmates help them with learning also encouraged them with their study. They felt that they needed more time to study and do assignment work, and would like more marks to be allocated for the assignments. It was found that the achievement of students who attended the special tutorial classes was significantly higher than that of those who did not. The pass rate in this semester dramatically increased compared to the previous semester, 50.72% and 30.34% respectively. But when comparing students' final exam scores for both groups, it was found that there was no significant difference in the scores. However students were satisfied with these special tutorial classes.

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